I argue that the separation of conjoined twins in infancy or early childhood is unethical. Cases may be divided into three types: both twins suffer from lethal abnormalities, only one twin has a lethal abnormality, or neither twin does. In the first kind of case, there is no reason to separate, since both twins will die regardless of treatment. In the third kind of case, I argue that separation at an early age is unethical because the twins are likely to (...) achieve an irreplaceably good quality of life—the goods of conjoinment—that separation takes away. Evaluation of this possibility requires maturation past early childhood. Regarding the second type, I point out that with conceivable but unrecorded exceptions, these cases will consistently involve sacrifice separation. I present an argument that sacrifice separation is unethical, but in some cases a moral dilemma may exist in which separation and refraining from separation are both unethical. Perhaps in such cases a decision can be made on non-moral grounds; however, the possibility of such a decision serves not to mitigate but to underscore the fact that the separation is unethical. My conclusion, which applies to all three types of cases, is that it is unethical to separate conjoined twins before their developing personalities give some reliable indication as to whether they desire separation and whether they will achieve those goods of conjoinment. (shrink)

Amongst traditionally-available frameworks within which end-of-life decisions in Intensive Care Units (ICU) are situated, we favour Ordinary versus Extra-ordinary care distinctions as the most helpful. Predicated on this framework, we revisit the concepts of personhood and autonomy. We argue that a full account of personhood locates its foundation in relationships with others, rather than merely in “rationality”. A full account of autonomy also recognises relationships with others, as well as the actual reality of the patient’s situation-in-the-world. The fact that, when (...) critically ill, the patient may no longer be able to take an active role in decision-making does not bring about the end of their personhood, or of their autonomy. Because the patient’s autonomy is intimately linked to their relationships with others, once critical illness supervenes, respect for their autonomy devolves to those others with whom the patient is in relationship. In practical application, this means that there must be a dialogue, as the end-of-life of the critically-ill patient in ICU comes into view. Such dialogue should be grounded on this understanding in order to conform best to moral philosophical principles. Ideally the dialogue will involve all those with whom the patient is in relationship and, practical difficulties within an ICU notwithstanding, will aim to be inclusive, non-coercive and reflective as it seeks to maximise the good of the patient in their unique context. (shrink)

When it comes to dealing with population growth, there are a number of misconceptions about the position of the Catholic Church. Official teaching during the twentieth century gradually moved toward the acceptance of limiting family size and endorsed the concept of responsible parenthood during the Second Vatican Council. One cannot, therefore, justifiably claim that the church is against birth control. It is an entirely different matter, however, when it comes to the practical question about how a couple might go about (...) regulating fertility. Since the publication of Pope Paul VI's 1968 encyclical, an intense controversy has taken place within the church about the use of artificial contraception. Behind that controversy lies an important methodological issue. For, the traditional teaching to which Paul VI returned in his letter was based upon the presumption that it is possible to morally judge a physical, material act without any consideration of the persons who performed that act, the circumstances within which it took place, or the reasons why the act was chosen. This behavioural approach to morality stands in some contrast to the way that other moral questions are dealt with. Inflicting pain or even taking a person's life, for instance, can be justified for a good reason when one acts in a virtuous manner to instil discipline or safeguard justice. Until this methodological controversy is addressed, the problem of using artificial means to regulate fertility will not be resolved. A helpful key for solving the methodological ambiguities is to use moral language in a consistent and understandable manner. (shrink)

Herbert McCabe, OP (d. 2001), was a significant theological figure in England in the last century. A scholar of Aquinas, he was also influenced by Wittgenstein and Marx, his reading of whom helped him articulate a distinctive Thomistic account of human embodiment that serves as a critique of other dominant approaches in ethics. This article shows McCabe's contribution to moral theology by placing his work in conversation with other important approaches, namely, situation ethics, proportionalism, and the New Natural Law Theory.