This article appears in the November 2006 edition of the Catholic Medical Quarterly
Summon the Moral Tax Lawyer
In our May issue we discussed the current crisis at the Hospital of St. John and St. Elizabeth, which has arisen as a result of the decision of the management to invite a local General Practice to relocate its surgery within the hospital's premises. But it quickly became apparent that the practice, if admitted, would not breach its terms of service to continue referring patient's for abortion and providing the full range of contraceptive services, including the prescription of the abortifacient morning after pill with other abortifacient pills. Such a practice would conflict with traditional Catholic ethics.
It seems worthwhile, therefore, to discuss whether the referral of a patient for an abortion is co-operating in evil. The referral is obviously a form of co-operation, but is it remote or proximal, or as the moral theologians classify it material or formal? What is meant by material or formal co-operation anyway?
The traditional view is that co-operating in evil means performing an act which in some way assists the evil activity of another agent. Formal co-operation is where the co-operator's act shares in the wrongfulness of the principal agent's act, either its end or the intention or decision to pursue it. Material co-operation is where the co-operator's action, although it may be neutral in itself, has the foreseen effect of facilitating the principal agent's wrongdoing.
When any attempt to attribute the onus or define the co-operator's guilt in this problem it must be remembered as Henry Davis remarked half a century ago there is no more difficult question in the whole range of moral theology than that of co-operation in evil. (1) Indeed, it is inevitable that those who live `in the world' will engage in such co-operation from time to time - sometimes it is their duty to do so. As Bishop Fisher points out in his contribution to the recent Linacre Centre book (2), to avoid all co-operation in evil would require that we abandon almost all areas of human activity - family, workplace, government, health systems - and could well be guilty of the sin of omission.
But there are well defined actions which have to be avoided and examples in the sphere of abortion are listed by Bishop Fisher,
- a doctor or nurse assists in an illicit procedure such as abortion or sterilisation, physically supporting every step of the principal surgeon, performing an essential part of the procedure and/or being ready to take over in case of necessity;
- a person volunteers his/her services to an abortion clinic, helping people to fill out forms in order to help women seeking abortion to get them;
- a physician or counsellor refers someone for an abortion.
Under permitted material co-operation are;
- an intern or nurse in an operating room performs the usual duties, such as the preparation of instruments, drugs and patients, but sometimes finds him/herself caught up in immoral procedures,
- an engineer keeps utilities working in a hospital where abortions are being done, only to make a living and further the other good activities carried out there;
- a legislator who, having tried and failed to exclude abortion from a general appropriation bill, then votes for the bill, only to bring about the good things it will fund.
Under wrongful material co-operation were;
- An intern or nurse who is frequently asked to assist in immoral procedures rather than protesting or looking for an alternative position where she/he will not be asked to do this;
- A religious takes part in an abortion;
- A Catholic hospital permits abortions or sterilisations to be performed on its premises.
The above are taken from classical examples including the very cases of formal and wrongful material co-operation repudiated by the magisterium in recent years. This is where the Catholic Tax Lawyer is summoned. According to Bishop Fisher these gentlemen believe that ‘the role of the moral advisor is to help people find a way around the moral law, or at least a way of sailing as close to the wind as possible without falling into the water.’
In his opinion they ‘end up by reducing almost all cases of co-operation in evil to material and not formal co-operation and almost all cases of material co-operation to permissible co-operation.’
This means they use to pay less moral tax are to attach traditional sounding labels such as duress, probable opinion, proportionate reason, the common good and prudence to their novel schemes. If we look at some of these categories in relation to the John and Lizzy crisis we see some glaring anomalies. It has been argued that the doctor should only be regarded, when referring, as a counsellor, thus limiting his guilt. But the third category includes a counsellor also as indulging in formal co-operation if he/she refers for an abortion. Both, in their actions, accept the abortion solution and provide the initial means for its resolution.
Again, the third category under wrongful material co-operation quite clearly denounces the Catholic hospital if it permits abortion or sterilisations on its premises.
It is always exceedingly difficult when confronted directly with a patient for whom abortion appears to be the only solution. The situation may well have arisen under conditions where pregnancy was far from being contemplated or expected. It may concern a close friend or relative. Negative moral obligations may then appear to lack compassion.
It is then perhaps useful to remember that the culture of life proposed in Evangelium Vitae does not merely reject practices such as abortion and euthanasia; it also calls for the protection of the weak and vulnerable. Although no direct assistance by the doctor is offered to further the abortion, it must be made clear that if the patient undergoes the operation the doctor is only too happy to continue to look after that patient in the future.
- "Collaboration and Co-operation in Catholic Health Care" 77 (April 200) Australian Catholic Record: 163
- "Co-operation, Complicity & Conscience" Problems in healthcare, science, law and public policy: The Linacre Centre 2005Goto Home Page