Catholic Bioethics for a New Millennium Book Summary

Title: Catholic Bioethics for a New Millennium
Author: Anthony Fisher

TLDR: Bishop Anthony Fisher tackles the modern bioethical dilemmas surrounding abortion, stem cells, transplants, and end-of-life care through the lens of Catholic teaching, advocating for a culture of life and love in a world increasingly embracing a “culture of death.”

Part I: How are we to do bioethics?

Chapter 1: Context: Challenges and Resources of a New Millennium

This chapter sets the stage for the book by outlining the major challenges to traditional Catholic views on life and love in the contemporary world. Bishop Fisher argues that the rise of “post-modernity” has led to a commodification of the body, recreational sex, commitment-free relationships, and a devaluation of children. This shift in values, he argues, has resulted in a “culture of death” where abortion, infanticide, and euthanasia are increasingly tolerated and even promoted.

Fisher draws on the work of social commentators such as Elizabeth Knox, Christopher Lasch, and Anne Manne to illustrate these trends. Knox’s novel, The Vintner’s Luck, serves as a stark example of the normalization of sexual perversion and violence in a world where individual autonomy trumps all other values. Lasch’s writings on the “culture of narcissism” and the fear of commitment are used to explain the decline in marriage and family life. Manne’s observations on the “shadowland of moral chaos” and the need for “islands of obligation” highlight the societal consequences of unchecked individualism.

In contrast to these developments, Fisher identifies several “promising directions” in contemporary Catholic thought that offer a robust response to the challenges of post-modernity:

• Greater emphasis on Scripture in moral theology: The call of Vatican II for a renewed focus on the Bible is gaining momentum, leading to a richer understanding of the scriptural foundations of Catholic bioethics.
• The renewal of natural law theory: Drawing on the work of Aquinas and contemporary thinkers such as John Finnis and Germain Grisez, a revitalized natural law theory is providing a compelling account of human dignity and the objective moral order.
• The recovery of virtue, community, tradition and culture: Communitarian thinkers and proponents of virtue ethics are helping to challenge the individualism of the modern age and to re-emphasize the importance of social bonds and the common good.
• The specifically Catholic-Christian contribution: There is a growing awareness that Catholic bioethics needs to be distinctively Christian, drawing upon the unique insights of revelation, tradition, and the magisterium.

Fisher concludes by arguing that a “more richly textured morality” is needed to address the complex bioethical dilemmas of the new millennium. This morality will be rooted in a strong understanding of human dignity, the inviolability of life, the importance of virtue, and the need for a renewed sense of community.

Chapter 2: Conscience: The Crisis of Authority

This chapter explores the concept of conscience and its relationship to Church authority, particularly in the face of modern challenges. Fisher argues that conscience is not an infallible inner voice but rather the human capacity for moral reasoning, which needs to be informed and formed by objective truth.

He traces the history of the conscience idea, from the Old Testament’s notion of a “true heart” to the Greek concept of synderesis to the writings of Paul, Augustine, Aquinas, and Newman. Fisher explains how the Second Vatican Council, while emphasizing the dignity of conscience, also recognized its fallibility and the importance of its formation by Church teaching.

However, he notes that the Council’s emphasis on conscience was often misinterpreted as promoting a kind of “private infallibility” that pitted the individual against Church authority. This led to theological dissent from Church teaching on issues such as contraception and abortion, with some theologians claiming that Catholics could legitimately “follow their conscience instead” of the magisterium.

Fisher argues that this view misconstrues both conscience and authority. He offers two complementary approaches to understanding their relationship:

• Communitarian account: The Church, as a moral community, shapes the identity and conscience of its members through its traditions, practices, and teachings.
• Practical reason account: Church teaching is not an external imposition but rather an authoritative articulation of moral truth that informs the conscience of the believer.

He concludes by emphasizing the importance of forming a “rightly reasoning conscience” guided by objective truth and the authoritative teachings of the Church. A proper understanding of conscience, he argues, is crucial for navigating the complex bioethical challenges of the present age.

Chapter 3: Cooperation: Should We Ever Collaborate with Wrongdoing?

This chapter tackles the difficult question of cooperation in evil, particularly in the context of healthcare. Fisher begins by outlining the traditional Catholic distinctions between formal and material cooperation, immediate and mediate cooperation, and so on. He then examines several contemporary cases where Catholic hospitals and healthcare providers have faced accusations of cooperating in morally objectionable practices such as sterilization, condom distribution, and the provision of drug-injecting rooms.

Fisher analyzes these cases in light of Church teaching, the arguments of theologians who have supported or opposed cooperation in these situations, and the broader ethical principles at stake. He highlights the importance of several factors in determining the permissibility of material cooperation:

• The gravity of the evil act itself.
• The harm caused to the principal agent and to third parties.
• The likelihood of scandal.
• The possibility of achieving the same good by other means.

He concludes by arguing that a deep commitment to the “culture of life” and a strong sense of moral solidarity should make Catholics reluctant to cooperate in serious evil unless there are very compelling reasons to do so. He also criticizes those who adopt a “tax-lawyer” approach to morality, seeking to find ways around moral norms rather than embracing the Church’s vision of the good life.

Part II: Beginning of Life

Chapter 4: Beginnings: When Do People Begin?

This chapter tackles the fundamental question of when human life begins, which underpins all of the beginning-of-life issues addressed in subsequent chapters. Fisher critically examines the arguments of those who claim that human life begins well after fertilization, focusing on the influential book When Did I Begin? by Norman Ford.

Ford argued that a human individual does not exist until two to three weeks after fertilization, when the “primitive streak” forms and twinning is no longer possible. He based his argument on a combination of biological data and philosophical reasoning, claiming that the early embryo lacks the necessary unity and individuality to qualify as a human being.

Fisher challenges Ford’s conclusions on both scientific and philosophical grounds:

• Science: He argues that Ford’s account of fertilization, twinning, and the development of extra-embryonic tissues is outdated and inaccurate. Modern embryology, he argues, supports the view that a human organism exists from the moment of conception.
• Philosophy: Fisher criticizes Ford’s reliance on an unmodified Aristotelian-Thomistic ontology that is inconsistent with the scientific data. He also argues that Ford’s appeals to “common sense” and “common usage” are unreliable and inconclusive in such complex matters.

Fisher examines several criteria that have been proposed for determining when a human individual is present: untwinnability, unchimaerability, species membership, genetic uniqueness, spatial oneness, spatio-temporal continuity, differentiation of parts, and organization and direction. He argues that none of these criteria supports a delayed hominization view, and that the weight of evidence points to the existence of a human individual from fertilization.

Chapter 5: Stem Cells: What’s All the Fuss About?

This chapter explores the ethical and social issues surrounding stem cell research, particularly the use of human embryos as a source of embryonic stem cells. Fisher explains the scientific potential of stem cells for regenerative medicine and outlines the six potential sources for stem cells: adult stem cells, placental and umbilical cord blood, induced pluripotent stem cells (iPS cells), pseudo-human organisms, human–animal hybrids, and human embryos.

He argues that adult stem cells and iPS cells offer the greatest therapeutic potential and are ethically unproblematic, as they can be obtained without harming anyone. Other sources, such as embryoid bodies and human–animal hybrids, raise serious ethical concerns regarding the instrumentalization of human life and the blurring of species boundaries.

Fisher focuses on the ethical objections to the use of human embryos for stem cell research, drawing on the teachings of the Catholic Church and other pro-life arguments. He explains why the Catholic Church considers the human embryo to be a human person worthy of unconditional respect from the moment of conception. He also addresses the common arguments in favor of embryo destruction, such as the claim that embryos are “too young” or “too small” to be considered human beings, or that they are “going to die anyway” and so should be used for something useful.

Fisher criticizes the “salami technique” employed by the embryo industry, which starts with seemingly modest proposals (e.g., using “excess” embryos) but then gradually expands the permissible uses of embryos, ultimately leading to the normalization of their destruction. He also expresses concern about the hype surrounding embryonic stem cell research, noting that these cells have yet to demonstrate any real therapeutic benefit, while adult stem cell therapies are already showing considerable promise.

He concludes by calling for a cautious approach to stem cell research, one that avoids the instrumentalization of human embryos and respects the sanctity of human life at all stages of development.

Chapter 6: Abortion: The New Eugenics?

This chapter revisits the abortion debate in light of the new genetics and other technological developments. Fisher argues that abortion, though always morally wrong, has become increasingly common in the modern world due to a confluence of factors: the sexual revolution, the availability of safer and more convenient abortion methods, and the widespread acceptance of a “culture of death.”

He begins by reviewing the scriptural and traditional teachings of the Catholic Church on the sanctity of life and the immorality of abortion. He then examines the ethical and social consequences of the widespread practice of abortion, emphasizing the physical, psychological, and spiritual harms it inflicts on women, families, and society as a whole.

Fisher focuses on the role of prenatal testing in contributing to the abortion epidemic. He argues that while prenatal diagnosis can be ethically justifiable in cases where it allows for the treatment of the unborn child, it is too often used as a tool for eugenic abortion, with parents choosing to terminate pregnancies based on the presence of a disability or other unwanted characteristics. He explains the dangers of this “search-and-destroy mission” mentality, noting the expanding list of conditions that are now screened for, the pressure on parents to use these tests, and the discriminatory message this sends to people with disabilities.

Fisher concludes by offering several suggestions for responding to the contemporary abortion scene:

• Proclaiming the humanity of the unborn child: Pro-lifers need to continue challenging the “foetus-ain’t-a-person” rhetoric and emphasizing the intrinsic dignity of the unborn child.
• Contesting the “culture of choice”: The dogma of individual autonomy needs to be challenged, and a richer understanding of freedom, responsibility, and the common good must be promoted.
• Empowering women to choose well: Pro-lifers need to offer real alternatives to abortion, including practical support, counseling, and a more family-friendly social environment.
• Engaging men in the pro-life effort: Men need to be encouraged to take responsibility for their actions and to support women facing unplanned pregnancies.
• Challenging the “contraception panacea”: The evidence shows that increased access to contraception does not lead to a reduction in abortion rates.
• Improving the pro-life message: Pro-lifers need to be more sophisticated in their messaging, targeting their audience and using persuasive language and arguments.
• Promoting a culture of life and love: The pro-life movement needs to be about more than just opposing abortion; it must also work to build a society that values and supports life at all stages.

Part III: Later Life

Chapter 7: Transplants: Bodies, Relationships and Ethics

This chapter examines the ethical issues surrounding tissue transplantation, focusing on the relationship between the body, relationships, and ethical decision-making. Fisher argues that different conceptions of the body and the tissue transfer relationship have significant implications for ethical practice.

He identifies three main models:

• The body as property: In this model, the body is viewed as a commodity that can be bought, sold, or donated like any other possession.
• The body as trust: Here, the body is seen as a gift from God, entrusted to our stewardship.
• The body as personal: In this model, the body is understood as an integral part of the person, and tissue transfer is seen as a sharing of life.

Fisher argues that the “body as personal” model offers the most compelling account of tissue transplantation, emphasizing the importance of respect for the donor, the recipient, and the shared humanity they embody. He explores the ethical issues surrounding tissue procurement, including the complexities of consent, the risks of commodification, and the need for sensitivity to the needs of grieving families and healthcare professionals.

He pays particular attention to the ethical challenges of xenotransplantation, the transplantation of non-human tissues to human beings. He notes the potential risks associated with such procedures, including the danger of cross-species disease transmission and the blurring of species boundaries. He also considers the theological implications of xenotransplantation, asking whether it might compromise the human person’s “image and likeness” to God.

Fisher concludes by emphasizing the need for a cautious and ethical approach to transplantation, one that respects the dignity of the human person and avoids the instrumentalization of the body.

Chapter 8: Artificial Nutrition: Why Do Unresponsive Patients Matter?

This chapter addresses the controversial issue of artificial nutrition and hydration for persistently unresponsive patients, such as those in a “persistent vegetative state” (PVS). Fisher argues that these patients, despite their inability to exercise rational autonomy, are still human persons worthy of respect, care, and feeding.

He begins by revisiting the Terri Schiavo case, which sparked a national debate in the United States about the ethics of withdrawing assisted feeding from a PVS patient. He analyzes the arguments of those who supported the removal of Schiavo’s feeding tube, noting their reliance on autonomy-based ethics and their view that persistently unresponsive patients are “better off dead.”

Fisher then makes a twofold case for why unresponsive patients still matter:

• Philosophical account: He draws on the work of Alasdair MacIntyre and others to challenge the “élitist” account of human personhood, which ties dignity and worth to the exercise of rational autonomy. He argues that human beings are fundamentally dependent beings, and that our dependence is not just chronological but also ontological. He also emphasizes the importance of our embodied nature, arguing that the body is not a mere instrument but an integral part of the person.
• Theological account: Fisher explores the scriptural and traditional teachings of the Catholic Church on the sanctity of life, the importance of feeding the hungry, and the call to care for the sick and dying. He analyzes the magisterial pronouncements on assisted feeding, noting the presumption in favor of providing nutrition and hydration to all patients unless there are compelling reasons not to do so.

He examines the arguments of those who oppose assisted feeding for unresponsive patients, including those who appeal to “spiritual acts personism,” claiming that life without consciousness or spiritual experience is meaningless. He criticizes this view as dualistic, elitist, and ultimately unsustainable, arguing that it leads to a devaluation of all human life.

Fisher concludes by emphasizing the importance of providing basic care for those lacking the exercise of rational autonomy, including assisted nutrition and hydration when necessary. He argues that such care expresses our solidarity with those who are most vulnerable and affirms the inherent dignity of the human person at all stages of life.

Chapter 9: Endings: Suicide and Euthanasia in the Bible

This chapter examines the scriptural evidence regarding suicide and euthanasia, arguing that the Bible, taken as a whole, does not endorse these practices. Fisher critically analyzes the arguments of those who claim that the Bible permits or even commends suicide and euthanasia, particularly the work of Arthur Droge, James Tabor, James Clemons, and Paul Badham.

He reviews the various reports of suicides and euthanasias in the Bible, examining the contexts in which they occur, the motives of those involved, and the theological interpretations offered by exegetes. He argues that these stories, while sometimes ambiguous, do not provide support for a pro-suicide or pro-euthanasia position. In almost every case, suicide and euthanasia are presented as tragic events associated with despair, disgrace, or divine judgment.

Fisher emphasizes the scriptural themes of the sanctity of life, the importance of choosing life over death, and God’s sovereignty over life and death. He argues that these themes, along with the example of Jesus’ Passion, have consistently informed the Judeo-Christian opposition to suicide and euthanasia.

He also explores the theological basis for the Church’s compassion for those who commit suicide, noting the recognition of diminished responsibility in cases of mental illness, suffering, or despair. He concludes by affirming the hope for God’s mercy even for those who die by their own hands, and the duty of the Christian community to offer consolation and support to the survivors of suicide.

Part IV: Protecting Life

Chapter 10: Identity: What Role for a Catholic Hospital?

This chapter addresses the challenges of maintaining Catholic identity in healthcare institutions, particularly in the face of contemporary pressures such as secularization, cost containment, and the technological imperative. Fisher uses the fictional examples of two Catholic hospitals, St. Mary Magdalene’s and St. Norbert’s, to illustrate different approaches to this challenge.

St. Mary Magdalene’s represents a hospital that has adapted to the modern healthcare environment by offering top-quality services but at the cost of some compromise to its Catholic identity. St. Norbert’s, on the other hand, maintains a strong religious character and focuses on the needs of the most vulnerable, even at the risk of becoming financially marginal.

Fisher argues that both types of hospitals face significant challenges in maintaining their Catholic identity. He draws on the work of Richard McCormick, Benedict Ashley, and Germain Grisez to illustrate the ethical dilemmas posed by the need for financial viability and the pressures to cooperate with secular providers who do not share Catholic moral principles.

He argues that Catholic hospitals, in order to preserve their identity and fulfill their mission, must be distinctively Christian, offering a genuine alternative to the secular healthcare system. He identifies three key aspects of their “sacramental” character:

• Diakonia (ministry of charity): Catholic hospitals should be committed to a preferential option for the poor and marginalized, ensuring access to care for those who are most vulnerable.
• Martyria (proclaiming the Word of God): Catholic hospitals should give witness to the Gospel through their ethical practices, their commitment to the sanctity of life, and their advocacy for a culture of life and love.
• Leitourgia (celebrating the sacraments): Catholic hospitals should provide spiritual care for their patients and staff, including access to the sacraments, prayer, and pastoral counseling.

Fisher concludes by offering six suggestions for strengthening Catholic identity in healthcare institutions:

• Reappropriating the distinctively Christian: Sponsors and leaders need to consciously embrace the Catholic vision of healthcare and be willing to stand apart from the secular system.
• Developing a “critical mass” of committed personnel: The hospital must employ a sufficient number of staff who share the Catholic faith and ethos.
• Increasing cooperation within the Catholic healthcare sector: Catholic hospitals should work together to share resources and expertise, potentially forming integrated delivery networks or other alliances.
• Responding astutely to political and financial pressures: Leaders need to be savvy in navigating the healthcare system while remaining faithful to the Catholic mission.
• Ensuring ethical integrity: Policies, practices, and clinical decisions must be consistent with Catholic moral teaching and the hospital’s mission statement.
• Strong episcopal oversight: Bishops need to exercise their authority to ensure that Catholic hospitals are truly Catholic in their identity and mission.

Chapter 11: Regulation: What Kinds of Laws and Social Policies?

This chapter addresses the responsibilities of Catholic politicians in the face of imperfect bio-legislation, particularly in situations where it is not possible to achieve ideal legal protections for human life. Fisher begins by outlining the duties of politicians to uphold the common good, to protect the vulnerable, and to act in accordance with fundamental moral norms. He then examines the specific challenges faced by pro-life politicians in countries where abortion, euthanasia, and other offences against life are legally permitted.

He draws on the teaching of John Paul II in Evangelium Vitae and the subsequent commentary by Archbishop Bertone to explain the permissible stances for pro-life politicians in such situations. These include:

• Opposing permissive bio-laws at all stages: In some cases, politicians may judge that any attempt at legal reform will be counterproductive or will make the situation worse.
• Supporting restrictive bio-law reform in a permissive situation: Politicians may choose to initiate or support legislation that restricts abortion, euthanasia, or other practices while acknowledging that it does not eliminate them entirely.
• Supporting restrictive amendments to permissive bio-legislation but opposing the unjust bill as a whole: Politicians may seek to improve a bad bill by amending it to include restrictions, while still opposing the bill in its final form.

Fisher analyzes the arguments for and against each of these stances, emphasizing the importance of prudential judgment in determining which course of action will best serve the common good and the goal of protecting life. He highlights the complexities of determining the “existing law” in situations where courts or law enforcement agencies have failed to uphold the letter of the law. He also addresses the ethical dilemmas posed by material cooperation in evil, particularly the risk of scandal and the importance of giving witness to the truth.

He concludes by emphasizing the virtues that pro-life politicians must cultivate: faith, prudence, courage, humility, and hope. He stresses the importance of unity of purpose among pro-lifers, even when there is legitimate diversity in strategies. He also calls for a spirit of charity and understanding in dealing with those who hold different views, recognizing that there can be honest disagreement among people of good will.

These summaries offer a comprehensive overview of the key themes and arguments presented in “Catholic Bioethics for a New Millennium.” Bishop Fisher’s book provides a valuable resource for anyone seeking to understand the challenges and opportunities facing Catholic bioethics in the twenty-first century.