Vital Conflicts in Medical Ethics: A Virtue Approach to Craniotomy and Tubal Pregnancies

Author’s Preface

xiii Author’s Preface This wide-ranging study was drafted for the Roman Congregation for the Doctrine of the Faith and completed and submitted to the Congregation in 2000. After it was carefully studied in the Congregation and by its then prefect , Cardinal Joseph Ratzinger, the Congregation in turn asked that it be published, so that the theses it contains could be discussed by specialists. Obviously, the observations made here are my personal opinions and not those of the Congregation for the Doctrine of the Faith. The text was first published in German under the title “Güterabwägung, Tötungsverbot und Abtreibung in vitalen Konfliktfällen. Lösungsversuch eines klassischen gynäkologischen Dilemmas aus tugendethischer Perspektive ,” which can be translated as “The Prohibition of Killing, Abortion, and the Weighing of Goods in Vital Conflicts: A Proposed Solution for a Classic Gynecological Dilemma from the Perspective of Virtue Ethics.” It was included in M. Rhonheimer, Abtreibung und Lebensschutz . Tötungsverbot und Recht auf Leben in der politischen und medizinischen Ethik (Paderborn: Schöningh, 2003). The proposals made in this work had a relatively feeble impact in German-speaking areas, possibly because they conflict with the dominant paradigm for establishing norms in those areas, i.e., proportionalistic xiv • Author’s Preface and so-called “teleological ethics.” In contrast to that method, the proposals of the present work follow a path that is new in many respects but stands in continuity with the encyclical Veritatis splendor (1993) and its rejection of “weighing of goods” as a fundamental and universal method for making ethical decisions. Except for changes made for reasons of clarity and improved readability and some footnotes (marked in each case as “Author’s note 2008”) added to include some clarifications and references to recent criticism of some aspects of my action theory, the English version presented here is essentially the same as that submitted to the Congregation of the Doctrine of Faith and previously published in German. It combines a large number of questions. It deals (always in the concrete context of the problem expressed in the title) with the problem of how medical ethics or moral theologians assess medical actions, and also with a problem in (Catholic) moral theology itself. By this latter “problem ” I mean that I discuss not only a particular problem or case in moral theology, but also a methodological problem of moral theology itself, a problem that will be explored through action analysis from the perspective of philosophical ethics. In addressing this problem, I will use virtue ethics to suggest a way out of a situation that appears to me to have reached an impasse because of an outdated approach. In the present study, we will therefore look at the so-called “principle of actions with double effect” (hereafter, “principle of double effect” or PDE), the categories of “direct” and “indirect” actions, legitimate self-defense, and “indirect killing,” etc. But our attention will be directed particularly to the problem of the (proportionalist and consequentialist) method of “weighing of goods” in connection with the prohibition of killing, and specifically to a classic gynecological dilemma that has dominated the discussion in contemporary moral theology, a discussion that began with the nineteenth-century debate on craniotomy. As experts in this area know, in the second half of the nineteenth century the Holy Office (now the Congregation for the Doctrine of the Faith), by means of various decrees, practically committed Catholic Author’s Preface • xv moral theology to the principle that a doctor was obligated in certain gynecological borderline situations to let both child and mother die. This judgment held even in cases where the mother could be saved, but only through a procedure that was considered to be a “direct” killing of the fetus; therefore—even though the unborn child had no chance of survival—the procedure to save the mother was not permitted. It is obvious why medical ethics, which is oriented toward preserving and saving lives, finds this judgment offensive: it is offensive to demand of the mother that she sacrifice herself, not for the survival of her child (who will die anyway), but, it seems, simply to safeguard the moral principle that “an innocent should not be killed directly.” The question is of considerable importance, and in recent years was often misused in discussions of fundamental moral theology to promote a certain model of ethical decision making, namely that of the “weighing of...