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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