MEDICAL DECISIONS FROM A TO Z

Moral decisions, whatever their exact nature, must stem from the Scriptural, theological and philosophical foundations and principles that constitute Catholic morality and proper conscience formation. Every medical decision has moral and/or ethical implications, from the simple blood test to the most invasive type of surgery. Thus, some basic method of determining what is the right thing to do, in a particular concrete situation, is necessary. In Western Christianity, Scholasticism was the dominant method of philosophy and theology in the Middle Ages. Its proponents sought both a system and a method to synthesize Christian theology with pagan philosophy. Its method was inductive and sought a priori knowledge—a proposition is a priori if it is known independently of experience. The Scholastics developed a distinction between actus humanus (or a human act) versus actus hominis (or an act of man) which is still important in morality. So, not every act that we undertake is a human act, but only those actions accomplished through rational knowledge and free will can be truly human. An act of man, on the other hand, is something which takes place independently of the human will, e.g. tire blowout on the highway. An actus humanus has a moral dimension while the actus hominis does not entail moral implications.

Tres fontes moralitatis – The Principles of Morality

The Catechism of the Catholic Church (CCC) summarizes the traditional approach to morality by stating that the first principles (or fonts) of morality are three-fold: (1) the object chosen – finis operis; (2) the end in view or the intention – finis operantis; and (3) the circumstances of the action (CCC, n.1750). The object chosen or the moral object is the first determinant—the act, toward which the will directs itself, must be assessed—the question is whether the act under consideration conforms or does not conform to the true good and this constitutes the material element in a moral act. The second font, i.e., the intention or the end in view, lies within the moral agent and must be voluntary or freely engaged in. The intention determines the end or goal of a particular action, as well as answers the question why something is being done, namely, its purpose. “The intention is a movement of the will toward the end: it is concerned with the goal of the activity” (CCC, n.1752). Intention does not only apply to single, discrete, individual actions; no, it can serve as the guiding principle of a lifetime or incorporate multiple actions under a single or it can even be labeled an ultimate intention. Intention alone is not sufficient because the other two fonts of morality must be included. The desire for some moral objects are inherently (or intrinsically) wrong. In the encyclical Veritatis Splendor (1993), Pope John Paul II stated, “reason attests that there are objects of the human act which are by their nature ‘incapable of being ordered’ to God, because they radically contradict the good of the person made in his image. These are acts which, in the Church’s moral tradition, have been termed ‘intrinsically evil’ (intrinsece malum) on account of their very object, and quite apart from the ulterior intentions of the one acting and the circumstances” (Veritatis Splendor, n.80). A good intention cannot make an evil act good—evil cannot be done because something good may result from it. Finally, the circumstances or the secondary elements (e.g., foreseeable consequences of an action, mitigating elements, etc.) either increase or decrease the moral goodness or evil of a human act, as well as affect an agent’s moral responsibility in the same manner.

Thomas Aquinas-Principles of Practical Reason

For St. Thomas Aquinas the rule for moral goodness is recta ratio agibilium (or right reason applied to action) which is prudence; thus, determining whether or not an act of the will is good depends upon the goodness of the will’s object. The human will is a rational appetite that is drawn toward objects presented to it by the intellect. Moreover, practical reason (or prudential judgment) governs morality and it is determined by what are known as first principles—the primary precepts of the natural law and humanity’s unique means of participating in God’s eternal law. Summary of the natural law—do good avoid evil. Moral agents actively rule and measure their actions in accord with divine (or eternal) law. Human life itself, marriage and procreation, self-preservation and so on are first principles that perfect human nature because they are suitable objects for the human will to desire. “…the good is the first thing grasped by practical reason which is ordered to action, for every agent acts for the sake of an end, which has the character of good. Therefore, the first principle of practical reason is grounded in the notion of good: the good is that which all things desire . This, then, is the first precept of the law: good should be done and pursued and evil avoided” (Summa theologiae I-II, q.94, a.2). The basic elements of morality, then, are the human act (actus humanus), the natural law, moral precepts like do good, avoid evil and prudence.