What is the Position of the Catholic Church on Organ Donation?

 

Pope Pius XII and Pope John Paul II both agree that it is the responsibility of doctors and scientists to determine the exact moment of death. In addition, the United States Catholic Bishops Conference asserted that the determination of death should be made by the physician or competent medical authority in accordance with responsible and commonly accepted scientific criteria (Ethical and Religious Directive, no. 62). To this end, a working group of doctors and scientists assembled by the Pontifical Academy of Sciences gave this clinical definition of death: “a person is dead when there has been total and irreversible loss of all capacity for integrating and coordinating physical and mental functions of the body as a unit” (1989, p. 81). The Church teaches that when an indisputable pronouncement of death has been made, donation of organs can commence. The Catechism of the Catholic Church states that Organ transplants are in conformity with the moral law if the physical and psychological dangers and risks to the donor are proportionate to the good sought for the recipient. Organ donation after death is a noble and meritorious act and is to be encouraged as an expression of generous solidarity. It is not morally acceptable if the donor or his proxy has not given explicit consent (no. 2296). Pope John Paul II vigorously affirmed that a beautiful act expressing the culture of life “is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even of life itself to the sick who sometimes have no other hope” (“Evangelium Vitae,” No. 86).

The Ethical and Religious Directives for Catholic Health Care Services (ERDs) based on the principle of totality (body parts are ordered for the good of the whole, and may be disposed of, if necessary, for the good of the whole) affirm that organ donations from the living is a noble and charitable act, while specifying at the same time that the donation will not sacrifice or seriously impair and essential functioning of the donor. It added that to avoid conflicts of interest the physician determining death ought not be a member of the transplant team (Directives, 64). May (2011) observed that the morality of the self-giving of vital organs depends on how the acting person relates himself in his freely chosen act to the great goods of healthy functioning and life itself. If the harm (including the mutilation) suffered by the donor — but in no way intended either by him or those involved in the transplant — does not impair his functional integrity, the evil suffered is an unintended side-effect of an act of self-giving, a morally good act. However, were the donor’s own functional integrity and hence his own health and life to be impaired, it would be wrong for him to choose to give it because the means he would choose, endangering his own health and life, is bad although intended for a good end, but one can never intend or choose evil for the sake of good to come. In all, the Catholic Church applauds and encourages organ donation as a morally good act of self-giving.

How does the Magisterium of the Catholic Church view research on embryos obtained through In Vitro Fertilization?

According to Donum Vitae: Human embryos obtained in vitro are human beings and subjects with rights: their dignity and right to life must be respected from the first moment of their existence. It is immoral to produce human embryos destined to be exploited as disposable “biological material”. In the usual practice of in vitro fertilization, not all of the embryos are transferred to the woman’s body; some are destroyed. Just as the Church condemns induced abortion, so she also forbids acts against the life of these human beings.

It is a duty to condemn the particular gravity of the voluntary destruction of human embryos obtained ‘in vitro’ for the sole purpose of research, either by means of artificial insemination of by means of “twin fission”.

By acting in this way the researcher usurps the place of God; and, even though he may be unaware of this, he sets himself up as the master of the destiny of others inasmuch as he arbitrarily chooses whom he will allow to live and whom he will send to death and kills defenseless human beings.

Methods of observation or experimentation which damage or impose grave and disproportionate risks upon embryos obtained in vitro are morally illicit for the same reasons. Every human being is to be respected for himself, and cannot be reduced in worth to a pure and simple instrument for the advantage of others. It is therefore not in conformity with the moral law deliberately to expose to death human embryos obtained ‘in vitro’. In consequence of the fact that they have been produced in vitro, those embryos which art not transferred into the body of the mother and are called “spare” are exposed to an absurd fate, with no possibility of their being offered safe means of survival which can be licitly pursued.

Congregation for the Doctrine of the Faith, Instruction on Respect For Human Life In Its Origin And On The Dignity Pf Procreation Replies To Certain Questions Of The Day, #5.

 

Is prenatal testing allowable by the Magisterium of the Roman Catholic Church?

According to Donum Vitae: For prenatal diagnosis makes it possible to know the condition of the embryo and of the fetus when still in the mother’s womb. It permits, or makes it possible to anticipate earlier and more effectively, certain therapeutic, medical or surgical procedures. Such diagnosis is permissible, with the consent of the parents after they have been adequately informed, if the methods employed safeguard the life and integrity of the embryo and the mother, without subjecting them to disproportionate risks.

But this diagnosis is gravely opposed to the moral law when it is done with the thought of possibly inducing an abortion depending upon the results: a diagnosis which shows the existence of a malformation or a hereditary illness must not be the equivalent of a death-sentence. Thus a woman would be committing a gravely illicit act if she were to request such a diagnosis with the deliberate intention of having an abortion should the results confirm the existence of a malformation or abnormality. The spouse or relatives or anyone else would similarly be acting in a manner contrary to the moral law if they were to counsel or impose such a diagnostic procedure on the expectant mother with the same intention of possibly proceeding to an abortion. So too the specialist would be guilty of illicit collaboration if, in conducting the diagnosis and in communicating its results, he were deliberately to contribute to establishing or favoring a link between prenatal diagnosis and abortion. In conclusion, any directive or program of the civil and health authorities or of scientific organizations which in any way were to favor a link between prenatal diagnosis and abortion, or which were to go as far as directly to induce expectant mothers to submit to prenatal diagnosis planned for the purpose of eliminating fetuses which are affected by malformations or which are carriers of hereditary illness, is to be condemned as a violation of the unborn child’s right to life and as an abuse of the prior rights and duties of the spouses.

 

Congregation for the Doctrine of the Faith, Instruction on Respect For Human Life In Its Origin And On The Dignity Pf Procreation Replies To Certain Questions Of The Day, #2.

 

Is Condom Use Morally Justified for Serodiscordant HIV Couples?

HIV/AIDS has continued to ravage developing countries of the world especially Sub-Saharan Africa. Sub-Saharan Africa generates no more than 1 percent of the total wealth produced in the world. Yet it is the home of 10% of the world’s population, lives on 1% of the global economy, and carries 68% of the world’s HIV/AIDS burden. WHO estimates that in 2014 only about 41% of people living with HIV were able to access life-saving medications. Given the epidemic nature of this disease and the lack of cure, is condom use morally justified to prevent the spread of the disease in serodiscordant couples? The Church teaches that condoms and all other related methods of birth control sever the unitive and procreative significance inherent in the marital act. Humanae Vitae prohibits “any action which either before, at the moment of, or after sexual intercourse, is specifically intended to prevent procreation” (no. 14). In addition, the U.S Catholic Bishops assert that “The use of prophylactics to prevent the spread of HIV is technically unreliable. Moreover, advocating this approach means in effect, promoting behavior which is morally unacceptable. Campaigns advocating ‘safe/safer’ sex rest on false assumptions about sexuality and intercourse.”

However, Pope Benedict XVI, in his 2010 book-length interview, “Light of the World,” hypothesized that use of a condom to prevent infection could be a first step toward moral responsibility. He used the example of a male prostitute. The Pope’s remarks have been criticized by some as a deviation from the Church’s position on contraception and supported by numerous moral theologians and ethicists. On Dec 21, 2010 Congregation for the Doctrine of Faith (CDF) expounded on the Pope’s remarks and stated that “those who know themselves to be infected with HIV and who therefore run the risk of infecting others, apart from committing a sin against the sixth commandment are also committing a sin against the fifth commandment – because they are consciously putting the lives of others at risk through behavior which has repercussions on public health.” The Note concludes that “those involved in prostitution who are HIV positive and who seek to diminish the risk of contagion by the use of a condom may be taking the first step in respecting the life of another – even if the evil of prostitution remains in all its gravity.” Similarly, the Southern African Catholic Bishops Conference (who carry the greatest burden of HIV/AIDS) asserted in the 2001 pastoral letter that in a case of a married serodiscordant couple, the use of condom to prevent the spread of the disease to the spouse was acceptable. This position was based on the principle that everyone has the right to defend one’s life against mortal danger. Furthermore, moral theologians and ethicists argue that “a married man who is HIV-infected and uses the condom to protect his wife from infection is not acting to render procreation impossible, but to prevent infection. If conception is prevented, this will be an –unintentional – side-effect and will not therefore shape the moral meaning of the act as a contraceptive act” (Rhonheimer, 2004). These views are anchored on two moral principles: Lesser of Two Evils and Double Effect. Finally, the Church has always taught that individuals can follow their well-formed consciences in difficult situation:  “Catholics with a well-formed conscience can decide to use contraceptives ‘in cases of particular emergency.'” This decision must follow only after a “serious discernment of conscience” (National Catholic Reporter, Feb, 2016).

“Can a pregnant woman infected with the Zika virus abort the fetus?”

Answer: The question can be answered from legal and ethical standpoints. To begin with the legal, in the United States, since the 1973 Roe v. Wade decision that legalized abortion at the federal level, each state has responded with its own legislation regulating abortion. In general, most current U.S. states allow abortion before the fetus gets 20 to 24 weeks old (around the end of the second trimester). Thus, the pregnant woman diagnosed with the Zika infection can get an abortion within the state’s jurisprudence. On the other hand, abortion is legally permitted in the period later than the legal period, typically when the mother is in a dire medical condition. Thus, it is unlikely that this legal exception applies to the pregnant woman with the Zika infection because it is not the woman’s health that is in peril. Some states allow the late-term abortion in the case of an extreme fetal deformity; it is up to the state’s decision whether or not the Zika-infected, microcephalic fetus belongs to that category though we do not believe it is the case.

To discuss the case from the ethical perspective, we need to frame the question within the reasoning of a particular ethical tradition. As our society is getting more religiously and culturally diversified, many different ethical traditions co-exist in the U.S. However, let us confine our response to the ethical framework of one particular tradition, which is the Roman Catholic tradition. The Church understands a “human person” to begin at conception and thus even a zygote is called a “mono-celled person” who holds the same dignity and sanctity as adult human beings. Accordingly, abortion in any embryonic or fetal developmental stage is morally prohibited. However, as in the case of law, this general moral principle is overridden when the mother’s life is in danger. The Church sees it as morally justifiable to save the mother with the death of the fetus/embryo as the unintended consequence. However, the Church nuances the verdict that, while a direct killing of the fetus is never permitted, the death of the fetus occurs in the way of saving the mother’s life as an act “not intended but merely foreseen.” Also, the Church emphasizes that the justifiable act of killing should be evidenced by a proper technical medical procedure that fits in with the category. However, one seeming controversy is that a further rule or principle is not shown why the justifiable act of killing is made in favor of saving the mother, not the fetus. It is neither that the fetus is less human person than the mother, nor that the fetus’s personhood is “potential” while the mother is “actual.” Both persons are actual human beings with the same degrees of dignity and sanctity. Then, why save the mother, not the fetus? The Church calls for “conscience” as the moral judge that determines in this type of case.

Critics argue that, since one’s conscience can voice a different opinion from that of another’s conscience, the Church has practically opened the possibility that two opposing moral solutions are possible for the same case. Thus, one can decide to save the mother or the fetus based on one’s own conscience. To say further, the Church condones the faithful to do whatever they want based on their arbitrary feelings. Then, in our case, the Zika-infected pregnant woman’s abortion in any stage is ethically permissible.

However, this is a misleading understanding of the nature of conscience. While it is admitted that a theological discussion on conscience must be furthered, the Church’s use of conscience is not to endorse or secretly allow the arbitrariness, but to explain the nature of its theological moral reasoning. In all ethical cases, relevant general moral principles should be upheld. However, there are moral dilemmas, that is, the cases where two or more moral principles or rules are in conflict. And in the cases of moral dilemmas, conscience decides which principle should be prioritized over the other. Since conscience is largely of human reason, it has a direction. Thus, it does not provide arbitrary verdicts. On the other hand, conscience as a pathway to God’s will implies the element of divinity, so it demands one’s obedience. In sum, conscience is “rational-divine moral intuition” bound to generate similar solutions for similar cases. For example, when the pregnant mother’s life is in danger, the moral intuition dictates that “Save the life of a dying adult person” should be balanced over against “Do not kill the life of an unborn person.” And all similar cases like this should be treated in this manner.

In the case of the pregnant woman with the Zika infection, at least three moral rules are relevant: “Do not kill the life of an unborn person,” “Do not put a financial burden on a society to care for mentally retarded babies,” and “Do not put a financial as well as emotional burden on an adult person to care for mentally retarded babies.” According to the Church, it seems unlikely that conscience, our moral intuition, decides in the way that the first rule trumps the other two in cases like this; nor is found a theological precedent that endorses moral prioritization in favor of the first rule against the two. Therefore, Pope Francis emphasizes that abortion is absolutely not permitted when fight the Zika virus.

What is the position of the Catholic Church on Natural Family Planning?

Natural family planning (NPF) or “periodic abstinence” according the United States Conference of Catholic Bishops (USCCB) is an umbrella term for certain methods used to achieve and avoid pregnancies. These methods rely on observation of the naturally occurring signs and symptoms of the fertile and infertile phases of a woman’s menstrual cycle. Couples seeking to avoid pregnancy through NPF abstain from intercourse and genital contact during the fertile phase of the woman’s cycle. NPF does not require the use of drugs, devices or surgical procedures to be effective in avoiding pregnancy. NPF “reflects the dignity of the human person within the context of marriage and family life, promotes openness to life, and recognizes the value of the child. By respecting the love-giving and life-giving natures of marriage, NPF can enrich the bond between husband and wife” (USCCB, Standards for Diocesan Natural Family Planning Ministry, p.23).

The Catholic Church supports and approves of NPF because it respects the ends of marriage (unitive and procreative). From the beginning of creation, God designed marriage as an intimate partnership of life and love between a man and a woman for the whole of life (Gaudium et spes, 48; Code of Canon Law, n. 1055). Therefore, the fecundity of marriage and responsible parenthood demand that husband and wife embrace the sacred responsibility of deciding when and how many children to have in marriage. Pope Paul VI wrote “if there are well-grounded reasons for spacing births, arising from physical or psychological condition of husband or wife, or from external circumstances, the Church teaches that married people may then take advantage of the natural cycles immanent in the reproductive system and engage in marital intercourse only during those times that are infertile…” (Humanae Vitae, 16). NPF or “recourse to the rhythm of the cycle” as John Paul II calls it, is open to love and life. It conforms to the culture of life and the civilization of love that characterize the sacrament of marriage. The Second Vatican Council advocates that “parents should regard as their proper mission the task of transmitting human life and educating those to whom it has been transmitted. They should realize that they are thereby cooperators with the love of God the Creator, and are, so to speak, the interpreters of that love” (Gaudium et spes, 50). The Catholic Church therefore condemns unnatural forms of birth control and approves the use of NPF where there is a sufficient reason to avoid or postpone pregnancy. The Church warns against selfishness in family planning and recommends that “it must be done with respect for the order established by God” (Humanae Vitae, 16)

What does the Catholic Church teach about contraception?

Contraception is “any action which, either in anticipation of the conjugal act [sexual intercourse], or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible” (Humanae Vitae 14).  The teachings of the Catholic Church on contraception are derived from Scripture, Natural law, Apostolic Tradition, The magisterium and human experience. Marriage is a sacrament with both unitive and procreative ends. Therefore, the fecundity of marriage is vital in the Church’s teaching about contraception. Pope Paul VI, in his 1968 encyclical, Humanae Vitae said this about marital love:  “Finally, this love is fecund. It is not confined wholly to the loving interchange of husband and wife; it also contrives to go beyond this to bring new life into being. ‘Marriage and conjugal love are by their nature ordained toward the procreation and education of children. Children are really the supreme gift of marriage and contribute in the highest degree to their parents’ welfare’” (Humanae Vitae 9). Similarly, the Catechism of the Catholic Church, # 2366 teaches that “Fecundity is a gift; an end of marriage, for conjugal love naturally tends to be fruitful. A child does not come from outside as something added on to the mutual love of the spouses, but springs from the very heart of that mutual giving, as its fruit and fulfillment. So the Church, which is on the side of life, teaches that it is necessary that each and every marriage act remain ordered per se to the procreation of human life. This particular doctrine, expounded on numerous occasions by the Magisterium, is based on the inseparable connection, established by God, which man on his own initiative may not break, between the unitive significance and the procreative significance which are both inherent to the marriage act.”

It follows therefore that contraceptive acts which include all forms of sterilization, male and female condoms and other barrier methods, spermicides, coitus interruptus (withdrawal method), the Pill, and all other related methods of birth control sever the unitive and procreative significance inherent in the marital act. Consequently in Catholic health institutions only procedures that do not separate the unitive and procreative dimensions of the marriage act may be employed to help couples conceive. The Ethical and Religious Directives for Catholic Health Care Services (5th edition) promulgated by the United States Conference of Catholic Bishops state that “Catholic health institutions may not promote or condone contraceptive practices but should provide, for married couples and the medical staff who counsel them, instruction both about the Church’s teaching on responsible parenthood and in methods of natural family planning” (# 52). The Bishops also declare that “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available (#53).

 

Does Preimplantation Genetic Diagnosis violate the Catholic Church’s teaching on the dignity of the human person?

 

According to CONGREGATION FOR THE DOCTRINE OF THE FAITH INSTRUCTION DIGNITAS PERSONAE ON CERTAIN BIOETHICAL QUESTIONS:

Preimplantation diagnosis is a form of prenatal diagnosis connected with techniques of artificial fertilization in which embryos formed in vitro undergo genetic diagnosis before being transferred into a woman’s womb. Such diagnosis is done in order to ensure that only embryos free from defects or having the desired  sex or other particular qualities are transferred.

Unlike other forms of prenatal diagnosis, in which the diagnostic phase is clearly separated from any possible later elimination and which provide therefore a period in which a couple would be free to accept a child with medical problems, in this case, the diagnosis before implantation is immediately followed by the elimination of an embryo suspected of having genetic or chromosomal defects, or not having the sex desired, or having other qualities that are not wanted. Preimplantation diagnosis – connected as it is with artificial fertilization, which is itself always intrinsically illicit – is directed toward the qualitative selection and consequent destruction of embryos, which constitutes an act of abortion. Preimplantation diagnosis is therefore the expression of a eugenic mentality that “accepts selective abortion in order to prevent the birth of children affected by various types of anomalies. Such an attitude is shameful and utterly reprehensible, since it presumes to measure the value of a human life only within the parameters of ‘normality’ and physical well-being, thus opening the way to legitimizing infanticide and euthanasia as well”.[1]

By treating the human embryo as mere “laboratory material”, the concept itself of human dignity is also subjected to alteration and discrimination. Dignity belongs equally to every single human being, irrespective of his parents’ desires, his social condition, educational formation or level of physical development. If at other times in history, while the concept and requirements of human dignity were accepted in general, discrimination was practiced on the basis of race, religion or social condition, today there is a no less serious and unjust form of discrimination which leads to the non-recognition of the ethical and legal status of human beings suffering from serious diseases or disabilities. It is forgotten that sick and disabled people are not some separate category of humanity; in fact, sickness and disability are part of the human condition and affect every individual, even when there is no direct experience of it. Such discrimination is immoral and must therefore be considered legally unacceptable, just as there is a duty to eliminate cultural, economic and social barriers which undermine the full recognition and protection of disabled or ill people.

[1] John Paul II, Encyclical Letter Evangelium vitae, 63: AAS 87 (1995), 473.

My wife was told that her fetus in the 16th week of pregnancy has Trisomy 18. The Ob/Gyn is recommending an elective abortion because the condition of Trisomy 18 is not compatible with life. What is your opinion?

Trisomy 18, also known as Edwards’ syndrome, is a chromosomal abnormality associated with severe developmental abnormalities affecting multiple organs. Because of those anomalies the majority of the fetuses do not survive to term or die within their first months of life. However, 5% to 10% of infants with trisomy 18, most of whom possess an extra copy of chromosome 18 only in few cells of the body, live longer than one year and survive to the teenage years in spite of serious medical and development problems.

Elective abortion or early induction of labor constitutes the currently most common medical recommendation provided to a pregnant woman carrying a fetus with trisomy 18, on the ground that this chromosomal abnormality is a lethal and incompatible with life. According to the Catechism of the Catholic Church it is gravely immoral to support a couple’s decision to end the pregnancy through an early induction of labor when the developmental stage of the fetus is incompatible with life outside the uterus and when neither the mother’s health nor the fetal life are in danger [1]. In those circumstances, the early induction of labor configures an act of elective abortion that is morally unacceptable. That moral stance has been confirmed by the US Conference of Bishops in the Ethics and Directive for Catholic Health Care Services. In particular, paragraph 49 of that document states “For a proportionate reason, labor may be induced after the fetus is viable”.[2] Since the threshold for fetal survival in the US has been set up at 24 weeks of gestation, the early delivery of a 16 week fetus is an act of elective abortion that is utterly immoral. Furthermore, the scenario depicted in the question reveals the incorrectness of the provided medical counseling that failed to take into consideration both the improvement of survival of those infants with trisomy 13 and 18 submitted to multiple surgeries [3] as well the reports of the rewarding experience of families living with a child with trisomy 18.[4] It is highly advisable that obstetricians, genetic counselors and ethicist abandon the ‘lethal language’ leading to ‘lethal decisions’ and be more respectful of the parents’ decisions and preferences of not terminating the life of a baby with trisomy 18.[5]


[1] Catechism of the Catholic Church, nn 2270-1.

[2] United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, 2009: n 49.

[3] Nelson KE, Hexem KR, Fudtner C. Inpatient Hospital Care of Children with Trisomy 13 and Trisomy 18 in the United States, Pediatrics, 2012:129(5):869-76. doi: 10.1542/peds.2011-2139. Epub 2012 Apr 9. http://www.ncbi.nlm.nih.gov/pubmed/22492767 (Accessed on August 9, 2013).

[4] Janvier A, Farlow B., Wilfond B, The Experience of Families with Children
with Trisomy 13 and 18 in Social Networks Pediatrics 2012 Aug;130(2):293-8. doi: 10.1542/peds.2012-0151. Epub 2012 Jul 23.

http://www.ncbi.nlm.nih.gov/pubmed/22826570 (Accessed on August 12, 2013).

[5] Koogler TK, Wilfond BS, Friedman Ross L. Lethal Language, Lethal Decisions Hasting Center Report. 2003:33, 37-41.

Is pre-implantation genetic diagnosis (PGD) acceptable for Catholics?

The official position of the Catholic Magisterium on prenatal diagnosis has been articulated in the instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation (Donum Vitae) issued by the Congregation for the Doctrine of the Faith (CDF). In that document it has been stated that prenatal diagnosis is “ permissible if the methods used, with the consent of the parents who have been adequately instructed, safeguard the life and integrity of the embryo and its mother and does not subject them to disproportionate risks. But this diagnosis is gravely opposed to the moral law when it is done with the thought of possibly inducing an abortion depending upon the result…”.

Although the document does not address explicitly the moral acceptability of pre-implantation genetic diagnosis (PDG) it is reasonable to infer that genetic testing performed on early, pre-implantation embryos obtained by uterine lavage with the aim to identify a suspect genetic abnormality and eventually to correct it through somatic gene therapy is morally licit. PGD can be performed either through noninvasive blastocyst culture or by splitting the 4 to 8 cell embryo in two. By virtue of the totipotency of the embryonic cells even the implantation of a ‘half’ of the embryo can develop into a whole individual. Unfortunately, this diagnostic technique has been increasingly used as a means of selecting those embryos carrying genetic abnormalities and eliminating them.  In that case PDG is manifestly contrary to the respect of every human life from the very moment of conception defended by the Catholic Magisterium and, thus, morally unacceptable.