Revising the ERDS'94: Goals,Opposition and Resolution

The National Conference of Catholic Bishops, “Ethical and Religious Directives for Catholic Health Care Services,” in Origins, December 15, 1994.

United States Catholic Conference Department of Health Affairs, “Ethical and Religious Directives for Catholic Health Facilities,” in Origins, December 2, 1971.

The Sacred Congregation for the Doctrine of the Faith, “The Reply of the Sacred Congregation for the Doctrine of the Faith to the National Conference of Catholic Bishops on Sterilization in Catholic Hospitals (Quaecumque Sterilizatio),” March 13, 1975, in Origins, June 10, 1977.

The National Conference of Catholic Bishops, “Commentary on the Reply of the Sacred Congregation for the Doctrine of the Faith to National Conference of Catholic Bishops on Sterilization in Catholic Hospitals,” September 15, 1977, in Origins, December 8, 1977.

ERDs'94.

For a basic outline of the history of ethical norms, see: Rohlfs Steven P. , “Theological Weight and the Directives,” Ethics and Medics, July, 1997.

ERDs'71, Preamble.

See, for example, the debate that took place at the November 27-28, 1971, meeting of the National Federation of Catholic Physicians Guilds in New Orleans reported in the December 9, 1971, issue of Origins. For other examples of the theological debate on this topic see the December 16, 197), and December 23, 1971, issues of Origins, and the entire Fall 1972 issue of Chicago Studies.

For a report on the dialogue between the Sisters of Mercy and the Congregation for the Doctrine of the Faith on direct sterilization see: Farley Margaret , R.S.M. , “Power and Powerlessness: A Case in Point,” Proceedings of the Catholic Theological Society of America 37 (1982) pp. 116–119.

The procedure known as “Uterine Isolation,” was viewed by some as indirect sterilization. This position remained uncorrected until a judgement was made about it by the CDF. See, Congregation for the Doctrine of the Faith, “Responses on Uterine Isolation and Related Matters,” July 31, 1993, in Origins 24 (1994): 211–212.

. The Fathers of the Second Vatican Council, “Gaudium et Spes,” in the Documents of Vatican II, 1965; Pope Paul VI, Humanae Vitae, 1968.

By contrast, Catholic physicians and hospital administrators did not dissent from Church teaching on the immorality of direct abortion and continued to refuse to do abortions even after it became legalized in 1973. In subsequent years special interest groups would present arguments similar to those used to justify direct sterilization in an effort to force Catholic institutions to perform abortions.

See, for example, the Report of the Commission on Ethical and Religious Directives of the Catholic Theological Society of America in Linacre Quarterly, November, 1972, and Charles Curran, “Cooperation: Toward a Revision of the Concept and Its Application,” in Linacre Quarterly, August, 1974.

ERDs'71, directives 18 and 19.

Quaecumque Sterilizatio.

Quaecumque Sterilizatio.

Quaecumque Sterilizatio, n. 3 b).

Commentary.

Commentary, n. 2.

Commentary, n. 4.

Commentary, paragraph following n. 6.

Quaecumque Sterilizatio, n. 3. a., (emphasis added)

Archbishop Daniel E. Pilarczyk and Bishop Donald Wuerl, Memorandum to the Bishops of the United States, June 30, 2000.

Congregation for the Doctrine of the Faith, “Responses on Uterine Isolation and Related Matters,” July 31, 1993, in Origins 24 (1994), pp. 211–212.

Hamel Ron , “In the Name of God and Truth: The Catholic Ban on Sterilization,” Second Opinion, January 1994, p. 93.

Hamel Ron , “In the Name of God and Truth: The Catholic Ban on Sterilization,” p. 96.

The packet sent by Father Michael Place to Colleagues in the Catholic Health Care Ministry on September 26, 2000, also included three examples of such cases that were judged unacceptable by the Holy See. The descriptions of the cases and the critiques provided in “Concerns of the Congregation for the Doctrine of the Faith with Some Partnerships: Examples and Critique,” are attributed to the Holy See.

See, McDonald Matt , “The Limits of Cooperation,” in The Catholic World Report, December 2000, pp. 48–50, for an account of the number and types of mergers among health care institutions that have been proposed or have actually taken place in the United States over the past several years. Some of the agreements reached between Catholic and non-Catholic facilities have resulted in similar arrangements to those made in the more publicized cases.

Pilarczyk , and Wuerl , Memorandum to the Bishops of the United States, June 30, 2000.

Pilarczyk , and Wuerl , Memorandum to the Bishops of the United States, June 30, 2000.

Pilarczyk , and Wuerl , Memorandum to the Bishops of the United States, June 30, 2000.

“The Congregation for the Doctrine of the Faith's Concerns Regarding the Application of the Principle of Cooperation,” included in packet sent by Father Michael D. Place under cover memorandum to Colleagues in the Catholic Health Care Ministry, September 26, 2000.

“The Congregation for the Doctrine of the Faith's Concerns Regarding the Application of the Principle of Cooperation,” included in packet sent by Father Michael D. Place under cover memorandum to Colleagues in the Catholic Health Care Ministry, September 26, 2000.

First drafts of the revised ERDs'94 and Commentary were sent to all the bishops for their review and comment in June, 2000, and were subsequently shared with staff of the Catholic Health Association. A second draft of the revised ERDs'94 was sent to the bishops in September, 2000. Copies of this draft and related documentation were sent to CHA members by Father Michael D. Place on September 26, 2000.

Pilarczyk , and Wuerl , Memorandum to the Bishops of the United States, June 30, 2000.

Consider the statements and actions made by such groups as Merger Watch of Albany, New York, Advocates for Reproductive Choice in Healthcare working out of Los Angeles, Catholics for Free Choice and Planned Parenthood.

Comments made by Father Michael Place as reported in, McDonald Matt , “The Limits of Cooperation,” in The Catholic World Report, December, 2000, p. 51. In reading the materials on the proposed revisions to the ERDs'94 sent by CHA to its members on July 25, 2000, and September 26, 2000, it would seem that the CHA took a practical, though perhaps not formal, position against the May and September drafts. By contrast, there have not yet been any mailings critical of the November 8^th draft. In fact, according to Father Place's memorandum to CHA colleagues dated November 15, 2000, the draft “reflects the work of the theologian/ethicist resource group that met on November 1^st and of Archbishop Pilarczyk, Bishop Wuerl, several other NCCB staff and ten representatives from the ministry who met on November 8^th.” (Ron Hamel, whose views regarding the Church's teaching on direct sterilization were presented above – “In the Name of God and Truth: The Catholic Ban on Sterilization,” Second Opinion, January 1994 – was a representative of CHA at least at one meeting.) Father Place seems happier with the November 8^th draft and comments that “We are in a very different place today than we were at the end of June.”

“Themes from the NCCB Consultation, September 14, 2000,” included in the CHA mailing under cover memorandum from Father Michael D. Place to colleagues in Catholic health care ministry, dated September 26, 2000.

“Themes from the NCCB Consultation, September 14, 2000,” included in the CHA mailing under cover memorandum from Father Michael D. Place to colleagues in Catholic health care ministry, dated September 26, 2000.

Pilarczyk , and Wuerl , Memorandum to the Bishops of the United States, June 30, 2000.

Novembers, 2000, revised draft of the ERDs'94, Part VI.

The Principle of Cooperation is used to evaluate the morality of a secondary agent's actions that in some way contribute to the immoral acts of a primary agent. Since a basic principle of Catholic moral teaching is that evil cannot be done for any reason including the pursuit of good, the Principle of Cooperation could never justify a secondary agent's agreement with the evil intended by the primary agent. Both the primary and secondary agents' intentions, it should be noted, are present in what they do and in the motive for which they do it. Although evil can never be directly intended, the Catholic moral tradition has recognized that evil may sometimes be tolerated. Both the Principle of Double Effect and the Principle of Cooperation address situations in which the pursuit of good may well involve the toleration of evil. In all cases the moral agents must be truly reluctant to do something that requires the toleration of evil. Obviously, neither principle should be employed as a method to rationalize participation in evil. The Principle of Cooperation addresses situations in which a secondary agent's pursuit of some good necessitates the toleration of the evil done by the primary agent. The Principle of Cooperation assists the secondary agent in evaluating his participation in evil by stating those conditions that make cooperation morally justifiable. These conditions are well stated by a series of questions. Is it necessary to pursue this good here and now if it involves cooperation in evil? Do the circumstances make it clear that the evil is only tolerated? Is the good that is pursued proportionate to the evil that is tolerated? Will cooperation with evil contribute in any way to the spread of evil; that is, will it make it seem less evil and lead others to perform the same evil action themselves? By answering such questions, one is able to distinguish cooperation that is the same as doing evil, from cooperation that demonstrates a toleration of evil necessitated by an obligation to pursue some proportionate good that cannot otherwise be reasonably achieved. If the secondary agent claims to be pursing some necessary good and only tolerating the evil the primary agent is engaged in, then the Principle assesses the validity of this claim. It does so by examining the secondary agent's intention as it is found in what he does (object of the act) and in why he does it (motive). Regarding what the agent does, the Principle asks if the cooperation is necessary or essential to the primary agent's action, or whether it helps in some material but nonessential way. Regarding why the secondary agent cooperates, the Principle asks if there is any obligation to pursue the good and if the good pursued is proportionate to the evil tolerated. Since evil can never be directly intended, the will of the secondary agent can never be in agreement with the evil will of the primary agent. This level of cooperation is called formal and is always forbidden. Such formal agreement with the immoral will of the primary agent is explicit when the secondary agent makes no claim to the contrary. It is implicit when, even if he claims otherwise, no other plausible explanation can be given for his level of participation in the primary agent's evil action. Still there are circumstances in which a secondary agent's cooperation, though essential to the evil act, is provided despite his opposition to the evil will of the primary agent. For example, an anesthesiologist who would never willingly assist with a direct abortion provides anesthesia to a pregnant woman who is undergoing surgery for injuries sustained in an automobile accident. During the course of the operation, the surgeon decides that the woman's chances for survival would be improved if he aborts the fetus. There are no other anesthesiologists available and the attending anesthesiologist has no alternative but to continue participating in the operation. His cooperation in the immoral act of the surgeon is essential and necessary, yet his claim not to agree with the evil will of the primary agent is made credible by the duress under which he is made to cooperate. This is called immediate material cooperation and is permissible in such circumstances as those described here. (The Holy See has rightly denied the claim that duress – such as the continuing threat of closure – can justify immediate material cooperation on the part of a Catholic institution.) When the secondary agent's will is not in agreement with the evil intention of the primary agent and his cooperation is non-essential to the evil act, the cooperation is mediate and material. He cooperates in this fashion because of some good that he is obligated to pursue and cannot otherwise reasonably attain. Theologians have introduced two other categories to test the credibility of the secondary agent's claim not to agree with the evil intention of the primary agent. These deal with the physical relationship of the secondary agent to the evil action itself. The closer the secondary agent is to the immoral act of the primary agent, the more compelling must be his reasons for cooperating. This is the basis for the distinction between remote mediate material cooperation and proximate mediate material cooperation. The tradition has allowed for mediate material cooperation (proximate or remote) when the good at stake is proportionate to the evil tolerated and every effort is made to avoid giving scandal. When scandal; that is, leading others to sin by making it seem less immoral or more acceptable is likely, then even mediate material cooperation is impermissible.

National Coalition on Catholic Health Care Ministry, Catholic Health Ministry in Transition: A Handbook for Responsible Leadership, (Silver Spring, Maryland: National Coalition on Catholic Health Care Ministry), 1995.