Moral Principles and Medical Practice - Abortion [Imprimatur 1897]

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Moral Principles and Medical Practice
by Rev. Charles Coppens, S.J.
Imprimatur † by Michael Augustine, 1897

A Series of Lectures on the Evils of Abortion and the Defense of the Unborn

Lecture I: Medical Jurisprudence
Lecture II: Craniotomy
Lecture III: Abortion
Lecture IV: Views of Scientists and Sciolists

Lecture I : The Foundation of Medical Jurisprudence

Gentlemen: 1. When I thoughtfully consider the subject on which I am to address you in this course of lectures, i.e., Medical Jurisprudence, I am deeply impressed with the dignity and the importance of the matter.

The study of medicine is one of the noblest pursuits to which human talent can be devoted. It is as far superior to geology, botany, entomology, zoology, and a score of kindred sciences as its subject, the body of man, the visible lord of the creation, is superior to the subject of all other physical sciences, which do so much honor to the power of the human mind; astronomy, which explores the vast realms of space, traces the courses and weighs the bulks of its mighty orbs; chemistry, which analyzes the minutest atoms of matter; physics, which discovers the properties, and mechanics, which utilizes the powers of an endless variety of bodies--all these noble sciences together are of less service to man than that study which directly promotes the welfare of his own structure, guards his very life, fosters the vigor of his youth, promotes the physical and mental, aye, even the moral, powers of his manhood, sustains his failing strength, restores his shattered health, preserves the integrity of his aging faculties, and throughout his whole career supplies those conditions without which both enjoyment and utility of life would be impossible.

The physician, indeed, is one of the most highly valued benefactors of mankind. Therefore he has ever been held in honor among his fellow-men; by barbarous tribes he is looked upon as a connecting link between the visible and the invisible world; in the most civilized communities, from the time of Hippocrates, the father of medicine, to the present day, he has been held in deeper veneration than the members of almost any other profession; even in the sacred oracles of Revelation his office is spoken of with the highest commendation: "Honor the physician," writes the inspired penman, "for the need thou hast of him; for the Most High hath created him. The skill of the physician shall lift up his head, and in the sight of great men he shall be praised. The Most High has created medicines out of the earth, and a wise man shall not abhor them. The virtue of these things is come to the knowledge of men, and the Most High has given knowledge to men, that He may be honored in His wonders. By these He shall cure and shall allay their pains, and of these the apothecary shall make sweet confections, and shall make up ointments of health, and of His works there shall be no end" (Ecclus. xxxiii. 1-7).

2. It is well to remind you thus, gentlemen, at the opening of this new year of studies, of the excellence of your intended profession; for you cannot help seeing that a science so noble should be studied for a noble purpose. In this age of utilitarianism, it is, alas! too common an evil that the most excellent objects are coveted exclusively for lower purposes. True, no one can find fault with a physician for making his profession, no matter how exalted, a means of earning an honest livelihood and a decent competency; but to ambition this career solely for its pecuniary remuneration would be to degrade one of the most sublime vocations to which man may aspire. There is unfortunately too much of this spirit abroad in our day. There are too many who talk and act as if the one highest and worthiest ambition of life were to make as large a fortune in as short a time and in as easy a way as possible. If this spirit of utilitarianism should become universal, the sad consequence of it to our civilization would be incalculable.

Fancy what would become of the virtue of patriotism if officers and men had no higher ambition than to make money! As a patriotic army is the strongest defence of a nation's rights, so a mercenary army is a dreadful danger to a people's liberty, a ready tool in the hand of a tyrant; as heroism with consequent glory is the noble attribute of a patriot, so a mercenary spirit is a stigma on the career of any public officer.

We find no fault with an artisan, a merchant, or a common laborer if he estimate the value of his toil by the pecuniary advantages attached to it; for that is the nature of such ordinary occupations, since for man labor is the ordinary and providential condition of existence. But in the higher professions we always look for loftier aspirations. This distinction of rewards for different avocations is so evident that it has passed into the very terms of our language: we speak of "wages" as due to common laborers, of a "salary" as paid to those who render more regular and more intellectual services; of a "fee" as appointed for official and professional actions; and the money paid to a physician or a lawyer is distinguished from ordinary fees by the especial name of "honorary" or "honorarium." This term evidently implies, not only that special honor is due to the recipients of such fees, but besides that the services they render are too noble to be measured in money values, and therefore the money offered is rather in the form of a tribute to a benefactor than of pecuniary compensation for a definite amount of service rendered.

Wages may be measured by the time bestowed, or by the effect produced, or by the wants of the laborer to lead a life of reasonable comfort; a salary is measured by the period of service; but an honorary is not dependent on time employed, or on needs of support, or on effect produced, but it is a tribute of gratitude due to a special benefactor. Whatever practical arrangements may be necessary or excusable in special circumstances, this is the ideal which makes the medical profession so honorable in society.

3. From these and many other considerations that might be added, it is evident, gentlemen, that in the pursuit of the distinguished career for which you are preparing, you are expected to make yourselves the benefactors of your fellow-men. Now, in order to do so, it will not suffice for you to understand the nature of the various diseases which flesh is heir to, together with the specific powers of every drug described in works on materia medica. The knowledge of anatomy and surgery, and of the various branches that are taught by the many professors with whom I have the honor of being associated in the work of your medical education, no matter how fully that knowledge be mastered, is not sure by itself to make you benefactors to your fellow-men, unless your conduct in the management of all your resources of science and art be directed to procure the real welfare of your patients. Just as a skilful politician may do more harm than good to his country if he direct his efforts to improper ends, or make use of disgraceful means; as a dishonest lawyer may be more potent for the perversion than the maintenance of justice among his fellow-citizens; so likewise an able physician may abuse the beneficent resources of his profession to procure inferior advantages at the sacrifice of moral rights and superior blessings.

Your career, gentlemen, to be truly useful to others and pursued with safety and benefit to yourselves, needs to be directed by a science whose principles it will be my task to explain in this course of lectures--the science of Medical Jurisprudence.

It is the characteristic of science to trace results to their causes. The science of Jurisprudence investigates the causes or principles of law. It is defined as "the study of law in connection with its underlying principles." Medical Jurisprudence, in its wider sense, comprises two departments, namely, the study of the laws regarding medical practice, and, more, especially, the study of the principles on which those laws are founded, and from which they derive their binding power on the human conscience. The former department, styled Medical Law, is assigned in the Prospectus of this College to a gentleman of the legal profession. He will acquaint you with the laws of the land, and of this State in particular, which regulate the practice of medicine; he will explain the points on which a Doctor may come in contact with the law courts, either as a practitioner having to account for his own actions, under a charge of malpractice perhaps, or as an expert summoned as a witness before a court in matters of civil contests or criminal prosecutions. His field is wide and important, but the field of Medical Jurisprudence, in its stricter or more specific sense, is wider still and its research much deeper: it considers those principles of reason that underlie the laws of the land, the natural rights and duties which these laws are indeed to enforce to some extent, but which are antecedent and superior to all human laws, being themselves founded on the essential and eternal fitness of things. For things are not right or wrong simply because men have chosen to make them so. You all understand, gentlemen, that, even if we were living in a newly discovered land, where no code of human laws had yet been adopted, nor courts of justice established, nor civil government organized, still even there certain acts of Doctors, as of any other men, would be right and praiseworthy, and others wrong and worthy of condemnation; even there Doctors and patients and their relatives would have certain rights and duties.

In such a land, the lecturer on Medical Law would have nothing to explain; for there would be no human laws and law courts with which a physician could come in contact. But the lecturer on Medical Jurisprudence proper would have as much to explain as I have in this country at present; because he treats of the Ethics or moral principles of Medical Practice, he deals with what is ever the same for all men whereever they dwell, it being consequent on the very nature of man and his essential relations to his Maker and his fellow-man. Unfortunately the term " Medical Jurisprudence " has been generally misused. Dr. Ewell, in his text book on the subject, writes: "While the term 'Medical Jurisprudence' is a misnomer,--the collection of facts and conclusions usually passing by that name being principally only matters of evidence, and rarely rules of law,--still the term is so generally employed that it would be idle to attempt to bring into use a new term, and we shall accordingly continue the employment of that which has only the sanction of usage to recommend it" (Ch. I).

I prefer to use terms in their genuine meaning; for misnomers are out of place in science, since they are misleading. Yet, to avoid all danger of misunderstanding, I will call my subject "Moral Principles and Medical Practice," and distinctly style it "The Basis of Medical Jurisprudence."

On what lines will my treatment of the subject depart from the beaten path? On the same lines on which most other improvements have been made in the science of medicine. Science has not discovered new laws of physical nature that did not exist before; but it has succeeded in understanding existing laws more perfectly than before, and has shaped its practice accordingly. So, too, the leaders of thought among physicians, especially in English-speaking countries, now understand the laws of moral nature-- the principles of Ethics--more thoroughly than most of their predecessors did, and they have modified their treatment so as to conform it to these rules of morality. Hitherto Medical Jurisprudence had regulated the conduct of practitioners by human, positive laws, and sanctioned acts because they were not condemned by civil courts.

Now we go deeper in our studies, and appeal from human legislation to the first principles of right and wrong, as Jurisprudence ought to do; and, in consequence, some medical operations which used to be tolerated, or even approved, by many in the profession are at present absolutely and justly condemned. The learned physician these days is no longer afraid to face the moral philosopher; there is no longer any estrangement between Ethics and Medical Practice. Medicine, sent from Heaven to be an angel of mercy to man, is now ever faithful to its beneficent mission; it never more performs the task of a destroying spirit, as--not in wantonness, but in ignorance--it did frequently before. On these lines, then, of the improved understanding of first principles, I will now proceed to develop the teachings of Medical Jurisprudence.

The first principle that I will lay down for explanation is, that a man is not to be held responsible for all his acts, but only for those which he does of his own free will, which, therefore, it is in his power to do or not to do. These are called human acts, because they proceed from a distinctively human power. A brute animal cannot perform such acts; it can only do under given circumstances what its impulses prompt it to do; or, when it experiences various impulses in different directions, it can only follow its strongest impulse; as when a dog, rushing up to attack a man, turns and runs away before his uplifted stick. When a bird sings, it cannot help singing; but a man may sing or not sing at his choice; his singing is a human act. When, however, under the impulse of violent pain, a person happens involuntarily to sigh or groan or even shriek, this indeed is the act of a man, but, inasmuch as it is physically uncontrollable, it is not a human act. So whatever a patient may do while under the influence of chloroform is not a human act, and he is not morally responsible for it. His conduct under the circumstances may denote a brave or a cowardly disposition, or it may indicate habits of self-command or the absence of them. His prayers or curses while thus unconscious are no doubt the effects of acquired virtues or vices; yet, in as far as his will has no share in the present acts, they are not free or human acts. He deserves praise or blame for his former acts, by which he acquired such habits, but not for his unconscious acts as such.

From this principle it follows that a physician is not responsible to God or man for such evil consequences of his prescriptions or surgical operations as are entirely beyond his will and therefore independent of his control. If, however, his mistakes arise from his ignorance or want of skill, he is blamable in as far as he is the wilful cause of such ignorance; he should have known better; or, not knowing better, he should not have undertaken the case for which he knew he was not qualified.

But it often happens that the best informed and most skilful practitioner, even when acting with his utmost care, causes real harm to his patients; he is the accidental, not the wilful, cause of that harm, and therefore he is free from all responsibility in the matter.

The practical lessons, however, which all of you must lay to heart on this subject are: 1st. That you are in duty bound to acquire sound knowledge and great skill in your profession; since the consequences involved are of the greatest moment, your obligation is of a most serious nature. 2d. That in your future practice you will be obliged on all occasions to use all reasonable care for the benefit of your patients. 3d. That you cannot in conscience undertake the management of cases of unusual difficulty unless you possess the special knowledge required, or avail yourselves of the best counsel that can reasonably be obtained.

5. A second principle of Ethics in medical practice, gentlemen, is this, that many human acts may be highly criminal of which, however, human laws and courts take no notice whatsoever. In this matter I am not finding fault with human legislation. The laws of the land, considering the end and the nature of civil government, need take no cognizance of any but overt acts; a man's heart may be a very cesspool of vice, envy, malice, impurity, pride, hatred, etc., yet human law does not and ought not to punish him for this, as long as his actions do not disturb the public peace nor trench upon the happiness of his neighbor. Even his open outward acts which injure only himself, such as gluttony, blasphemy, impiety, private drunkenness, self-abuse, even seduction and fornication, are not usually legislated against or punished in our courts. Does it follow that they are innocent acts and lawful before God? No man in his right senses will say so.

The goodness and the evil of human acts is not dependent on human legislation alone; in many cases the moral good or evil is so intrinsic to the very nature of the acts that God Himself could not change the radical difference between them. Thus justice, obedience to lawful authority, gratitude to benefactors, are essentially good; while injustice, disobedience, and ingratitude are essentially evil. Our reason informs us of this difference; and our reason is nothing else than our very nature as intelligent beings capable of knowing truth. The voice of our reason or conscience is the voice of God Himself, who speaks through the rational nature that He has made. Through our reason God not only tells us of the difference between good and evil acts, but He also commands us to do good and avoid evil;--to do certain acts because they are proper, right, orderly, suitable to the end for which we are created; and to avoid other acts because they are improper, wrong, disorderly, unsuitable to the end of our existence. There is a third class of acts, which, in themselves, are indifferent, i.e., neither good nor evil, neither necessary for our end nor interfering with its attainment. These we are free to do or to omit as we prefer; but even these become good and even obligatory when they are commanded by proper authority, and they become evil when forbidden. In themselves, they are indifferent acts.

6. These explanations are not mere abstractions, gentlemen, or mere philosophical speculations. True, my subject is philosophical; but it is the philosophy of every-day life; we are dealing with live issues, which give rise to the gravest discussions of your medical journals; issues on which practically depend the lives of thousands of human beings every year, issues which regard physicians more than any other class of men, and for the proper consideration of which Doctors are responsible to their conscience, to human society, and to their God. To show you how we are dealing with present live issues, let me give you an example of a case in point. In the "Medical Record," an estimable weekly, now in almost the fiftieth year of its existence, there was lately carried on a lengthy and, in some of its parts, a learned discussion, regarding the truth of the principles which I have just now explained, namely, the intrinsic difference between right and wrong, independently of the ruling of law courts and of any human legislation. The subject of the discussion was the lawfulness in any case at all of performing craniotomy, or of directly destroying the life of the child by any process whatever, at the time of parturition, with the intention of saving the life of the mother.

I will not examine this important matter in all its bearings at present; I mean to take it up later on in our course, and to lay before you the teachings of science on this subject, together with the principles on which they are based. For the present I will confine myself to the point we are treating just now, namely, the existence of a higher law than that of human tribunals, the superiority of the claims of natural to those of legal justice. Some might think, at first sight, that this needs no proof. In fact we are all convinced that human laws are often unjust, or, at least, very imperfect, and therefore they cannot be the ultimate test or fixed standard of right and wrong; yet the main argument advanced by one of the advocates of craniotomy rests upon the denial of a higher law, and the assertion of the authority of human tribunals as final in such matters.

In the "Medical Record " for July 27, 1895, p. 141, this gentleman writes in defence of craniotomy: "The question is a legal one per se against which any conflicting view is untenable. The subdivisions under which the common law takes consideration of craniotomy are answers in themselves to the conclusions quoted above, under the unfortunate necessity which demands the operation." Next he quotes the Ohio statute law, which, he remarks, was enacted in protection of physicians who are confronted with this dire necessity. He is answered with much ability and sound learning by Dr. Thomas J. Kearney, of New York, in the same "Medical Record" for August 31, 1895, p. 320, who writes: "Dr. G. bases his argument for the lawfulness of craniotomy in the teachings of common law, contending, at least implicitly, that it is unnecessary to seek farther the desired justification. However, the basis of common law, though broad, is certainly not broad enough for the consideration of such a question as the present one. His coolness rises to sublime heights, in thus assuming infallibility for common law, ignoring the very important fact that behind it there is another and higher law, whose imperative, to every one with a conscience, is ultimate. It evidently never occurs to him that some time could be profitably spent in research, with the view to discovering how often common-law maxims, seen to be at variance with the principles of morality, have been abrogated by statutory enactments. Now the maxims of common law relating to craniotomy, the statutes in conformity therewith, as well as Dr. G.'s arguments (some of them at least), rest on a basis of pure unmitigated expediency; and this is certainly in direct contravention of the teachings of all schools of moral science, even the utilitarian."

Dr. Kearney's doctrine of the existence of a higher law, superior to all human law, is the doctrine that has been universally accepted, in all Christian lands at least, and is so to the present day. Froude explains it correctly when he writes: "Our human laws are but the copies, more or less imperfect, of the eternal laws so far as we can read them, and either succeed and promote our welfare or fail and bring confusion and disaster, according as the legislator's insight has detected the true principle, or has been distorted by ignorance or selfishness" (Century Diet., " Law ").

Whoever calmly reflects on the manner in which laws are enacted by legislative bodies, under the influence of human passions and prejudices, often at the dictation of party leaders or of popular sentiment, of office-seekers or wealthy corporations, etc., will not maintain for a moment that human laws and human tribunals are to be accepted as the supreme measure or norma of right and wrong. The common law of England, which lies at the basis of our American legislation, and is an integral portion of our civil government, is less fluctuating than our statutory law, and is in the main sound and in conformity with the principles of Jurisprudence. But no one will claim infallibility for its enactments; the esteem we have for it is chiefly due to its general accord with the requirements of the higher law.

7. There is, then, a higher law, which all men are bound to obey, even lawgivers and rulers themselves as well as their humblest subjects, a law from which no man nor class of men can claim exemption, a law which the Creator cannot fail to impose upon His rational creatures: although God was free to create or not to create as He chose, since He did not need anything to complete His own happiness,--yet, if He did create, He was bound by His own wisdom to put order into His work; else it would not be worthy of His supreme wisdom. As the poet has so tersely expressed it, "Order is Heaven's first law."

How admirably is this order displayed in the material universe! The more we study the sciences-- astronomy, biology, botany, physiology, medicine, etc.--the more we are lost in admiration at the beautiful order we see displayed in the tiniest as well as in the vastest portions of the creation. And shall man alone, the masterpiece of God in this visible universe, be allowed to be disorderly, to be a failure in the noblest part of his being, to make himself like to the brute or to a demon of malice, to waste his choicest gifts in the indulgence of debasing pleasure? The Creator is bound by His own wisdom to direct men to high purposes, worthy of their exalted intellectual nature. But how shall He direct man? He compels material things to move with order to the accomplishment of their alloted tasks by the physical laws of matter. He directs brute animals most admirably to run their appointed careers by the wonderful laws of instinct, which none of them can resist at will. But man He has made free; He must direct him to do worthy actions by means suitable to a free being, that is, by the enacting of the moral law.

He makes known to us what is right and wrong. He informs every one of us, by the voice of reason itself, that He requires us to do the right and avoid the wrong. He has implanted in us the sense of duty to obey that law. If we do so, we lead worthy lives, we please Him, and, in His goodness, He has rewards in store.

But can He be pleased with us if we thwart His designs; if we, His noblest works on earth, instead of adding to the universal harmony of His creation, make monsters of ourselves, moral blots upon the beautiful face of His world? It were idle for Him to give us the knowledge of His will and then to stand by and let us disfigure His fairest designs; to bid us do what is right, and then let us do wrong without exacting redress or atonement. If He is wise, He must not only lay down the law, but He must also enforce it; He must make it our highest interest to keep His law, to do the right; so that ultimately those men shall be happy who have done it, and those who have thwarted His designs shall be compelled to rue it. He will not deprive us of liberty, the fairest gift to an intelligent creature, but He will hold out rewards and punishments to induce us to keep the law and to avoid its violation. Once He has promised and threatened, His justice and His holiness compel Him to fulfil His threats and promises. A man can commit no rasher act than to ignore, defy, and violate that higher law of which we are speaking, and which, if it must direct all men, especially requires the respect and obedience of those into whose hands he has placed at times the lives of their fellow-men, the greatest of earthly treasures.

I have insisted so much, gentlemen, on the existence of the higher law, on its binding power and on the necessity of observing it, because it is the foundation of my whole course of lectures. If there were no higher law, then there would be no Medical Jurisprudence, in the true sense of the word. For Jurisprudence studies the principles that underlie legal enactments, and if there were no higher law, there would be no such principles; then the knowledge of the human law would fill the whole programme. This in fact is the contention of the defendant of craniotomy to whom I have referred; and he boldly applies his speculation to a matter in which the physician has the most frequent opportunity to exhibit his fidelity to principle, or his subserviency to the requirements of temporary expediency at the sacrifice of duty.

8. You will find, gentlemen, as we proceed in our course, that Doctors have very many occasions in which to apply the lessons of Jurisprudence in their medical practice. I even suspect that they need to be more conscientious in regard to the dictates of the higher law than any other class of men, the clergy alone, perhaps, excepted. They need this not only for their own good, but also for the good of their patients and of the community at large. The reasons are these:

A. The matters entrusted to their keeping are the most important of all earthly possessions; for they are life itself, and, along with life, health, the necessary condition of almost all temporal enjoyment. No other class of men is entrusted with more weighty earthly interests. Hence the physician's responsibility is very great; hence the common good requires that he be eminently faithful and conscientious.

B. With no other class of men does the performance of duty depend more on personal integrity, on conscientious regard for the higher law of morality than with the Doctor. For the Doctor's conduct is less open to observation than that of other professions. The lawyer may have many temptations to act unjustly; but other lawyers are watching him, and the courts of justice are at hand to check his evil practices. As to the judge, he is to pronounce his decisions in public and give reasons for his ruling. The politician is jealously watched by his political opponents. The public functionary, if he is unjust in his dealings, is likely sooner or later to be brought to an account. But the physician, on very many occasions, can be morally sure that his conduct will never be publicly scrutinized. Such is the nature of his ministrations, and such too is the confidence habitually reposed in his integrity, that he is and must be implicitly trusted in matters in which, if he happens to be unworthy of his vocation, he may be guilty of the most outrageous wrongs.

The highest interests of earth are in his hands. If he is not conscientious, or if he lets himself be carried about by every wind of modern speculations, he can readily persuade himself that a measure is lawful because it is presently expedient, that acts can justly be performed because the courts do not punish them; and thus he will often violate the most sacred rights of his patients or of their relatives. Who has more frequent opportunities than a licentious Doctor to seduce the innocent, to pander to the passions of the guilty, to play into the hands of greedy heirs, who may be most willing to pay him for his services? No one can do it more safely, as far as human tribunals are concerned. As a matter of fact, many, all over this land and other lands, are often guilty of prostituting their noble profession to the vilest uses. The evil becomes all the more serious when false doctrines are insinuated, or publicly advocated, which throw doubt upon the most sacred principles of morality. True, the sounder and by far the larger portion of medical men protest against these false teachings by their own conduct at least; but it very frequently happens that the honest man is less zealous in his advocacy of what is right than is the propagandist of bold speculations and dangerous new theories in the spreading of what is pernicious.

The effect thus produced upon many minds is to shake their convictions, to say the least; and I need not tell you, gentlemen, that weak convictions are not likely to be proof against violent and repeated temptations. In fact, if a physician, misled by any of those many theories which are often inculcated or at least insinuated by false scientists, can ever convince himself, or even can begin to surmise that, after all, there may be no such thing as a higher law before which he is responsible for even his secret conduct, then what is to prevent him from becoming a dangerous person to the community? If he sees much temporal gain on the one hand, and security from legal prosecution on the other, what would keep him in the path of duty and honesty? Especially if he can once make himself believe that, for all he knows, he may be nothing more than a rather curiously developed lump of matter, which is to lose forever all consciousness in death. Why should he not get rid of any other evolved lump of matter if it stand in the way of his present or prospective happiness? Those are dangerous men who inculcate such theories; it were a sad day for the medical profession and for the world at large if ever they found much countenance among physicians. Society cannot do without the higher law; this law is to be studied in Medical Jurisprudence.

It is my direct object, gentlemen, to explain this law to you in its most important bearings, and thus to lay before you the chief duties of your profession. The principal reason why I have undertaken to deliver this course of lectures--the chief reason, in fact, why the Creighton University has assumed the management of this Medical College--is that we wish to provide for the West, as far as we are able, a goodly supply of conscientious physicians, who shall be as faithful and reliable as they will be able and well informed; whose solid principles and sterling integrity shall be guarantees of upright and virtuous conduct.

That this task of mine may be successfully accomplished, I will endeavor to answer all difficulties and objections that you may propose. I will never consider it a want of respect to me as your professor if you will urge your questions till I have answered them to your full satisfaction. On the contrary, I request you to be very inquisitive; and I will be best pleased with those who show themselves the most ready to point out those difficulties, connected with my lectures, which seem to require further answers and explanations.