McQuillen, Michael P.

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The Linacre QuarterlyVolume 62 | Number 1 Article 6February 1995The Tarnished Splendor of AutonomyMichael P. McQuillenFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationMcQuillen, Michael P. (1995) "The Tarnished Splendor of Autonomy," The Linacre Quarterly: Vol. 62: No. 1, Article 6.Available at: http://epublications.marquette.edu/lnq/vol62/iss1/6The Tarnished Splendor of Autonomy by Michael P. McQuillen, M.D. The author is a professor of neurology at the University of Rochester In Roman Catholic moral theology as in medicine, a central conflict has existed for some time between the proponents of authority, and those who would give primacy to the individuals in decision-making. Veritatis Splendor would seem to have settled the issue as far as the Church is concerned; but has it? And what lessons can be drawn for the physician from the concerns addressed in this document, and the comments of some moral theologians upon it? The body of the encyclical devotes a good deal of attention to the concepts of freedom and conscience, and to the process of moral decision-making by the individual. Concern is expressed that . . . some present-day cultural tendencies ... would grant to individuals ... the right to determine what is good or evil. Human freedom would thus be able to "create values" and would enjoy a primacy over truth, to the point that truth itself would be considered a creation of freedom. I With regard to conscience, (i)n their desire to emphasize (its) "creative" character ... , certain authors no longer call its action "judgments" but "decisions": only by making these decisions "autonomously" would man be able to attain moral maturity.2 Thus, (a) separation, or even an opposition, is .. . established in some cases between the teaching of the precept, which is valid in general, and the norm of the individual conscience, which would in fact make the final decision about what is good and what is eviP . .. Indeed, when all is said and done man would not even have a nature; he would be his own personal life-project.4 The encyclical contrasts teleological theories based on such concepts of freedom and conscience with "the teaching of Scripture and tradition", noting that (i)n his journey toward God, .. . man must freely do good and avoid evil. But in order to accomplish this he must be able to distinguish good from evil. And this takes place above all thanks to the light of natural reason .. . "the function of the natural law" (according to St. Thomas), ... the human expression of God's etemallaw.5 February, 1995 49 There is a "fundamental dependence of freedom upon truth", with the right to .. . freedom and to respect for conscience on its journey toward the truth ... increasingly perceived as the foundation of the cumulative rights of the person .. . (As well, HC )onscience has rights because it has duties. "6 Furthermore, God's plan poses no genuine threat to man's genuine freedom; on the contrary, the acceptance of God's plan is the only way to affirm that freedom'? One commentator upon the encyclical noted that it was an important response to some recent versions of the "autonomy school." Because autonomy ethics is grounded in the moral approach of Immanuel Kant, its proponents find it difficult if not impossible to qualify the noun ethics with the adjective Christian. By Kant's definition, ethics must be uni versal for all rational beings, so for Kant any reference to Christian is a non-universal limitation making Christian ethics a contradiction. "8 Another highlights the emphasis upon "objective moral norms", maintaining the concept of intrinsic malum, noting wryly (as the encyclical itself implied, that "if there were ways around exceptionless moral norms, many martyrs could have survived."9 Others are either woundedlO by their reading of the encyclical, or claim they are misunderstood 11,12; but it would appear that they are the ones who misunderstand, since they protest that the focus of the document was solely, if not primarily, upon contraception. Nothing would seem further from the truth. Examples of the consequences of the "interpretations of Christian morality which are not consistent with 'sound teaching"'13 are many and varied in the document, including the "duty of absolute respect for human life". There are abundant quotations from the documents of the Second Vatican Council, with examples from Gaudium et Spes of "intrinsically evil" acts including "(w)hatever is hostile to life itself, such as . . . abortion, euthanasia, and voluntary suicide ... "14 It is in this sense that the encyclical has particular meaning for medicine at this time. Pari passu with the changes in the Roman Catholic Church that prompted the issuance of the encyclical, there has taken place a revolution in decision-making in medical matters which has gone to a point that threatens the very fabric of the profession itself. No longer is primacy given to the learned, beneficent judgement of the physician; now it is the personal rule of the self while remaining free from both controlling influences by others and personal limitations, such as inadequate understanding, that prevent meaningful choice15 which rules supreme at the bedside. All of the " intrinsically evil" acts cited earlier are now either a reality or in the offing in American medicine; and while it "does not follow from the fact of action's being autonomous that it is morally acceptable or morally principled"16, acts such as these are in being as the consequence of an autonomous morality whichjudges specific kinds of behavior - even those which lead to the taking of life itself - as 50 Linacre Quarterly morally right or wrong only on the basis of a technical calculation of the proportion between "premoral" or "physical" goods and evils which actually result from the action1 7 Note also that a Kantian autonomous ethic is meant to apply only to rational beings (vide supra) - which effectively excludes the most vulnerable of society (the retarded, the demented, those in a "vegetative state", and the like) from utilitarian judgments made by the (allegedly) rational members of their communities. For example, there is not a single neurological diagnosis pertinent to such persons in the top half of the Prioritized List of Health Services proposed by the Oregon Health Services Commission in their effort to contain the cost of health care - a fact that would effectively deny care to such persons under such a rationing scheme, if it was enacted. IS Can the encyclical have any effect upon this state of affairs in medicine in America? It is doubtful that this will happen, primarily because - in a pluralistic society that waited almost 200 years to elect a Roman Catholic president; a society the decisions of whose Supreme Court grant a legitimacy to abortion and to actions which may "cause the death" of persons in a "vegetative state"19 - a document written by a Pope and considered "too technical and abstract to address anyone but specialists" by a prominent moral theologian II is not likely to provoke serious, thoughful reflection on such issues. Pity. REFERENCES 1. John Paul II , encyclical Venatis Splendor (August 6, 1993), 35. 2. ibid, 55. 3. ibid, 56. 4. ibid, 46. 5. ibid, 42. 6. ibid, 31 7. ibid, 45. 8. Archbishop John Quinn: Perspectives on "Veritatis Splendor". Origins, 1993; 23:398. 9. Grisez G: Veritatis Splendor in focus: 1. Revelation versus dissent. The Tablet, 16 October 1993, 1331. 10. Haring B: Veritatis Splendor in focus: 2. A distrust tha wounds. The Tablet, 23 October 1993, 1378-9. II. McCormick R: Vertatis Splendor in focus: Killing the patient. The Tablet, 30 October 1993, 1410-11. 12. Fuchs J : Veritatis Splendor in focus: 4. Good acts and good persons. The Tablet, 6 November 1993, 1444-5. 13. Veritatis Splendor, 29. 14. ibid, 80. 15. Beauchamp TL, Childress JF, Principles of Biomedical Ethics (ed 3); New York, Oxford University Press, 1989; p 68. 16. ibid, p71. 17. Veritatis Splendor, 65. 18. Oregon Health Services Commission, Prioritized Health Service List of February 20, 1991 . 19. Cruzan v Director, Missouri Department of Health et aL 88-1503, June 25, 1990. February, 1995 51 

The Tarnished Splendor of Autonomy

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