The liceity of deactivating pacemakers and implantable cardio-defibrillators at the end of life has been considered only recently. The current discussion divides into two main camps: those who view deactivation as the moral equivalent of the withdrawal of other life-sustaining interventions, and those who hold deactivation as the equivalent of physician-assisted suicide. Some authors contend that similar to a transplanted organ, the pacemaker establishes an organic unity with the human body. Hence, its deactivation is equivalent to the removal or disabling of an organ. On the contrary, the relationship of a pacemaker to the human body is similar to other supportive mechanical devices. There are burdens associated with the presence of these devices. In the face of a terminal diagnosis, the deactivation of a cardio-pacemaker is morally similar to the withdrawal of other extraordinary measures currently accepted within the Catholic moral teachings.

Over the past few years The National Catholic Bioethics Center (NCBC) has received numerous inquiries from Catholic school principals and superintendents asking for guidance on how they can (1) respond to gender ideology in their schools and (2) address the particular challenges that arise when a student (or parent) announces that he or she is transgender. In the absence of specific, practical guidance on these issues from the US bishops or the Church universal, these administrators are confused and often at a loss for what they should—and should not—do. The NCBC reviewed various Catholic school policies concerning transgenderism to identify best practices. The following list is neither complete nor exhaustive. Instead it is presented as a guide or framework for other schools to use in drafting their own policies in response to this powerful, but erroneous, social trend.

Genetic enhancement runs up against several moral issues, perhaps the chief of which is the inevitable eugenic attitude it would foster and the associated inequality it would create between those who have the “proper” enhancements and those who do not. For simplicity’s sake, this analysis leaves aside questions related to genetic enhancement and considers only changes made for therapeutic purposes. Regardless, most of the censure of He Jiankui focuses on the results of human modification and often overlooks the prior question of how gene editing research itself conducted. Germline gene editing in humans is not safe or morally licit under current practices and technology, because of its reliance on technologies such as IVF, the danger to and destruction of the embryos used, and the unknown consequences of changing the germline.

On May 17, 2019, the United States House of Representatives passed the Equality Act by a vote of 236 to 173. This bill is touted by supporters as a necessary measure to protect individuals from unjust discrimination based on sexual orientation or gender identity. Yet, when one reads the bill it very quickly becomes evident that it goes far beyond this stated claim. There are many harms that arise from the so-called Equality Act.

The very first amendment to the United States Constitution protects not only the freedom to worship as one wishes, but the free exercise of religion within society. But increasingly, some medical ethicists, and clearly many employers, are coercing health care providers to leave their religious beliefs in the locker when they don their scrubs or lab coats. The examples of conscience violations are staggering: in states where physician-assisted suicide is legal, palliative care physicians are told that they must implement such procedures; medical students are given poor grades for refusing to participate in sterilizing procedures; and in egregious violations, employers coerce nurses to participate in abortion. The new rule promulgated by the US Department of Health and Human Services protects not only health care providers, but other health care entities as well.

Proponents of euthanasia and assisted suicide suggest that animals are treated better than humans because we can “put down” animals when they become lame, sick, or old. Veterinary practice includes euthanasia as a kindness to dumb animals who are suffering. Why do we not do this to humans? Christianity has the definitive answer. God created human beings in his image, bestowing dignity on us that is not based on our abilities or competence. The founding fathers of our great nation recognized the self-evident truth that all human beings “are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life.” Suffering and dependency on others, therefore, does not cause human beings to lose their inherent dignity, nor does it justify taking another human life or forfeiting our own.

The Catholic Church missed an opportunity to be more proactive and change the course of secular biotechnology when unethical cell lines were first introduced several decades ago. No ethical alternative human cell lines to the HEK293, WI-38, and MRC-5 have been generally accepted by the scientific community. While some animal cell lines are used in creating safe alternative vaccines, no alternative human cell lines for producing vaccines, biologics, or gene therapy have met the scientific rigor of efficacy and safety of these cell lines. It is both possible and within reach to create ethical human cell lines to replace current morally objectionable lines used for producing biologics (proteins and vaccines), but it will take considerable research that requires financial support. Dignitas personae should be backed by leadership and supported by stakeholders.

While the concept of safe injection sites, which are geared toward addressing harms related to illicit drug consumption and addiction, has been around for several decades—such facilities were operational in the Netherlands as early as the 1970s—it has again been brought to the fore due to developments in California. Other large American cities, such as Philadelphia, have also proposed such sites. The debate over these sites often takes a public policy focus, weighing societal costs and benefits, but these ultimately fail to justify moral liceity. After describing what safe injection sites are and what they seek to accomplish, a general argument in defense of these sites will be constructed based primarily on Andrew Hathaway and Kirk Tousaw. I will argue against such facilities because they are ultimately founded on a framework with a fundamentally flawed consequentialist outlook and because they encourage illicit cooperation in immoral acts.

Should a person with same-sex attraction live chastely? Can a person with SSA live celibately? Should a person with SSA be ordained? Care has to be taken in asking such questions, remembering that the person with SSA should be treated fairly and with equality. We could also ask these questions of heterosexual persons. In line with current pronouncements of Church teaching, the priestly life appears unsuited for persons with deep-seated SSA. If the SSA is transitory or passing, and the candidate is open to be formed, then there may be no impediments to future ordination. Where the same-sex feelings lie somewhere in between, careful and prudent discernment (as for heterosexual candidates, too) is needed.

There was a time when the clergy, medical providers, philosophers, and individuals agreed on how to achieve a happy and holy death. In the fourteenth century, as a response to the horror of the black death, a document emerged that was accepted and adopted by these disparate parties. Translated as the art of dying, the ars moriendi was a set of common instructions and coaching tools to facilitate a peaceful transition for providers and patients alike. The contemporary world needs a new ars moriendi that articulates a triple aim: standardizing the service terms and definitions of hospice and palliative care, promoting early initiation of end-of-life services, and de-emphasizing services provided by intensive care units (ICUs) and emergency departments. If consensus could coalesce around these three goals, the experience of death and dying could be significantly improved.

In response to activists’ demands and new regulations and guidance, some Catholic health care institutions and systems have begun implementing mandatory sexual orientation and gender identity (SOGI) training programs for employees. The National Catholic Bioethics Center is con- cerned that such programs may be heavily influenced by, or adapted directly from, transgender advocacy organizations. If these programs fail to accurately reflect Catholic teaching, they can undermine the witness of the Church and create conflicts of conscience for many in Catholic health care.

Recently, I was a physician-observer in a clinic for children and adolescents who are struggling with gender identity. Since the clinic opened several years ago, the number of patients seen annually has grown well over six hundred. The staff includes an adolescent-medicine physician, a pediatric endocrinologist, a nurse, and a social worker. I spent twenty-four hours over three clinic days observing the interactions of staff and listening to intake synopses of patients and discussions of treatment plans. My aim was to better understand the working diagnosis of gender dysphoria, the protocols used in treatment, and the ethical concerns. These objectives were not achieved in the way I expected.

In July 2018, the United States Conference of Catholic Bishops published the sixth edition of the Ethical and Religious Directives for Catholic Health Care Services. While only part 6 of the ERDs was revised, the revisions were substantial. These revisions strengthen the role of the local bishop, provide new guidance for assessing collaborative arrangements, and introduce a new consideration for assessment beyond the principles of cooperation and theological scandal—the witness of the Church. This article provides an initial overview of the revisions and some brief commentary on their significance.

The three crucial aspects at the heart of the journey toward healing after miscarriage and stillbirth are pastoral, physiological, and psychological. It starts with drawing close to the heart of Christ so that He can transform our minds, bodies, and souls. The sufferer will move from feelings of abandonment to the knowledge of a powerful accompaniment. This passage toward healing reflects Christ, who unites our humanity with his divinity, meets us in our pain, and accepts us as we are in life. The pastoral dimension guides us toward the God who is love, manifested through peace and mercy. The physiological dimension addresses the physical trauma experienced by the body and keeps mothers connected to their children. The psychological dimension heals the mind following injury by way of continuous renewal and transformation through the love of God.

As consumers of information, we must have the skill to distinguish between hard data and the interpretation of those data. Otherwise we become victims of narratives that are not properly grounded in fact, but are instead informed by speculative conjectures. A post- modern narrative is an ideologically informed viewpoint that is designed to appear convincing whether or not it is rationally grounded. The sophistication of the flow of information and its overwhelming abundance can make it difficult for the reader or listener to identify postmodern narratives, which present themselves as reflections of science when in fact they cannot be substantiated through the best scientific methods. One of the more subtle and dangerous areas of this postmodern approach to truth is the ease with which computer modeling can be altered to suit a researcher’s biases.

How much certitude is warranted in bioethics? According to Aristotle and St. Thomas Aquinas, it is the mark of an educated man to seek that level of certitude that is appropriate to a particular arena of human experience. Thus, for the ancients, it would be foolish to expect the same level of certitude in psychology, the study of human behavior, as one would expect in mathematics, the study of number and quantity. By the very nature of their subject matter, fickle human beings in psychology and stable unchanging quantities in mathematics, less certitude is attainable in the former than in the latter. Given the contingent nature of the types of judgments common in bioethics, therefore, it is not reasonable to expect metaphysical or physical certitude in this arena of human conduct. Moral certitude can and must suffice.

For millennia, gender identity did not generate much confusion. In every epoch it has been accepted that one is either male or female. Gender confusion is a modern phenomenon, caused by the advance of gender ideology, an attempt to radically sever biological sex (the condition of being male or female) from the outward cultural and social expression of sex (gender). In doing so, it gives free rein to sexual expression, including homosexual and bisexual activity. This is clear from recent attempts to enshrine these concepts in national legislation. Various countries, including the United States, Australia, Canada, and the United Kingdom, are now aggressively exporting their ideologies to the developing world.

The Catholic Church has a long history of providing health care, particularly for the dying as an extension of Christ’s command of charity to one’s neighbor. The Western medical tradition has in most ways adopted this approach. However, such an approach is clearly under assault in an increasing secular medical world view dominated by utilitarian ethics and an idea of autonomy that recognizes no moral boundaries. The support for physician-assisted suicide and euthanasia, as well as threats at the beginning of life, can be understood as a logical conclusion to this expansive view, which puts man at the center of all existence. The Christian health profession must answer this movement with reason animated by love.

It is estimated that 90 percent of mothers now opt for abortion, unfortunately, once a diagnosis of Down syndrome is confirmed, in what should be called “extermination of pregnancy.” Instead of denouncing such vile acts, society lauds them in the name of progress and technology. At times Catholic health care workers may be afraid to speak out against abortion. Usually they are presented with difficult scenarios, tragic and morally complex situations where the life of the mother, the life of the child in the womb, or the lives of both are in danger. However, while of vital importance, in developed countries these cases are extremely rare because of the availability of excellent obstetric care. Yet such rare cases are often used as a justification for allowing abortions in general.

Both the principle of double effect and the teaching of the magisterium allow for the use of opioids for the suppression of pain and consciousness as death approaches, even if one foresees that the use of narcotics will shorten life. But the principle of double effect should not be used to justify the administration of large doses of opiates or other mind-altering medications under the assumption that a dying patient should or might be having pain, anxiety, or dyspnea. What makes a dying patient uncomfortable or causes them suffering must be determined and appropriately treated. The assessment should include the following questions: Is the patient experiencing physiological pain? Is the discomfort caused by psychological, emotional, or spiritual distress (suffering)? Or is there a particular distressing symptom that needs to be identified and appropriately treated? Medicine and nursing practice are based on the assessment and treatment of disease and symptoms.