Medicine is intrinsically ethical

There is no medicine without ethics. Hospitals don’t need to be under church or religious influence but they cannot exist without an ethos.

Medicine has three main purposes: to prevent and cure diseases, and to take care of patients. It is not simply a science but also a practice inspired by ethical values. So, what is the difference with other sciences? Take for instance mineralogy. It is the description of the chemical and physical properties of minerals. Medicine, instead, aims not simply at describing what a human body is but it is also based on the assumption that there is a natural order, which we call health, and the purpose of the medical practice is to keep or to restore this order. There is an intrinsic good (health) that we discover through science and we preserve and reestablish through practice.

For instance, anatomy and physiology tell us what is the proper function of the eyes, i.e. to see. This is not simply a description but it also contains a prescriptive element because the ideal eye is also the normative model that the doctor uses when she acts to keep the patient’s eyes healthy or to prevent their diseases.

This understanding of medicine doesn’t require a particular religious faith but it is nonetheless intrinsically ethical. It is inspired by a certain conception of the good (health) that we find in human nature through the correct use of reason. The principle of “do not harm”, which has guided health care since ancient times, has the form of an ethical imperative.

Not everything that happens (or might happen) in a hospital or a clinic is necessarily medicine, unless it aims at preventing and curing diseases, and also at the same time at taking care of patients.

Not all interventions that alter our bodies surgically or chemically are medicine, even if a scientist (medical expert) might be involved. Getting your facial features surgically changed to look more like your music idol is not medicine. Killing the unborn because she was unplanned or is disabled is not medicine. Augmenting your muscles through drugs to win a weightlifting contest is not medicine. Removing a perfectly healthy organ to adjust your body to your perceived gender is not medicine. Facilitating suicide is not medicine.

In all these examples a certain level of scientific knowledge is necessary but they lack what makes medicine more than a science: the ethical value of health. They might involve someone who has a proper knowledge of the human body but his purpose, in these examples, is not to restore or preserve the good of the functioning body.

They are instances of scientific techniques without ethics.

There is a growing pressure by certain ideologies to transform medicine, which is necessarily lead by an objective good that we call health, into the satisfaction of the subjective requests of the patient.

If bodily autonomy (my body, my choice), rather than health, is the ultimate value then there is no reason why doctor should not amputate a healthy arm or leg, when requested, or administer a dangerous substance, for recreation or self-harm. Without the guiding principle of health, practitioners become simply the executors of someone else’s desires. Obviously, people can do what they want with their bodies but this is not medicine.

There is no medicine without ethics. Hospitals don’t need to be under church or religious influence but they cannot exist without an ethos, without values. When their core value is not health – an intrinsic good indicated by human nature- they don’t serve medicine anymore but trends, ideologies, business.

KINGS KALEIDOSCOPE - Felix Culpa

Turn the lights on, look at what I have See the twisted trophies of a dead man Countless stories, tell of sin and pain But they sing the sweetness of my savior’s grace I’m a torn man, spirit fighting flesh There’s a battle raging deep in my chest But all that haunts me, all that leaves a stain Only sings the sweetness of my savior’s grace A fortunate fall, my sins are stories of grace to recall A fortunate fall, I glory in my sins forgiven Jesus bought me, and now I am His Dying with Him, in His death I now live All my vices, to which I was chained Only speak the sweetness of my savior’s grace And still I’m a wicked, wretched man, I do everything I hate I am fighting to be god, I seethe and claw and thrash and shake I have killed and stacked the dead, on a throne from which I reign In the end I just want blood, and with His blood my hands are stained See the God who reigns on high, He has opened His own veins From His wounds a rushing torrent that can wash it all away Grace upon grace, upon grace upon grace

The Citizens’ Assembly report ignores conscientious objection

At the end of June, Ms Justice Laffoy  presented her report on the Citizens’ Assembly meetings dedicated to the discussion of the 8th amendment. In spite of calls for the provision and regulation of conscientious objection to abortion, the report has made no recommendation about it.

The Citizens’ Assembly members voted for Article 40.3.3 to “be replaced with a constitutional provision that explicitly authorises the Oireachtas to legislate to address termination of pregnancy, any rights of the unborn, and any rights of the pregnant woman.” If this will happen it will be also necessary to regulate the right of conscientious objectors.

As one of the purposes of the Citizens’ Assembly was to make recommendations about what should be included in a possible new legislation, one wonders why it failed to address this fundamental issue, ignoring the suggestions and requests coming from Assembly members, private citizens, advocacy groups and professional bodies.

During the first weekend of the Citizens’ Assembly, in November, members were asked to identify topics that they believed to be important. The regulation of conscientious objection was one of the key points raised. Following their request, at the February meeting prof. Gerard Bury delivered a paper on the “Regulation of the medical profession and issues arising including conscientious objection”. Other speakers have occasionally referred to the same issue.

Some submissions from private citizens, advocacy groups and professional bodies have also dealt with this topic, suggesting different solutions to the regulation of conscientious objection. These submissions came both from the pro-life and the pro-choice sides. (See, for instance, the contributions of the Green Party, Amnesty International Ireland or the Irish Council for Civil Liberty.) Unfortunately, we know that the large majority of those submissions have been ignored by the Assembly and only a random selection have been offered to its members for reflection.

Freedom of conscience is recognised by art. 9 of the European Convention on Human Rights. The Parliamentary Assembly of the Council of Europe approved a resolution on the right of conscientious objection in lawful medical care stating that “No personal, hospital or institution shall be coerced, held liable or discriminated against in any manner because of a refusal to perform, accommodate, assist or submit to an abortion, the performance of a human miscarriage, or euthanasia or any act which could cause the death of a human foetus or embryo, for any reason”.

Note that the resolution refers not only to individuals but also to hospitals and institutions. This is precisely what is missing in the current legislation, which allows conscientious objection only to some healthcare professionals but not to entire hospitals and institutions. Any discussion on abortion inevitably has to address who can object to their performance and in what circumstances. The submissions have proposed different solutions. Why then there was no vote by Assembly members on conscientious objection? Why not even an ancillary recommendation about it?

Exclusivity no longer an essential element of marriage, Supreme Court decides

The recent ruling by the Supreme Court on a polygamous marriage means that exclusivity is no longer considered an essential element in marriage. So, marriage does not have to be exclusive under the new legal dispensation, it does not have to be the conjugal union of a man and a woman, it cannot be legally permanent and indissoluble, and it need not even be a sexual union, at any stage of the marriage. Little is therefore left of how we once understood marriage. Certainly, the Christian idea of marriage, mirrored to a large extent in most cultures, is dead and buried as a legal concept.
At stake in ‘H.A.H – v – S.A.A & ors’ was whether the polygamous marriages of a man entered into Lebanon could be recognised here. The Supreme Court ruled that the first marriage was valid but not the second marriage. However, in accepting the first marriage of the Lebanese man the court has also, perhaps inadvertently, treated exclusivity as a non-essential element of marriage. His first marriage was not intended to be to the exclusion of all others. He did not intend to be monogamous. His commitment wasn’t complete and exclusive as he was open to a possible second marriage.
Traditionally, in common law, the definition of marriage was based on the dictum of Sir James Wilde (later Lord Penzance) in the polygamy case Hyde v Hyde and Woodmansee (1866) “I conceive that marriage, as understood in Christendom, may for this purpose be defined as the voluntary union for life of one man and one woman, to the exclusion of all others.”
To repeat, after the introduction of divorce in 1995, marriage is no longer indissoluble. After the 2015 referendum, conjugality is no longer an essential feature. Now, the concept of “to the exclusion of all others” isn’t an essential element either in contracting marriage.
Indeed, as mentioned, marriage need not ever be a sexual relationship of any kind. The Referendum Commission confirmed this in 2015 when it said under the changed definition of marriage, two heterosexual friends could marry if they wished.
In this polygamy case, the Attorney General correctly took the position that neither of the two marriages should be recognised on the ground that “Irish public policy is opposed to the attachment of legal consequence in this State to polygamous marriage”.
The Supreme Court declared otherwise. In fact, in her ruling on behalf of the court, Justice O’Malley also declared the Christian understanding of marriage to be essentially dead and buried in Irish law.
“The combination of the introduction of no-fault divorce and, in particular, the amendment of the Constitution providing for the introduction of same-sex marriage have resulted in a legal institution of marriage that cannot be described in terms of traditional Christian doctrine.  ….  In my view the defining characteristic of marriage as envisaged by the Constitution in this era is that it entails the voluntary entry into mutual personal and legal commitments on the basis of an equal partnership between two persons, both of whom possess capacity to enter into such commitments, in accordance with the requirements laid down by law”.
She is certainly correct to say civil marriage and religious marriage in Ireland no longer bear much resemblance to each other. Indeed, her own definition of marriage, given in the passage above, reads more like something from company law.
This is what we have turned marriage into in Ireland. Is this really what we intended?