Concise Roman Catholic Medical Ethics

edition 2014 by J.A. Raymakers, MD PhD

1.2.1 Main principles used in medical ethics

These are:

  1. The therapeutic principle or the principle of totality;
  2. The principle of freedom with responsibility
  3. The principles of sociality and subsidiarity;
  4. The principle of proportionality.

In situations of conflict one may refer to the following principles:

  1. The principle of choosing the lesser evil;
  2. The principle of the action with double effect (shortly: the principle of double effect);
  3. The principles of acting to avoid co-operation with evil.
  4. Therapeutic principle or the principle of totality

1.2.2 The thrapeutic principle or principle of totality

The therapeutic principle, also called the principle of totality, means that any intervention or treatment of the human body or directed at psychical functioning of a person, should always aim at the health and total functional integrity of the person as a whole. It follows that interventions that are solely intended to change the shape of the body, the natural capacity to perform or aim at the abolition of modification of natural capacities, are not permitted.

1.2.3 The principle of freedom and responsibility

The principle of freedom and responsibility means that man must be free to make decisions about medical treatment and interventions and that nobody can force him to undergo these. He is to decide while taking into account adequate information about the nature and the consequences of the treatment or intervention and a reasonable consideration of its advantages and disadvantages. Man is the first one responsible for his own health.

1.2.4 The principles of sociality and subsidiarity

The principle of sociality means that all humans are responsible for each other because they form one community as children of one Father: God.

The principle of subsidiarity means that one should not give authority to any higher official body on matters that can be handled as well at a lower level. In healthcare, this concerns mainly the meddling of governments in the allocation of financial means and treatment options.

1.2.5 The principle of proportionality

Hereby is meant that the burden that a treatment or an intervention involves for a sick person should stand in reasonable proportion to the positive result that one may expect from them. One should take into account the situation of the patient, the experience that is available, and the circumstances such as the availability of the necessary means and expertise. This principle should offer a safeguard against unnecessary and unduly burdensome treatments that could be effective from a purely medical point of view, but would not be life-saving.

1.2.6 The principle of the choice for the lesser evil

In a situation of conflict, where one is forced to choose between two actions that both have an unwanted secondary effect, one has to choose the one with less bad consequences.It is obvious that any option that is intrinsically evil (e.g. taking a human life) should be rejected beforehand.

1.2.7 The principle of double effect

This principle concerns any action that has two effects, one that is intended and favorable and a second adverse one that is not intended, but that one is ready to accept as unavoidable. Four conditions have to be met:

  1. The action should not be intrinsically bad;
  2. The intention behind the action has to be good;
  3. The favorable effect may not be the consequence of the adverse effect;
  4. A reasonable proportion should exist between the favorable and the adverse effect to the benefit of the favorable one, and a serious motive to accept the adverse effect is required.

1.2.8 The principle of the cooperation with evil

One is never allowed to co-operate in an action that is evil. Principally, it is not allowed to co-operate in any action that is illicit, unless the co-operation is indirect, necessary and remote and only if there is a compelling reason to do so.

The following distinctions apply:

  • According to the intention:
  • Formal and material co-operation
  • According to practical involvement:
  • Direct and indirect co-operation

Concerning indirect material co-operation one should distinguish:

  • According to the proximity or the involvement:
  • Near and remote co-operation
  • According to necessity:
  • Necessary and unnecessary co-operation

Explanation: Formal co-operation means that one agrees with the intention of the principal author of the action even though one does not perform the act oneself.

Material co-operation means that one’s own action is part of the action under concern, while it may be that one does not agree with that action, but one is in some way forced to cooperate and/or to be involved, necessarily or unnecessarily, directly or indirectly. Formal co-operation with evil is always illicit. Material co-operation is also illicit, especially if it is direct, near and/or necessary. Material co-operation may be excused is it occurs under duress or if the rejection of indirect, necessary and remote material cooperation would entail serious consequences for the person involved, which can then be seen as a situation of duress.

Apart from formal or material co-operation one should avoid to cause scandal by consenting publicly to an evil act or omitting to condemn it when one is in a position to do so, even if one is not participating in the act.