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Catholic bioethicists draw on the rich intellectual heritage of the Church that goes back centuries. These ethical principles give us remarkable guidance in analyzing difficult situations and giving advice. The secular academic discipline of bioethics only came into being in the early 1970s. The four principles of beneficence, autonomy, non-maleficence, and justice that bioethicists often invoke are part of the Catholic approach to bioethics as well, but we supplement them with more advanced principles like double effect, totality, solidarity, subsidiarity, and others.

In any serious approach to ethics justice has to be the goal and underlying rationale. If a bioethicist were to propose an unjust solution to an ethical dilemma, it would be a travesty. Still, there are situations where rights come into conflict, like the right to life of pregnant mothers and their preborn children. We sometimes refer to these situations as maternal/fetal vital conflicts. Clearly the Catholic approach is to do everything possible to save both lives. Tragically, in some circumstances neither can be saved or only one. In those latter cases the principle of double effect is applied as formulated by St. Thomas Aquinas. Is the action proposed good in itself and done with a good intention? Is it clear that the good effect is not caused by the bad effect? Is there proportionality between the good and bad effects? Are there no viable alternatives that have no bad effects or less of them? This principle can help clarify very difficult moral situations without ever condoning evil acts. 

Beneficence and non-maleficence essentially mean intending what is good for patients and avoiding harming them as much as possible. This is basic as far as ethics goes but must be supplemented by other criteria. For example, the principle of solidarity affirms that we should seek ways to ease the burdens of the poor or the vulnerable. It is sometimes expressed as a “preferential option for the poor.” This calls not just for a generally positive attitude towards people but to actually make sacrifices to help them. The Church has always praised efforts to care for the poor that go beyond justice and benevolence. We are called to actively display mercy and compassion.

Subsidiarity is also a great principle of Catholic social teaching that goes beyond simply respecting the autonomy of individuals and institutions. Subsidiarity points out that decision-making is most often efficient and just when done at the lowest practical level. It is one reason why the family is seen as the basic unit of society by the Church. This is easy to grasp when looked at in practice. Bureaucrats in Washington DC are rarely capable of making better decisions than local officials who are much closer to the situation. Similarly, patients, their loved ones, and the physicians directly involved in a case tend to make better concrete ethical decisions than distant health insurance or hospital system administrators.

Then there is the principle of totality. This also came from St. Thomas Aquinas’ ethical reflection in the 13th century. He pointed out that one should preserve one’s physical integrity and not mutilate the body, but there are exceptions to this rule. If a gangrenous leg is threatening the life of the patient, and it is not possible to cure the problem in any other way, it is the ethical to amputate the limb to save the life of the patient. The totality of the person should be saved even if sacrificing a part is the only way to achieve this good.

Catholic bioethicists are indeed blessed to have wonderful intellectual resources to provide answers in order to help people make moral decisions. We have not just the basic principles of ethics that tell us to do good and avoid evil, but tools to help us decide what is best to do or refrain from when faced with terrible dilemmas. It is fundamental that we be constantly reminded by the Church that a moral person may never do evil that good may come from it. Some ethical systems allow for a “greater good” that flows from an evil action. Once one has accepted this kind of moral compromise, however, the floodgates of evil are opened.

One of the greatest strengths of Catholic moral reasoning is that it has absolutes that cannot be violated. This provides a solid foundation for everything else. These principles enable us to maximize the good in difficult situations while never committing — but at most tolerating — some proportionate evils.

In the end, what is most important is to live our earthly lives in view of our spiritual destiny. Suffering and ethical decisions here and now take on a very different character when considered in the light of an eternity with God or separated from Him. Also, the ocean of mercy and forgiveness shown by God and the Church when we do sin but then repent is a marvelous consolation. Compassion and goodness guide Catholic bioethics, even after we make mistakes. We are so blessed to have the Church to express God’s infinite love for us.

Joseph Meaney received his PhD in bioethics from the Catholic University of the Sacred Heart in Rome. His doctoral program was founded by the late Elio Cardinal Sgreccia and linked to the medical school and Gemelli teaching hospital. His dissertation topic was Conscience and Health Care: A Bioethical Analysis. Dr. Meaney earned his master’s in Latin American studies, focusing on health care in Guatemala, from the University of Texas at Austin. He graduated from the University of Dallas with a BA in history and a concentration in international studies. The Benedict XVI Catholic University in Trujillo, Peru, awarded Dr. Meaney an honorary visiting professorship. The University of Dallas bestowed on him an honorary doctorate in Humane Letters in 2022.