Tag Archives: national catholic bioethics center

CRISPR: A new challenge to the Culture of Life?

The journal Science named “CRISPR” the “breakthrough of the year” for 2015. What is CRISPR, and what challenges could it pose to building a Culture of Life?

John F. Brehany, PH.D, S.T.L.

“CRISPR” is an acronym for a new biotech tool scientists developed in 2012-2013 by harnessing two features that Strep bacteria use to fight viruses: first, an ability to reliably identify specific strands of DNA, and second, an ability to use enzymes to cut such strands at precise points. CRISPR is the most powerful gene editing tool yet, theoretically able to accurately identify, cut, and replace more than one gene at a time in DNA — including human DNA.

Over 30 years ago, in developing ethical and procedural proposals to begin genetic engineering, scientists distinguished between using genetic engineering for therapy and for enhancing human traits. An additional distinction was drawn between inducing genetic changes in individuals (somatic cell) and creating genetic changes that could be passed down to future generations (germ line). Somatic cell gene therapy was widely embraced in principle — including by Pope St. John Paul II in 1983 — while germ line genetic engineering was outlawed by a number of countries and taken off the table in the United States.

Yet few human diseases have been successfully treated with somatic cell gene therapy, in part due to the challenge of delivering replacement genes with precision. Scientists tried everything from disabled retroviruses to “gene guns” shooting gold particles coated with DNA. Now CRISPR appears to overcome this hurdle — well enough, some argue, to safely introduce changes into the human germ line.

Indeed, CRISPR hit the headlines in early 2015 when Chinese researchers tested it on human embryos. While many in the scientific community greeted news of this unethical experiment with angst and even outrage, influential scientists, journals, and bioethicists called for additional research and discussion.

Last December, the National Academies of Science of the U.S., the U.K., and China held a summit about CRISPR in Washington, D.C. Their closing statement favored use of CRISPR in somatic cell therapies and research into human germ line applications, but stopped short of endorsing clinical applications to the human germ line — for the time being. Meanwhile, CRISPR’s impact is being felt outside of laboratories and conferences. I met late last fall with a financial analyst who told me that CRISPR was the hot new topic at venture capital meetings.

Catholics are called to be leaven, salt, and light in a fallen world. Catholics can and should be leaders in the ethical debate and the scientific development of CRISPR. If indeed practical (reliability and safety) obstacles to significant genetic engineering are soon to be overcome, it’s more important than ever to be clear on issues of principle.

Some issues of principle are clear. The potential abuse of technology does not rule out legitimate use — and there are clear ethical and practical uses of CRISPR. For example, it can be used to quickly create lab animals to study diseases, to control rather than change genes (for example, to “turn on” some genes to grow heart muscles after a heart attack), and to enhance the effectiveness of ethical stem-cell therapies.

Some moral harms are clearly and widely rejected. Eugenics is almost universally condemned, as is employing technology to exacerbate social disparities. And Catholics should faithfully apply John Paul II’s clear teachings regarding respect for the dignity of every human life (including at the embryonic stage) in research and treatment.

However, some ethical issues raised by CRISPR have not yet been comprehensively examined or defined by the Church. What if gene editing or control can be used to promote human health in new or better ways, for example, by replacing vaccines in providing immunity? Questions like these require new and careful discernment.

Finally, Catholics need to bring an enhanced level of prudence to respond to the enhanced powers this new technology provides. There is no doubt that CRISPR will fuel substantial personal and cultural temptations. It’s being celebrated as a scientific game-changer. Some scientists will be tempted to fight against limits on their work, and ordinary people will be tempted to use technology to meet deeply felt human needs or to advance their children with the continuous growth of the reproductive technology industry.

Catholics need to be aware of what CRISPR is and how it can affect science and society. We should encourage greater regulation of research, particularly research on human embryos. We should also renew our efforts to form students in the Church’s moral vision of the human person, science and society.

JOHN F. BREHANY, PH.D., S.T.L. is the National Catholic Bioethics Center’s director of institutional relations.

Stem cell ‘miracle’

Legate Linda Stafford recovers from rare brain disease after stem cell treatment . . .

Linda and Jerry Stafford

Linda and Jerry Stafford

Jerry and Linda Stafford first met at a Pittsburgh-area diner. Linda was 18.  Jerry was 20. Linda’s girlfriend didn’t have enough money, so they asked Jerry for 35 cents. In response, he asked for a date. Three months later the couple was married.

Members of Legatus’ Las Vegas Chapter, the Staffords have been married 50 years. Jerry, who had been an electrical contractor most of his career, served as president of Republic Energy Services, which provided electrical contracting throughout Nevada and California. He retired last year so that he could concentrate on his wife’s health.

Health problems

Linda first noticed the signs of trouble in 2007, when she began experiencing numbness in her left hand.

“While at our Lake Tahoe summer home, she said something wasn’t right,” recalled Jerry, a member of Legatus’ board of governors. “She was an avid golfer with a 12 handicap, and she started whiffing the ball. I wondered how could that be?”

As time progressed, Linda found herself limited physically and cognitively. She began having trouble determining spatial relationships, which led to difficulty driving and staying in the proper lane. That led to an auto accident in 2010. She also began dropping things with her left hand and felt as if it was “floating by itself,” a condition known as Alien Hand Syndrome.

A year later, she began having difficulty with her speech. While she could remember what an item was, she would have trouble remembering its name, and was increasingly having difficulty finding the words that she wanted to say. She also began having trouble reading. Two or three times per day, Linda suffered from a tremor behind her right ear that led to spasms in her right shoulder and neck. Overall, she found that the symptoms severely hindered her daily life, rendering her unable to multi-task.

An initial medical work-up found no evidence of either a stroke or a transient ischemic attack (mini-stroke).

Linda hugs her daughter-in-law Jlynn Stafford.

Linda hugs her daughter-in-law Jlynn Stafford.

During Legatus’ 2013 Summit in Scottsdale, Ariz., a health representative suggested that Linda visit a clinic in San Francisco. That May, she was diagnosed with corticobasal degeneration (CBD), a rare, progressive neurodegenerative disease that affects the cerebral cortex and is marked by disorders in movement and cognitive dysfunction.

“We were told they could do nothing; there was no cure,” said Jerry. The Staffords were advised to quit their jobs and enjoy what time Linda had left. Patients diagnosed with the disease are typically given five years to live.

Adult stem-cell therapy

Some weeks later, a fellow Legate recommended and set up a conference call with hematologist Dr. Dipnarine Maharaj of the South Florida Bone Marrow/Stem Cell Transplant Institute in Boynton Beach, Fla. After an initial consultation, Maharaj said that he could help Linda.

Maharaj performs stem cell/bone marrow transplants for patients with leukemia and other cancers and blood disorders. He has also pioneered a method for mobilizing patients’ own stem cells using protein injections. The protein releases a patient’s own stem cells in order to repair the body. Since the treatment doesn’t involve killing children in the embryonic stage, Maharaj’s therapy is ethical according to Catholic teaching.

“There are plenty of adult stem cells in the body,” said Edward Furton, an ethicist with the National Catholic Bioethics Center. “There are no concerns with something like this because it’s not dealing with embryonic stem cells.”

In 2003, Maharaj developed a process where doctors could allow the stem cells in reserve in the bone marrow to be released in larger numbers. Those cells then find their way to areas of inflammation and reduce it, allowing areas of the brain to function better.

“I was treating a patient for blood cancer who had had a stroke,” Maharaj said. “I used a protein to increase the white blood cell count and the patient had a significant recovery.”

Because this particular treatment is experimental and not a standard of care recognized by the FDA, it’s not covered by insurance. A six-week cycle of treatment costs approximately $60,000.

Successful treatment

Dr. Dipnarine Maharaj

Dr. Dipnarine Maharaj

In June 2013, while attending a Legatus board meeting in Naples, Fla., the Staffords took time to meet with Maharaj for an evaluation. Linda returned two weeks later for her first six-week treatment.

According to Maharaj, Linda experienced significant improvement. Her Unified Parkinson’s Disease Rating Scale, a scale used to study the course of Parkinson’s and other neurological diseases, improved dramatically. According to Maharaj, Linda’s score went from 33 prior to therapy to 12 following therapy.

“She dramatically improved,” Jerry agreed. “Everything improved. She got movement back in her left arm.”

Jerry noticed some regression at the end of 2013, so they returned for a second treatment the following February and March.

“That treatment gave her significant improvement in the brain,” said Jerry. “But after about seven months we began seeing regression again. When we returned, a brain scan showed some inflammation had returned. At that point we decided to go through a third round of treatment.”

After her third course of stem cell mobilization therapy, a subsequent SPECT brain scan showed an improvement in hypoperfusion, or blood flow in the brain.

According to the medical report, Linda “now displays increased facial expression, improved speech and memory as well as better gait, balance and control of her left arm/hand. Her spatial understanding has improved with enhanced awareness of her hand when performing tasks such as writing. Her incidence of traumatic fall has decreased significantly. She is sleeping better and all tremors have resolved. Overall there is marked improvement in the patient’s ability to perform activities of daily living and in her quality of life.”

Jerry says he’s overjoyed to see Linda returning to her old self.

“At her worst, she was unable to smile,” he explained. “She described herself as ‘being in a bubble.’ You could look in her eyes and see that something wasn’t there. She has completely rebounded from that.

“No one has ever been cured of this. We’re very hopeful that her brain will totally heal. Everything has been very positive. Today, she is very healthy physically. I can only attribute that to the work of God. The medical profession will tell you that you can do nothing about some of these diseases, but I want to let people who have who have put some money away know that they can do something.”

Linda plans to go through another two weeks of treatment in April and another in August to continue the healing.

“There’s no question it’s a miracle,” said Jerry. “The most important thing is that she has given hope to a lot of people. Corticobasal degeneration doesn’t have to be a death sentence.”

TIM DRAKE is Legatus magazine’s editorial assistant.

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National Catholic Bioethics Center

Philosophy and the Catholic faith

Edward Furton writes that the Church has a deep and profound appreciation of philosophy . . .

Edward J. Furton

Edward J. Furton

The Catholic Church has always had high regard for the disciplines of philosophy and theology. Every Catholic college in the country has professors of these two subjects, sometimes in very significant numbers. This is a mark of respect for the intellectual tradition of the West.

Although it’s perhaps obvious why there should be an emphasis on theology, the importance of philosophy is sometimes neglected. The great philosophers of the past — especially those of the ancient world — have profoundly influenced Church teaching. St. Aurelius Augustine, for example, was strongly influenced by Plato’s philosophy. Similarly, St. Thomas Aquinas was deeply indebted to Aristotle’s thought.

Why this openness to philosophy? Primarily because we hold that faith is added to reason. Faith is neither a substitute for reason nor a contradiction to reason. God created the world, so it’s not surprising that evidence of what He expects of us should be present there. The Catholic Church thus defends the moral outlook known as “natural law philosophy.”

In this understanding of ethics, nature exists as a teleological system that moves under the governance of the Divine Providence. The word “teleological” derives from “telos” and “logos,” two Greek words which combine to mean “the study of purposes.” Catholic philosophy, in its most representative form, sees nature as a realm of purposeful motion in which all things are drawn to the good by the mind of God.

The purposes of nature show themselves in the activities of everything that exists. The spider spins a web for the sake of catching the fly. In doing so, it fulfills its own purposeful activities, which in fact involve highly complex behavior.

Even nonliving things have purposes. Were it not for gravity, the planets would not have been drawn together to form habitable worlds. Without planets, life would not have appeared. If life had not appeared, there would have been no animals — including rational animals like you and me — and therefore no arts, sciences, culture or religion.

Nature is purposeful. This is immediately obvious to any reflective mind. Certain truths of our faith can only be known through revelation, but the common moral code that God has made known to us in nature is given equally to everyone. The Ten Commandments is the essential summary of the natural law as it applies to human society, but Moses should not have had to bring those famous tablets down from the mountain. We all know these already.

Natural law morality is metaphorically described as “written on the heart,” but in fact it is known by the mind. If nature moves under the governance of the Supreme Being, then the goods toward which we are drawn are the natural aims of human action. The love of the opposite sex, for example, is a good towards which men and women are naturally attracted. From this desire there derives the objective truth that men and women are suited for marriage.

The goods of nature are purposes that move us to action. We are free to choose from among a wide range of goods, but we are not free to determine whether or not these things are goods. I may choose not eat broccoli or cauliflower, but I cannot choose to give up eating altogether. Food is a natural good of human beings. To starve myself would be to violate a fundamental law of nature.

Under the teleological conception, morality is objective. What is right and wrong can be deduced from reflection on the purposes that God has made evident to reason in nature. The laws of nature are evident to reason and therefore universally binding on all human beings — Catholic and non-Catholic alike.

Perhaps there is no better example of the respect that the Church has shown philosophy than the First Vatican Council’s affirmation that every Catholic must hold de fidei (the highest standard of fidelity to the faith) that God’s existence is evident to reason. The Council affirmed that the human mind can know, independently of scripture, that there is a Divine Being. Think about that for a moment. We must hold that God’s existence is evident through reflection on nature. This doesn’t mean that every individual Catholic must find this type of philosophical argument persuasive, but only that all Catholics must affirm that this type of knowledge is possible. Behind the metaphysical idea of nature as a teleological system there lies the philosophical conviction that God governs the world as the Divine Providence.

So when someone says that Christianity is about making a leap of faith, remember the role of philosophy within Catholicism. Catholics don’t leap while floating in space without any means of support, but do so only after planting our feet on the firm ground of reason.

EDWARD J. FURTON, PH.D., is the director of publications for the National Catholic Bioethics Center.

Who lives, who dies, who decides?

Marie Hilliard: People who want a ‘perfect life’ will even kill children . . .

Marie T. Hilliard

Marie T. Hilliard

We live in a culture that perpetuates the myth that we can have a perfect life. Baby Boomers embraced the fable that they can control everything, including life and death. After all, technology has provided such great advances that children can be engendered on demand.

If less than perfect offspring are identified before birth, they can be eliminated. In the Netherlands, parents have the option of “after birth abortion” — also known as murder or infanticide. This has evolved into a cultural mindset that deems less-than-“perfect” persons — such as those with disabilities and the elderly with dementia — as unfit to live, or at least unworthy to have equitable access to health care resources.

As we witness the generation that embraced abortion-on-demand advancing in age, will this generation now be the subject of the next generation’s similar approach to the frail or disabled elderly?

As faith is being driven out of the public square, the concept that suffering can have meaning is increasingly alien to our culture. Many of us remember being formed by faithful nuns. They showed us how suffering can have meaning when united to the cross. How often did we hear, “Offer it up” — especially for the poor souls in Purgatory?

We live in a culture that only accepts the redemption that is falsely depicted as a perfect life in this world. Public policy makers, including elected officials, are merely products of our culture whom we’ve empowered to represent us in the public square; and as these polices unfold, there is growing evidence that the only acceptable way to deal with suffering is to abandon or eradicate the sufferer.

The evidence is everywhere. Studies demonstrate that in vitro fertilization (IVF) is being used by some parents to accomplish preimplantation genetic diagnosis on their very own offspring. A recent study indicates that 42% of the centers that engage in such lethal procedures will do so for sex selection. This move toward designer babies is a clear indication of a eugenic mentality, where only the flawless are allowed to live. No one can ignore the changing attitudes on how we treat the frail elderly and persons with disabilities.

Three states have legalized physician-assisted suicide (PAS): Oregon, Washington and Vermont. Montana decriminalized it through court order. The frightening fact is that there is a trend progressing toward active euthanasia, which is the case in the Netherlands. And if one looks at the statistics from Oregon, the data give great pause. Despite the fact that Oregon law mandates that a physician require a psychological evaluation of a patient if there is any question of whether a mental health condition may be causing the person to want to die, of the 673 persons assisted to die, only 42 were referred for such an evaluation.

What person wanting to end their life is not experiencing a treatable depression that could be alleviated if someone merely accompanied them in their suffering? Furthermore, Oregon law will not allow family members to be told of the request without explicit consent, nor allow the death certificate to list anything other than the underlying pathology as the cause of death. Thus, the frail elderly and disabled may easily be convinced by an exhausted or greedy family member that to kill oneself might be in everyone’s best interests.

Then enter the government with its own eugenic version of health care reform. The Affordable Care Act (ObamaCare) supports programs that provide abortion-on-demand and requires employers to provide employees with contraceptive and abortifacient drugs. It also penalizes health care providers who, in caring for the elderly and disabled, are costing the government too much money. There are penalties for hospital readmissions for the same diagnosis within a 30-day period. There is a 15-member Medicare Advisory Panel which will determine reimbursement polices on cost effectiveness.

The evidence is clear: Social policy is dictating who is worthy to be accompanied in their suffering and who is to be eliminated as too great a burden to our society. This is heralding a whole new approach to the sufferer and with it the denigration of our humanity. As Pope Benedict XVI wrote in Spe Salvi : “The true measure of humanity is essentially determined in relationship to suffering and to the sufferer. This holds true both for the individual and for society. A society unable to accept its suffering members and incapable of helping to share their suffering and to bear it inwardly through compassion is a cruel and inhuman society” (II, 38).

If we do not accompany the sufferer, and even worse, if we eliminate him from our midst, we have become a cruel and inhumane society.

MARIE T. HILLIARD, JCL, PhD, RN, is a staff ethicist at the National Catholic Bioethics Center.

Making tough end-of-life decisions

John Haas writes that Catholics should be equipped to address end-of-life questions . . .

Dr. John Haas

The National Catholic Bioethics Center provides over 1,400 consultations in a given year. Without a doubt, the issue most often raised with our ethicists has to do with making difficult, sometimes heart-wrenching, decisions at the end of life.

Catholics, however, should be the best equipped to address these challenges calmly. After all, we know that our final destiny lies not here but in the life beyond the grave. Also, how many times a day do we bring up our own death when we pray the Hail Mary? And then there’s the wonderful Catholic devotion of praying to St. Joseph for a holy death.

Nonetheless, when we face the challenge of making decisions for our loved ones, it can be very difficult. We don’t want them to suffer on the one hand, and we don’t want to lose them on the other. We’re also sometimes conflicted because we don’t know exactly what the Church would have us do.

Because of our love for life, many Catholics think the Church insists that we use every means available to keep someone alive as long as possible. This is not the case. The U.S. bishops have issued a guide known as The Ethical and Religious Directives for Catholic Health Care Services. This useful document, however, cannot tell Catholics exactly what must be done in every situation. Decisions must be taken in each individual case — and there are countless details that can enter into each situation.

For this reason, the Church generally discourages the use of a “living will” or “advance medical directive” which presume to state what one wants at the end of life (for example, “I do not want tubes”). However, one cannot know ahead of time whether the “tube” will alleviate suffering or assist in significantly extending one’s life. This is why we at the Center encourage people to designate a “health care proxy,” someone to make decisions on their behalf when they’re no longer able to do so.

One time I received a “living will” from a parish priest who asked me to read through it to see if it was ethically sound. He had written 27 pages, single-spaced, about what medical interventions ought to be taken if this or that happened. I wrote him back and said, “Father, I have one criticism of your living will: It’s not long enough!” It was not long enough because we simply cannot anticipate all the problems that could arise. That’s why it’s better to designate a trusted friend or family member who can make such decisions when you can’t.

But what about some specific advice our tradition can give us? Directive 56 of the Directives reads: “A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.” This is a very helpful guideline for Catholics, and it’s obvious that the facts of the case can vary with each individual.

It’s important to note that the judgment with respect to what would constitute an excessive burden or an excessive expense rests with the patient. It might be that the patient simply doesn’t believe that an experimental cancer treatment which has terrible side-effects and which might extend his or her life for two months offers a “reasonable hope of benefit.”

Or the patient might prefer that family resources be used to send his last child to college rather than be used on an experimental treatment. This ought to be a judgment made by the patient, not by an insurance company or a governmental agency!

And one step we should certainly take near the end of our earthly pilgrimage is to call a priest to bring the comfort and joy of the sacraments of Reconciliation and Anointing.

The bishops’ Directives remind us that we must ultimately be prepared for eternity. “The dignity of human life flows from creation in the image of God, from redemption by Jesus Christ, and from our common destiny to share a life with God beyond all corruption.” The only thing that could risk the loss of that shared destiny is sin.

The bishops’ Directives are available at the USCCB website or through The National Catholic Bioethics Center. The Center also provides the simple and easy to understand Catholic Guide to End of Life Decisions, which includes a form for an “advance medical directive” or the designation of a “health care proxy” which conforms to Catholic moral teaching.

John M. Haas, PH.D., is president of the National Catholic Bioethics Center and founding president of the International Institute for Culture. He is a member of the Pontifical Academy for Life.

Value-driven service and spending

John Di Camillo writes that we have the obligation to avoid compromising our faith and values . . .

John Di Camillo

The Riverbend Bed & Breakfast in Canada denied a double bed to homosexual couples and offered them separate rooms, citing their objection to abetting immoral sexual practices. It was sued for discrimination. Courts could not grasp the distinction between sexual orientation and practice. The business was fined and had to close.

Jim and Mary O’Reilly, Roman Catholic owners of the Wildflower Inn in Vermont, were sued after their events manager inaccurately informed a lesbian couple that the inn would not host receptions for homosexual marriages. To comply with anti-discrimination laws, the inn’s actual practice was to disclose the owners’ opposition to same-sex marriage but not to deny service. Nonetheless, under the settlement, the O’Reillys must pay $30,000.

Many argue that business owners’ and consumers’ beliefs and values should have no impact on economic decisions because engaging in commercial activity entails a tacit prohibition on manifesting religious belief or moral values. Yet this position constitutes implicit acceptance of the belief in a moral exemption for commercial activity and the value of material goods over spiritual goods.

In his encyclical letter Caritas in Veritate, Pope Benedict XVI instead reaffirms that economic activity “needs to be directed towards the pursuit of the common good” and therefore “must be structured and  governed in an ethical manner.” This is because “the economy needs [person-centered] ethics in order to function correctly.” We must acknowledge and participate in commerce as Christian witnesses, responding to Paul’s call “to live sober, upright, and godly lives in this world” (Titus 2:12) while ever mindful of his warning not to be conformed to this world (see Rom 12:2).

The social responsibility of businesses entails stewardship of resources, respect for employees and consumers, and promotion of the common good through policies, services and products. Benedict’s encyclical confirms that the consumer likewise “has a specific social responsibility, which goes hand-in-hand with the social responsibility of the enterprise,” because “purchasing is always a moral — and not simply [an] economic — act.” In a free market system, the array of choices means I might purchase a comparable quality product at a comparable price from a different vendor; and if, with minimal inconvenience, I can patronize the one that better promotes human dignity, then I am morally impelled to do so.

The practical impact of purchasing decisions on the behavior of a large enterprise is negligible if taken alone. However,  as the Holy Father notes in Caritas in Veritate, “global interconnectedness has led to the emergence of a new political power, that of consumers and their associations.” Consumers working together can acquire the clout of an investor and challenge injustices in business — this is the power of a boycott. Life Decisions International, which researches and publishes The Boycott List, claims that 287 corporations have withdrawn funding from Planned Parenthood as a result of the coordinated efforts of pro-family people, causing estimated losses of over $40 million.

Alternatively, consumers can actively favor businesses. Chick-fil-A Appreciation Day was a resounding success on Aug. 1. Over 650,000 confirmed RSVPs, showing strong support for the company’s CEO, Dan Cathy, who had affirmed the natural and biblical understanding of marriage. The company confirmed that it generated record sales that day, reflecting the constructive witness of consumers to good values while integrating multiple facets of human activity.

Given the relevance of morality to economic activity, is there an obligation to boycott every business that supports evil or to refuse every client who may abuse a service? An absolute yes or no would be reassuring but inaccurate. The clear imperative is never to do evil that good may come (as Paul tells us in his letter to the Romans), but cases of foreseen evil following from otherwise good or indifferent actions are more nebulous. The principle of material cooperation with evil provides helpful guidance but requires case-specific assessments about the moral distance of causal associations, the moral gravity of the evil, proportionate reasons, and other factors. Careful discretion and prayer must guide these practical judgments.

When it comes to business services and spending, we cannot participate in every good cause or prevent all possible evils. Yet each of us has the obligation to avoid compromising our faith and values, to object to unjust impositions of the civil law, to avoid misrepresentation and scandal, and to work ceaselessly to turn ourselves, our habits, our families, our work, our businesses, and our communities more toward the respect of a fruitful culture of life, recognizing and pruning away what is harmful as best we can.

John A. Di Camillo is a staff ethicist at the National Catholic Bioethics Center in Philadelphia.

With liberty and justice for some?

Marie Hilliard contends that the HHS mandate is unfair and unconstitutional . . .

Marie T. Hilliard

With the economy in the doldrums, times are difficult enough for businesspeople. Americans now have to decide whether to violate their consciences or a federal law. If left unabated, these dilemmas will continue — even if the U.S. Supreme Court rules that the Patient Protection and Affordable Care Act is unconstitutional.

In a social system that is increasingly hostile to our free market heritage, hostility is also growing toward the Catholic Church. When seeking to insert faith-based values into public policy debates, Catholics often are accused of violating the separation of church and state. Nothing could be further from the truth. “The most significant aspect of the separation of church and state is not, as some seem to think, the shielding of the secular world from too strong a religious influence,” according to Yale constitutional law scholar Stephen Carter. “The principal task … is to secure religious freedom.”

During his 2010 visit to the United Kingdom, Pope Benedict XVI spoke of St. Thomas More’s integrity in following his conscience. “Each generation, as it seeks to advance the common good, must ask anew: What are the requirements that governments may reasonably impose upon citizens, and how far do they extend?

“There are those who would advocate that the voice of religion be silenced, or at least relegated to the purely private sphere….And there are those who argue — paradoxically with the intention of eliminating discrimination — that Christians in public roles should be required at times to act against their conscience. These are worrying signs of a failure to appreciate not only the rights of believers to freedom of conscience and freedom of religion, but also the legitimate role of religion in the public square.”

This has been seen blatantly in the U.S. Department of Health and Human Services (HHS) mandate that the employers provide — at no cost to their employees — contraception, sterilization, and abortion-inducing drugs and devices. Furthermore, religious or faith-based ministries may be exempted only if they evangelize, employ and provide services primarily to their own members. Only three states with laws mandating such employee prescriptive coverage define a religious agency as narrowly as the HHS mandate: Oregon, New York and California.

However, state laws do not impact self-insured plans under the Employee Retirement Income Security Act, under which many Catholic dioceses are regulated. The HHS mandate will negate this protection. It’s clearly disingenuous for the federal government to state that it’s mimicking state laws already in existence. Clearly our Gospel-mandated ministries are under attack.

But what about the private employer? Shouldn’t they also have conscience protection under the law? Of course! That’s why it’s so appropriate that Legatus has filed a lawsuit against the HHS mandate, reflecting the need to protect businesspeople from HHS’s violation of religious liberty. (Click here for related story) Yet attacks against the consciences of private employers, employees, and businesses existed before there was an HHS mandate — and they continue.

A fertility practice that limited its practice to married couples was ordered by the California Supreme Court in 2008 to provide service to lesbians despite the physicians’ religious objections. In New York, a nurse was forced in 2009 to assist in a not-immediately-life-threatening abortion after having given all the appropriate notice of such objections. Her supervisor threatened her with actions against her nursing license. The court determined that the nurse had no right of private action against her employer.

Twenty-five states have passed legal mandates requiring pharmacies to provide emergency contraception to customers. Fortunately, brave pharmacy owners in Washington stepped up to the plate to challenge this injustice. The courts recently reversed the position of the Washington State Board of Pharmacy after the Becket Fund, representing the pharmacists, got the Board’s anti-conscience position reversed. However, the state’s attorney general is appealing the decision.

Where is Thomas Jefferson when we need him? “Our rules can have authority over such natural rights only as we have submitted to them. The rights of conscience we never submitted, we could not submit. We are answerable for them to our God.”

All of us — particularly lay people — need to echo this assertion: “We cannot submit; we will not submit. Our conscience is answerable not to the state, but to God.” We cannot accept that there be liberty and justice only for some. Persons of faith can lay claim to the “first right” guaranteed by the First Amendment of the U.S. Constitution — the right to religious liberty. We can and we must.

Marie T. Hilliard, JCL, PhD, RN, is a staff ethicist at the National Catholic Bioethics Center.

Odd things said about embryos

Ted Furton writes that about 50% of children conceived do not implant and thus die . . .

Ted Furton

One of our failures as human beings is the inability to conceive of God in his full greatness. This is not really surprising, given that we have finite minds. But one would hope that we might at least imitate the wisdom of Socrates who said, “All I know is that I know nothing.”

When it comes to theology, we apparently know a lot more than we should. God has arranged the world as it is, but we sometimes put ourselves in the position of telling God how we might improve upon his work. We ought, instead, to appreciate the mysteries that nature poses to our minds.

Complaints against God concerning bioethics cover a wide range of topics, but one of the areas that is regularly troublesome concerns the apparently ruthless way in which nature treats the embryo. It’s well known in scientific circles that an extraordinary number of embryos perish shortly after conception. According to studies, as many as 50% or more of human embryos do not implant in the uterus or otherwise die. This is often perceived as a horrible “blotch” on the face of God, and yet, those are the facts.

Some see this as proof that there cannot be a Divine Being. Others say that, if we Catholics were serious about human life, we would see this loss as one of the greatest tragedies of our time and work tirelessly to prevent it from happening. I’ve heard some say, in so many words, that “until you can explain how God could allow this to happen, I will never be a Christian.”

Apparently God is not living up to our standards. And yet, is it all that surprising that the Supreme Being would show his power in terrible and frightening ways? We like to think of God as a purely benevolent being whom we hope will one day judge us lightly, but that benevolence also has a fearsome side. The world is filled with enormous suffering. Compared against that backdrop, the high loss rate among embryos is but another and rather minor example.

As Catholics, we hold that at death the soul continues to exist in the presence of God. The body, perfected by God’s grace, will eventually rejoin the soul at the final judgment. With confidence in God’s great mercy and love of innocence, we rightly hope that these tiny embryos, who barely have any experience of earthly life at all, will join the ranks of those who stand in eternal chorus praising God.

Although some might find God’s decision to allow this loss of life incomprehensible, to be a person is an inestimable blessing — even if we live for only a moment. In view of our final destination, where is the harm? Let’s suppose that these embryos are minimally aware and so experience some measure of suffering at death. To be brought into being out of nothingness, and to exist as a person, is to be given a supreme gift. Given our eternal destiny, where is death’s sting?

Where life can be saved, it falls to us to try. But the high rate of loss among embryos reminds us that the things of this world, including our own earthly lives, are passing. These embryos, in a sense, have been given a great gift at little cost. It is as if they have been specifically made for heaven.

Still, some say that it’s more reasonable to suppose that what exists at this early stage is a “pre-embryo” or a “potential person.” Such a hypothesis thereby resolves the “moral alarm” that embryo-loss causes because these are simply not “persons.” Others say there cannot be a person from conception because of the possibility of twinning. How could one person become two people? Until the possibility of twinning has passed (somewhere around 14 days post-conception), we shouldn’t talk about an embryo as a person.

This view, however, doesn’t conform to the empirical data. Late-stage twinning (after 12 days) typically results in conjoined twins. Here the bodies of two individuals have not yet managed to fully separate, yet no one doubts that they are two unique persons. If personhood were impossible before the possibility of twinning had passed, how could these be two persons when their bodies have not successfully completed the process?

The more plausible view is to say that there is indeed a person from the moment of conception, but that when twinning occurs, a second soul is infused. The bodily matter, at that point, is shared temporarily between the two persons. One person does not become two people, but one set of bodily materials houses two souls until the separation of twinning is complete. Thus a person does exist from conception, and a second person appears later as a twin.

So it appears … but I wouldn’t want to tell God how to conduct his business.

Edward J. Furton, PH.D., is the director of publications for the National Catholic Bioethics Center.

Caring for victims of sexual assault

Dr. Marie Hilliard discusses the Catholic ethical position on caring for rape victims . . .

Dr. Marie T. Hilliard

Dr. Marie T. Hilliard

Historically, those subject to the canonical penalty of a latae sententiae excommunication for abortion were the doctor and woman who consented to the surgical procedure — and those who cooperated with it by either causing the abortion to happen (a coercing parent or boyfriend) or making it possible (the anesthesiologist).

With the advent of drugs which induce non-surgical abortions, the Pontifical Council for Legislative Texts clarified in 1988 that abortion includes the destruction of the embryo or fetus any time after conception. Thus, the health care professionals who prescribe, dispense or administer interceptives — which interfere with the embryo before implantation (intrauterine devices and the “morning-after pills”) or contragestatives which eliminate the implanted embryo (RU-486) — also would be subject to canonical penalties if there is certainty that a completed abortion has resulted and the conditions for such penalties were present.

The use of Plan B or any other “morning after pill” for the purpose of avoiding conception following consensual sex is contraceptive in nature and is rejected by the Church. Many Catholics are surprised to discover that sexual assault is another matter. The issue of sexual assault is not addressed in the Vatican’s new bioethical document, Dignitas Personae, so sound moral reasoning has to be used to determine which protocol is morally acceptable for the administration of emergency contraceptive drugs. The U.S. Conference of Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services (ERD) states:

“A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction or interference with the implantation of a fertilized ovum” (#36).

Thus, it would be moral to administer medications to prevent conception from a sexual assault. The question remains: What protocol would be moral in accomplishing this good without endangering the life of the potentially conceived embryo?

The primary action of the Plan B “morning-after pill” (sometimes referred to as emergency contraception or EC) is anovulatory. It suppresses ovulation — the release of the woman’s ovum — preventing the engendering of an embryo. However, depending on when the medication is administered, Plan B also may prevent the implantation of a conceived embryo in the uterus, thus acting as an interceptive.

Dignitas Personae states that “scientific studies indicate that the effect of inhibiting implantation is certainly present, even if this does not mean that such interceptives cause an abortion every time they are used, also because conception does not occur after every act of sexual intercourse” (#23).

Some hold that EC may never be administered to a victim of sexual assault unless one definitively could determine the day of the victim’s reproductive cycle. They cite research indicating that it does not always prevent ovulation, but if administered during or around the time of ovulation, precipitates a disruption in the complex mechanisms of the endometrium, negatively impacting the implantation of any conceived embryo.

Others hold that before the administration of EC, all that is morally required is a negative pregnancy test. However, pregnancy test results become accurate only after implantation, about 10-14 days after ovulation. A pregnancy test performed within 72 hours after the assault (the optimal time period for effective EC administration) cannot indicate whether conception has or will result from the assault. These proponents cite research indicating that EC will not disrupt or harm an implanted embryo, and studies indicating that any effect on the endometrium is insufficient to prevent implantation. However, there is credible research to the contrary.

The National Catholic Bioethics Center holds that administration of EC must be consistent with ERD (#36) —to “prevent ovulation, sperm capacitation or fertilization.” Current research indicates that the impact of EC on sperm capacitation is not fast enough to prevent fertilization. Therefore, the only reason for which EC morally can be given is to prevent ovulation. The key is to have as much medical certainty as possible that ovulation can be prevented in the particular patient in question. EC alone is unable to prevent ovulation once the surge of luteinizing hormone (LH) stimulates ovulation and the pregnancy-test-only protocol does not tell us whether this surge has begun.

Adding an ovulation (LH) test to the protocol indicates whether ovulation is occurring or imminent. With a positive ovulation test, one may conclude that EC will not prevent ovulation and that conception likely could take place with the potential for the disruption of embryo implantation. Some would go further and argue for a serum progesterone test, which would determine the pre- or post-ovulation day more accurately. However, equipment for such testing is not readily available in many emergency rooms.

Furthermore, if undetected “breakthrough” ovulation does occur, despite the administration of EC in the presence of a negative LH test result, the conditions for the moral administration of EC under the principle of double effect would have been met. Any minimal potential for harm would be an unintended consequence of the legitimate desire to suppress ovulation.

Marie T. Hilliard, JCL, PhD, R.N., is a staff ethicist at the National Catholic Bioethics Center.

Death in a test tube

Dignitas Personae takes on bioethical concerns including freezing human egg cells. . . 

Fr. Alfred Cioffi

Fr. Alfred Cioffi

The Vatican examines the treatment of human embryos in its bioethics document Dignitas Personae, released late last year. The document takes on a myriad of bioethical concerns including freezing oocytes (immature ova or egg cells), the reduction of embryos and preimplantation diagnosis. Though none of these procedures is new, they have drawn the Vatican’s attention and that of Catholics around the world.

Freezing oocytes

Sperm banks have been freezing and thawing sperm (cryopreservation) for over 40 years. Freezing and thawing eggs (oocytes or ova), however, has been more difficult, mostly due to their much higher water content which tends to expand and contract during the process, thus destroying the cell. But earlier this decade, scientists began reporting success in cryo-preserving human eggs to the point that there are now also egg banks.

Theoretically, freezing human eggs is not intrinsically evil since there are some clinical settings in which a woman might benefit from such a technique (for example, to evaluate some aspect of her fertility that is otherwise impossible to ascertain). That is why, in making its moral evaluation, Dignitas Personae (DP) focuses on the intention for freezing a human egg. If the purpose is for in vitro fertilization (IVF), then the procedure is morally tainted. “In this regard it needs to be stated that cryopreservation of oocytes for the purpose of being used in artificial procreation is to be considered morally unacceptable” (DP #20). Emphasis in the original.

In June, New York’s stem cell board agreed to use public funds to pay women who donate their eggs for research. However, there are serious risks involved: Ovarian hyperstimulation and egg retrieval are dangerous and can be fatal. They can only be justified for extremely grave reasons. Women are often exploited for their eggs through financial incentives, which is the case in New York.

Embryo reduction

In a normal IVF procedure, typically three to four embryos (blastocysts) are inserted into the woman’s uterus; on average, only one implants. The other two or three are discarded by her body. There are times, however, when two, three, four or even more of the embryos implant. Because the woman or couple only wanted one child, they are offered the choice to terminate the “excess” embryos. In order to make an informed choice, the embryos or fetuses in her womb are tested for genetic defects and for gender. They can then select to abort the ones that might be carrying some genetic defect or are the “wrong” gender.

To intentionally kill a human being, no matter how early in development, is a grave moral evil. When this is done on the basis of the intentional selection of inheritable traits, it’s called “eugenics” and has serious consequences for all of society. “From the ethical point of view, embryo reduction is an intentional selective abortion. It is in fact the deliberate and direct elimination of one or more innocent human beings in the initial phase of their existence and as such it always constitutes a grave moral disorder” (DP #21). Emphasis in the original.

Preimplantation diagnosis

Preimplantation diagnosis (PID) is a type of prenatal diagnosis involving the three-to-four-day-old embryo before implantation (thus, PID is associated with IVF). Typically at the eight-cell stage, while the embryo is still growing in a Petri dish in a lab incubator, a single cell is plucked out and sent for genetic testing (karyotyping) and gender determination. The results can be used to choose for or against implanting that particular embryo.

This is another form of eugenics. In addition, there are further grave considerations for condemning PID: First, since each cell has the capacity to develop into a whole new embryo, extracting one cell (which could in fact be creating a new human being who will then be destroyed during the genetic analysis), another abortion will have occurred.

Second, there is no solid evidence yet that extracting a cell at this stage does not cause significant damage to the early embryo. To find out with certainty would require even more human embryo experimentation, which would be a gross violation of human rights.

Third, PID genetic testing is not accurate science, leading to the real possibility that many “normal” embryos will be killed due to false positive results (that is, that they indicate anomalies where there are none). Also, lethal selection based on gender is a grave intrinsic evil which should be self-evidently abominable.

“Preimplantation diagnosis, connected as it is with artificial fertilization — which is itself always intrinsically illicit, is directed toward the qualitative selection and consequent destruction of embryos, which constitutes an act of abortion” (DP #22). Emphasis in the original.

All three procedures — egg freezing, embryo reduction and preimplantation diagnosis — are closely associated with IVF, which has drastically negative consequences for human embryos, the parents who choose this method, the medical profession and society at large. Hence, it is imperative for people of influence (and all people of good will) to speak up against the IVF industry and its associated technologies, which is leading the contemporary developed world into eugenics. What makes the nefariousness of this eugenics even more urgently condemnable is the fact that IVF gives the appearance of being pro-life, but is not.

Rev. Alfred Cioffi, STD, Ph.D., is a staff ethicist for the National Catholic Bioethics Center.