Tinkering with god: just how moral is conservative catholic morality? a more humane medicine needs a liberal catholic bioethics based on natural law.

THE CATHOLIC CHURCH DESperately needs a broader perspective on the pressing moral issues facing humanity today. Over the centuries, Christianity has been torn apart by what we could most easily describe as arguments between liberals and conservatives and looking from the outside, one could get the impression that Christianity is all about ethical and doctrinal formulae. Especially since the Reformation, the way Christians and other religious people relate to one another is by arguing about who is right and who is not. But the arguments can easily ignore the basic moral values that are endorsed by major religions and which all believers share.

Perhaps the primary problem within the Catholic community today is that there is no unifying influence that can heal the liberal/conservative split any time soon. In the medium term, the only reasonable thing to do is to insist upon respect for one another and attempt to use history and tough reasoning to advance honest dialogue. We can also take a few small steps toward healing splits by examining how natural law, understood in a liberal way, can provide a foundation for bioethics to which persons from different backgrounds can agree. In this process, we do need to answer some basic questions. What is the relationship between reason and authority in Catholic moral teaching? Can a humane medicine and a defensible bioethics be grounded in a Catholic natural law perspective? Are all Catholics obliged to accept the official position of Catholic bishops on issues such as stem cell research, even when that position aligns the church with the most extreme conservative moralists?

We need to push for a more open cross-disciplinary communication and for serious attention to developments in contemporary science, technology and ethics. I do not presume to provide final answers, but rather support attempts to start an ongoing dialogue between scientists, biotechnologists, bioethicists and healthcare professionals. Dialogue in the liberal tradition has to take into account the reflection and insights that have already taken place on these topics in history. But we cannot stop there. Rather we must use that historical perspective to argue for openess to future change.

NEW TECHNOLOGIES

In the Catholic tradition, reality, was always the foundation of ethics, but reality is not reducible to bits of matter coming together by chance, as some strands of postmodernist thought would have it. Reality is much more complex than what pure chance can produce and it is never finished. Catholic moral standards are grounded in the very structure of reality which poses questions and makes answers to serious investigation possible. There is a sense in which morality in this tradition is based on physics, but not physics reduced to bits of matter randomly clashing. Rather, the reality on which Catholic morality is based is a created, structured, intelligible reality" which can be accessed by the mind of a philosopher, a mystic, a poet or a scientist.

However, when it comes to interpreting functioning in the real world, this dependence on reality seems to break down. In official Catholic (Vatican) interpretations (as opposed to academic ones) of natural law, the morality of any given action is based on a distinction between secundum naturam and contra naturam. This distinction tends to be all too clear. Secundum naturam is action or behavior in conformity with nature in the narrowest physiological sense. For example, human intervention into nature is permitted, but only as long as the intervention corrects or improves a pro-creative function of sex organs. Physiologically viewed, sexual intercourse is reduced to nature's system for reproduction. It is all about eggs and sperm and the system for bringing these two cells to procreativity.

In current official Catholic teachings, sexual intercourse is right and good for married couples as long as the couple does not interfere with reproductive physiology. Only married couples should have sexual relations, because only they could care for the possible offspring. And time only way married couples can ethically control reproduction is to have relations during physiology's in fertile periods. Such sexual intercourse is secundum naturam. Anything else, like using birth control technologies, is considered contra naturam.

If one were to do a survey of time millions of former Catholics who now are Protestants or agnostics, the vast majority would refer at least to the narrowness of official moral teachings on issues of sexuality as one reason they are no longer Catholic. If celibate men are the main producers of official Catholic moral teachings, then it is altogether understandable that the teachings will be unrelated to the experience of married people. If sexuality in secular culture is too often treated as frivolous and permissive, in official Catholic cultures there is too much seriousness and almost everything sexual is sinful.

A more reasonable Catholic perspective on sexuality, would support the use of birth control by couples trying responsibly to control procreation. It would strongly support condom use to prevent the transmission of HIV. For liberal Catholic ethicists, the time has come for natural law morality to get in touch with reality. It's time for the church's moral teachings to address the people's experiences, to help them with the issues that trouble them, and to develop moral teachings that are reasonable and convincing.

EMBRYONIC ANSWERS

In December 2000, a 19-page document reported on a meeting between bishops and scientists. The meeting was held in September 1998 on the issue of cloning. By cloning, the bishops and scientists meant the replication of genes, cells, tissues and whole organisms. Time bishops and scientists agreed that there is no moral objection to the cloning of animals, human cells, tissues or genes. Time scientists supported embryonic cloning for research purposes. The bishops objected to embryonic cloning because they attributed human status to the embryo and objected to harming or destroying embryos.

Both groups agreed that chining of human beings was possible and would soon be a reality, despite it being morally controversial. One of the major moral issues is the high percentage of defects in cloned animals; i.e., the extensiveness of harm done. Bishops and scientists agreed that scientific research is important and must not be discouraged. Human life, too, it was agreed, needs to be defended. But the scientists did not agree that human life from the moment of conception must be defended, certainly not in the same way as fully formed human life. The two groups also disagreed about two other issues: that the embryo was the subject of human rights, and that reproduction must not be separated from marriage. There was agreement, however, about concern for social justice, the role of commercial interests in the development of cloning, time inadequacy of today's cloning science to make the leap to becoming a procreative option and consequently to alter time structure of human life. Not every issue was settled but there was extensive ethical agreement achieved.

Related to cloning but closer to public decision making is time issue of stem cell research. The liberal/conservative split shows up clearly on stem cell questions. The conservative view is articulated by die US Conference of Catholic Bishops which in turn reflects a Vatican perspective. For time bishops, stem cell research is a violation of the sanctity of life. It is comparable to abortion. The use of embryonic stem cells is seen as a use of human life as a means to an end and as such the violation of a categorical imperative. They emphasize that no one has been helped (so far) by embryonic stem cells. They resist that adult stem cells are a morally noncontroversial alternative. The bishops equate an embryo with a human person and consider the use of embryonic stem cells equivalent to the killing of a person. This teaching stands in opposition to official positions taken by governments in France, Canada, Great Britain and Germany and comes across as clear but extreme.

Liberal Catholics are not so quick with definitive negative judgments. They tend to agree with scientists that studying stem cells will reveal important insights into the basic biology of human beings and will lead to breakthrough treatments for devastating human diseases. They distinguish totipotent stem cells in an embryo until four days old (these can develop into all the cells of the body); pluripotent stem cells or embryonic stem cells which begin forming after four days and continue for eight months (these can develop into most of the cells in the body); and multipotent stem cells which can develop into many body cells but have significant limitations (these exist throughout human life). Liberal ethicists and scientists generally do not equate human embryos with human persons. For them, development counts ethically. It seems ironic that liberals base their moral judgment on an analysis of the structure of the biological reality, following a traditional Catholic natural law ethics. The Vatican, the pope and the bishops, on the other hand, use a categorical imperative which reflects a Kantian Protestant ethics. Maybe some forms of ecumenism are working.

The promise of embryonic stem cells is seen as justification for allowing some federal support for this type of research. The fact that so many frozen embryos are available--left over from in vitro fertilization and which otherwise would be discarded--is an important dimension of the reality" being morally evaluated. Added to this is the fact that we have the potential of curing some diseases from the use of embryonic stem cells. In a liberal view, the human person develops, and the human form--as well as uniquely human capacities--contribute to moral status. The human embryo is human life, but the idea that it has the status of a full person is counterintuitive. No one would intuitively treat a microscopic speck of human embryo as a person. From a liberal Catholic perspective, the human embryo has moral status and demands respect. The level of respect increases with the development of cells into human form and human capabilities.

The use of embryonic stem cells for research is not a disruption or an undermining of the created order. Talk about this type of research as contributing to a "culture of death" is rhetorical and not rationally defensible. If this science and technology continues to advance and turns out to have unforeseen consequences that disrupt created order, then a negative moral judgment would be more rationally grounded. In the meantime, a natural law perspective supports the careful continuation of genetic research. Scientists should be sensitive to the moral value of the embryo and the moral dimensions of their research. The bioethicists and religious moralists in turn should stay informed about research directions and the consequences of this type of science and technology.

The core moral, philosophical and religious question has to do with what constitutes a human being and the need to protect human life. Since it is the core ethical question, liberal Catholics resist solving the problem or answering the question by authoritative church pronouncements. Natural law ethics insists on keeping the question open. It requires responsible science, careful moral analysis of the reality under consideration, attention to consequences, respect for human creativity, and for the inevitable technological interventionism of human beings.

NATURAL LAW AND HUMANE MEDICINE

Catholic natural law bioethics starts with experience, and uses understood experience in constructing a morality. Catholic ethics is objectively based. It does not turn its back on what others have thought and argued in history', but it continually reviews even long-standing moral teachings in light of new experience and new insights. It is neither radical nor revolutionary but unrelentingly critical. And it does not hesitate to speak out when official teachings no longer make sense. Liberal Catholic bioethics has to establish limits and to say what is contra naturam, but it does not speak too quickly. Reasonable ethics requires patience as well as courage. It has to be willing to learn even from laypersons in the church who have been ignored as a source of insight. Especially in the area of reproductive medicine, the Catholic perspective has to be open to change. But how does one draw the line between secundum naturam and contra naturam in this broader and more liberal understanding of human nature? That is what the conservative perspective does best.

Post-enlightenment scientism and conservative Catholic teachings are rejected by most people today because they are both seen as too confining. Both fail to take into account the experiences of intelligent people. Postmodern culture was embraced by some because it offered an attractive alternative. But tiffs alternative easily leads to rampant nihilism. The official church's insistence that people bow to its teaching authority while giving few reasonable arguments to support the teachings played into the postmodern argument that religion represents unjustifiable authoritarianism and philosophical obscurantism.

Acceptance of change in moral teachings does not mean advocating open season in accepting any and all novelties that present themselves. Rather it calls for openness to and understanding of cultural developments. Catholics have left the church in droves because of the irrelevance and irrationality of official moral teachings. A church that goes totally against contemporary, culture is more like a sect. It gives up on the more difficult task of staying in dialogue with cultural changes and practices. It gives up trying to provide direction for the broader culture and moral teachings based on nature that the mass majority of people can understand. If the church were a business, what is happening today is equivalent to failing to protect its market and its market share. Pope John Paul II and conservative moralists who follow his lead ignore the insight of Thomas in his Commentary on the Nicomachaen Ethics. "What pertains to moral science is known mostly through experience." (Chicago, IL: Reginary, 1964)

TOWARDS A LIBERAL CATHOLIC BIOETHICS

We are constantly provided with new challenges in developing an ethics of technology. We have yet to determine clearly what may be considered a right or wrong intervention into nature. In fields like genetics, ethical use of science and technology neither imitates nor dominates nature. In these fields, imitation and domination have given way to creativity, in the sense of "creating nature anew." Scientists with powerful technologies create what never existed before. Human beings in this perspective are considered God-like, not when they imitate or dominate nature, but when they become co-creators.

Humans create not ex nihilo (out of nothing), but from a nature susceptible to creative manipulation. Historical ethical limits of technological intervention sometimes no longer work. For today's biotechnologists, geneticists and molecular biologists, the established order has given way to limitless possibility for creativity. Human creations are justified by a philosophical anthropology which sees human beings as most Godlike when they create, not when they imitate or dominate nature.

Historically, creativity was understood as a divine characteristic. In the Renaissance geniuses like Michelangelo were thought to be creative. In the 20th century creativity became a characteristic of every young poet, of nursery school finger painters, indeed of everyone who departed from conventional standards. This understanding of creativity is all too easily assigned to scientists, especially the life scientists and biotechnologists. Creativity as understood today does not provide a reliable ethical justification.

Today ethics and bioethics in the US are differently grounded. Science, pleasure, consequence and autonomy are some of the more popular modern foundations of morality. In Catholic culture however, ethics continues to be grounded in the rationally accessible structure of reality. Natural law ethics continues to derive the good from the real. It is nature or the human reality that provides the foundation for what is determined to be good. Good and right contribute to human fulfillment. If the issue is sexuality, then the nature of sexuality is the ground for what is good and ethical. It is therefore not all that amazing that distinguished Catholic physicians, obstetricians and gynecologists would step forward to provide direction in the form of sound rational arguments for change in moral teachings based on an updated and more adequate understanding of nature and the structure of sexual reality.

A more humane medicine is an objectively based and intelligible moral ideal. Ideals do not translate easily into concrete improvements in the way doctors treat patients. But they do have an influence. Reforms and improvements take a long time. Based on long experience, Catholics know about being persistent and being patient. A more humane medicine will not be realized tomorrow, but steps can be taken, improvements can be made and people can speak out against violations of basic ethical principles. If the speaking out is rational, objective, intelligent and convincing, it will be traditionally catholic and will have a good chance ultimately of making a difference. Hope springs eternal.

A Liberal Catholic Bioethicist: Dr. John Rock

Dr. John Rock was born in Marlborough, Massachusetts, and in the 1920s he started a fertility clinic. Throughout his professional life he was concerned with the needs of couples who were childless and his research concentrated on the first stages of conception and on disorders of human reproductive physiology. Dr. Rock's experimentation over many years led to the development of the oral contraceptive pill.

Dr. Rock was a physician devoted to his church and devoted to his patients. He was both a good Catholic and a humane physician. He was a scientist who understood the anatomy and physiology of sexuality and he had, as well, a rare competency in moral philosophy. He not only discovered the birth control pill but also defended its use by well-articulated argumentation based on natural law theory. (John Rock, The Time Has Come: A Catholic Doctor's Proposals to End the Battle over Birth Control, Alfred A. Knopt, New York, 1963.)

Dr. Rock knew about sexuality not only from personal experience with a beloved wife but from dealing all his life with women's concerns with aspects of sexuality, especially with the possibilities of pregnancy and childbirth. He looked carefully at all the complex anatomical and physiological factors in sexuality, but Looked carefully as well at emotional and psychological dimensions expressed in the personal needs of the women whom he treated. He was a humane physician and it was his humaneness joined to his medical competency that compelled hint to work to discover an effective way of aiding the unreliable natural system of birth control. He came up with an effective birth control technology and sound explanations based on natural law theory for its moral legitimacy. I didn't know him personally, but from what I have read about him and his work, I believe he is not just a practitioner of humane medicine but a saintly liberal Catholic.

Dr. Rock made convincing arguments for the satisfaction of legitimate sexual needs and for the use of sexuality beyond procreative purpose. He distinguished between enduring abstract principals of the natural taw and concrete applications of the principals in changing situations that justify evolution in moral teachings. Practical concrete moral judgments, he argued, have to benefit from accumulated insight and have to be open to change.

Reasonable and convincing moral direction in the area of sexuality came from this physician who understood the structure of sexuality. From his medical understanding joined with his personal experience and that of his thousands of patients, he provided a solid foundation for a convincing sexual ethics. Sad to say, his reasonable, practical natural law-based moral direction in the area of sexuality was rejected by church authorities.

--JD

DR. James F. DRANE is the Russell B. Roth Professor of Clinical Bioethics at Edinboro University of Pennsylvania (Emeritus) and has held visiting appointments at the University of Madrid and University of Tennessee Medical Schools, Kennedy Institute of Ethics, and the Menninger School of Psychiatry.

This essay is put together from segments in Dr. Drane's most recent book, More Humane Medicine: A liberal Catholic Bioethic (Edinboro University Press, 2003). See page 27 for ordering details.