The COVID-19 Response is the Greatest Bioethical Issue of Our Time
This understanding of order within the human person is the foundation of a proper philosophy of medicine
In the last six months, all sorts of institutions ranging from churches to private businesses to cities have been forming advisory committees on how to deal with the coronavirus.
While these committees are often filled with a range of people, they nearly always contain the best medical experts available. Getting medical advice from experts is completely appropriate given the nature of the epidemic, but these committees should also get advice from bioethicists.
I fear that most leaders would be baffled by this approach. After all, why should bioethicists be consulted? How is the response to COVID-19 a bioethics issue at all? And if it is, how is it the greatest issue of our time? To answer these questions an explanation of role of bioethics in medicine is essential.
Bioethics Places Medicine Within the Big Picture
Working within the moral tradition of great theologians like St. Thomas Aquinas, St. Augustine and St. John Paul II, the bioethicist begins with the belief that there is a wise and loving God. Through his wisdom God has created an ordered world where everything has a purpose.
For example, humans are made with the purpose of entering into loving relationships with God and others. At an abstract level, actions that help attain this purpose are good and all actions that go against this purpose are evil. For example, if I love and take care of my children, I am performing a good action because I am fulfilling my purpose of loving others and ultimately loving God.
To simply say that an action is good because it is ordered toward loving God and others can be a bit abstract, since it is not always easy to know when something is a truly loving action. One way to help identify loving actions in the realm of bioethics is to examine the different parts and faculties that make up a human person. Anytime a wise person designs something, the function of the parts is determined by the order to the end (the purpose of the thing). Human parts and faculties, as designed by God, all have purposes that are ordered to the ultimate purpose of a human.
An analogy of a car can help elucidate this statement. A car is designed for the purpose of driving. All the parts within the car are also ordered toward the act of driving.
Likewise, God made humans so that every part or ability of the person is ordered toward their ultimate purpose. For example, tissues are ordered to the functioning of organs. Organs are ordered to the functioning of systems. Systems are ordered to the functioning of the body as a whole. The body is ordered toward the functioning of the soul. The soul is ordered toward the purpose of the person as a whole: entering into loving relationships with God and others.
A good action is one in conformity with the purpose of each part — keeping in mind that, because they are ordered toward higher ends, in certain cases the lower parts can be sacrificed for the sake of the higher parts.
For instance, generally speaking a human has a moral obligation to pursue good health, as this is the proper end of the body. Since the body is ordered to the functioning of the soul, good health is also necessary for the functioning of the soul and for proper relationships. However, in certain situations it might be necessary to forgo the pursuit of health for the good of the family or community.
This understanding of order within the human person is the foundation of a proper philosophy of medicine. Physical health is ordered toward psychological health which is ordered toward social health, which is ordered toward spiritual health. When this order is followed, humans fulfill their purpose, but when it is forgotten, immoral actions are performed.
For example, a direct sterilization is immoral because it contradicts the health of the reproductive system, but an indirect sterilization (one done for serious health reasons) is allowable because it recognizes that systems are ordered toward the health of the body as a whole. If someone has ovarian cancer, the removal of the ovaries is a moral action.
With a few exceptions, most medical professionals recognize at least some aspects of this order in medicine. Normally, a cardiologist seeks to make sure the heart is functioning properly for the sake of the circulatory system and ultimately the body as whole. A neurologist seeks to make sure the different parts of the nervous system are functioning properly for the sake of person as a whole. If a treatment regimen is given that aids bodily health but causes the person to have suicidal thoughts, then it is not proper treatment since physical health must be ordered toward psychological, social and spiritual health.
A medical professional with a proper philosophy of medicine will look not only at the effects of a particular treatment on the physical body but also at the effects on the psychological, social and spiritual life of a patient in determining the risks and benefits of a treatment. Most immoral bioethical actions come from medical or research professionals not taking into consideration the order found within human nature. For example, proponents of direct sterilization fail to recognize how the reproductive system is ordered to the higher ends of health, procreation and unity. Direct sterilization is immoral because it violates these higher ends that are further ordered to the ultimate end of unity with God.
Since every medical action affects the entirety of the human person, body and soul, every medical action requires bioethical decisions. However, most of the time these decisions are relatively obvious. They become more complicated when either the effects of the psychological, social, and spiritual life are hard to determine or people fail to recognize how their actions affect these higher ends of medicine. This latter reason is usually the cause of the moral confusion regarding bioethical issues like abortion, euthanasia, sex reassignment surgeries and other related issues.
The Response to COVID-19 is Especially a Bioethical Decision
The constant drumbeat of the media repeats how the COVID-19 response of every institution should be based on medical science. Every single day headlines highlight a medical professional giving advice based on some new scientific study.
COVID-19 does cause deadly symptoms for some people, and a response should be based on medical science. However, in a nearly unparalleled way, the response to COVID-19 affects the psychological, social and spiritual needs of people. Any response plan should take into consideration that bodily health is ordered toward psychological, social and spiritual health. If a COVID-19 response plan fails to fully consider the significance of these higher human needs, then it is an inappropriate plan.
Mother Teresa would frequently say, “Loneliness is the greatest poverty.” She believed it was greater than extreme material poverty, greater than horrible diseases like leprosy, and even greater than death. She believed this because she recognized that humans are made for loving unity with God and others, and loneliness is much more contrary to this unity than physical sickness is.
She also recognized the extreme importance of receiving the Eucharist for the spiritual health of her sisters. The Eucharist is the food from heaven and the medicine for immorality which is as necessary to maintain spiritual health as regular food is to attain physical health.
A proper COVID-19 response must recognize that one’s spiritual life is more important than one’s physical life. Although normally it is essential to pursue physical health for the sake of social and spiritual health, if the act of seeking physical health impairs or destroys one’s spiritual health, then the act is contrary to a proper understanding of medicine. Hence, Christian philosophers, psychologists, theologians or bioethicists should always be consulted when forming a response plan to COVID-19 to make sure these most important needs are met.
In moral theology, a distinction is made between true freedom and false freedom, true happiness and false happiness, true rights and false rights, and the list goes on. In all of these cases, the distinction is based on whether or not humans are fulfilling their purpose.
For instance, true happiness comes from contemplating the good found in loving relationships with God and others, whereas false happiness comes from sinful activities that are contrary to these loving relationships.
The same distinction can be applied to medicine: there is true medicine and false medicine. Medical actions that improve bodily health for the sake of psychological, social and spiritual health are true medical actions. Medical actions that violate physical, psychological, social or spiritual health are false medical actions, for they do not result in the health of the whole person. Actions like direct sterilization and abortion are great examples of false medicine.
When determining the proper response to COVID-19, neglecting (or even rejecting) true scientific data results in false medicine, for it contradicts the physical health of the person or the society. However, even more so, neglecting the psychological, social or spiritual health of the person or society results in false medicine.
Immoral bioethical actions like euthanasia, abortion and sex-reassignment surgery often happen because the higher human purposes are not properly taken into consideration.
A COVID-19 response plan that fails to recognize the significance of these higher human purposes can have just as devastating effects on society as these other immoral actions have. The response to COVID-19 is the greatest bioethical issue of our time because it has radically affects the psychological, social, and spiritual life of nearly every Christian in the world.