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.

The metaphysical status of the placenta has bearing on several ongoing discussions within Catholic moral theology. Numerous bioethicists and theologians have touched on this topic briefly, but to date no robust metaphysical argument appears in the literature. The authors aim to provide such an analysis. First, they provide an overview of the existing literature on the topic. Second, they briefly review the anatomy and physiology of the placenta. Third, they provide metaphysical and biological reasons why the placenta cannot be a part of the fetus, a part of the mother, simultaneously a part of both, the border at which mother and fetus meet, or a separate individual substance. Finally, they provide reasons that support their claim that the placenta is a quasi-substance that exists in symbiosis with mother and child. National Catholic Bioethics Quarterly 14.2 (Summer 2014): 295–333.

In our postmodern, secular, and liberal society, many individuals are struggling with a crisis of meaningful desire. In response, the goal of preaching Catholic bioethics should be to help people to order their desires so that they are all oriented toward their authentic good. This is done by infusing their intellects with truth and by exhorting them to order their appetites and emotions with virtue. Specifically, preachers should speak about bioethics in a way that shows our brothers and sisters that the moral truths of the Gospel will help them to find joy. However, it is not enough to speak about joy. One should never speak about these controversial and deeply personal issues without also speaking about the mercy of God. National Catholic Bioethics Quarterly 14.2 (Summer 2014): 217–226.

The author discusses natural law reasoning, from the 1960s in the context of Pope Paul VI’s Humanae vitae, to recent cultural and intellectual currents and their influence on the tradition. The challenges that have skewed acceptance of a common human nature and the existence of natural law are addressed. The author shows how the debate on contraception initiated this challenge against natural law reasoning and led to a more evolutive concept of human nature. Attention is drawn to a need for natural law theorists trained in both modern science and Thomistic philosophy to engage the different scientific fields to clarify, adapt, rethink, and even modify the natural law language in accord with the latest discoveries compatitible with evolutionary findings. National Catholic Bioethics Quarterly 14.2 (Summer 2014): 245–255.

Whether levonorgestrel taken as an emergency contraceptive (LNG-EC) has an abortifacient effect is a matter of great importance for Catholic bioethics. While many have argued that LNG-EC does not have a postovulatory effect, a recent literature review has convincingly established that inhibition of ovulation cannot account for all of the pregnancy reduction observed in clinical settings among those who take LNG-EC. This essay proposes a secondary mechanism of action of LNG-EC that is postovulatory but prefertilization; it argues that LNG-EC may act in a contraceptive fashion by interfering with transport of the ovum to the site of fertilization in the timely fashion needed for reproductive success. While this mechanism of action cannot be established with the moral certitude required of these matters of life and death, further research may validate this mechanism beyond a reasonable doubt. National Catholic Bioethics Quarterly 14.2 (Summer 2014): 235–244.

Christopher Tollefsen, relying on the new natural law theory, has suggested that in the Phoenix abortion case, the action might be characterized simply as removing the baby rather than killing the baby. Tollefsen and other proponents of the new natural law theory fail to give proper weight to the observable facts of the world around us, and thereby tend to ignore the importance of observable causes in shaping the character of our intentions and our actions. An appreciation of the role of causes reveals that our intentions cannot so readily land on one description of an action and exclude other descriptions. For the Phoenix case, the description “harming the baby” cannot fall outside the doctors’ intention. National Catholic Bioethics Quarterly 14.2 (Summer 2014): 273–293.

An article by Mark Repenshek and a letter by Edward Delaquil published recently in The National Catholic Bioethics Quarterly underscore the urgent need for further moral and magisterial clarification regarding a number of highly complex and difficult bioethical issues. These involve ex utero therapeutic genomic interventions, the practice of in vitro fertilization and embryo transfer, and the ongoing debate over the morality of embryo adoption to help resolve the “absurd” fate of countless, cryopreserved human embryos. This essay critiques and argues against the use of therapeutic IVF, helps clarify why embryo transfer and embryo adoption do not violate the sacred bond of marriage, and uses key magisterial passages from both Donum vitae and the Catechism of the Catholic Church to defend the practice of embryo transfer. National Catholic Bioethics Quarterly 14.2 (Summer 2014): 227–234.

Today, Catholic health care involves complex medical professional organizations, incredible technological and scientific accomplishments, prohibitive costs, and interfering governmental participation. Notwithstanding the challenges presented by the structural transformation of Catholic hospitals in recent years, Pope Francis’s instruction revives the duty of health care professionals to act as missionaries. This essay explores why Francis maintains the importance of building Catholic health care during these changing circumstances. Confronting the penchant of our modern medical culture to marginalize the weakest members of our society, Francis addresses the perils that follow when health care professionals are no longer seen as servants to the dignity of all life. National Catholic Bioethics Quarterly 14.3 (Autumn 2014): 421–428.

The development of hormonal contraception introduced a new era in medical practice, marked by the suppression of female fertility by interventions in the hormonal system. The interventions are very grave, as sex hormones are of existential importance both to preserve human life and to preserve the human species. This article conducts an ethical evaluation of the use of hormonal contraception through two ethical theories: natural law theory and virtue ethics. Based on philosophical reflection, the author examines what effects hormonal contraception has on primary goods and whether its use is congruent with the cardinal virtues. National Catholic Bioethics Quarterly 14.3 (Autumn 2014): 491–524.

When the delivery of a baby at the edge of viability (twenty-two to twenty-five weeks) is imminent, gestational age is usually the primary indi­cator for resuscitation. However, four other variables—female sex, antenatal corticosteroid therapy, singleton birth, and increased birth weight—are also associated with better infant survival and neurologic outcome in intensive care, and the combination of all five variables provides a stronger prognostic tool. An ethical framework is provided here for use in determining whether proposed treatments are likely to defend the dignity and sanctity of a fragile periviable life. The framework is based on the principle of ordinary/propor­tionate and extraordinary/disproportionate medical treatment. The author recommends using the most recent outcome data and this ethical framework together to make perinatal resuscitation decisions. Use of gestational age alone is insufficient and ethically immoral. National Catholic Bioethics Quarterly 14.3 (Autumn 2014): 429–439.

This article explores the evolution of Principles of Biomedical Ethics by Tom Beauchamp and James Childress over its seven editions (1979–2013). Many changes have occurred in the text over the last thirty-five years, including the expansion of the section on virtue ethics, the modification of the authors’ position on physician-assisted suicide, and the addition of many other ethical theories to the original two (deontology and utilitarianism) found in the first editions. The basis for these changes and others seems to be their development of the theme of the “common morality.” The author suggests that Beauchamp and Childress develop the connection between their common morality and metaphysics, as it would serve to strengthen their theory and make it less susceptible to changes in society’s opinions and traditions. National Catholic Bioethics Quarterly 14.3 (Autumn 2014): 459–475.

Approximately 800,000 human embryos are currently in cryostorage in the United States. The Catholic Church holds that in vitro fertilization (IVF) and cryopreservation of human embryos are intrinsically evil. IVF continues to increase at a rate of approximately 9 percent per annum. Many Catholic couples have used IVF as a means to conceive a child. There are typically additional embryos that are cryopreserved for later use. Once a couple has reached the number of children they desire, they are faced with a very difficult moral decision regarding the disposition of their remaining frozen embryos. The biological parents must choose one of four options. Three result in death of their frozen embryos. Only one can possibly result in life. The only moral option is embryo adoption, a life-giving choice that is strongly supported by Sacred Scripture and Sacred Tradition. National Catholic Bioethics Quarterly 14.3 (Autumn 2014): 441–447.

Catholic ethical teaching has increasingly relied on a concept of the common good for making and evaluating social decisions. The authors have argued that the common good is a maximal and ideal concept about which people and communities differ fundamentally. In practice, it does not resolve moral and social disagreements. The concept of the common harm is preferable because it is a minimal standard that can be more clearly identified and agreed for individuals and society, providing a basis for legislative and social action. Bioethics and public health both have strong roots in doing no harm and preventing harm to both individuals and communities in society. The authors argue that the application of the concept of the common harm from these disciplines into wider use in the health professions and public policy would be beneficial. National Catholic Bioethics Quarterly 14.3 (Autumn 2014): 449–455.