Bioethics and end-of-life questions

It’s time for a conversation about justice, top Catholic scholar says

Famed ethicist Alasdair MacIntyre called upon academia and other Catholics and intellectuals to invest in the “expensive conversation” about justice, and to sharpen their understanding of what constitutes human dignity. MacIntyre, whose teaching career spans 70 years and includes some of the most important books on virtue ethics such as "After Virtue" and "Dependent Rational Animal," gave a reflection entitled “Human Dignity: A Puzzling and Possibly Dangerous Idea?” at the University of Notre Dame’s de Nicola Fall Conference Nov. 12. During the presentation, he argued that the modern term “human dignity” is doing the work that justice should be doing and that the current definition of human dignity and its implications have puzzling limitations. He posed the question of whether or not Hitler has human dignity— and if he does, what is he afforded by it? Can human dignity never be lost, MacIntyre asked. He analyzed the limits of the modern conception of human dignity, which differs starkly from the Thomistic understandings of "dignitas" advanced by the Belgian Thomist Charles De Koninck. According to this view, which MacIntyre asserted was a more accurate understanding of the term, human beings have dignity in virtue of what they can become--not because of the simple fact that they are persons. Accordingly, this means that human beings can also lose their dignity through sin. “A bad human being is worse than a bad animal,” he said. It also means that in order to live a dignified life, in addition to having access to basic needs such as food, clothing, and shelter, human beings must be given the chance to exercise virtues which ennoble their nature and bring it to its highest level of flourishing, MacIntyre said, adding that this requires a social restoration of the common good. MacIntyre critiqued pervasive individualist ethics, which often focus on negative prohibitions rather than the common good. He gave the example of a state that outlaws slavery, but does nothing other than allow them to live in “miserable freedom.” The elimination of evil did not ennoble the former slaves in the way it should, he argued, which is a problem of conceptualizing and seeking the common good. “One cannot have a care for human dignitas if we ascribe to political and social individualism,” he decried. MacIntyre also argued that a state that outlaws abortion, but then fails to provide basic medical and maternity care as well as economic provisions, exemplifies this same individualist ethos centered on eliminating negative prohibitions but not aimed at achieving the common good. His remarks come as the Supreme Court prepares to hear oral arguments in one of the most significant challenges to Roe v. Wade since its inception— Dobbs vs. Jackson Women’s Health Organization. Many believe Dobbs will overturn Roe. During a Q&A Nov. 12, several participants questioned MacIntyre’s assertion that human dignity be recognized in its potential form rather than by virtue of the fact that a human being is a human being, citing concerns for the implications on moral arguments against embryonic stem cell research. MacIntyre responded that too many are attempting to make the modern term human dignity— widely used in United Nations documents and constitutions in the post-war period because it allowed fighting political, religious, and philosophical factions to bridge unsurmountable gaps because of its lack of definition— to do the work that properly belongs to understanding the virtue of justice. Justice, which Aristotle defines as rendering to another person his due, is where answers to questions of embryonic stem cell research and torture properly belong, MacIntyre said. He said the dignity of an embryo, or of Hitler, lies in his or her potential and urged the attendees to have “expensive conversations” about the question “what is justice?” so they can better articulate what is owed to human beings. MacIntyre has often written about the loss of moral vocabulary and vision in today’s world. The philosopher considers this to be one of the biggest obstacles to allowing human beings to flourish, since the path to happiness through virtue is largely unknown. This was MacIntyre’s 20th contribution to the de Nicola Fall Conference on Ethics.

Pope Francis insists on right to conscientious objection for abortion refuseniks

h/t to Bioedge Health workers have a non-negotiable right to conscientious objection if they are asked to participate in an abortion, Pope Francis told a conference of hospital pharmacists this week. CO is actually “fidelity to your profession, if validly motivated,” he said. “Today there is something of a tendency to think that perhaps it would be a good way to approach conscientious objection,” he said. “But this is the ethical intimacy of every health professional and this should never be negotiated, it is the ultimate responsibility of health professionals. It is also a denunciation of the injustices done to the detriment of innocent and defenceless life.” However, he acknowledged the complexity of CO, which “requires both great competence and great rectitude”. And, pushing back against accusations that Catholic doctrine is harsh and unyielding, he said that “our duty is to be close to people, our positive duty: to be close to situations, especially women, so that they do not come to think of abortion as the solution.” The Pope, who is often viewed as a progressive because of his views on the environment, on greater tolerance of LGBTQI+ people, and on inflexible clergy, is still vehemently opposed to abortion. It was at least the third time in a month that Francis has denounced abortion, which has become a major political issue in many countries, especially the United States. In an in-flight press conference in September he declared: “Abortion is more than an issue. Abortion is murder … It’s a human life, period.”

Wisconsin bishops encourage vaccination while affirming conscience rights

Interesting article from CNA about the ethical issues of COVID vacinations and Conscience. The five bishops of Wisconsin on Friday issued a message encouraging vaccination against COVID-19, while maintaining that people ought not be forced to accept a COVID vaccine. “We encourage those eligible to receive the COVID-19 vaccine to do so because it is the most effective way to combat this virus. We are all morally responsible to protect our lives and the lives of others. This is an imperative of natural law that we treasure in our faith,” the bishops wrote. They also acknowledged “many health or ethical reasons why a person may refuse COVID-19 vaccination,” but added that “it is the responsibility of the individual” to explain their decision to decline the vaccine, and recommended that clergy not intervene in such cases. “However, the Church also treasures her teaching on the sanctity of conscience,” they stated. “Nobody should violate the sanctity of conscience by forcing a person to do something contrary to his or her conscience.” In cases of conscientious objection to the COVID vaccine, “[p]astors should not feel compelled to issue documentation recognizing this conscientious objection and are recommended not to do so,” the bishops stated. The bishops stressed that anyone refusing to be vaccinated against COVID-19 must take steps to avoid spreading the virus. “Every decision has consequences; and in this case, the person claiming a religious or ethical exemption should be ready to properly assume other scientifically recommended means of avoiding infection and contagion: face-coverings, social distancing, hand sanitizing, periodic testing, and quarantine,” the bishops wrote. Bishops across the country have issued guidance for Catholics seeking conscience exemptions to COVID-19 vaccine mandates. Some bishops, including the bishops of South Dakota, have explicitly supported Catholics wishing to seek conscience exemptions. In contrast, many bishops in California, as well as in Chicago and Philadelphia, have instructed clergy not to assist parishioners seeking religious exemptions to mandates, stating that there is no basis in Catholic moral teaching for rejecting vaccine mandates on religious grounds. Quoting Pope Paul VI’s encyclical Dignitatis Humanae, the Wisconsin bishops wrote that “the Christian faithful, in common with all other men, possess the civil right not to be hindered in leading their lives in accordance with their consciences.” Given “the urgency of this pandemic and the frustration some may experience because of the number of unvaccinated people,” a person’s conscientious refusal of a COVID vaccine may offend some, the bishops said, but that decision still retains its “dignity,” they wrote. “Consequently, someone who in conscience decides that he or she should not receive the COVID-19 vaccine should be granted an exemption based on his or her beliefs or convictions,” the bishops asserted. “It is the responsibility of the individual to raise moral or ethical objections to vaccination based on the dictates of his or her conscience. Pastors should not feel compelled to issue documentation recognizing this conscientious objection and are recommended not to do so.” Before COVID-19 vaccines were authorized for use in the United States, some Catholics raised concerns about their use of cell lines likely derived from fetal tissue of an abortion decades prior. Those vaccines produced by Pfizer and Moderna were tested on the controversial cell lines, while the vaccine created by Johnson & Johnson was both tested on and directly produced with the cell lines. The U.S. Conference of Catholic Bishops, echoing guidance from the Vatican, has since stated that all three vaccines approved for use in the United States are “morally acceptable” for use despite their remote connection with abortion. If one had the ability to choose a vaccine, the bishops recommended that they choose one with the least connection to abortion. Pope Francis has strongly encouraged vaccination, collaborating with the Ad Council on a video promoting vaccination. The pope called getting vaccinated against COVID “an act of love,” in the video. December 2020 guidance from the Vatican’s Congregation for the Doctrine of the Faith stated that “vaccination is not, as a rule, a moral obligation,” and “therefore, it must be voluntary.”

A utilitarian’s Apocalypse?

by Michael Cook | 15 Aug 2021 | Gerard Butler sees extinction coming / 'Greenland' Australia’s most erudite columnist is probably Henry Ergas, an economist who spent many years at the OECD in Paris before returning to Australia. In a recent article, “It’s the end of the world as we know it – again”, he galloped through Western visions of the apocalypse – the Greeks’ myth of the eternal return, the Last Coming of Christ, Jean-Baptiste Cousin de Grainville’s Last Days of Humanity (a new one to me), H.G. Wells’s The World Set Free (which predicted the A-bomb), and nowadays, environmental collapse. His point was that the modern Western imagination is easily captured by visions of ultimate catastrophe – as in the Covid-19 pandemic, climate change, or nuclear warfare. His premise was that extinction is obviously a bad thing. But what if extinction is really not a bad option in the light of the alternative? Writing in the Practical Ethics blog (republished from the New Statesman), philosopher Roger Crisp, of Oxford University, muses that immediate extinction would at least put an end to the collective pain of existence: Perhaps one reason we think extinction would be so bad is that we have failed to recognize just how awful extreme agony is. Nevertheless, we have enough evidence, and imaginative capacity, to say that it is not unreasonable to see the pain of an hour of torture as something that can never be counter-balanced by any amount of positive value. And if this view is correct, then it suggests that the best outcome would be the immediate extinction that follows from allowing an asteroid to hit our planet…. The question of whether extinction would be good or bad overall is obviously very important, especially in the face of potential catastrophic events at the hinge of history. But this question is also very difficult to answer. Ultimately, I am not claiming that extinction would be good, only that, since it might be, we should devote a lot more attention to thinking about the value of extinction than we have to date. Crisp is a utilitarian and the purpose and value of suffering poses a conundrum for those who balance pleasure against pain. It’s interesting to get a glimpse of utilitarian eschatology. Michael Cook is editor of BioEdge

Policy shift in Finland for gender dysphoria treatment

The international activist group SEGM, the Society for Evidence-Based Gender Medicine, has published a review of a radical shift in the standards of care for gender dysphoric children in Finland. A year ago, the Finnish Health Authority issued new guidelines which back psychotherapy, rather than puberty blockers and cross-sex hormones, as the first-line of treatment. It took this step after a systematic review of the evidence which found the evidence for paediatric evidence “inconclusive”. Here are a few excerpts from SEGM’s summary. Although pediatric medical transition is still allowed in Finland, the guidelines urge caution given the unclear nature of the benefits of these interventions, largely reserving puberty blocker and cross-sex hormones for minors with early-childhood onset of gender dysphoria and no co-occurring mental health conditions. Surgery is not offered to those <18. Eligibility for pediatric gender reassignment is being determined on a "case-by-case basis" in two centralized gender dysphoria research clinics. The Finnish guidelines warn of the uncertainty of providing any irreversible "gender-affirming" interventions for those 25 and under, due to the lack of neurological maturity. The guidelines also raise the concern that puberty blockers may negatively impact brain maturity and impair the young person's ability to provide informed consent to the subsequent and more irreversible parts of the Dutch protocol: cross-sex hormones and surgeries. The Finnish guidelines reflect the growing international concern about the unexplained sharp rise in adolescents presenting with gender dysphoria, which is occurring in increasingly complex developmentaland mental health contexts, and often without a childhood history of gender-related distress. There are significant questions as to whether the Dutch protocol (hormonal and surgical interventions for youth), designed for a distinctly different population of high-functioning teens with childhood-onset cross-sex identification and with no significant mental health comorbidities, is appropriate for this novel population. The Finnish Health Authority states that the guidelines will not be further revised until research is able to: explain the recent sharp rise in adolescents presenting with gender dysphoria; determine whether transgender identities in this population are stable or will evolve; assess whether gender-affirming treatments are able to improve health outcomes of those who present with co-occurring mental health problems, including improvements in depression and suicide; and quantify the rate of regret. h/t to Bioedge

London newspaper reveals ‘shocking evidence’ about transgender treatments

After a legal battle The Mail on Sunday has published what it called “shocking evidence” about transgender medicine which led a High Court judge to ban a government gender clinic from prescribing puberty-blockers. The Gender Identity Development Service (GIDS) clinic in London, also known as the Tavistock Centre, began prescribing these for children under 16 in 2011. In December the clinic was forced to stop after the Court ruled that it was “very doubtful” that youngsters could give informed consent. Swedish psychiatrist Christopher Gillberg testified that the use of puberty blockers is basically “a live experiment” on vulnerable children. “In my years as a physician,” he wrote, “I cannot remember an issue of greater significance for the practice of medicine. We have left established evidence-based clinical practice and are using powerful life-altering medication for a vulnerable group of adolescents and children based upon a belief.” According to the newspaper, the evidence of Gillberg and other experts was that: Puberty-halting drugs can harm a patient's brain and bone development; Clinics are urging gender-changing teen girls to choose sperm donors to fertilise eggs before freezing them; Medics are failing to warn about the infertility risks posed by puberty blockers; Children who regret treatment find themselves “locked” into new bodies; Internet sites persuade autistic children that they are transgender when they simply have “identity issues”. The Tavistock centre has had a 60-fold increase in requests for its services over the past 15 years. Judges were told that there had been a steep rise in the number of girls aged 12 to 17 requesting help and that they outnumbered biological males wanting to transition by two to one. Doctors also testified that there was a “disproportionate number” of children across the world claiming trans identities who were in care, adopted, autistic, anorexic or had psychiatric or mental illnesses. The evidence included testimony from dozens of young women who claimed that their lives had been ruined by sex change treatments. Lucy, a woman who underwent sex change surgery, described herself as “mutilated”. “I'm horrified that when I went for the hysterectomy they didn't emphasise to me how important these organs are. Now it's too late. I'm 23 and I am basically in menopause and all the health implications that come with that. I can't comprehend how doctors could let this happen.” Professor Stephen Levine, an American expert in the field of gender treatment, testified that “there was no other field of medicine where such radical interventions are offered to children with such a poor evidence base”. He also claimed that treatment was taking place in such a “toxic and febrile context that critical and cautious voices are shouted down as transphobic, hateful and engaging in conversion therapy. “Such a climate has created an intimidating and hostile environment where silence and acquiescence are the inevitable consequence. It is left to those of us at the end of our careers, who have nothing to lose, to voice our concerns.' “Scientific requirements for establishing an intervention's utility are well known in medicine,” he said. “Advances are undertaken through carefully controlled clinical trials. Why should gender problems be considered an exception?” The director of GIDS, Dr Polly Carmichael, insisted in her submission to the High Court that all the potential side effects and impacts were explained to young people by clinicians before referring them for puberty blockers. She submitted that the primary purpose of puberty blockers was to give a young person time “to think about their gender identity”. Conservative peer Baroness Nicholson, a former director of Save The Children, told Mail on Sunday: “Puberty blockers are... a harrowing, physical destructive experiment on immature boys and girls. It closes normal development in favour of a painful life and a curtailed barren future – the NHS should never have allowed such unresearched use of public money on irremediable surgery on healthy bodies.”