Therapeutic Decisions

Today, there is a broadening use of the term “therapeutic,” and it is problematic.  The term is being applied to practices and procedures that intervene upon the human person, but which do not constitute therapy.  For example, there is talk of “therapeutic” abortions, “therapeutic” cloning and even procured death as a “therapy” for various forms of suffering.  But by definition, therapies heal and treat disorders.

If we are to engage each other intelligently, words must have meaning.  Pregnancy is not a disorder.  Killing is not healing.

Principles To Assist In Making Therapeutic Decisions

A doctor’s mission, and the nature of medicine, is to save lives and to heal.  Accordingly, the following two principles must guide his or her actions.

1. “We Must Do Good And Avoid Evil”

The supreme principle for every human act is to do good and avoid evil.  Simple.  Some in bioethics refer to this as the Principle of Beneficence: the true or integral good of the person should always be sought (that of the embryo, or of a terminal patient); or the Principle of Nonmaleficence, i.e. do no harm.  The latter formulation is the equivalent of the Hippocratic primum non nocere (first, do no harm).  What is demanded above all of a health care professional is that he or she not cause more harm than is already being suffered by the patient.

Through the universal value of this principle, we see the error in any procedure that implies choosing an evil (as a means) to obtain any good, be it physical or moral.   In a more familiar formulation: The ends don’t justify the means.  Ever.

For example, one cannot procure an abortion in the form of intentional killing (as a means) for the good end of the mother, or, as is ringing in current headlines, to obtain tissue and parts as a means to develop therapies for other individuals.  There is no such thing as a “therapeutic abortion,” just as there is no “therapy” that would justify the destruction and use of one human life for the benefit of another.  The harvesting and sale of fetal tissues and parts from aborted fetuses, before or after death, unequivocally violates the therapeutic principle.  To say that some good can come from abortion in the way of therapy for others does not diminish the moral gravity of killing human life but further aggravates it.  We will discuss this further in a following brief on the Principle of Double Effect.

The more specific application to the field of bioethics of doing good and avoiding evil can be expressed as “the absolute need to value and respect the human person” in all of its stages, from conception till natural death.  St. John Paul II wrote in Evangelium Vitae:

As explicitly formulated, the precept ‘You shall not kill’ is strongly negative: it indicates the extreme limit which can never be exceeded. Implicitly, however, it encourages a positive attitude of absolute respect for life; it leads to the promotion of life and to progress along the way of a love which gives, receives and serves.

In this sense, one of the fundamental contributions of Evangelium Vitae is what Sgreccia has called the Principle of Moral Tutiorism: “the mere probability that a human person is involved would suffice to justify an absolutely clear prohibition of any intervention aimed at killing a human embryo.”

Furthermore, the need to respect the constitutive structure of human life allows man to intervene in human nature to correct defects or pathologies, but not to alter it.

2. The Therapeutic Principle

This principle assists us in evaluating what is licit or illicit regarding a directly-intended loss of a member as a means to save the whole organism.

As Pius XII wrote:

The decisive point rests not in the fact that the organ which is amputated or paralyzed be itself infected, but that its continued presence or functioning cause either directly or indirectly a serious menace for the whole body.  It is quite possible that in functioning normally a healthy organ could cause harm to one which is unhealthy, in such a way as to aggravate the evil and the repercussions of this last on the organism as a whole.

This principle safeguards surgery by requiring that:

a)     the operation be oriented to the good of the organism that is affected;
b)     the operation is necessary to intervene on the unhealthy member;
c)     there exists no other reasonable means for healing the illness;
d)     improvement is highly probable; and
e)     the patient has consented.

Taking into account all of this, we can analyze the following examples:

When an appendectomy is performed, there is a recognizable good, that is, the appendix cannot be left in place because it is unhealthy.  A surgery causes certain harm, but it is less than the harm that would be caused by leaving the appendix in place.  To heal a part of the body is to treat the patient in all of his or her bodily integrity.

By contrast, tubal ligation or salpingectomy is clearly the mutilation of a healthy organ, the Fallopian tubes, whose continuous presence and state poses no risk whatsoever.  Thus, the procedure cannot be justified.