Societies have an obligation to ensure that their citizens have access to health care, but there are disagreements over how this system should be structured. The most contentious issue centers on the morality of specific therapies or actions. In this essay, the author examines the influence of the Patient Protection and Affordable Care Act on private employer health plans. He concludes that the Church’s teaching on the inherent dignity and worth of every human life should be the guiding principle for assessing the relative merits of differing approaches to constructing a comprehensive and equitable system for financing and delivering medical care. The patient’s conscience should be primary. National Catholic Bioethics Quarterly 13.3 (Autumn 2013): 419–426.

In Evangelium vitae, Pope John Paul II writes that the culture of death is the consequence of society embracing a “positivist mentality.” Given both where the Church is culturally situated as well as her call for a New Evangelization, this article offers a critique of positivist mentality that attempts to draw out of its advocates the natural law that is “written in the heart.” This critique includes an analysis of the article “After-Birth Abortion: Why Should the Baby Live?” authored by Alberto Giubilini and Francesca Minerva and published in 2013 in the Journal of Medical Ethics. National Catholic Bioethics Quarterly 13.4 (Winter 2013): 601–609.

The Obama administration’s HHS mandate to force Catholic and other religious organizations to provide insurance coverage for morally objectionable practices has been the source of a great deal of controversy. While the religious liberty question has received the most attention, the mandate reveals a yet deeper problem in the mainstream acceptance of contraception and even abortion as normal parts of medical practice. The author argues that these practices constitute a deep corruption of medicine itself, away from its original meaning as a kind of restorative justice grounded in a substantive understanding of the human good and toward a formalist emphasis on preference satisfaction and patient autonomy. National Catholic Bioethics Quarterly 13.4 (Winter 2013): 625–633.

It can be confusing to define the object of an action because it may be unclear if there is a per se or a per accidens order to the end. Three common difficulties in distinguishing between these are that the per se ordering must be either in the nature of the end or in the act, that this ordering to an end is a real and not merely a logical one, and that technology has a tendency to ignore the teleology of natures by breaking things down to their parts for manipulation. Having drawn these distinctions, craniotomy is then compared to lethal self-defense. National Catholic Bioethics Quarterly 13.4 (Winter 2013): 611–616.

The purpose of this essay is to explain what the terms “formal cooperation” and “material cooperation” mean in the thought of St. Alphonsus Liguori, who is a pivotal figure in the Church’s tradition of reflection on cooperation and is often referenced when the distinction between formal and material cooperation in evil is discussed. The author explains why—and to some extent when—mainstream Catholic moralists who associate themselves with Alphonsus speak of some cooperation as formal and other cooperation as material. Specifically, he discusses two factors that are essential for the analysis of cooperation in evil—(1) the meaning of the term “formal” and (2) the role of “segments of intelligibility” in determining what is material rather than formal cooperation. National Catholic Bioethics Quarterly 13.4 (Winter 2013): 663–675.

Levonorgestrel is widely used as emergency contraception, yet much confusion surrounds its use. Consensus statements and reviews typically attribute its efficacy to prefertilization mechanisms of action (MOAs), such as suppression of ovulation and interference with cervical mucus or sperm function, yet studies do not rule out a postovulatory MOA. To yield greater clarity, the authors review recent scientific studies examining the MOAs of LNG-EC. They conclude that LNG-EC exerts minimal effects on cervical mucus and sperm function and that suppression of ovulation is not the dominant MOA accounting for the contraceptive efficacy of LNG-EC. Luteal deficiencies and endometrial changes reported in the literature strongly suggest a postovulatory MOA when LNG-EC is given during the critical preovulatory (or fertile) period. National Catholic Bioethics Quarterly 13.4 (Winter 2013): 677–716.

Certain scholars wish to acquit St. Thomas Aquinas of the “illicit inference from facts to norms” commonly referred to as the naturalistic fallacy. Seeing in certain passages his awareness of illegitimate ways to derive morality from natural ends, many have come to read Aquinas as agreeing with the view that knowledge of the moral order does not derive from knowledge of human nature and of the natural ends of its parts and powers. This paper aims to expose the deficiencies of this reading as a way of bringing more fully into view the whole thought of Aquinas on the question. National Catholic Bioethics Quarterly 13.4 (Winter 2013): 637–661.

This article offers a critical examination of the notion of the common good in Catholic social ethical teaching, comparing this concept with utilitarianism and examining parallels between them and common critiques of both. Rather than focusing on the common good and trying to reach agreement on its content as a maximum standard for persons and communities in society, we argue that it is preferable to focus on the common harm. The common harm serves as a minimum standard of what causes harm to individuals and communities in society and should be avoided. The common harm provides both a conceptually sound and practically achievable construct for contributing positively to the social ethical discussion in an increasingly secular society. National Catholic Bioethics Quarterly 13.4 (Winter 2013): 617–623.

The authors offer a fresh look at the debate about the use of assisted nutrition and hydration (ANH) in advanced dementia. The philosophical and ethical issues are presented. The importance of distinguishing basic care from medical acts is explained. A key question is addressed: Does ANH nourish and hydrate the patient with dementia? The ANH debate is placed in its cultural context and contrasted with the Catholic response. A clinical analysis of the evidence for benefit and harm of ANH in advanced dementia is given. The authors point out the lack of hard evidence against ANH, discuss questions that need further clinical research, and argue that there is sufficient evidence for a presumption, in principle, in favor of ANH in patients with advanced dementia. National Catholic Bioethics Quarterly 14.1 (Spring 2014): 53–63.

Following new scientific evidence, removal of the fallopian tubes or the ovaries, or both, are options for reducing the risk of ovarian cancer. This paper examines the new scientific evidence on the origin of ovarian cancer and argues that the removal of fallopian tubes or ovaries in high-risk patients for the purpose of reducing risk of cancer is not intrinsically disordered. Although a present and serious pathology may not exist, this removal constitutes an indirect sterilization, because the immediate and primary effect is the reduction in risk of a pathological condition. This effect occurs immediately, directly, and effectively, and sterilization is a secondary effect. The paper then reflects on the subsequent inadequacy of the language of “present and serious pathology” given the new evidence on ovarian cancer. National Catholic Bioethics Quarterly 14.1 (Spring 2014): 67–79.

Through personal testimony, the author details the experience of fathering a baby with a poor prenatal diagnosis. The author invites the reader to follow his journey, from learning his wife is pregnant, through their experiences as a family with their unborn daughter’s poor prenatal diagnosis, welcoming their baby girl at her birth, and ultimately finding peace in her early passing. Perinatal peer support is discussed and encouraged, drawing attention to the needs and concerns of the babies, women, and families who may not know to seek help in a similar situation. Great honor is given to the beauty and sanctity of life from the perspective of a father with a sick unborn child. National Catholic Bioethics Quarterly 14.1 (Spring 2014): 31–37.

Evidence suggests that the nurse’s role as an advocate for patients and for the professional right to conscience is being eroded because of a lack of conscience protections in the Patient Affordable Care Act and because of a faulty understanding in general of the separation of church and state. While the main task of the principle of separation of church and state is to secure religious liberty, the principle is increasingly interpreted in a secularist way to mean that religion must be confined to the home and church and that people of conscience may not object to immoral practices in the workplace or public square. If nurses must risk their jobs to advocate for their patients, patient care will suffer. National Catholic Bioethics Quarterly 14.1 (Spring 2014): 47–52.

Rev. Kevin Flannery, SJ, has helpfully drawn attention to some key sources for magisterial teaching on “vital conflicts,” where interventions to save a mother’s life would involve or lead to the death of her unborn child. However, former responsa by the Holy Office on this topic from 1884 to 1902 need to be interpreted carefully and understood in relation to the context of the time. Recent teaching has indeed clarified that the condemnation of direct abortion is de fide. Nevertheless, in the last forty years, the magisterium has, de facto, tolerated debate among faithful Catholic scholars over the ethics of craniotomy. Appeal to former magisterial teaching is not sufficient to settle this contemporary debate over what constitutes direct abortion. National Catholic Bioethics Quarterly 14.1 (Spring 2014): 81–104.

The term “medical futility” was developed in the 1980s to enable physicians to withdraw life-prolonging procedures over the objections of patients or family members. Using clinical expertise, the physician determines that a particular treatment would be futile in a particular clinical situation. A futility judgment is clear cut when the procedure does not work, but a difficulty arises when a physician believes that a procedure provides too little benefit and then invokes futility. In that case, a patient might consider if the relatively small medical benefit might contribute to appropriately defined goals of treatment, and if so request “extraordinary means.” This article places the concept “medical futility” in relation to the principle of ordinary and extraordinary means, clarifies the concept of futility, and explains the problem of redefining futile means to include procedures that retain some benefit. It advocates very limited use of the term “medical futility” and suggests an alternative reason to withhold or withdraw treatment. National Catholic Bioethics Quarterly 14.1 (Spring 2014): 39–45.

Issues surrounding transsexualism, especially when surgical operations have been performed to achieve the desired sex, can create serious problems for canon law. After an examination of how sex is determined, the author provides a clear explanation of transsexualism and then differentiates it from hermaphroditism, homosexuality, and transvestitism. Transsexualism’s effect on the liciety of marriage is analyzed, followed by an exploration of considerations regarding transsexualism and Holy Orders. Finally, transsexualism and the vowed religious life are examined. The author encourages those faced with such situations to pursue solutions that preserve, as well as possible, the good of the patient and their community, as well as the Church. National Catholic Bioethics Quarterly 14.1 (Spring 2014): 105–118.

In the debates surrounding the Patient Protection and Affordable Care Act, little attention has been paid to definitions of important terms like “health care,” “disease,” and “disorder.” When health care is discussed, one assumes universal definitions of terms and a common understanding of their meanings. But delving deeper into the subject, one finds that a common understanding is lacking. Specifically, the liberal tradition, from which the health care act was derived, defines important health care terms in ways that most people would not. This paper applies Alasdair MacIntyre’s discussion of tradition-based rational enquiry to show that proper definitions of “health care,” “disease,” and “disorder” should be based on the normal functioning of the organs and organ systems of the human body. National Catholic Bioethics Quarterly 14.2 (Summer 2014): 259–272.