Barbara Golder, MD, JD

First Published February 5, 2021 Editorial

https://doi.org/10.1177/0024363921991262

Keywords Bioethics, CDF, Cooperation with evil, COVID, Difficult moral questions, Prudence, Prudential judgment, Remote material cooperation, Vaccines

One of the not-unexpected side effects of the COVID pandemic has been to thrust bioethics into the spotlight, and not just for Catholics. Questions of how to manage competing interests and concerns, how to spend scarce health care resources, how much information the public is entitled to, what modifications of testing and development are acceptable in an accelerated time frame, and the finer points of vaccine production have all surfaced over the past year.

Nowhere has the discussion been so vigorous as that concerning whether—and how—cells derived from aborted fetuses have been used in developing, testing, or marketing the new COVID vaccines. There has been a great deal of back and forth discussion, culminating, finally, in a clarifying document from the Vatican on the subject: all vaccinations recognized as clinically safe and effective can be used in good conscience with the certain knowledge that the use of such vaccines does not constitute formal cooperation with the abortion from which the cells used in production of the vaccines derive (Congregation for the Doctrine of the Faith 2020). One might have thought that such a document would end discussion; it did not.

The Value of Dialogue

That’s probably a good thing because extended discussion highlights an oft-overlooked aspect of bioethics: making ethical decisions is more often a matter of prudence than of mathematical certainty. As such, the task of the bioethicist—and in some measure, the task of The Linacre Quarterly—is to lay out the permissible range in which prudential judgments can be made according to one’s own and particular experience, formation, gifts, and limitations. That also means understanding that different people can come to different and equally acceptable moral resolutions of a single bioethical problem. Perhaps even more important, there are some situations we have created that, in the words of Dignitas personae (referring to frozen embryos) represent situations of injustice that cannot be resolved (Congregation for the Doctrine of the Faith 2008). In short, bioethics isn’t so simple these days.

We live in a world in which it just isn’t possible to detach ourselves completely from the immoral or imprudent decisions of others. Catholic moral teaching provides a remarkably flexible and consistent framework for discerning when that connection is tenuous (remote) enough to permit our consciences to be comfortable, but within that context, people may weigh the various factors that go into decision-making very differently and come to very different conclusions. That’s only to be expected.

Cooperation with Evil and Social Consistency

I was, for example, struck by the vigor of discussions on Facebook, in which the Pfizer and Moderna vaccines were deemed completely unacceptable by armchair ethicists and theologians, despite the wealth of information that explained why Catholics could, in good conscience, take those vaccines according to long-established principles. Fr. Matthew Schneider apparently had a similar experience and produced an article which included list of things in which we regularly engage that, arguably, have a much closer connection to ongoing evil than a cell line derived from an abortion in 1974, and about which no great concerns are raised (Schneider 2020) His list: products made by companies that support Planned Parenthood (a huge list including common brands we all use), diamonds, bananas, smartphones and tablets, anything made in China, the live action movie Mulan, coffee, search engines, major banks and insurers, social media platforms, taxes, and anything involved in alcohol production and distribution.

Feel free to quibble with his list and even his rationale, but the point remains: we tend to draw lines in interesting and sometimes inconsistent places when it comes to cooperation with evil. Curiously absent from discussion about the use of fetal cell lines in vaccine development and testing, for example, is any concern for their use in the development and testing of drugs used to treat cancer. My own sense is that, overwhelmed by so much that we cannot control and so many situations that cause us moral pain, we come to a point where drawing a line becomes important, and so we do. This far, but no farther. I suspect that is a way of reminding ourselves that the Divine spark and the Divine imperatives are still alive within us, and that is a good thing. It’s not, however, always perfectly consistent.

Pared Down, the Questions Still Grow

The great temptation in trying to reconcile these difficulties with life as a Christian is to pare down the subject to something that we can more easily—and definitively—answer. An example: is it ethical to transplant organs? The answer, a qualified yes: it can be a great act of charity and love for another to donate an organ and a great blessing to receive one. But expand that question the slightest bit and things get complicated, and quickly: how do we allocate scarce organs? Can a poor man sell an organ to support his family? Is it ethical to presume consent for donation when no specific direction has been made? Is it ethical for families to make a decision for a loved one who can no longer answer for himself? Importantly, how do we recognize death has occurred, so that unpaired, vital organs can be taken?

Expand it a little further and other questions arise: in a world where health care monies are interconnected, how many expensive transplant procedures can we support when basic health care goes lacking in so many ways? Draw the circle a little wider and the imbalance of consumption of medical resources around the world comes into focus and raises significant questions for Catholics, who understand the ultimate destination of human goods and the preferential option for the poor. Pope Francis himself raised this, to the discomfort of many, in his discussion of the COVID vaccines and his concern that the poor, and poor countries, not be cast off to second place. How likely is it that the prosperous West might insist that worldwide economic concerns justify a globally prioritized reception?

There are some questions to which there are simple, specific, and single answers in the realm of medical ethics. But there are far more for which the answer is an honest “Beats me, but here’s how I solve it,” And that is the realm in which considered, and considerate, conversation is needed.

The COVID pandemic has revealed the fault lines in medicine in a great many areas, not the least of which is the damage that can be done by manipulating a medical issue to make political hay. It’s also revealed the great strengths of modern medicine when people of different disciplines and visions collaborate for the greater good. Last, it has made it crystal clear that the average Catholic is not well equipped to wade through the mire of complicated bioethical issues—and that he wants some help.

The temptation is to provide firm answers to particular questions: May I take this COVID vaccine? Must I?

Keep Asking

If there’s only one permissible answer, wonderful. But for the great majority of situations, including the COVID vaccine, concepts as well as answers are needed. The Catholic faithful need help in understanding that there are many, many situations in which people of good conscience and deep faith will disagree on a course of action, and not just in bioethics. In short, we must be careful to distinguish a personal resolution of an ethical dilemma from an obligatory one. Those in charge of educating the faithful, whether teachers, or doctors, or editors, or priests, or bishops, have a particular obligation to make the faithful aware of the permissible latitude of Catholic thought and make that distinction clear.

It is my hope that The Linacre Quarterly will be of some help to those charged with that enormous responsibility.Barbara Golder, MD, JD, Editor in Chief

The Linacre Quarterly

References

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