Application of Ethical Systems

Here Christian ethics as applied to abortion will be covered as an outline for the whole section of Medical Ethics.

The Orthodox Church has rejected Platonic views outlined by Origen that the soul pre-exists conception in that same way that it has rejected the belief that life begins at some time during or after pregnancy. It maintains that ensoulment occurs at conception. There are several references to support this view in the Bible.

(i) Newborn children have original sin since they are ?seminally present in the loins of Adam?. David tells us, ?Surely I was sinful at birth, sinful from the time my mother conceived me? [Ps. 51:5]. Since sinfulness is a spiritual rather than physical condition, David must have had a spiritual nature from the time of his conception and thus a soul to carry the burden of original sin.

(ii) James 2:26 tells us ?the body without the spirit is dead?. Thus the soul is the defining attribute of a human life. Life infers the existence of a soul. From conception, a foetus can be said to be alive (in the sense that it is growing ? an attribute unique to life). Thus since life infers the existence of a soul, ensoulment must occur at conception.

(iii) We are told that Christ became flesh (incarnate) at the moment of conception. The Virgin Mother?s cousin, Elizabeth testified to this: ?For, lo, as soon as the voice of thy salutation sounded in my ears, the babe leaped in me for joy? [Luke 1:44]. In other words, Elizabeth?s child (John the Baptist) reacted to the incarnation of Christ with a joyful leap.

These Biblical quotes tell us that human life cannot exist without the soul and that with ensoulment life begins both spiritually and physically, concurrently.

So, Life begins at conception. This has great implications in the Abortion debate. If life begins at conception then there are no grounds to treat a zygote, a foetus, an embryo, an infant or an adult any differently. A foetus is no less a ?human? than you or I. The opinion that a foetus is less of a human than an adult is nevertheless held by some people. The Church has challenged this view.

(iv) Orthodox Christians are called to be like God as far as that is possible in a spiritual sense (known as Theosis). This is one of the reasons why Christ sent His son ? to show us how better to be like God. Since no one will ever be like God, the process of becoming like Him is unending. It begins from the moment of conception ?til the moment of death. In this way, no one can say that he is a ?person? or ?fully developed? in the spiritual sense. However, all human life can be said to have the potentiality of becoming God-like in whatever stage of physical (and spiritual) development.

The Orthodox Church maintains that the 6th commandment, ?Thou shalt not kill? [Exodus] gives a direct command not to kill. However, there is more evidence in the Bible to support the idea that God holds that life is more sacred than all else.

(v) The Church confesses that human life is created by God and so it is a supreme gift. However, it is not given unconditionally but under the condition that man will be responsible enough to preserve it in accordance with divine law. We are told, ?For God so loved that world, that he gave his only begotten son, that whosoever believeth in him should not perish, but have everlasting life? [John 3:16]. That God should give his only son to man is true testimony for his love for human life and its sanctity.

By definition, artificial abortion is that which prematurely ends the development of a foetus or embryo. Since the church maintains that (a) life beings at conception and that (b) it is inherently sacrosanct, the Church completely rejects abortion in principle.

However, life is not quite as simple. The complicated nature of life presents many circumstances, which do not fall under the ?ideal? abortion scenario, which is often talked about by the church. What if the life of the mother is threatened by the pregnancy? What if it was due to incest or rape? What if the child will be severely handicapped?

Under the banner of Christian Orthodoxy and Catholicism, three different ethical approaches have become apparent. Each approaches the question of abortion with a different slant, but yet still in accordance with orthodox Christian teachings.

The deontological approach puts emphasis on human actions in assessing morality. It asks ?what is my duty?? It states that behaviour is moral if the act in itself is right and is done with the right motive/intention, regardless of the consequences.

A major proponent of this approach is Germain Grisez. He says that knowledge of good is self evident in humans, in that there are certain things, which persons are naturally inclined to and desire in and of themselves. These things are life, play, aesthetic experience, speculative knowledge, integrity, practical reasonableness, friendship and religion. Each of these eight is equal and human fulfilment means enjoying all these ?basic goods?.

How are actions to be evaluated? Human actions are moral only if they are aimed at securing one or more of these basic goods. An action which aims at one basic good, while arbitrarily slighting another is immoral to the extent that it turns from a basic good without adequate reason. This is important since it means that some moral actions are never morally permissible i.e. they are ?intrinsically evil? ? always wrong regardless of the circumstances. So, any action which violates a basic good is always wrong.

How is this approach applied to the abortion debate? Direct abortion is always wrong since it violates the basic good of human life. However, indirect abortion can be justified, although undesirable if the intended effect is good. I.e. abortion for a mother with a cancerous uterus can be justified.

This approach has traditionally been typical of Protestant theologians, although it has greatly influenced the teaching of Pope John Paul II.

?Abortion and euthanasia have become pre-eminent threats to human dignity because they directly attack life itself, and the most basic human good and the condition for all others [life].? [Living the Gospel of Life: A Challenge to American Catholics, 1998]

The main strength of this approach may also be it major weakness. The deontological approach is principally absolute ? it has no exceptions regardless of the consequences. This concrete approach to the complexities of the abortion debate, while giving simple and easy to follow instruction, often violates the Christian call for compassion. This has proven a heavy burden on the shoulders of many Christians and has resulted in the formulation of the principle of Double Effect. However, it still remains very ?strict? and according to some people, its oversimplification of life is its overriding weakness.

Proportionalism or ?Revisionism? also puts emphasis on human action in assessing the morality of actions. However, it evaluates morality teleologically, asking ?what is my goal?? This ultimate goal is union with God and thus actions are evaluated with regards to their conduciveness in achieving this ultimate goal.

This approach takes into account the act, the intention as well as the consequences. It asks, ?Which alternative course of action would not intend wrong and would result in a proportionally greater amount of good over evil??

A supporter of this approach is Richard McCormick. He agrees with Grisez about the notion of basic goods and that slighting any one of these for the gain of another without adequate reason is morally wrong. However, he claims that there are no ?intrinsically evil? acts and that directly turning against a basic good is not always wrong. Instead, he insists that a direct attack on a basic human good is only a ?premoral? rather than a moral evil if there is proportionate reason for doing that act. Premoral evil refers to the inconvenience, limitations and harm that are inevitable in human efforts to do good, since we live in a world of sin.

Where is there proportionate reason for performing an action that contains premoral evil? Proportionate reason exists when (a) there is a value at stake at least equal to the value being sacrificed; (b) there is no less harmful way of protecting the value at present; (c) the manner of protecting it under the circumstances will not undermine it.

What implications are there in the abortion debate? McCormick says that there needs to be a natural assumption against abortion since it involves ending a human life, which is sacred. However, abortion is acceptable in saving the life of a mother suffering from a cancerous uterus. McCormick goes on to suggest that not only are indirect abortions permissible but direct abortions can also be justified in some circumstances where there is proportionate reason. Such situations he suggested may be where the life of the mother is threatened by a bad heart or high blood pressure. His argument can also be extended to support arguments for abortion, where the child or mother will most probably suffer a bad quality of life.

Proportionalism has traditionally been seen as a solution to the criticism levied against the deontological approach. Instead of oversimplifying life, it aims to take the consequences of an act into consideration. However, the problem with such ?middle-ground? ethical approaches is that there is always an area of ambiguity brought about by alternate interpretations. In Proportionalism, we are given three conditions which constitute the criterion for proportionate reason in abortion. Each of these may be interpreted differently, since there is no absolute objective source to evaluate every given situation. This is the major weakness of Proportionalism. Besides, this and the obvious complications of predicting the consequences, it seems to give clear and reasoned instructions to make subjective moral decisions.

The virtue ethics approach does not focus on human actions but rather on being a certain kind of person. Virtue ethics criticises the deontological and proportionalist approaches for not focussing enough on moral character. It states that who we are extends into what we do and do not do, and what we do and do not do shapes the kind of person we become.

It is similar to Proportionalism in that it evaluates the moral character teleologically by asking ?what is my goal?? The final goal is union with God. Virtue ethics attempts to determine which virtues ought to be cultivated to reach this telos. The traditional theological and moral virtues employed to achieve this end are faith, hope, love; prudence, justice, temperance and fortitude; respectively.

A representative of this ethical approach is an American, James Keenen who says that we should focus on ?who we are, who we are to become and how we are to get there? rather than on singular acts. The virtues inform us of who we are to be and what we are to do, and should be exercised through human relationship.

What implications does the virtue ethics approach have on the abortion debate? Rather than questioning whether abortion is always morally illicit, Keenen has criticised aspects of American culture that have led to the most liberal abortion policy in the developed world. Keenen says that we should rediscover concern for the common good by asking why so many pregnancies are unwanted and attempt to better ourselves. Only then, by cultivating virtue can we act morally.

This approach is difficult to use in justifying or condemning abortion since the act itself nor its consequences are taken into account. It is taken for granted that if the mother is a virtuous person, she will choose the virtuous course of action. The perfect model of virtue for Christians is Jesus Christ, for his being is the telos that should be aimed for. Thus, this approach, where short of a direct answer regarding abortion asks, ?What would Jesus have said?? Although, Jesus never made a direct reference to abortion as recorded in the Gospels, his teaching can be interpreted accordingly.

However, following Jesus? teachings brings the morality of abortion back into the act centred arena rather than being agent centred. This is the major weakness of the virtue approach. As Schaller said, virtue ethics is no more than a ?disposition to obey moral rules? ? it does not give any answers, rather it studies what kind of person would know the answers.

Here are three different scenarios, which outline the difference in the three basic ethical approaches in Catholic and Orthodox ethics.

Profile 1: Jane

Jane is a 28 year old journalist who often reports from abroad. She comes from a strictly Catholic background and still follows the Church. She has been married to her husband, Mark for 6 years who works full time. She has become pregnant with her husband but having the baby means giving up her career for at least a few years. What should she do?

Deontology ? a direct abortion is not aimed at any of the eight basic goods outlined by Grisez but clearly slights the basic right of the baby to life. Thus, it is clear that an abortion for Jane is immoral.

Proportionalism ? is there proportionate reason for an abortion?

(a) the value being sacrificed (a life) is greater than that which is to be gained (development of Jane?s career);

(b) there are many less harmful ways of protecting the value being sacrificed e.g. they could employ a nanny, Mark or Jane could work only part time, they could adopt the child;

Thus an abortion for Jane would be immoral.

Virtue Ethics ? as has been discussed, virtue ethics is not very helpful in act centred issues. Rather, it says that if Jane is a virtuous person, which she seems to be since she is a practicing Catholic, then she will make the right choice.

Profile 2: Sarah

Sarah is a 38 year old housewife suffering from mild depression. She has been married to her husband, Joe for 18 years. Sarah and Joe have 6 children already and support them in a three bedroom terrace with an annual income of £30,000. Another baby will severely reduce the quality of life of both the baby and Sarah and Joe?s current children. Should they abort the child?

Deontology ? although an abortion is aimed at five of the eight basic goods: play, aesthetic experience, speculative knowledge, integrity and friendship, it still slights the prerequisite for all of these, the baby?s life. Therefore, an abortion for Sarah is still wrong.

Proportionalism - is there proportionate reason for an abortion?

(a) some people may interpret the sacrifice being made (the abortion of the child) as being less valuable as the basic goods being preserved;

(b) the other alternately less harmful way to preserve the family?s basic goods is adoption;

(c) the manner of preserving the family?s quality of life may end up undermining it. For example, Sarah may feel guilt after the abortion and fall deeper into depression, not being able to care for her children, reducing their quality of life.

Thus, it may be acceptable for Sarah to have the abortion. The area of ambiguity discussed leads to different opinion of whether there is proportionate reason for abortion. Also, the problem with judging consequences accurately adds to the complications of this problem. This means that two equally reasonable people may come to completely polar conclusions using this approach. Who is right?

Virtue Ethics ? again, virtue ethics states that if Sarah is a virtuous person then she will make the right decision.

Profile 3: Laura

Laura is 20 years old and single with no children. She is still at university. She suffers from abnormal blood pressure. Doctors have told her that if she becomes pregnant, there is an 80% chance that she will die along with the baby. Laura found out that she became pregnant after a one night stand. What should she do?

Deontology ? the abortion is aimed at all the basic goods since the mother?s life is the prerequisite for all the others. The abortion becomes indirect. It is aimed at the preservation of all the basic goods. Since the intention of the abortion is good, the death of the child becomes an undesired lesser effect. Thus abortion for Laura is permissible, regardless of the means by which she became pregnant and the probable consequences of the abortion itself.

Proportionalism - is there proportionate reason for an abortion?

(a) the value being sacrificed (the baby?s life) is less than that being preserved (all eight basic goods);

(b) there is no less harmful way to preserve these basic goods since there is an 80% chance the baby will also die anyway;

(c) the abortion does not undermine the value being preserved (Laura?s life) since if she does not have the abortion both she and the bay will die.

Thus, it is permissible for Laura to have the abortion.

Virtue Ethics ? According to the teachings of Jesus, Laura does not seem to be a virtuous person since she has no problem with promiscuity. Although this does not tell us whether she is right to have an abortion, it tells us that she is clearly not in a position to make a virtuous decision herself.

One of the most evident features of modern reflection on Christian ethics is its plurality. We have seen that the Catholic and Orthodox Christian stand on the issues of abortion are concrete; human life is sacred and life begins at conception.

However, the three different schools of thought discussed approach the debate differently. Although, they are all congruent with Christian doctrine, some have said that moral theology?s multifaceted nature undermines the unity of the Church as a whole, leaving it in a state of ?disarray?. This has left the common man uncertain as to which school to follow, rendering the usefulness of Christian ethics as a whole less so.

Although, there is evident denomination in Christian thought, it can be argued that this for the common man is not detrimental, since each can act within the boundaries of his own denomination with little confliction. This leaves Christian ethics on the whole a very useful system by which to act morally, since it gives absolute teachings on the act of abortion itself and clear instructions on how to resolve conflicts between competing moral concerns (i.e. the right of the mother and child to life).