Lynch, John J.

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The Linacre QuarterlyVolume 27 | Number 2 Article 3May 1960Human Experimentation in Medicine: MoralAspectsJohn J. LynchFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationLynch, John J. (1960) "Human Experimentation in Medicine: Moral Aspects," The Linacre Quarterly: Vol. 27 : No. 2 , Article 3.Available at: http://epublications.marquette.edu/lnq/vol27/iss2/3Human Experimentation in Medicine: Moral Aspects* JOHN J. LYNCH, S.J. Pro essor o or ' f f M al Theology Weston College. Weston, Mass. TO AVOID ambiguiti_es, a the­ologian generally begms a c�n­sideration of this kind by definmg as precisely as possible the terms of the discussion as he under­stands them. For it often happens that moralists and physicians use the same terminology in somew_hatdivergent senses. If these possible differences of meaning are not made initially apparent, the unf�r­tunate result will be mutual mis­understanding. To the theologian, medical ex-. . a l ly  connotes per1mentation usu . either the use of treatments ":'h1ch are not as yet fully established sc ientillcally, or the use of proce­dures precisely for the purpose �f discovering some truth or of ven­fying some hypothesis. And the notion for us further presupposes that the subject is thereby exposed to some significant degree of nsk or inconvenience; for if thi� la_tterI t l·s lacking there 1s little e emen · 1or no moral problem involved. By dellnition, therefore, exp�ri­mentation admits of two possible purposes: benefit to the indi�idual patient who submits to exper1men-•Reprinted from the May, 1960 issue of C/· . I Pharmacology and Therape_u­tic��"New York, N.Y., with kind permis­sion of the Editor. ta! treatment and/or the advan e of medical science and conseque t benefit to the common good ,f future patients in general. A cording as one or the other pt· ·­pose is sought exclusively, or. itleast is paramount in the intent1 n of the physician, two distinct mo al problems present themselves. T ie first yields more easily to solutic n. both medically and morally. T ie second, which currently represe ts the more urgent problem m me,h­cal circles. is considerably m re involved as a moral question. EXPERIMENTATION FOR BENEFI" OF PATIENT When the good of the i1 d!· vidual patient is the physici, n s I . or predominant conc, .rn, exc us1ve ·11 the canons of good medicine w1 d. t te the course of treatmentIC a , J 1 )" h·ch it is the doctor s mora 00 1• w I h d tor gation to provide. For t e oc . is always first and foremost his patient's agent in the sense that he is contractually committed to the total best interests of that pat,_en� Thus, for example, if there 1s sure cure available in a g1v�n instance, it should ordinarily e employed in preference to treat;ment of doubtful efficacy. Or_ 'sthe only choice of remedy lie LINACRE QUARTERLY among several which are at bestdoubtful, the most promising ofthese should generally be used.In other words, the patient is en­titled in justice to the surest meansreasonably available for achievingthe object of his medical contract,viz., the cure or control of hismalady. And since this is thepatient's right, the doctor's corre-­sponding obligation is immediately clear. the patient or his juridical repre­.sl'ntative. or unless this consent{ ) another procedure may be rea-'rJably presumed. And since by.ipposition the patient in this in­, .. ince represents the doctor·s sole,>, primary concern, common sensea:nne would make the same re­quirement. EXPERIMENTATION FOR BENEFIT OF OTHERS However, it is also true that ifa proven remedy would entail ex­ceptional expense, pain, or other inconvenience, the patient may bejustified in choosing instead a pro cedure whose effectiveness is asyet incompletely established, butwhich circumvents the consider­able disadvantage presumably in­herent in his using the provenprocedure. The patient, in otherwords. may legitimately run the risk, even though it be consider­able, of a less certain remedy,provided that there is sufficientlyserious reason for so doing. A fortiori, if there is little or no riskinvolved in accepting a remedy of dubious efficacy, no one woulddeny the patient's right to makesuch a choice for any reasonablemotive. Actually this latter wouldnot be experimentation in the strictsense of the word. In order to discern the limita­tions which must be placed onhuman experimentat ion under­taken for the benefit of others, onemust appreciate two basic moral truths. These are not exclusivelyCatholic convictions, even thoughthey have more than once beenenunciated in the authoritative teaching of the Catholic Church.Rather they are fundamental phil­osophical principles which shouldbe evident merely upon analysisBut it should be clear that anysuch decision or choice is the pa­tient's prerogative and not thedoctor's. Hence the doctor mustPrefer the certain to the uncertainrtlnedy, the more probable to thelas probable, unless the patient'slegitimate choke to the contrary la explicitly expressed either byMAY, l 960 of the nature of man in his variousrelationships to others. In combi­nation they protect society and itsmembers from each of two socio­moral extremes of thought, neitherof which is compatible with ourhuman status viewed in properperspective. The llrst of these principles issimply a denial of that extremistattitude which we have come toidentify as totalitarianism andwhich would subject the individualcompletely to the community orstate by subordinating all individ­ual rights to the prior claims ofthe common good. Such a phi­losophy in its most blatant formfound expression in the experi­mental excesses encouraged andpracticed under Nazism and later63 . epudiated by the free world in the formulation at the Nuremberg medical trials of a IO-point state-­ment of limitations to be placed on medical experiments performed on human subjects. To put the same principle posi­tively: with regard to his life and bodily integrity, each individual possesses a God-given right of immunity from unprovoked attack by any other person. Such is the dignity of the human person that even civil authority must respect that immunity as long as th'e indi­vidual does not, by crime against society, becoqie a serious threat to the common good. No individ­ual subject, therefore, can legiti­mately be considered an expend­able member of the body politic to be exploited for the common good. For this reason it follows, in the words of Pius XII, that: the doctor can take no measure or try ·no course of action without the con­sent of the patient. The doctor has. no other rights or power over th_e pallent than those which the latter gives him. explicitly or implicitly and tacitly.2 The practical impact of this truth lies in the fact that, as laud­able as may be the desire to con­tribute to the advance of medical science, doctors are nonetheless initially restricted in their human experimentation by this inalienable right of the patient to forbid such use of his otganic entity. Or as the very first rule of the Nurem­berg Tribunal expresses it, "The voluntary consent of the human subject is absolutely essential." That this consent can sometimes be legitimately presumed does not detract in the slightest from a doctor's total dependence upon 61 patient consent, in some genuine sense of that term, for the right to intervene in any way which affects the subject's bodily integ­rity.:: The second pertinent principl, denies what might be called ex treme individualism on our part and imposes certain fundament, limitations on each one's right t dispose of his own life and bodil members. Because of the dignit of his human nature, as alread · explained, man enjoys a larg: measure of independence from h equals. fellow men. But becam : of his creaturehood, he must al� J admit himself to be essential 1 dependent upon his Creator. . 1 context this dependence mea• s that man is not complete and a solute master of his life and bein f. He is not proprietor of himse t. but rather a steward entrust d with the care of "property" whi h strictly belongs to God. He m; r', therefore, administrate this tn ,t only in compliance with the i­vine will as manifested to him m various ways. The first practical corollary fr m this principle is the natural-!. w prohibition against suicide. To n­tend directly the termination of one's own life is the usurpation of a right which belongs exclusivJy to God; for our earthly existe ce is our trial for a future life. a (!ial whose duration can rightfully be decided only by the Crea,or. There are circumstances in wHch we are justified in risking our lives by actions which are neces­sary for the achievement of some momentous good; but in such cases LINACRE QUARTERLY death, if it should occur, is the unintended by-product of an actlegitimately performed for anotherpurpose and is not imputable as a moral evil. Even for the very laudable purpose of advancingmedical science, no one would bejustified in making his own deaththe intended means to that end.A second consequence of the same principle relates to bodilydamage short of death which forone reason or another one mightinflict upon himself or allow an­other to inflict. We are responsi­ble to God not only for life itselfbut also for our physical integrity,and only within certain limits maywe legitimately mutilate our bodiesor suppress their natural func­tions. Pius XI expressed this age­old truth in these words:c,· to dispose of his bodily mem-1· ·rs and functions is the conces­,,on that he does possess a limited ;.]ht of self-disposition. How-,. ·er, relatively easy as it is to, lineate certain areas in which\' may or may not claim that t'ght, its maximum limits are still rcatter for speculation among the­ologians. . . . Christian doctrine establishes, andthe light of human reason makes it most clear, that private individuals have no other power over the members of their bodies than that which. pertains to their natural ends; and they are not free todestroy or mutilate their members, or in any other way to render themselves unfit for their natural functions, except when no other provision can be made for the good of the whole body.• The same principle was repeatedby Pius XII on many occasionsin such language as this: Certainly the "immanent tele­ology" of which Pius XII spokeincludes above all an essentialSt:bordination of each corporalmember to the organic totalitywhich comprises the individualperson. It therefore follows, forexample, that if an individual bod­ily member because of malfunctionbecomes a serious threat to the life or well-being of the total man, that part may be sacrificed, if nec­essary, for the good of the whole. It is in this "principle of totality"that we find both justification formost legitimate surgery of a de­structive nature and grounds, too, for condemning patently unneces-sary surgery. Again in the words of Pius XIJ: . . by virtue _of the principle of totality,by virtue of his right to use the services of his organisms as a whole, the patientcan allow individual parts to be destroyed or mutilated when and to the extent necessary for the good of his being as a whole. He may do so to ensure his being's existence and to avoid or, nat­urally, to repair serious and lasting dam­age which cannot otherwise be avoided or repaired.2 · · . [ the patient J is not absolute masterof himself, of his body or of his soul. Hecannot, therefore, freely dispose of him­.self as he pleases. Even the reason forWhich he acts is of itself neither sufficient nor _determining. The patient is bound by the immanent teleology laid down by na­ture. He has the right to use, limited by natural finality, of the faculties and pow­ers of his human nature. Because he is a user and not a proprietor, he does nothave unlimited power to destroy or muti­late his body and its functions.2 Implicit in the statement that man does not have unlimited pow­MAv, 1960 But in a context of investigative. procedures undertaken exclusivelyfor the benefit of others, the more pertinent question relates to the ordination, if any. of our bodiesand their members to the good of our fellow men. ( Note that the 65 term used is "ordination" and not"subordination": for to admit sub­ordination would logically lead to corollaries of an inadmissible to­talitarian character.) It wouldseem to be theologically beyonddoubt that the principle of charity- i.e., love - toward one's fellowman does legitimatize a certain de­gree of bodily self-sacrifice foraltruistic motives. For example, not only are blood transfusions,skin grafts, and the like, unani­mously admitted by theologians to be permissible, but the donors inthese instances have been singledout for explicit commendation inpapal documents. Going a sub­stantial step further on thestrength of the same principle, a good many moralists of highestrepute vigorously defend someforms of organic transplantationintec uiuos, always with certainqualifications which good medicinewould likewise stipulate. And fi­nally, although one may neverintend his own death as a meansof saving another's life, it is some­times permissible deliberately toperform an heroic act which willhave two immediate results, viz.,the preservation of another's lifeand the unintended, but in thecircumstances inevitable, loss ofone's own. I.n none of these in­stances does any bodily benefitaccrue to the donor subject - infact, quite the contrary is true,especially where the sacrifice ofan organ or risk to life is con­cerned.To the theologian, therefore, i tis clear that the "immanent tele­ology" of our corporal being doesadmit of a certain ordination to66 the benefit of others. In terms o/experimental medicine, it is alscevident that as the genuine necessity of investigative procedure' becomes increasingly more urgentone is morally justified in submit ting to consideraby more than modicum of risk to life or bo.dil integrity. But where draw th · line beyond which one may nc permissibly go in this regard? N , mathematical answer, applicable t , all cases indiscriminately, is possble. As does the physician in an • good medical decision, the morali. t must weigh the pros and cor , of individual cases, chiefly in c 1 ·attempt to judge whether the � is reason sufficient to justify tl � necessary risk or harm entail, j in the particular procedure co; -templated. In attempting to come to } s decision as to the morality of , n experimental procedure not cl :­signed to benefit the subject, t e theologian would accordingly c 1-erate on such generic norms 1s these:I ) When bodily damage and, .Jr risk to life are insignificant, the re is no valid moral reason for f, r­bidding the subject to submit tothe procedure in question. 2) No one may legitimately c, n­sent to a procedure which ent.iils certain death as a necessary me.ms of achieving the experiment's p,.1r­pose. (Although there is guod reason to suggest that a criminal already justly condemned to de.1th might licitly choose this form of execution, such a contingency rep­resents the sole possible exception to an · otherwise universal abso­lute.) LINACRE QUARTERLY Of primary importance among · 'Se requirements is the informed · nsent  of the subject. As a very · neral rule this consent should explicit, especially if the sub­-. is to be exposed to any ap­c1able risk or inconvenience for t ·' benefit of others. Presumed ··-sent remains a speculative pos­s.hdity in some few instances· but·r: the majority of practical c;ses titi., presumption would be eithe; m, justified or at very least inad­visable. 3) In the vast intermediate area where hazard to life or health mayrange from notable to very serious, the maximum limit of permissible risk is not as yet sharply defined.Many o f  the specific problems in­volved are relatively new and still require more thought and discus­sion before they can be settledwith total satisfaction. But at the present time it seems safe to saythat a subject may for the benefitof others authorize and submit to any experimental procedure which :,Vill not �eriously and permanently impair h is  functional integrity or cause a grave risk to his life. Im­plicit in this concession is the sup­position that the procedure hasbeen adequately tested short ofhuman experimentation; that it pro�i�es r e a so nable hope of achievmg a good proportionate to the risk; that there is proportion­ate necessity here and now for employing human .subjects, and that all r easonable care is takento avoid even unintended harm to any who submit to the experiment.But consent of itself does not suffice to justify all human experi­mentation, since there are limits, as yet not defined with total ex­actitude, beyond which man is notmor�lly free to go in disposing of his life or bodily entity. The cir­cumstances of individual casesmust be considered in order todetermine whether there exists sufficiently serious reason ·for in­ducing whatever degree of risk or harm may threaten from the contemplated procedure. SUMMARY AND CONCLUSION No attempt has ·been made _in the course of this discussion to assess the morality of individualconcrete cases of human experi­�entation. So numerous and var­ied are its species that such a treatment would be prohibitivelylengthy. Rather an attempt hasbeen made t o  indicate the genericmoral principles which shouldcomprise the basis of such anassessment whenever one is made.References 1Kelly, G.: Medico-Moral Problems, St. Louis, Catholic Hospital Association 2To the First International Congress 0� the Histopathology of the Nervous Sys­tem, Sept. 13, 1952. The official text ofthis addr�ss, delivered in French, will be found m Acta Aposlolicae Sedis 44. 779•7�9 ( 1952); an English version i� rni�2rd m Catholic Mind 51: 305-3133 Fo� a detailed discussion of requisitepat1�nt consent from a moralist's point4 of vie':, cf. Kelly, op. cit., pp. 36-41. Encyc_hcal letter, Casti connubii ( OnChristian Marriage). A.A.S. 22: 539_592 ( 1930); cf. Catholic Mind 29· 21-64 ( 1931). 67 

Human Experimentation in Medicine: Moral Aspects

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Human Experimentation in Medicine: Moral Aspects

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