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Transcriber's note:
Text enclosed by underscores is in italics (_italics_).
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THE ETHICS OF MEDICAL HOMICIDE AND MUTILATION
by
AUSTIN O'MALLEY, M.D., PH.D., LL.D.
[Illustration: printer logo]
New York
The Devin-Adair Company
1922
Nihil obstat
Arthur J. Scanlan, S.T.D.
_Censor Librorum_
Imprimatur
[see Transcriber's note below] JOHN CARDINAL FARLEY
Archbishop of New York
Copyright, 1919, by
The Devin-Adair Company
All Rights Reserved by
The Devin-Adair Company
Third Printing
Printed in U.S.A.
CONTENTS
CHAPTER I
GENERAL PRINCIPLES CONCERNING SUICIDE AND HOMICIDE
PAGE
There is a Supreme Being who alone is master of life. The
Natural Law. The nature and determinants of morality.
Probabilism. Permissive suicide. Suicide is illicit.
Conscience. Homicide, direct and indirect. Self-defence.
Formal and material aggressors. Legalized homicide.
Bibliography 1-22
CHAPTER II
GENERAL PRINCIPLES CONCERNING MUTILATION
Mutilation. Canonical irregularity. Self-mutilation. The
double effect in morality. Direct and indirect mutilation.
The State and mutilation. The dominion of the State 23-32
CHAPTER III
WHEN DOES HUMAN LIFE BEGIN?
Ancient and modern opinions. The fetus is animated at the
moment of conception. The single cell as the primal
life-organ. Cell growth and division. Germ cells. The
development of the embryo. Fetal viability. Theories
of development. The Aristotelian and Thomistic opinions.
The formal principle. A soul exists. The primordial
cell is a sufficient organ for the soul. Metabolism
in the cell. Cell motion. Animal heat and energy.
Life in separated tissues. The soul in monsters 33-82
CHAPTER IV
WHEN DOES HUMAN LIFE END?
The heart and life. Resuscitation after apparent death. The
last sacraments in apparent death. Suspended animation.
The living fetus in the womb of a dying or dead
mother. Methods of resuscitation. Signs of death 83-91
CHAPTER V
ABORTION
Abortion and miscarriage. Causes of abortion, fetal,
maternal and paternal. Surgical operations and abortion.
The debitum in pregnancy. Premature labor. Threatened,
inevitable, and incomplete abortions. Treatment. The
use of the tampon. Precautions against abortion. Therapeutic
abortion. Methods of inducing abortion. Artificial
abortion of an inviable fetus is never licit. Decrees
of the church concerning abortion. The civil law
on abortion 92-123
CHAPTER VI
ECTOPIC GESTATION
Ectopic gestation or extrauterine pregnancy. Anatomy of the
uterus and its adnexa. Place of fecundation. The abnormal
uterus. Tubal rupture and tubal abortion. Diagnosis.
Decrees of the church on ectopic gestation. Removal
of an inviable ectopic fetus except in present
peril of life is illicit 124-132
CHAPTER VII
CESAREAN DELIVERY
Indications for cesarean delivery. Abnormal pelves.
Symphyseotomy. Varieties of cesarean delivery. Morality.
Amputation of the uterus after cesarean delivery.
Precautionary sterilization of a cesarean case is illicit 133-142
CHAPTER VIII
PLACENTA PRAEVIA AND ABRUPTIO PLACENTAE
Nature and effects of placenta praevia. Treatment. Morality
and methods of treatment. Abruptio placentae. Morality
of fetal removal 143-146
CHAPTER IX
ABDOMINAL TUMORS IN PREGNANCY
Tumors blocking parturition. Fibroids or myomata. Ovarian
tumors. Cancer. Effects and morality of operation 147-152
CHAPTER X
APPENDICITIS IN PREGNANCY
Occurrence. Time of operation. Diagnosis 153-154
CHAPTER XI
PUERPERAL INSANITY AND STERILIZATION
Causes. Varieties. Prognosis. Precautionary sterilization
of puerperal psychopaths is illicit 155-157
CHAPTER XII
NEPHRITIS IN PREGNANCY
Frequency. Effects. Abortion as a treatment. Varieties of
nephritis. Pyelitis. Catalepsy 158-161
CHAPTER XIII
ECLAMPSIA PARTURIENTIUM
Definition. Symptoms. Prognosis. Causes. Precautions
against eclampsia. Forced delivery. The expectant
treatment. Relative mortality and morality of the
methods. Cesarean delivery as a treatment. The expectant
treatment is apparently the best 162-169
CHAPTER XIV
HEART DISEASES IN PREGNANCY
Factors in abnormal gestation. The use of pituitrin. Weak
pains and the diseased heart. The diseased heart in
actual parturition. Operative risk in cardiopaths. Heart
block and mitral regurgitation in labor. Prognosis 170-176
CHAPTER XV
HYPEREMESIS GRAVIDARUM
Pernicious vomiting. Occurrence. Symptoms. Stages. Effects.
Causes. Therapeutic abortion in pernicious vomiting.
Treatment 177-181
CHAPTER XVI
CHOREA GRAVIDARUM AND HYSTERIA
Varieties of chorea. Differentiation. Prognosis. Hysteria.
Causes. Epidemics of hysteria. Symptoms. Prognosis 182-186
CHAPTER XVII
ACUTE YELLOW ATROPHY OF THE LIVER IN PREGNANCY
Icterus gravis. Causes. Symptoms. Prognosis 187-188
CHAPTER XVIII
INFECTIOUS DISEASES IN PREGNANCY
Effects on mother and fetus. Abortions in infectious
diseases. Placental permeability. Typhoid. Smallpox.
Pneumonia. Influenza. Scarlatina. Measles. Cholera.
Tuberculosis. Artificial abortion in tuberculosis 189-200
CHAPTER XIX
SYPHILIS IN PREGNANCY AND MARRIAGE
Prognosis. Abortion. Infection of mother and fetus. Colles'
Law. Erroneous notions on the curability of syphilis.
Once a syphilitic probably always a syphilitic. The
professional secret in syphilis. Nature of secrets. The
physician may warn an innocent person 201-211
CHAPTER XX
GONORRHOEA IN MARRIAGE
The cause of gonorrhoea. Tests of cure. Effects on a woman.
Chronicity. Prevalence. Surgical treatment in women.
Morality of the surgical treatment. Conservative surgery.
Salpingotomy. Ovariotomy. Evil effects of
ovariotomy. Internal secretion of the ovary. Results of
various operations. Pregnancy after operation. Morality
of infection. General effects of gonorrhoea. Ophthalmia
neonatorum and gonorrhoea 212-229
CHAPTER XXI
DIABETES IN PREGNANCY
Fatality of diabetes in pregnancy. Diagnosis. Sterility
of diabetics. Prognosis. Heredity in diabetes. Therapeutic
abortion in diabetes 230-231
CHAPTER XXII
CHILDBIRTH IN TWILIGHT SLEEP
Twilight sleep to avert pain in parturition. Stages of labor.
Drugs used. Scopolamine and morphine. Danger in
the use of these drugs in labor. Contradictory report
of physicians on twilight sleep. Eminent authorities opposed
to the methods. Baer's report on the evil effects.
The methods are morally illicit and useless 232-244
CHAPTER XXIII
VASECTOMY, OR STERILIZATION, BY STATE LAW
The States that have this law. Reasons for the law. Hereditary
transmission of certain diseases. The operation.
Its effects. Restoration of the function of the interrupted
vas deferens. Vasectomy and impotence. Onanism.
Vasectomy effects impotence from the moral
point of view. Other conditions in the male that effect
moral impotence. Immorality of artificial impregnation.
Vasectomy a grave mutilation. Vasectomy as ordinarily
practised is illicit. The State and vasectomy.
The limitations of the State's dominion. The State surgeon
and vasectomy. Bibliography 245-268
CHAPTER XXIV
THE ETHICS OF BIRTH CONTROL 269
Index 281
PREFACE
In this book is discussed the morality involved in the ordinary cases
of medical homicide and mutilation. Craniotomy has been omitted
because this operation on the living child is never morally licit,
and when done on the dead fetus it has no moral quality that requires
explanation.
The articles may seem to be intended for Catholic physicians and
spiritual directors alone, but the desire in writing them was to
reach all practitioners, to the end that the Natural Law which
binds every man may be observed. Morality is not made such in
its fundamental principles by any religious creed, but by the
requirements of Divine Order, which finally prevails no matter what
the opposition. Killing and maiming without sufficient extenuation
did not become unlawful solely by the establishment of Christianity.
Practically, however, physicians who have no religion, or a religion
which is so illogical as to pay no attention to dogma, or even to
rail at it as obtrusive, necessarily gravitates to the emotional in
morality, and the principles of this book will not even interest
them. Dogmas are abstract propositions, and all human society rests
on abstract propositions. The most vital facts in morality, the basic
distinction between crime and all that is virtuous or indifferent
morally, is in abstract principle alone, but physicians and pastors
who are not trained in philosophy and rational religion cannot
appreciate an abstract principle--they are influenced only by the
concrete.
Obstetrical text-books, unfortunately, are written by such emotional
men; by men who lack all training in ethics other than that
inculcated in childhood out of the mental vagaries of the women in
the household; and these authors prescribe therapeutic homicide as
if it were a drug in the American Pharmacopœia. The reader is told
that if the patient is a Catholic he is to respect her religious
"prejudices"; if she is not a Catholic one need not bother about
moral scruples when it is necessary to take a life to stop fits.
Since the civil law does not prosecute a physician for therapeutic
abortion on an inviable child, most physicians deem such an act
not only permissible but scientific, and they hold that if a man's
conscience will not let him kill a fetus to alleviate maternal
distress he is guilty of malpractice.
Decrees of the Catholic Church are cited in these pages, not because
morality is an asset of the Catholic Church alone, but because
it alone pronounces officially on these medical subjects after
careful consideration by competent specialists. This Church has
made decisions in comparatively few medico-moral cases, and the
questions still undecided authoritatively are very numerous. They
are quite difficult, too, because judgment supposes a knowledge
of both medicine and ethics, a combination seldom found in one
person. As physicians do not know ethics, and moralists do not know
medicine, there is often trouble in getting at even a statement of
the questions at issue between them. In the preface to _Essays in
Pastoral Medicine_, in 1906, I mentioned a noted case of this kind,
and in 1911 a similar incident occurred in a discussion of the
morality involved in the sterilization of criminals and the defective
by the state. This dispute was taken up by the leading canonists and
moral theologians in the United States, Belgium, Holland, Austria,
Spain, Italy and France, and for nearly two years these men wrote
article after article based upon utterly erroneous physical data.
The books we have on medico-moral subjects are either obsolete at
present, or insufficient; or, more commonly, they are the work of
amateurs in medicine. These last are worthless when they are not
harmful. If, however, I may judge from the questions sent to me for
answer by clergymen and physicians from all parts of the country,
our theological seminaries and medical schools are in grave need of
courses on the morality of medical practice. In this book, to the
preparation of which I have given years of anxious thought because of
the extreme responsibility involved in its decisions, the data for
the most important parts of such courses are presented.
AUSTIN O'MALLEY.
THE ETHICS OF
MEDICAL HOMICIDE AND MUTILATION
THE ETHICS OF MEDICAL HOMICIDE AND MUTILATION
CHAPTER I
GENERAL PRINCIPLES CONCERNING SUICIDE AND HOMICIDE
A Discussion of euthanasia through the use of narcotics in cases of
incurable diseases periodically recurs, and the opinions of those in
favor of putting the patient out of his misery are expressions of
mere sentimentality, as in Maeterlinck's essay, _Our Eternity_. They
think either that the passing of a law by a legislature removes all
moral difficulty, or that morality is a trifle which should never
stand in the way of expediency. Those who oppose this method of
euthanasia base their argument, first, on the fact that many patients
supposed by even clever diagnosticians to be incurable recover
health; and, secondly, on the fact that the giving power of life and
death to physicians is liable to grave abuse. This side misses the
central truth and argues from accidental and secondary premises.
Whether it is expedient, humane, or impolitic to kill incurable
patients are almost irrelevant considerations: the fundamental
question to be answered here is, Is there a Supreme Being who alone
is master of life, to give it or to take it?
By its very definition such a Being is necessary (as opposed to
contingent), self-existent; its essence always has been and always
will be actualized into existence, and that from itself alone; it is
an individual substance of an intelligent nature, and therefore a
person. A contingent being is one that happens to be (_contingere_);
it is of necessity neither existent nor non-existent; it has no
logical aversion to existence, but in itself it has no more than
a possibility of actuality. A necessary Being, on the contrary,
essentially must be; it cannot not be; it is absolutely and
essentially its own existence.
There must be such a Necessary Being. If there were not, all things
would be contingent, which is an absurdity. The absurdity arises
from the fact that if all things were contingent nothing would be
actual, nothing could ever come into existence, because there would
be nothing to bring the primitive potentiality of the contingent
beings into actual existence. The sufficient reason for the existence
of contingent beings is either in themselves or in something outside
themselves. It cannot be in themselves, because as they do not yet
exist they are nothing; therefore it is in a Being which is not
contingent, but whatever is not contingent is necessary. Therefore
the existence of contingent beings absolutely requires the existence
of a Necessary Being, which always was in existence. The ordinary
name for this Necessary Being is God. Contingent beings are all
creatures, all organic and inorganic beings without exception. There
is, then, a God, the first cause or creator of all contingent beings,
among whom is man; and since God created man wholly, this creature is
wholly subservient to God, under the dominion of God, and his life is
owned solely by God; God alone is the master of life and death, and
he alone can delegate such mastery.
From the relation between the Creator and the creatures arises the
natural law. Violation of this law is the source of all moral evil
in the world, and of much of the physical evil. Reason shows us
this law, and the method of observing it; and reason and unreason,
observance or disregard, of the order fixed by the natural law are
the foundation of happiness and unhappiness. Whatever a human being
is or does, he must seek happiness; that is an essential quality
of his being. Happiness is the satisfying of our desires; but as
our desires are limitless, only infinite good can satisfy them. The
sole sufficient good that sates all human longing is the infinite
Necessary Being, and to be happy we must be united with that Being.
Obviously the only possible method of possessing this infinite
God is through mental union, by undisturbable contemplation of his
infinite truth, goodness, being, beauty, and his other attributes. If
perfect, everlasting happiness is not in that, in what can it be? Is
it in human fame, honor, riches, science, art, man, woman, or child?
None of these can give _lasting_ happiness, and no other happiness is
real happiness.
Now, the only means we have to obtain union with infinite good is to
follow out the condition inexorably placed by God, which is to act
in life in keeping with right reason, to obey the law. Man's supreme
honor is in freedom from the tyranny of unreason, and in a full
obedience to external and immovable order, with the belief that his
chief duty is to apprehend and to conform thereto.
This is morality. From the beginning men have held that certain
acts are wrong and to be avoided, and that others are to be done.
What is wrong, moreover, is such of its own nature, not from our
will: we deem the fulfillment of duty, obedience to law, the first,
highest, and last necessity of life. If we deny this truth we let in
chaos. What is right or wrong is one or the other on its own merits,
prescinding from its pleasurableness or pain.
We must seek good whether we will or not. Good is the sole object
upon which the will operates, it is the raw material of the will's
business. The ultimate standard of this good is God himself as its
exemplary cause, but proximately the standard of moral good is our
rational nature. Through our reason we judge whether a thing is good
or bad; that is, whether it perfects or injures us; and as it is good
or bad for us our will's tendency toward it is good or bad. Many acts
are indifferent in themselves, but take on a good or bad quality from
our intention; others are good or bad in themselves apart from our
volition: charity is good, lying is bad, whether they are willed by
us or not.
The morality of any action is determined (1) by the object of the
action; (2) by the circumstances that accompany the action; (3) by
the end the agent had in view.
1. The term _object_ has various meanings, but here it means the
deed performed in the action, the thing which the will chooses. That
deed by its very nature may be good, or it may be bad, or it may
be indifferent morally. To help the afflicted is in itself a good
action, to blaspheme is a bad action, to walk is an indifferent
action. Some bad actions are absolutely bad; they never can become
good or indifferent--blasphemy or adultery, for example; others, as
stealing, are evil because of a lack of right in the agent: these
may become indifferent or good by acquiring the missing right.
Others are evil because of the danger necessarily connected with
their performance,--the danger of sin connected with them, or the
unnecessary peril to life. An action, to have a moral quality, must
be voluntary, deliberate; and mere repugnance in doing an act does
not in itself make the act involuntary.
2. Circumstances sometimes, though not always, may add a new element
of good or evil to an action. The circumstances of an action are
the Agent, the Object, the Place in which the action is done, the
Means used, the End in view, the Method observed in using the means,
and the Time in which the deed is done. If a judge in his official
capacity tells a sheriff to hang a criminal, and a private citizen
gives the same command, the actions are very different morally
because of the circumstance of the agent giving the command. The
object--it changes the morality of the deed whether one steals a
cent or a thousand dollars. The place--what might be an offensive
action in a residence might be a sacrilege in a church. The means--to
support a family by labor or thievery. The end in view--to give alms
in obedience to divine command or to give them to buy votes. The
method used in employing the means--kindly, say, or cruelly. The
time--to do manual labor on Sunday or on Monday. Some circumstances
aggravate the evil in a deed, others excuse or attenuate it. Others
may so color the deed that they specify it, make it some special
virtue or vice. The circumstance that a murderer is the son of the
man he kills specifies the deed as parricide.
3. The end also determines the morality of an action. Since the
end is the first thing in the intention of the agent, he passes
from the object wished for in the end to choosing the means for
obtaining it. Without the end the means cannot exist as such. There
are occasions when an end is only a circumstance: for example, if
it is a concomitant or extrinsic end. When this extrinsic end is in
keeping with right reason or when it is discordant thereto, it may
become a determinant of morality. In every voluntary, or human, act
there is an interior and exterior act of the will, and each of these
acts has its own object. The end is the proper object of the interior
act of the will; the exterior object acted upon is the object of
the exterior act of the will; both specify the morality, but the
interior object or end specifies more importantly, as a rule, than
the exterior object does. The will uses the body as an instrument on
the external object, and the action of the body is connected with
morality only through the will. We judge the morality of a blow not
by the physical stroke, but from the intention of the striker. The
exterior object of the will is, in a way, the matter of the morality,
and the interior object of the will, or the end, is the form.
Aristotle said: "He that steals to be able to commit adultery is more
of an adulterer than a thief."[1] The thievery is a means to the
principal end, and this principal end chiefly specifies or informs
the action.
[1] _Ethics_, v, c. 2.
The means used to obtain an end are very important in a consideration
of the morality of an act. There are four classes of means--the
good, bad, indifferent, and excusable. Good means may be absolutely
good, but commonly they are liable to become vitiated by
circumstances,--almsgiving is an example. Some means are bad always
and inexcusable--lying, for instance. The excusable means are those
which are bad, but justifiable through circumstances. To save a man's
life by cutting off his leg is an excusable means. The end sometimes
may vitiate or hallow indifferent means, but it does not in itself
justify all means. Means, like other circumstances, are accidents
of an action, but they are in the action just as much as color is
in a man. Color is not of a man's essence, but we cannot have a man
without color.
The effect of an action, the result or product of an effective cause
or agency, may in itself be an end or an object or a circumstance,
and it has influence in the determination of morality. Sometimes
an act has two immediate effects, one good and the other bad. For
example, ligating the blood-vessels going to the uterus to stop a
hemorrhage and so save a woman's life, a good effect, has also in
ectopic gestation while the fetus is living another immediate effect,
namely, to shut off the blood supply from the fetus and so kill it, a
bad effect. To make such a double-effect action licit there are four
conditions which are explained in the chapter on Mutilation.
The doctrine of Probabilism is very important in morality. Any law
must be promulgated before it really becomes a law, and promulgation
in a rational conscience is sufficient. Sometimes there is rational
doubt of the existence, the interpretation, or the application of a
law in a given case. Here probability is the only rule we can follow.
A law which is doubtful after honest and capable investigation has
not been sufficiently promulgated, and therefore it cannot impose a
certain obligation because it lacks an essential element of a law.
When we have used such moral diligence as the gravity of the matter
calls for, but still the applicability of the law is doubtful in
the action in view, the law does not bind; and what a law does not
forbid it leaves open. Probabilism is not permissible where there is
question of the worth of an action as compared with another, or of
issues like the physical consequences of an act. If a physician knows
a remedy for a disease that is certainly efficacious and another that
is doubtfully efficacious, he may not choose this probable cure.
Probabilism has to do only with the existence, interpretation, or
applicability of a law, not with the differentiation of actions.
The term probable means provable, not guessed at, not jumped at
without reason. The doubt must be positive, founded on reason, not
a matter of mere ignorance, suspicion, emotional bias. The opinion
against a law to permit probabilism must be solid. It must rest upon
an intrinsic reason from the nature of the case, or an extrinsic
reason from authority, always supposing the authority is really an
authority. The probability is to be comparative also. What seems to
be a very good reason when standing alone may be weak when compared
with reasons on the other side. When we have weighed the arguments
on both sides, and we still have a good reason for holding our
opinion in a doubtful case, our opinion is probable. The probability
is, moreover, to be practical. It must have considered all the
circumstances of the case.
There is, then, a Supreme Being whom we _must_ obey, who created
and owns human life primarily; there is also a moral law. On these
facts rests the argument relating to the destruction of human life.
How far, then, has a human being dominion over his own life, and,
secondly, over the life of any one else?
St. Thomas,[2] Lessius,[3] and others offer as one argument to prove
suicide is not licit, that it is an injury to society or the state
of which the suicide is part, and to which the use and profit of
his service rightly belong. Lessius, while developing this proof,
acknowledges its weakness.
[2] _Summa Theologica_, 1, 2, q. 64, a. 5.
[3] _De Justitia et Jure_, lib. 2, cap. 9.
If there were only one man in the world, and no society or state,
suicide would still be illicit, because its basic deordination lies
deeper than society or the state. If suicide were a moral evil solely
because it deprives the state of the suicide's life, then for the
same reason no one might become a citizen of another state, emigrate,
nor might man abandon society and live as a recluse. Moreover, if a
man were detrimental to the state rather than beneficial, in this
point of view that fact alone would justify suicide, and the state
would then be justified in permitting or even commanding suicide; and
we shall show later that the state has not this power.
It is true that the injury done the state or society by loss of use
and profit, by scandal and similar evils, is a solid argument against
suicide, as such injury aggravates the deordination of suicide,
but in itself the injury done to the state and society is not the
fundamental reason against suicide.
St. Thomas[4] argues against suicide because it is contrary to
the charity a human being should have for himself. This is true
ordinarily, and suicide takes on part of its guilt just because it
is an offence against the rational regard a person should have for
himself; yet this argument is not basic. We are told that if one sins
against charity in killing his neighbor, _a fortiori_ he sins in
killing himself. Yet suppose just what the advocates of euthanasia
suggest, viz., that a neighbor is in great agony and incurable: then
the act of killing him takes on a quality of charity rather than
of uncharity. And so for the suicide: if the patient is willing to
be killed, there would be no uncharity; if he were unwilling, then
homicide in any form would be uncharitable and unjust. The argument
from charity, therefore, is too narrow to fit the whole case; and its
very weakness is a source of error for the advocates of euthanasia.
[4] _Ibid._
Still another argument is often advanced against suicide, viz., that
a man is obliged to love his own life, since it is the foundation, or
the necessary condition, to him, of all good and every virtue, and
this circumstance makes the destruction of that life unlawful. That
argument has solid truth, but if it held absolutely it would prevent
us from desiring death in any case, and no one denies that there are
conditions in which a desire for death is fully legitimate. No desire
for death, however, can give the slightest justification for the
destruction of life.
Again, the argument that suicide is cowardice is not broad enough.
Fortitude is a mean between fear and rashness, and this argument
maintains that the suicide sins against fortitude by rashness. If we
have good reason it is not rash to expose ourselves to death; the
soldier may do so, the person struggling to save a neighbor's life,
and so on; it may be the highest form of fortitude thus to expose
oneself to death. If the suicide can persuade himself that by his act
he is seeking greater good than the life he possesses he would have
reason for his act, and at least be above cowardice. This argument is
one that can be turned at times so as to cut the fingers of the man
that uses it. The fundamental reason that suicide is not lawful is
that man cannot be master of his own life, and therefore he may not
dispose of it as he pleases.
Suicide is the direct killing of oneself on one's own authority.
A killing is _direct_ when death is intended as an end, or chosen
as a means to an end. Direct killing is positive by commission, or
negative by omission. In such cases the will directly rests in the
death as a voluntary and free act. A killing is _indirect_ when the
act of which death is the effect by its nature and the intent of the
agent is directed toward another end, but concomitantly, or as a
consequence, results in death. In such case death is an accidental
effect, and comes indirectly from the activity of the will--it is not
necessarily voluntary. If one has a right to do that other deed, or
if it is his duty to do it, and there is a proportion between it and
his life, he may do the deed and permit the consequent death.
A direct homicide may be done on one's own authority, or on that
of another person. It is done on one's own authority if the agent
assumes a natural individual dominion over life, and by virtue of
such dominion directly kills himself or another; it is done on the
authority of another when a man directly kills himself or another
by the mandate of a positive divine or human law, and in the name
and on the authority of a positive divine or human legislator. It is
evident that God, as Creator, has supreme dominion over human life,
and therefore by his positive authority he may command a man directly
to kill himself. God, however, does not by the natural law confer on
man the right thus to kill. The question here is of the natural duty
or right which comes from the natural law alone.
Direct suicide on one's own authority may happen in two ways:
positively, that is, by doing an act which is directly homicidal;
or negatively, by omitting an act necessary for the preservation of
life. That a negative homicide be direct, death must be intended as
an end or means. If, however, one voluntarily intends an end or a
means, but for the sake of antecedent good or evil omits some act
necessary to preserve life, his suicide is indirect, _per accidens_,
and not always illicit unless there is a precept against just such
an omission. Man has no dominion over his own life, he has only
the use of it; and the natural law obliges us while using a thing
which is under the dominion of another not to omit ordinary means
for its preservation. We are not, however, held to extraordinary
means. His own death is criminally imputable to him who negatively
and indirectly kills himself by omitting the ordinary means for
preserving his life, because the precept he is under to preserve his
own life makes his act voluntary. If he omits extraordinary means,
the death is not criminally imputable to him because there is no
precept obliging such means. Certain circumstances may by accident
oblige one to use extraordinary means to preserve one's own life--a
dependent family, a public office in perilous times, or the like. The
proposition, then, is: The natural law does not give a man absolute
dominion over his own life.
I. The natural law gives no rights except such as are finally founded
in human nature itself; but human nature cannot give a title to
dominion over one's own life; therefore the natural law does not give
man such a right.
Every natural right is either congenital or acquired. The title to
a congenital right is human nature itself; the title to an acquired
right is some act consequent to the exercise of human activity. The
right to such exercise is, in turn, congenital and founded in human
nature.
If nature established the title to dominion over one's own life it
would thereby establish the power of destroying that life, and thus
of removing the fundamental title to all rights; but nature exists
as the foundation for rights, not for the subversion of rights;
therefore human nature cannot give a final title to dominion over our
own life.
Again, this minor of the first argument is confirmed by the fact that
if nature even remotely established the power of self-destruction
there should be in nature itself some natural tendency to such
destruction, but the direct contrary is the fact.
II. The natural law cannot grant a right to man which is not a means
to the common end of human life; but absolute dominion over one's own
life is not such a means, therefore the natural law cannot give one
dominion over his own life.
The natural law is only an ordination of man to that common end of
human life and to the means toward that end. As regards the minor of
this second argument, an absolute dominion over his own life would
give man power to stop all his human activity, yet the common end of
human life is attainable only by man's activity. The stopping, or the
power of stopping, all activity cannot be a means to that end.
III. The natural law cannot give man a power which is opposed to the
essential needs of human nature itself; but that a man should have
absolute dominion over his own life is opposed to an essential need
of human nature itself, therefore the natural law cannot give such a
power.
Dominion over his own life implies the power in man of rebelling
against the subjection which he owes to God; but human nature
essentially demands that man be in subjection to God, since dominion
over one's own life and subjection to God are contradictory.
Again, if man had absolute dominion over his own life he could stand
aloof from all influx of the natural law and avoid every duty arising
from that law. A law, however, cannot give a power which nullifies
itself.
The objection that suicide is licit because no injury can be done
a man by an act if the man is willing to submit to the act, is
irrelevant. The injury in suicide is not to man at all, but to God.
There is also nothing in the objection that a gratuitous gift may be
renounced. Life is not a gratuitous gift; it is an onerous gift with
obligations inseparably affixed thereto which forbid the destruction
of the gift.
IV. Destruction is an act proper to a master alone. Man cannot be
master of his own life; he can have dominion of things that are
outside himself, distinguishable from himself, but not of the very
existence of himself, which is not really distinguishable from
himself. The definition of dominion supposes relation. The offices
of master, father, magistrate, are relative conditions which suppose
superiority over _another_ person, not over oneself. Even God is not
a superior over himself, although he has all perfection. For this
reason a man cannot sell himself; he can sell only his labor.
God, who should have absolute dominion over all creatures, and who
has, wills to confine these creatures to certain lines of action
in keeping with the creature's nature. This is the law underlying
even the moral law when it touches humanity; it is the eternal law
coeternal with God's decree of creation, but not necessary as God is.
When this law exists in the mind of God it is the eternal law; when
it exists in the minds of creatures it is the natural law, governing
the free acts of intellectual creatures. When the natural law becomes
a motive to the human will, obliging but not forcing it, a law
through knowledge within the consciousness of a man regulating his
behavior, it is called the law of conscience.
Conscience is an act, a practical judgment on one's own action in
some particular case. It testifies, accuses, excuses, restrains,
urges. It is a rational faculty, not an emotional, sentimental power.
Emotion blinds its judgments. Yet mere emotion, and that foolish
deordination of emotion called sentimentality, are promptings which
the ignorant mistake for conscience and obey. Conscience is the
enlightened eye of the heart, not the vagary of any appetite that
blunders into action. It must be educated; left to itself, it is
guilty of all the perversions of the streets.
The natural law is immutable, not subject to recall by every rascal
under the goad of the flesh. In morality what was, is; what was once
right because reasonable, always will be right and reasonable. Since
opposition to the natural law as applied to man is repugnant to human
nature, no power can make opposition to that law licit. For the same
reason this law is not subject to evolution. Truth in morality is
eternal. What is ugly now was ugly a millennium ago; what was immoral
yesterday was immoral in the sixth century. If our ancestors thought
permissible what we know to be illicit, our ancestors were ignorant;
the fact has not changed. It was as immoral to steal, lie, or murder
in the day of Abraham as it is to-day.
The ultimate tendency of man is toward happiness, and, of course,
happiness, or any other perfection, is impossible without existence;
hence the instinctive recoil from the destruction of our life, which
is the requisite condition for happiness. Even those that abnormally
destroy their own life do so with horror for the destruction
itself, and act thus unreasonably to escape evil, not to escape
life; or they seek what they think will be a better life. We can do
no other injury to a man so great as the depriving him of his life,
for that deprivation destroys every right and possession he has. He
can recover from all other evil, or hold his soul above every other
evil, but death is the absolute conqueror. No matter how debased or
how diseased a man's body may be, no one may dissociate that body
from its soul, except in defence of individual or social life under
peculiarly abnormal conditions; but even such defence is permissible
only while the defender respects other human life and the social
life, while he is innocent, has done no harm to society commensurate
with the loss of his own life.
"The weariest and most loathed worldly life
That age, ache, penury, and imprisonment
Can lay on nature is a paradise
To what we fear of death."
Existence, no matter how sordid, is immeasurably better than
non-existence, for non-existence is nothing; and when we consider
eternal life after separation from the body, even as a probability,
that raises existence to infinite possibilities above the void
of non-existence. A human life, even in an Australian Bushman,
in a tuberculous pauper, in the vilest criminal, is in itself so
stupendously noble a thing that the whole universe exists for its
upholding toward betterment. The raising of human life toward a
higher condition has been the sole tendency of all the magnificent
charity, sacrifice, patriotism, and heroism the best men and women of
the world since time began have striven in. The necessary first cause
itself is life, and life is by far the most sacred thing possible for
the first cause to effect. Eternal life is the greatest reward of the
just.
It is not permissible under any possible circumstance _directly_ to
kill an innocent human being. By killing directly is meant either (1)
as an end desirable in itself, as when a man is killed for revenge;
or (2) as a means to an end. By an innocent human being is meant
a person who has not by any voluntary act of his own done harm
commensurate with the loss of his own life.
To kill a human being is to destroy human nature, by separating the
vital principle from the body; to destroy anything is to subordinate
and sacrifice that thing absolutely to the purposes of the slayer;
but (1) no one has a right so to subordinate another human being,
because man and his life are solely under the dominion of God. If
a man may not kill himself, as we proved above, because he is not
master of his own life, he surely may not kill another to whom he is
no more closely related as master than he is to himself. (2) No man
has a right to subordinate another human being as is done in slaying
him, because this other human being is a person, an intelligent
nature, and consequently free, independent, referring its operations
solely to itself as to their centre. This very freedom differentiates
man from brutes and inanimate things. These are not independent;
they are rightly possessed by man; but man may be possessed by no
one except God. Even extrinsic human slavery is abhorrent to us as a
corollary of the intrinsic freedom of man, which is absolute. This
intrinsic freedom is such that we may not under any circumstances
lawfully resign it to another's possession. This is one of the chief
moral objections to oath-bound secret societies which exact blind
obedience. All morality depends on that freedom, all peace in life,
all civilization, and society itself.
The end of our struggles, toil, fortitude, temperance, thrift, is
freedom,--freedom to do and to hold, freedom from the thraldom of
vice and barbarity. The rational endeavor of every civilized nation
is that it be free; and this means solely that every citizen thereof,
from the highest to the lowest, is made secure in his rights as a
human being. It intends that justice should prevail. Nearly all the
unhappiness, crime, moral misery, and much of the physical misery in
the world are due to a disregard for liberty, for the safeguarding
of men in their inalienable rights. Give every man his bare rights
as a man and all troubles of capital and labor, all race problems
would cease, the prisons would be empty, war would be unknown. Our
struggle toward justice, toward the protection of the rights of man,
toward liberty, must go on, or anarchy and social destruction will
ensue. Now, as there is nothing greater and nobler than liberty, the
freedom of the sons of God to do what they have a right to do, and as
every human being has a right to that liberty, so there is nothing
baser than its contrary, the destruction of that liberty; and no
destruction is so final as that of killing the man, no usurpation
so abhorrent to human nature and all liberty. Abhorrence for such
a destruction is the primal instinct of all human beings; even the
irrational reflexes of our bodies react quickest in protecting us
from that destruction.
Justice and order must prevail; that is a fundamental natural law
to which all other laws are subordinate. Justice, moreover, is a
moral equation, and whenever one right transcends another it must be
superior to the right it holds in abeyance. The right an innocent
human being has to his life, however, is so great that no other human
right can be superior to it while he remains innocent. Subversion
of this right by creatures is intrinsically evil, as blasphemy and
perjury are evil, although not in exactly the same degree.
There are occasions upon which it is permissible to kill,
_indirectly_, innocent persons. An effect is brought about indirectly
when it is neither intended as an end for its own sake, nor chosen as
means toward an end, but is attached as a circumstance to the end or
the means. Means help to an end, circumstances often do not, although
they may affect the morality of an act.
Suppose two swimmers, Peter and Paul, are trying to save Thomas, who
dies in the water; as he dies Thomas grips Peter and Paul so tightly
that they cannot shake the corpse off. Peter is weak, and he will
soon sink and drown, owing to his weakness and the weight of the
corpse; Paul also will go down later, owing to the weight of Peter
and Thomas. Peter, however, cuts his own clothing loose from the grip
of the corpse and is saved; but Paul immediately is drowned, owing
to the fact that the full weight of the corpse comes upon him. Is
Peter justified in cutting himself loose? Certainly he is. This is an
example of indirect killing, a case of double effect, one good, the
saving of Peter's life, the other evil, the loss of Paul's life, both
proceeding immediately and equally from the causal act, the cutting
loose of the clothing. The good effect is intended, the bad effect is
reluctantly permitted.
Again, let us set the same condition for Peter, Paul, and Thomas; but
Peter is not able to cut himself loose. John, a fourth person, can
cut Peter loose and save him, but can do no more; he must let Paul go
down with the corpse of Thomas. May John cut Peter loose? Certainly
he may, on the principle _quod liceat per se licet per alium_. This
is another case of double effect, with the extenuating circumstances
as above.
Suppose, however, Peter represents a living infant in the womb
of Ann, and that she is in labor; further, this infant cannot be
delivered owing to the contraction of Ann's pelvis. May John, a
physician, cut away Peter by craniotomy and so save Ann's life?
Certainly he may _not_. John here _directly_ brains Peter to save
Ann, although Peter is not an unjust aggressor; he does a murder to
get a good effect, and the end does not justify the means. There are
two effects, but the good effect follows from the bad one, and not
immediately from the causal act.
Take another example: Peter is a swimmer disabled by cramps and about
to drown; Paul, going to save Peter, is seized by Peter, and both
are now in danger of drowning; John goes to help Peter and Paul.
He cannot get Peter's grip loose by ordinary means, and he sees he
can save only one man, either Peter or Paul. May John knock Peter
senseless to loosen his grip from Paul, bring in Paul, and thus leave
Peter to drown? Certainly he may. You have the double effect here
also. Moreover, Peter is a materially unjust aggressor; he is like a
maniac trying to kill Paul. In the craniotomy case the child is not
a materially or formally unjust aggressor, it is not doing anything
at all. It is where the mother put it, and it has a full right to its
position and its life.
John most probably might also knock Paul senseless and save Peter,
if through affection or similar motive he preferred this course.
He would then be justified by the double-effect principle alone,
although Paul is in no sense an aggressor. The intention of the blow
would have to be solely to loosen Paul's hold.
In a just war a commander may shell an enemy's works and indirectly
thereby kill non-combatants. The gunners that cause the death of the
non-combatants do not intend this death; they permit it as the evil
effect which comes immediately with the good effect (the capture of
the works) from the causal act of firing the guns.
If we keep within the bounds of a just defence we may protect
ourselves against an unjust aggressor to the effusion of his blood,
or even, if need be, to killing him. An aggressor is any one who
does injury to us contrary to our rights and the ordination of
right. A formally unjust aggressor is a sane intelligent person who
intentionally attacks us; a materially unjust aggressor is one who
is not intelligent, not responsible, as an insane person, a child,
or a sane person who is injuring us unintentionally. This question
is important in medicine because the fetus _in utero_ is often
erroneously called an unjust aggressor.
It is a primary law of nature that every human being should and will
strive to resist injury and destruction. Justice requires a moral
equation, and if one right prevails over another it must be superior
to the right it supersedes. At the outset both the aggressor and
the intended victim have equal rights to life, but the fact that
the aggressor uses his own life for the destruction of a fellow man
sets the aggressor in a condition of juridic inferiority to the
victim. The moral power of the aggressor here is equal to his inborn
right to life, _less_ the unrighteous use he makes of it; while the
moral power of the intended victim remains in its integrity, and has
therefore a higher juridic value.
The right of self-defence is not annulled by the fact that the
aggressor is irresponsible. The absence of knowledge saves him
from moral guilt, but it does not alter the character of the act
considered objectively; it is yet an unjust aggression, and in the
conflict the life assailed has still a superior juridic value. In
any case the right of wounding or of killing in self-defence is
not based on the ill will of the aggressor, but on the illegitimate
character of the aggression.
The condition's of a blameless defence (_moderamen inculpatae
tutelae_) are: (1) that the aggressor really threatens the defender's
life, and there is no means of offsetting that violence except like
violence; (2) that no more violence is used than is adequately
required: if the aggression can be stopped by wounding the aggressor
the defender is not to kill him; (3) that the violence in the defence
is used with the intention of defence, not in revenge, hatred, anger,
or the like motives.
We may do an act good in itself from which a double effect
immediately follows, one good, to which the agent has a right, and
the other bad, which the agent is not obliged to omit if permitted
by him and not intended; but in the case of a necessary defence of
life against an unjust aggressor, made even with the death of the
aggressor, the defence is such an act, provided the moderation of a
blameless defence is observed.
The evil effect here is not a means to the good effect, nor does it
more immediately follow from the act done. The evil effect is an
effect _per accidens_, and thus not directly voluntary, either in
itself, because it is not intended, or in its cause. It lacks the
condition necessary to make it voluntary in cause as regards the
accidental effect since the act is not prohibited precisely because
this accidental effect follows.
The act in the case is good in itself; it is an application of
physical force in defence of a proper right, and any right supposes
a compulsive power. The two effects of this double-effect act are:
(_a_) the preservation of the defender's life, and (_b_) the death of
the aggressor. The first effect is good because the defender has a
right to his own life; the other effect is evil, not only physically
for the one who dies, but morally inasmuch as the death conflicts
with the dominion of God. This death, however, is an accidental
effect of the act, because in general the defensive act is not
directed by its nature to that death but to the preservation of the
defender's life; nor does the death follow more immediately than the
preservation. Thus it is not a means of the defence. Finally, the
defensive act is not prohibited precisely lest that death follow: not
in justice, for there is no justice in any right of the aggressor
which requires from the defender an omission of defence unto the loss
of life; there is no obligation in charity, since charity does not
oblige us to love another more than ourselves, or to exalt the good
of another above our own.
In an aggression which is merely material--say, in an attack by an
insane man--the defender has a right to the infliction of such damage
as is necessary and proportionate to an efficacious defence. The
right of the aggressor yields to the superior right of the defender,
not through the fault of the aggressor but through his misfortune.
There is a collision where both rights cannot be exercised at the
same time, and there is no reason obliging the defendant to forego
his own right.
We may defend another against an unjust aggressor because we can
assume that the attacked person communicates to us the use of his
own coactive right. If the aggressor is our own father, mother, son,
or daughter, or in general any one to whom charity obliges us more
than to the person attacked, we are not permitted to kill our own kin
because charity does not oblige us to prefer the good of an alien
to the good of one of our blood. Ordinarily we are not obliged in
justice or charity to defend another at the risk of our own life.
We may kill an unjust aggressor, _servatis servandis_, in defence
of good equivalent in value to life: for example, to prevent life
imprisonment, the loss of reason, a mutilation which would render us
useless, the loss of a woman's chastity.
There are cases of _accidental_ homicide, in medicine and elsewhere,
which have an element of guilt in them. If a death follows
accidentally upon an act which in itself is licit, and the agent
uses all proper precautions, he is not morally guilty in case of
an accidental death following his act. This is true even if the
agent foresaw a probable death but did not intend it. If, however,
the agent's primary act is illicit in itself, and an accidental
death follows from this act, the agent may be guilty of homicide,
provided the first act in itself is naturally likely to cause
homicide. Should the first act be always dangerous, such that
death commonly follows from it, like rocking a row-boat, aiming a
supposedly unloaded gun at a person and pulling the trigger, striking
a pregnant woman, drinking whiskey and then overlying an infant in
the bed, throwing building material from a roof to a street, racing
an automobile through a crowded thoroughfare, sending a crew out in
a rotten ship, and so on, the accidental homicide that follows is
imputable to the agent no matter how much precaution he may say he
has used to avert such a death.
Suppose, secondly, the original act of the agent is illicit but such
that accidental death rarely follows from it; then if he takes due
precaution he is not ordinarily guilty of homicide. He has, say,
stolen an automobile, and is going along the street leisurely, when a
careless child runs off the sidewalk under the machine and is killed.
1. No person, then, may hasten his own death or permit any one else
to hasten it.
2. No physician may in any possible condition kill a patient merely
to effect euthanasia.
3. The state has no more right than the physician to permit the
killing of patients to bring about euthanasia.
Were such permission given to physicians it would immediately be
abused by men with even the best intentions. In all countries and
in the largest cities the medical profession is swarming with
quacks. What is done in crass ignorance by licensed physicians and
specialists every day in the name of medicine is appalling. Professor
Orth of the Pathologic Institute in Berlin makes the statement that
of all the appendices that have been submitted to him for microscopic
examination after removal by conservative and supposedly skilled
physicians, 17 per cent. showed no disease at all, and should
not have been removed. In this country the percentage of normal
appendices removed because of vague abdominal pains is much larger.
The _Journal of the American Medical Association_ (June 7, 1913)
gave a list of post-mortem examinations where the diagnosis made
by men with a reputation for fair work had been correct in only the
following ratios:
Diagnosis Diagnosis
correct. incorrect.
Per cent. Per cent.
Diabetes Mellitus 95 5
Typhoid Fever 92 8
Aortic Regurgitation 84 16
Cancer of Colon 74 26
Lobar Pneumonia 74 26
Chronic Glomerular Nephritis 74 26
Cerebral Tumor 72.8 27.2
Tuberculous Meningitis 72 28
Gastric Cancer 72 28
Mitral Stenosis 69 31
Brain Hemorrhage 67 33
Septic Meningitis 64 36
Aortic Stenosis 61 39
Phthisis, Active 59 41
Miliary Tuberculosis 52 48
Chronic Interstitial Nephritis 50 50
Thoracic Aneurism 50 50
Hepatic Cirrhosis 39 61
Acute Endocarditis 39 61
Peptic Ulcer 36 64
Suppurative Nephritis 35 65
Renal Tuberculosis 33.3 66.7
Bronchopneumonia 33 66
Vertebral Tuberculosis 23 77
Chronic Myocarditis 22 78
Hepatic Abscess 20 80
Acute Pericarditis 20 80
Acute Nephritis 16 84
Pneumonia is a very common disease, extremely dangerous, and by
skilful treatment it is very often cured, yet of these 100 cases 66
were not diagnosed. I recently saw a severe case of double pneumonia
which a physician was treating as "indigestion," and he was giving
pepsin tablets for the supposed indigestion. There is such a thing
as extraordinary scientific precision in medical work, but it is
rare; the ordinary physician treats symptoms without knowing the
cause of the symptoms; that is, the symptom-treater is a quack,
and if euthanasia were legalized thousands of such quacks would
be permitted to murder with an overdose of morphine any querulous
old man or woman who might fall into their hands. Osteopaths and
chiropractors are masseurs, and they know very little of massage, but
they are licensed by legislatures to practise medicine, and some of
them even try obstetrical malpractice. They, too, would be licensed
to inflict euthanasia. Pure homeopathy is little more than a name at
present; it is faith-healing without prayer. It attenuates its drugs
100 per cent. for thirty repetitions, to a degree expressible by one
with sixty ciphers. Consequently it gives sugar of milk or alcohol
in minute quantities plus a label, and one cannot make much of an
impression on any disease with a label. Such practitioners also would
come under the euthanasia act.
BIBLIOGRAPHY
Cardinal John de Lugo. Disputationes Scholasticae et Morales,
vol. vi; De Justitia et Jure, disputatio x.
St. Augustine. I Contra Petilianum, cap. 24; Ad Marcellianum
Comitem, cap. 21; De Civitate Dei, cap. 17 to 28.
Aristotle. III Ethicorum, cap. 7, and lib. v, cap. ii. Plato.
Phaedo.
Cicero. Quaestiones Tusculanae. I, lib. v; De Somno Scipionis.
Lessius. De Justitia et Jure, lib. ii, c. 9, dub. 6, 7.
Molina. De Justitia et Jure, vol. i, tr. 2, disp. 119; vol. iv,
tr. 3, disp. 1 and 9.
St. Thomas Aquinas. Summa Theologica, 2, 2, q. 64, a. 5, 7.
St. Alphonsus Liguori. Theologia Moralis, vol. iv, tr. 4. See
this book for opposed opinions and a bibliography.
Costa-Rossetti. Philosophia Moralis, thesis 120.
Ferretti. Philosophia Moralis, theses xci, xciv.
Macksey. De Ethica Naturali, theses xxxiv _et seq._