Bioethics and the Human Goods: An Introduction to Natural Law Bioethics

John Keown has done a tremendous service to the bioethics community by bringing to light the late Alfonso Gómez-Lobo’s succinct, but sure to be impactful, volume. The authorship remains primarily Gómez-Lobo’s as he had already submitted the manuscript to Georgetown University Press and received three referees’ reports, to which he had written responses, but was precluded by his illness from finishing revisions to the manuscript. Keown thus had plenty of first-hand material to complete the revised manuscript—about a third of which comprises material he wrote—in a manner faithful to Gómez-Lobo’s authorial intent (ix).

Gómez-Lobo intended this volume, a follow-up to his Morality and the Human Goods (Gómez-Lobo ²⁰⁰²), to provide an explication and application of natural law theory and its metaphysical foundations to contemporary issues in bioethics. Far from being a polemical work, Keown sees natural law theory as augmenting the incomplete, and sometimes problematically interpreted, “principlist” approach predominant in bioethics (xii). Natural law theory does directly contrast, however, the utilitarian ethic favored by certain bioethicists (xi-xii). A natural law perspective on bioethics is most fitting insofar as, among the non-hierarchically ordered “basic goods” necessary for authentic human flourishing, life and health are instrumentally foundational for all other goods to be attainable (14). The primary purpose of this volume is thus to help inform the consciences of readers with an objective understanding of such goods and their proper application to bioethical issues, as opposed to a subjectivist or culturally relativist conception of moral values and principles (25).

While I share Gómez-Lobo’s overall ethical perspective, I would be remiss as a reviewer if I did not call attention to certain controverted points to which an alternative natural law-based conclusion may be argued. A foundational point of agreement among natural law theorists is the intrinsic dignity of human persons. It may be contested, however, whether one’s dignity is grounded in their existence qua human, such that any member of the biological species Homo sapiens possesses an inviolable moral status; or whether one’s dignity is grounded in their existence qua person. In raising this issue, I am presuming a shared concept of what it means to be a “person” with Gómez-Lobo: namely, a being who possesses “the capacity for rational thought, free choice and moral agency” (30). We also agree that such a capacity is present ab initio the moment an embryo comes into being with the right genetic constitution to develop itself into a mature thinking, willing moral agent, regardless of whether the embryo will actually be allowed to develop itself by being provided with the necessary supportive environment—that is, a uterus. Gómez-Lobo thereby concludes that this capacity is “an essential property of humankind [that] every human possesses in so far as he or she is human” (30). To be clear, every human being possesses the essential capacity by which they are a person even if circumstances conspire not to allow them ever to express that capacity.

But is it indeed the case that every member of the biological species Homo sapiens possesses this essential capacity? Gómez-Lobo considers the potentially problematic case of anencephalic newborns, who fail to develop critical cerebral structures and thereby are never able to think rationally or exercise moral agency. Gómez-Lobo contends that anencephalic newborns are “entitled to the same protection as other human beings” insofar as they are human. Gómez-Lobo holds that such newborns possess the same essential capacity definitive of personhood as other human newborns even though they lack the biological foundation to be able ever to exercise this capacity (64–65). His ethical concern here is with the explantation of vital organs from such newborns prior to their natural death, which typically is not long in coming.

I agree with Gómez-Lobo’s ethical conclusion for reasons that will become apparent; however, I do not share his ontological claim that all anencephalic newborns necessarily possesses the essential capacity of personhood just because they are biologically human. The issue at hand is that we do not fully understand all the potential causes of anencephaly. One evident cause is a lack of folic acid in the mother’s diet. When such is the cause, I would agree with Gómez-Lobo that the anencephalic newborn possesses the essential capacity of personhood but the ability to express that capacity has been completely attenuated by an extrinsic environmental cause—that is, lack of folic acid. What we do not know, though, is whether the cause of some cases of anencephaly might be intrinsic to the embryo ab initio, such that no amount of folic acid or other extrinsic causes could endow it with the essential capacity of personhood. In such a case, I would contend that, while the embryo—and later newborn—is, for the most part, genetically “human,” it inherently lacks the necessary genetic foundation to possess the essential capacity of personhood.

It is important to emphasize that this is an ontological point of disagreement with Gómez-Lobo; for, since we currently lack the epistemic means to determine whether the cause of any given anencephalic newborn’s condition is extrinsic or intrinsic, we ought to treat any such newborn with the fundamental respect due to a person. I thus agree with Gómez-Lobo’s ethical conclusion in this matter. It is nevertheless worth highlighting this ontological disagreement insofar as we may eventually develop a better understanding of the causes of anencephaly and ability to determine—perhaps in utero—the cause of a given fetus’s anencephaly. Such a determination could then have ethical implications different from what Gómez-Lobo concludes.

One might think that this ontological disagreement would lead to a further disagreement regarding human beings in a “persistent vegetative state.” Gómez-Lobo concludes that such individuals, despite having lost the material substratum to support rational and volitional activity, nevertheless retain the essential capacity for such activity and thereby qualify as persons (83–84). I agree with this conclusion insofar as such individuals clearly exhibited their possession of this capacity in their past activity; furthermore, I hold that a person is an ontological unity such that one continues to exist as a person so long as their biological life continues. In the case of congenital anencephalics, however—if there are such entities—I contend that they would never have possessed the essential capacity of personhood in the first place.

Within the realm of end-of-life ethics, another point of disagreement concerns the explantation of vital organs from individuals who have suffered “whole brain death,” which is currently a clinically and legally accepted standard for defining a human being’s death in the United States and several other countries, and which has also been consistently morally approved of by the Vatican since the mid-1980s. An appendix to this volume includes Gómez-Lobo’s statement as a member of the President’s Council on Bioethics regarding this topic, in which he raises various conceptual, physiological, and ethical issues. The first two categories of issues informs Gómez-Lobos’s ethical conclusion that it would violate the “dead donor rule” to explant vital organs from individuals who may still be alive despite the lack of both cerebral and brain stem function—necessary to sustain spontaneous respiration and regulate heartbeat.

Without diving headlong into the deep waters of this debate, I will offer here just two critical points. First, Gómez-Lobo appeals to the putative symmetry between embryonic development and the ontological status of whole-brain dead individuals: namely, that brain function is not necessary for a human organism to exist as an integrated individual (96, 113). The brain-birth/brain-death symmetry argument fails, however, insofar as what is physiologically required for the immature form of an organism to be an integrated whole may differ from what is required for the mature form of the numerically same individual. Second, while compelling cases have been raised to challenge the whole-brain criterion (96), it is debatable whether the interpretation of such cases and the arguments constructed upon such interpretations are sufficiently compelling to undercut the prudential certitude that whole-brain death constitutes a human person’s death. Given the recent spate of point/counterpoint articles in a volume published in 2007 by the Pontifical Academy of Sciences and a competing volume edited by Roberto de Mattei in ²⁰⁰⁶, as well as scholarly exchanges in a 2016 issue of The Journal of Medicine and Philosophy and at the 2016 University Faculty for Life conference at Marquette University, I do not believe that the challenges to the whole-brain criterion mustered thus far have yet eviscerated prudential certitude in its moral validity.

I offer the aforementioned points of contention in the spirit of fraternal dialogue to keep the conversation regarding the bioethical implications of natural law theory moving forward. Gómez-Lobo’s contribution to this dialogue will surely be a touchstone for scholars who concur with his ethical perspective, as well as those who disagree with his metaphysical and moral foundations but yet find his arguments worth engaging—such as David DeGrazia in his endorsement on the book’s back-cover. For bioethicists in the Roman Catholic tradition, it is most gratifying to have this volume representing the Church’s moral worldview in a manner that may engage debates within the Rawlsian public square by not requiring explicit adherence to faith-based tenets. Gómez-Lobo has indeed engaged such debates publicly throughout his laudable career and this volume is a fine testament to his scholarly legacy.