The Christian physician cannot both prescribe contraception at the office and believe that contraception is wrong at home. He or she cannot divide personal beliefs from the practice of medicine and still maintain integrity. This is a matter of character on which the Hippocratic Oath is instructive but which much of current medical ethics glosses over. A Christian physician acts out of a Christian metaphysics founded on God as Creator. The Christian anthropology built upon this foundation depicts the human being as made in the image of God and created for excellence. The development of good character through practicing the virtues is the path to excellence. The Christian physician of good character acting on his belief in God avoids prescribing contraception and takes strength from Christ the Good Samaritan and Divine Physician.
Hormonal contraceptives are sometimes prescribed as hormonal therapy for uses other than the prevention of pregnancy. This paper addresses only the use of contraception to prevent pregnancy.
4.
SmithJanetPh.D.“Veritatis Splendor, Proportionalism, and Contraception,”21, http://www.aodonline.org/aodonline-sqlimages/SHMS/Faculty/SmithJanet/Publications/MoralPhilosophy/VeritatisSplendor.pdf. See also Pope Pius XI, Casti connubii (1930; Boston: Daughters of St. Paul, n.d.), 28 and 29 (nn. 54, 56; contraception in marriage is “intrinsically vicious” and “a grave sin”); Pope Paul VI, Humanae vitae, esp. nn. 13-14; Pope John Paul II, Familiaris consortio, n. 32; idem, Evangelium vitae (1995), n. 13 (contraception “contradicts the full truth of the sexual act as the proper expression of conjugal love,” “is opposed to the virtue of chastity in marriage”; “fruits of the same tree” as abortion), http://www.vatican.va/holy_father/john_paul_ii/encyclicals/documents/hf_jp-ii_enc_25031995_evangelium-vitae_en.html; idem, The Theology of the Body: Human Love in the Divine Plan (Boston: Pauline Books & Media, 1997), 393-401; Catechism of the Catholic Church, nn. 2370, 2399; Jason T. Adams, M.A., “Why Is Contraception Immoral?” http://onemoresoul.com/contraception/church-teaching-contraception-abortion/why-is-contraceptionimmoral.html; Janet Smith, Humanae Vitae: A Generation Later (Washington, D.C.: The Catholic University of America Press, 1991); idem, ed., Why Humanae Vitae Was Right: A Reader (San Francisco: Ignatius Press, 1993). For a concise discussion on “how the teaching [of the Catholic Church on contraception] is rooted in Christian anthropology, the natural moral law, the Christian meaning of human sexuality, and the sacrament of matrimony,” see Peter Cataldo, Ph.D., “Compliance with Contraceptive Insurance Mandates: Licit or Illicit Cooperation in Evil?” National Catholic Bioethics Quarterly 4 (2004): 117-124.
There is also immediate and mediate material cooperation. Further discussion is beyond the scope of this paper. For more, see Germaine Grisez, The Way of the Lord Jesus, vol. 2, Living a Christian Life, ch. 7, q. F, http://twotlj.org/G-2-7-F.html; and Joseph Boyle, “Collaboration and Integrity: How to Think Clearly About Moral Problems of Cooperation,” in Issues for a Catholic Bioethic, ed. Luke Gormally (London: The Linacre Centre, 1999), 187-199.
7.
PaulPopeVIHumanae vitae, n. 17. See also Pope John Paul II, Evangelium vitae, n. 91: “It is … morally unacceptable to encourage, let alone impose, the use of methods such as contraception, sterilization, and abortion in order to regulate births.”
8.
See, for example, Rob Stein, “For Some, There Is No Choice,”Washington Post, July 16, 2006, A06, http://www.washingtonpost.com/wp-dyn/content/article/2006/07/15/AR2006071500790.html; Farr A. Curlin, et al., “Religion, Conscience, and Controversial Clinical Practices,” New England Journal of Medicine 356 (2007): 593-600. Along these lines, value neutrality in medicine is an illusion; see Edmund D. Pellegrino, “Value Neutrality, Moral Integrity, and the Physician,” Journal of Law, Medicine & Ethics 28.1 (April 2000).
This is not exactly the same as “may God strike me dead,” though some might think that the ignominy, suffering, and joblessness implied are close enough.
Tom Beauchamp and James Childress, Principles of Biomedical Ethics, 5th ed. (Oxford: Oxford University Press, 1979, 2001), 400. The authors seem to have backpedaled on this statement as it is not in the latest edition (6th ed., 2009).
13.
Beauchamp and Childress, Principles of Biomedical Ethics, 5th ed., 26 (6th ed., 30). This chapter discusses virtue and provides five examples (compassion, discernment, trustworthiness, integrity, and conscientiousness). It goes on to discuss moral ideals and moral excellence, saying that most people are not saints and most saints are not perfect moral models. It then concludes with a discussion of moral heroism in the form of organ donation.
14.
Beauchamp and Childress, Principles of Biomedical Ethics, 5th ed., 26 (6th ed., 30). This chapter discusses virtue and provides five examples (compassion, discernment, trustworthiness, integrity, and conscientiousness). It goes on to discuss moral ideals and moral excellence, saying that most people are not saints and most saints are not perfect moral models. It then concludes with a discussion of moral heroism in the form of organ donation.
15.
Catechism of the Catholic Church, nn. 1949-1950, 1953: “Called to beatitude but wounded by sin, man stands in need of salvation from God. Divine help comes to him in Christ through the law that guides him and the grace that sustains him….” The moral law is the work of divine Wisdom. Its biblical meaning can be defined as fatherly instruction, God's pedagogy. It prescribes for man the ways, the rules of conduct that lead to the promised beatitude; it proscribes the ways of evil which turn him away from God and his love. It is at once firm in its precepts and, in its promises, worthy of love. “Law is a rule of conduct enacted by competent authority for the sake of the common good [see St. Thomas Aquinas, Summa theologiae I-II, q. 90, a. 4]. The moral law presupposes the rational order, established among creatures for their good and to serve their final end, by the power, wisdom, and goodness of the Creator. All law finds its first and ultimate truth in the eternal law…. “The moral law finds its fullness and its unity in Christ. Jesus Christ is in person the way of perfection. He is the end of the law, for only he teaches and bestows the justice of God.”
16.
Webster's New Universal Unabridged Dictionary, 2nd ed. (New York: Simon and Schuster, 1983), s.v. “metaphysics.”
17.
Claude Tresmontant, Christian Metaphysics (New York: Sheed and Ward, 1965), 37. This is an easily read and understood book on Christian metaphysics.
See, for example, Mt 5: 3-12; Jn 14: 2-3; 1 Cor 13: 12; Catechism of the Catholic Church, nn. 260, 1024, 1716-24, 1820, 2795; St. Thomas Aquinas, Summa theologiae, trans. Fathers of the English Dominican Province (1948; Notre Dame, IN: Christian Classics, 1981), I-II, qq. 1-5.
20.
No clump of cells nor an organ has that same potency to grow into a human adult. Only the human embryo has that potency.
21.
Tresmontant, Christian Metaphysics, 68.
22.
Tresmontant, 109. For other metaphysical principles, such as perfection and excellence, and substance and accidents, see St. Thomas Aquinas, Commentary on Aristotle's Metaphysics, rev. ed., trans. John P. Rowan (Notre Dame, IN: Dumb Ox Books, 1995).
23.
Tresmontant, Christian Metaphysics, 65: “Between metaphysics, theology, cosmology, and anthropology there exist relationships which are not accidental. For well-defined organic reasons any metaphysic whatever is not compatible with any theology whatever. Any cosmology whatever, any anthropology whatever is not compatible with any metaphysic. From this we may conclude that any cosmology whatever and any anthropology whatever are not compatible with any theology whatever.”
24.
Rom 2: 14-15; Heb 8: 10; Jer 31: 33.
25.
For more on the natural law, see Catechism of the Catholic Church, nn. 1949-1960, 1978-1979; Aquinas, Summa theologiae I-II, q. 91.
26.
For an interesting discussion of third-person ethics (examination of acts) and first-person ethics (examination of the person acting), see Livio Melina, Sharing in Christ's Virtues: For a Renewal of Moral Theology in Light of Veritatis Splendor (Washington, D.C.: The Catholic University of America Press, 2001), esp. 39.
27.
PaulJohnIIVeritatis splendor, n. 71, original emphasis.
28.
See Aristotle, Nicomachean Ethics, esp. bk. 7.
29.
WojtylaKarolThe Acting Person, trans. Andrzej Potocki (1969; Dordrecht: D. Reidel Publishing Company, 1979), 11, original emphasis.
30.
AristotleNicomachean Ethics, bk. 2, ch. 5.
31.
See Wojtyla, The Acting Person, 106, 107.
32.
See, for example, Gal 2: 20 and Eph 4: 15. See also Pope John Paul II, Veritatis splendor (Boston: Pauline Books & Media, 1993), n. 73; W. Norris Clarke, S.J., Person and Being (Milwaukee: Marquette University Press, 1993), “Personal Being as Self-Transcending,” 94-108: the loss of oneself in becoming united with God, a movement from self-centeredness to God-centeredness, is a “finding of one's true self at a deeper level” (Veritatis splendor, 99).
33.
See Wojtyla, The Acting Person, 106, 107.
34.
TaylorPaul W.“Moral Virtue and Responsibility for Character,”Analysis25.1 (October 1964): 21–22, 23; Robert Audi, “Responsible Action and Virtuous Character,” Ethics 101.2 (January 1991): 304 note 1 (and other places); Aristotle, Nicomachean Ethics, bk. 2, ch. 1 (1103a), ch. 5 (1106a); bk 3, ch. 2 (1112a); ch. 5 (1114b).
35.
Some interesting comments on the formability of character have been made which cannot be explored in detail in this paper but are worth mentioning. Aquinas says, in Summa theologiae I-II, q. 96, a. 4, that “a law that inflicts unjust hurt on its subjects” (ad 3), that is, “wicked laws,” “often bring[s] loss of character” (obj. 3). Pope Leo XIII, in Inscrutabili Dei consilio (1878), nn. 14-15 (http://www.vatican.va/holy_father/leo_xiii/encyclicals/documents/hf_l-xiii_enc_21041878_inscrutabili-dei-consilio_en.html), said that character is “reformed” through teaching, “pursuit of virtue,” and obedience; and weakened by “seeking after self-interest alone”; also, in idem, Laetitiae sanctae (1893), n. 15 (http://www.vatican.va/holy_father/leo_xiii/encyclicals/documents/hf_l-xiii_enc_08091893_laetitiae-sanctae_en.html): “discover[ing] the true relation between time and eternity … form[s] strong and noble characters.” See also Paul Ricoeur, Oneself as Another, trans. Kathleen Blamey (1990; Chicago: University of Chicago Press, 1992), 120-121.
36.
See Pope John Paul II, Evangelium vitae (Boston: Pauline Books & Media, 1995), n. 4; Joshua Hauser, M.D., “Lines Between Palliative, Regular, Aggressive Care Blurring,” amednews.com, March 7, 2005; Edmund D. Pellegrino and David C. Thomasma, The Virtues in Medical Practice (New York: Oxford University Press, 1993), 38; Livio Melina, “Bioethics and Religion: Preliminary Epistemological Questions,” trans. Adrian Walker, Communio 25 (Fall 1998): 392: “the act of recognizing the value of life is laden with consequences for the subject who performs it. Not only does it immediately reveal definite moral obligations that he is bound to observe, but it also dramatically mirrors the very human identity of the person who makes a judgment about life's value…. “To recognize the personal dignity of a nascent human embryo or fetus, or of a terminally ill person, means at the same time to perceive definite moral obligations towards him.”
37.
GrisezLiving a Christian Life, ch. 7, q. F.
38.
John PaulPopeIIVeritatis splendor, n. 72.
39.
SchmitzKenneth L.At the Center of the Human Drama: The Philosophical Anthropology of Karol Wojtyla/Pope John Paul II (Washington, D.C.: The Catholic University of America Press, 1993), 66. As an aside, the implications of this on the issue of conscientious objection are a little frightening. To outlaw conscientious objection for religious reasons for physicians, pharmacists, and other health-care professionals—as some U.S. states, and now Congress in the health-care reform bill (which has now passed), are trying to do—is to say that they must, by law, make themselves into what they are not: non-Catholic or non-Christian physicians, pharmacists, health-care workers. This is in effect to outlaw Christianity. For more on this, see, for example, Hilliard, “Contraceptive Mandates”; and Stephen L. Carter, The Culture of Disbelief: How American Law and Politics Trivialize Religious Devotion (New York: Basic Books, 1993). Both Hilliard and Carter point out ways in which state governments and the courts are overstepping their bounds and the Constitution of the U.S., by either putting other “rights” above religious freedom or by abrogating to themselves the judgment of what is a religious institution. For example, in the case of abortion, the courts have determined that it is the woman's decision, and that the woman's “right” to abortion trumps conscientious objection (see Carter, Culture of Disbelief, 241); and in the case of the definition of a religious institution or ministry, some state governments and courts, imposing their will, decided that it is their own judgment whether a non-profit organization is religious or secular (Hilliard, “Contraceptive Mandates,” 4-5). And they did not look to the doctrines of the religion to determine whether the organization fit in with the religion's goals and purposes (e.g., the corporal works of mercy, Christ's call to feed the hungry, heal the sick, etc.), but made up their own rules (e.g., it must serve only people of its own religion). If you follow Hilliard's commentary out to its logical conclusion, the state (e.g., California) is saying that, in order to be considered a non-profit religious organization, a religious organization can no longer be an equal opportunity employer, but must employ only people of its own religious beliefs. Catholic non-profit institutions can no longer be open to hiring even those of other religions whose beliefs are nevertheless in line with Catholic doctrine, if they wish to remain a non-profit religious organization. In fact, the state of California has decided that Catholic Charities is not a religious organization and therefore not exempt from including contraception in its insurance coverage of employees, because it does not proselytize, does not hire only Catholics, and does not serve only Catholics in its ministry. Catholic Charities of Sacramento, Inc. v. the Superior Court of Sacramento County, no. C037025 (Court of Appeal of California, third appellate district, July 2, 2001; Carol N. Hogan, “Can the Government Define Religion?” National Catholic Bioethics Quarterly 1 (2001): 27-31; idem, “Catholic Charities Declared a Non-Religious Institution: A Stunning Decision in California,” National Catholic Bioethics Quarterly 4 (2004): 711-716. In spite of (or because of) these bills and court decisions, religious organizations and individuals conscientiously objecting have a responsibility to persevere. As Carter explains: “Religions are in effect independent centers of power, with bona fide claims on the allegiance of their members, claims that exist alongside, are not identical to, and will sometimes trump the claims to obedience that the state makes.” Carter, Culture of Disbelief, 35.
40.
SchmitzAt the Center of the Human Drama, 89. See also Wojtyla, Acting Person, 99; Pope John Paul II, Veritatis splendor, nn. 39, 71.
41.
For reasons why contraception is evil, see note 1 above.
42.
Taylor“Moral Virtue and Responsibility for Character,”21.
43.
MelinaSharing in Christ's Virtues, 54.
44.
Sharing in Christ's Virtues, 51; see also 51-53.
45.
Sharing in Christ's Virtues, 56.
46.
Catechism of the Catholic Church, n. 1810; Pope Leo XIII, Rerum novarum (1891), n. 50.
47.
CaffaraCarloLiving in Christ: Fundamental Principles of Catholic Moral Teaching (San Francisco: Ignatius Press, 1987), 166.
48.
Living in Christ: Fundamental Principles of Catholic Moral Teaching, 167: “The realization of the human person is not principally in morally good actions, but in the acquisition of the moral virtues.” See also John Finnis, Aquinas: Moral, Political, and Legal Theory (Oxford: Oxford University Press, 1998), 84-85; Melina, Sharing in Christ's Virtues, 44.
49.
FinnisAquinas, 84–85 note 114.
50.
PinckaersServaisSources of Christian Ethics, trans. Sr. Mary Thomas Noble, O.P. (Washington, D.C.: Catholic University of America Press, 1995), 225 and 225 note 3; Melina, Sharing in Christ's Virtues, 51-53.
51.
John PaulPopeIIVeritatis splendor, n. 67.
52.
SchmitzAt the Center of the Human Drama, 77; see also 79, 85-86, 118.
Also to keep in mind are two functions that Carter finds religion can serve: “Translating Tocuqeville's observations to the present day …, one therefore sees two chief functions that religions can serve in a democracy. First, they can serve as the sources of moral understanding without which any majoritarian system can deteriorate into simple tyranny, and second they can mediate between the citizen and the apparatus of government, providing an independent moral voice.” Carter, Culture of Disbelief, 36–37.
55.
Mt 5: 10-12; see also Col 1: 24; Rom 5: 3-5, 8: 15-18; Phil 1: 27-30; 2 Tim 1: 8-13, 4: 5; 1 Pt 1: 3-7, 2: 19-21, 3: 13-18, 5: 6-10; 2 Th 1: 5-7.
See, e.g., St. John Chrysostom's commentary on Luke, in Catena Aurea: Commentary on the Four Gospels, vol. 3, Luke, eds. Thomas Aquinas and John Henry Cardinal Newman (1841; London: The Saint Austin Press, 1997), 375; St. Ambrose, “Two Books Concerning Repentance,” bk. 1, ch. 6, n. 28, in Nicene and Post-Nicene Fathers, 2nd ser., vol. 10, Ambrose: Selected Works and Letters, ed. Philip Schaff (Grand Rapids: Christian Classics Ethereal Library, n.d.); St. Augustine, The Trinity, bk. 15, ch. 27, or “Tractate 43,” n. 11, in Nicene and Post-Nicene Fathers, 1st ser., vol. 7, St. Augustin: Homilies on the Gospel of John; Homilies on the First Epistle of John; Soliloquies, ed. Philip Schaff (New York: Christian Literature Publishing Co., 1886); Pope Benedict XV, the encyclical Pacem, Dei munus pulcherrimum (1920), n. 11. For Pope Pius XI, the encyclical Mit Brennender Sorge (1937), n. 35.
58.
John PaulPopeII address to the Italian Surgical Society (October 15, 1998), n. 2, http://www.vatican.va/holy_father/john_paul_ii/speeches/1998/october/documents/hf_jp-ii_spe_19981015_cong-chirurgia_en.html: “your main concern is to improve the patient's health, while respecting his physical, psychological, and spiritual integrity. In showing deep satisfaction with this noble intention, I hope that it will be the constant concern of every doctor and surgeon. The humanization of medicine is not a secondary aspect, but rather it is the center of a practical medical science that is prepared not to turn a deaf ear to the human being's expectations nor to disappoint them” (emphasis added).
