Austin O'Malley

The Ethics of Medical Homicide and Mutilation


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of the life of the whole body it is licit to subordinate this part to the good of the whole.

      A direct mutilation is one intended as an end, or as a means to an end; it is a voluntary and free act. An indirect mutilation is one in which the mutilation is the natural effect of the act, but the intention of the agent is directed toward another end. The mutilation follows indirectly from the activity of the will, but there is a satisfying proportion between the accidental effect (the mutilation) and the end intended. In such an act there are two effects which follow the causal act aeque immediate, or directly (not indirectly, that is, not all from the other effect, but each immediately from this cause): one effect is good (to save life, avoid unbearable pain, or the like), and the other evil (the mutilation), but the good effect is the end intended, the evil effect is reluctantly permitted. Such an act is licit provided the usual conditions of the double effect are present, that is:

      1. The action that is the cause of the good and bad effects must be itself good or indifferent morally.

      2. The good and the bad effects must each be an immediate result of the causal act; the good effect may be not so subordinated to the evil effect as to be obtainable only through the evil effect.

      

      3. The bad effect must not be intended, either immediately or remotely; it may at most be tolerated as unavoidable.

      4. There must be a sufficiently grave reason for the act.

      Indirect mutilation may be licit when the evil to be avoided is proportional to the mutilation. Direct mutilation, where there is one direct effect of, say, the surgical operation, namely, to remove the somatic organ, is not licit, except for the good of the whole body; and that good to the whole body must be juridically equivalent to the damage done the body by the mutilation. There is to be a direct effect in such mutilation, which is the good of the whole body. It is not permitted to kill directly to save the life of another, but it is permissible to mutilate directly to save the whole body. Direct mutilation, however, is never unavoidable because the agent can always correctly order his intention before the operation.

      All direct mutilation, unless for the good of the whole body, implies deordination: it offends against the supreme dominion of God, who reserves to himself, as Creator, ownership of human life and its organs. As we may not destroy life, which belongs to God, we may not amputate a member to suppress any vital function. The exception which permits us to mutilate a member or organ is, as has been said, the adequate good of the whole body. The reason for this is that man is the administrator of his members, to the good of the whole person. Each member is not for itself but for the whole body.

      The good of the body is the sole cause that renders direct mutilation licit. The members of the body by their nature are not immediately subordinate to anything except the conservation of the total natural good, or that of the body. Therefore direct mutilation is not permissible to effect immediately spiritual good, or the good of the soul. We may not castrate a man, or do vasectomy on him, to preserve his continence, because there is no immediate subordination and connection between the members of the body and the salvation of the soul. Moreover, as St. Thomas says,[14] "Spiritual health can always be preserved by means other than amputation of bodily members," that is, through moderating by the will the use of these members. If a mutilation that immediately conduces to the good of the whole body, happens also to do good to the soul, this second effect is then legitimate. (The various mutilations of the body by surgical operations will be considered separately hereafter.)

      May the state, then, sterilize criminals, and persons afflicted with dangerous hereditary diseases, to prevent the propagation of moral and physical defectives? This question is considered specially in another chapter.

      There is an error gradually infecting all nations of late which is that the state, as such, is above morality; that what the civil authority permits or orders is by that fact alone made licit or obligatory. Hence the interference with individual liberty, with the rights of man, shown by laws for the mutilation of the physically degenerate, laws conferring privileges on one part of the community to the detriment of another, meddling in parental rights, and so on. Political error has come to such a pass that the men on the street think any majority is justified, solely because it is a majority, in recalling a judge or a law, in overriding authority for the satisfaction of appetite. The sovereign people tries to be subject and sovereign at the same time, and it deems its rulers mere hired men who may be discharged at will like cooks.

      A law is a rule and standard of action; a just, permanent, and rational ordination for the good of the community, promulgated by one who has charge of that community. Dominion is the power of claiming a thing as one's own, the right of ownership; and if this possessor has created the object, his dominion may be absolute. A governor, lawgiver, judge, has power or jurisdiction for the good of the governed. The business of government, of the state, is to protect each citizen in the pursuit of temporal happiness, to develop his natural faculties, establish and preserve social order, wherein each citizen is secured in his natural and legal rights, and is held up to the fulfilment of his own duties so far as they bear on the good of the community as such; and also to put within the reach of all citizens, as far as possible, a fair allowance of means to acquire temporal happiness, or external peace and prosperity. This is the whole business of the state. The state is for the people, and it may not transgress an inch beyond its proper limits, which are as hard and fast as those that bind the individual citizen. The citizen is not to be treated solely as an industrial or military unit; nor are material progress and military power, or even sheer intellectual civilization, to be the sole aim of the state. The state should develop a man's entire nature, physical, mental, and moral.

      We must obey civil authority, but we are not slaves or chattels of that authority. The state's authority over us is not dominative; it is only a power for our good and utility. The civil authority has no more right to invade the rights of its meanest citizen than it has to lie or to blaspheme. God gives civil authority to the established community, and the community entrusts this to its ruler; authority is a divine institution, rulers are directly a human institution and only indirectly divine. When the ruler has once been set up, has had authority entrusted to him, obedience must be given to him while he acts in keeping with his contract. Kant and his followers erroneously separate the juridic from the moral order; they deny that beyond the state there are any rights preeminent to the state's rights, yet they say there is an innate liberty which belongs to every human being equally and inalienably. The moral order comprehends all factors that are necessary to make the free activity of man in every respect well disposed, and among these factors is the juridic order itself. Man is naturally social, and whatever means are necessary to preserve human society are also naturally befitting man. Such means are to preserve for each man what are his, and to abstain from injuring other men. Now, so to act, that is, to abstain from murder, theft, and the like, to fulfil contracts, are strictly juridic duties, and at the same time moral duties. Therefore the moral order comprehends the juridic order.

      The end of the state, then, is not the public good considered as an end in itself. The individual citizen is not his own end in life, and so no mere multitude of men ever can become their own end. If the end of the state is the public good, then private good is subordinate to this, and the public good becomes man's final end, which is subversive of human dignity and is despotism.

      A clear definition of the power of the state to interfere with the rights to life and limb of the individual citizen is very important, because, as has been said, of late there is an alarming tendency on the part of the civil authority to override the rights of private citizens, even in the most democratic forms of government. Encroachment on the liberty of the individual is characteristic of unchristian political societies, and all states are now receding from Christianity. A striking example of this tyranny is the laws recently passed in ten American states for the mutilation of degenerates. This definition is more readily made by considering concrete examples of public conduct.

      Suppose an enemy demands from a city the surrender for execution of an innocent man on pain of the burning of the city and the destruction of its inhabitants. May the city cut off that member for the safety of the whole body politic, as a person may cut off his own hand to save his life? The state has not dominion over the life of a citizen, nevertheless it may