Transcriber's Note In Lecture I, there are paragraphs numbered 1 to 8 but omitting 4. This is as in the original, as is the inconsistent hyphenation of the words "lawgiver" and "twofold". In two instances, errors of punctuation have been corrected, and in one case obscured words have been guessed. Full details can be found in the html version of this ebook.
MORAL PRINCIPLES AND
THE BASIS OF MEDICAL JURISPRUDENCE.
REV. CHARLES COPPENS, S.J.,
Professor of Medical Jurisprudence in the John A. Creighton Medical College, Omaha, Neb., author of Text-Books on Metaphysics, Ethics, Oratory, and Rhetoric.
NEW YORK, CINCINNATI, CHICAGO: BENZIGER BROTHERS, Printers to the Holy Apostolic See.
MR. JOHN A. CREIGHTON,
THE FOUNDER OF THIS MEDICAL COLLEGE AND OF ST. JOSEPH'S HOSPITAL, AS A SLIGHT TRIBUTE OF HONOR FOR HIS ENLIGHTENED PATRONAGE OF LEARNING AND HIS CHRISTIAN CHARITY TOWARDS HIS FELLOW-MEN, THIS VOLUME IS RESPECTFULLY INSCRIBED.
The undersigned, Provincial of the Missouri Province of the Society of Jesus, in virtue of faculties granted to him by Very Rev. L. MARTIN, General of the same Society, hereby permits the publication of a book entitled "Moral Principles and Medical Practice," by Rev. CHARLES COPPENS, S.J., the same having been approved by the censors appointed by him to revise it.
THOMAS S. FITZGERALD, S.J.
ST. LOUIS, MO., July 2, 1897.
* * * * *
MICHAEL AUGUSTINE, Archbishop of New York.
NEW YORK, July 20, 1897.
COPYRIGHT, 1897, BY BENZIGER BROTHERS.
The science of Medicine is progressive; genius irradiates its onward march. Few other sciences have advanced as rapidly as it has done within the last half century. Hence it has happened that in many of its branches text-books have not kept pace with the knowledge of its leading minds. Such is confessedly the case in the department of Medical Jurisprudence. This very term, Medical Jurisprudence, as now used in colleges, is generally acknowledged to be a misnomer. There is no reason why it should be so used. The leading medical writers and practitioners are sound at present on the moral principles that ought to direct the conduct of physicians. It is high time that their principles be more generally and distinctly inculcated on the younger members, and especially on the students of their noble profession. To promote this object is the purpose aimed at by the author. His brief volume is not intended to be substituted for existing text-books on Medical Jurisprudence, but to supply some chapters imperatively demanded by science for the thorough treatment of this important subject.
PAGE LECTURE I.—INTRODUCTION—THE FOUNDATION OF JURISPRUDENCE, 11
" II.—CRANIOTOMY, 37
" III.—ABORTION, 58
" IV.—VIEWS OF SCIENTISTS AND SCIOLISTS, 81
" V.—VENEREAL EXCESSES, 104
" VI.—THE PHYSICIAN'S PROFESSIONAL RIGHTS AND DUTIES, 128
" VII.—THE NATURE OF INSANITY, 151
" VIII.—THE LEGAL ASPECTS OF INSANITY, 177
" IX.—HYPNOTISM AND THE BORDER-LAND OF SCIENCE, 197
MORAL PRINCIPLES AND MEDICAL PRACTICE.
INTRODUCTORY—THE FOUNDATION OF 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, zooelogy, 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 where-ever 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 Dict., "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 see 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.
Gentlemen:—In my first lecture I proved to you the existence and the binding power of a higher law than that of human legislators, namely, of the eternal law, which, in His wisdom, the Creator, if He created at all, could not help enacting, and which He is bound by His wisdom and justice to enforce upon mankind.
We are next to consider what are the duties which that higher law imposes upon the physician. In this present lecture I will confine myself to one duty, that of respect for human life.
A duty is a bond imposed on our will. God, as I remarked before, imposes such bonds, and by them He directs free beings to lead worthy lives. As He directs matter by irresistible physical laws, so He directs intelligent and free beings by moral laws, that is, by laying duties or moral bonds upon them, which they ought to obey, which He must require them to obey, enforcing His commands by suitable rewards and punishments. Thus He establishes and enforces the moral order.
Now the duties He lays upon us are of three classes. First, there are duties of reverence and honor towards Himself as our sovereign Lord and Master. These are called the duties of Religion, the study of which does not belong to Medical Jurisprudence. The other classes of duties regard ourselves and our fellow-men, with these we are to deal in our lectures.
I. Order requires that the meaner species of creatures shall exist for the benefit of the nobler; the inert clod of earth supports vegetable life, the vegetable kingdom supplies the wants of animal life, the brute animal with all inferior things subserves the good of man; while man, the master of the visible universe, himself exists directly for the honor and glory of God. In this beautiful order of creation, man can use all inferior things for his own benefit.
This is what reason teaches concerning our status in this world; and this teaching of reason is confirmed by the convictions of all nations and all ages of mankind. The oldest page of literature that has come down to us, namely, the first chapter of the first book of Holy Writ, lays down this same law, and no improvement has been made in it during all subsequent ages. Whether we regard this writing as inspired, as Christians and Jews have always done, or only as the testimony of the most remote antiquity, confirmed by the acceptance of all subsequent generations, it is for every sensible man of the highest authority.
Here is the passage: "God said, Let us make man to our image and likeness; and let him have dominion over the fishes of the sea, and the fowls of the air, and the beasts, and the whole earth, and every creeping creature that creepeth upon the earth." And later on in history, after the deluge, God more explicitly declared the order thus established, saying to Noe and his posterity: "Every thing that moveth and liveth shall be meat for you; even as the green herbs have I delivered them to you." But He emphatically adds that the lives of men are not included in this grant; they are directly reserved for His own disposal. "At the hand of every man," He says, "will I require the life of man."
All things then are created for man; man is created directly for God, and is not to be sacrificed for the advantage of a fellow-man. Thus reason and Revelation in unison proclaim that we can use brute animals as well as plants for our benefit, taking away their lives when it is necessary or useful to do so for our own welfare; while no man is ever allowed to slay his fellow-man for his own use or benefit: "At the hand of every man will I require the life of man."
II. The first practical application I will make of these general principles to the conduct of physicians is this: a physician and a student of medicine can, with a safe conscience, use any brute animal that has not been appropriated by another man, whether it be bug or bird or beast, to experiment upon, whatever specious arguments humane societies may advance to the contrary. Brute animals are for the use of man, for his food and clothing, his mental and physical improvement, and even his reasonable recreations. Man can lawfully hunt and fish and practise his skill at the expense of the brute creation, notwithstanding the modern fad of sentimentalists. The teacher and the pupil can use vivisection, and thus to some extent prolong the sufferings of the brute subject for the sake of science, of mental improvement, and intelligent observation. But is not this cruelty? and has a man a right to be cruel? No man has a right to be cruel; cruelty is a vice, it is degrading to man's noble nature. But vivisection practised for scientific purposes is not cruel. Cruelty implies the wanton infliction of pain: there are people who delight in seeing a victim tortured; this is cruelty or savagery, and is a disgrace to man. Even to inflict pain without benefit is cruel and wrong; but not when it is inflicted on the brute creation for the benefit of man, unless the pain should be very great and the benefit very small. Certainly it is right to cultivate habits of kindness even to animals; but this matter must not be carried to excess.
The teaching of humane societies condemning all vivisection is due to the exaggeration of a good sentiment and to ignorance of first principles. For they suppose that sufferings inflicted on brute animals are a violation of their rights. Now we maintain that brute animals have no rights in the true sense of the word. To prove this thesis we must explain what a right is and how men get to have rights. A right is a moral claim to a thing, which claim other persons are obliged to respect. Since every man has a destiny appointed for him by his Creator, and which he is to work out by his own acts, he must have the means given him to do so. For to assign a person a task and not to give him the means of accomplishing it would be absurd. Therefore the Creator wants him to have those means, and forbids every one to deprive him of those means. Here is the foundation of rights. Every man, in virtue of the Creator's will, has certain advantages or claims to advantages assigned him which no other man may infringe. Those advantages and claims constitute his rights, guaranteed him by the Creator; and all other men have the duty imposed on them to respect those rights. Thus rights and duties are seen to be correlative and inseparable; the rights lodged in one man beget duties in other men. The same Creator that assigns rights to one man lays upon all others duties to respect those rights, that thus every free being may have the means of working out its Heaven-appointed destiny.
Thus it is apparent that rights and duties suppose free beings, persons; now an irrational animal is not a person; it is not a free being, having a destiny to work out by its free acts; it is therefore incapable of having duties. Duties are matters of conscience; therefore they cannot belong to the brute animal; for it has no conscience. And, since rights are given to creatures because of the duties incumbent on them, brute animals are incapable of having rights. When a brute animal has served man's purpose, it has reached its destiny.
III. But it is entirely different with man: there is what we may call an infinite distance between man and brute. Every man is created directly for the honor and service not of other men, but of God Himself: by serving God man must work out his own destiny—eternal happiness. In this respect all men are equal, having the same essence or nature and the same destiny. The poor child has as much right to attain eternal happiness as the rich child, the infant as much as the gray-bearded sire. Every one is only at the beginning of an endless existence, of which he is to determine the nature by his own free acts. In this infinite destiny lies the infinite superiority of man over the brute creation.
That all men are equal in their essential rights is the dictate of common-sense and of sound philosophy. This truth may not flatter kings and princes; but it is the charter of human rights, founded deeper and broader in nature and on the Creator's will than any other claim of mankind. As order requires the subordination of lower natures to higher, so it requires equality of essential rights among beings of the same nature. Now all men are of the same nature, hence they have all the same essential rights.
If any people on earth must stand by these principles, certainly the American people must do so; for we have put them as the foundation-stones of our civil liberty. There is more wisdom than many, even of its admirers, imagine in the preamble to our Declaration of Independence; upon it we are to base the most important rights and duties which belong to Jurisprudence. The words of the preamble read as follows: "We hold these truths as self-evident, that all men are created equal; that they are endowed by their Creator with certain inalienable rights; that among these are life, liberty, and the pursuit of happiness." I feel convinced, gentlemen, and I will take it for granted henceforth, unless you bring objections to the contrary, that you all agree with me on this important point that every man has a natural right to his life, a right which all other men are solemnly bound to respect. It is his chief earthly right. It is called an inalienable right; by which term the fathers of our liberty meant a right which under no circumstances can be lawfully disregarded. A man who takes it upon himself to deprive another of life commits two grievous wrongs: one towards his victim, whose most important right he violates, and one towards God, who has a right to the life and service of His creatures. "Thou shalt not kill" is a precept as deeply engraven on the human heart by reason itself as it was on the stone tables of the Ten Commandments by Revelation.
So far we have chiefly considered murder as a violation of man's right to his life. We must now turn our attention to God's right, which the murderer violates. It may indeed happen that a man willingly resigns his right to live, that he is tired of life, and longs and implores for some one to take it away. Can you then do it? You cannot. His life does not belong to him alone, but to God also, and to God principally; if you destroy it, you violate God's right, and you will have to settle with Him. God wills this man to live and serve Him, if it were only by patient endurance of his sufferings.
For a man may be much ennobled and perfected by the practice of patience under pain and agony. Some of the noblest characters of history are most glorious for such endurance. The suicide rejects this greatness; he robs God of service and glory, he rebels against his Creator. Even Plato of old understood the baseness of suicide, when he wrote in his dialogue called "Phaedon" that a man in this world is like a soldier stationed on guard; he must hold his post as long as his commander requires it; to desert it is cowardice and treachery; thus, he says, suicide is a grievous crime.
This being so, can a Doctor, or any other man, ever presume to contribute his share to the shortening of a person's life by aiding him to commit suicide? We must emphatically say No, even though the patient should desire death: the Doctor cannot, in any case, lend his assistance to violate the right and the law of the Creator: "Thou shalt not kill."
I have no doubt, gentlemen, that some of you have been saying to yourselves, Why does the lecturer insist so long upon a point which is so clear? Of course, none of us doubts that we can in no case aid a patient to commit suicide. My reason for thus insisting on this matter is that here again we are dealing with a living issue. There are to-day physicians and others who deny this truth, not in their secret practice only, but, of late, to justify their conduct, they have boldly formulated the thesis that present apparent expediency can lawfully be preferred to any higher consideration. Here is the fact. At a Medico-Legal Congress, held in the summer of 1895, Dr. Bach, one of its leading lights, openly maintained it as his opinion that "Physicians have the moral right to end life when the disease is incurable, painful, and agonizing."
What his arguments were in support of his startling proposition, I have not been able to learn. But I know that a cry of horror and indignation has gone up from many a heart. Many have protested in print; but unless, on an occasion like this, moralists raise their voice against it with all the influence which sound principles command, the saying of Dr. Bach may at least shake the convictions of the rising generation of physicians. The only argument for Dr. Bach's assertion that I can imagine—and it is one proceeding from the heart rather than the head—is that it is cruel to let a poor man suffer when there is no longer hope of recovery. It is not the Physician that makes him suffer; it is God who controls the case, and God is never cruel.
He knows His own business, and forbids you to thwart His designs. If the sufferer be virtuous, God has an eternity to reward his patient endurance; if guilty, the Lord often punishes in this world that He may spare in the next. Let Him have His way, if you are wise; His command to all is clear, "Thou shalt not kill."
One rash utterance, like that of Dr. Bach, can do an incalculable amount of harm. Why, gentlemen, just think what consequences must follow if his principle were, admitted! For the only reason that could give it any plausibility would be that the patient's life is become useless and insupportable. If that were a reason for taking human life away, then it would follow that, whenever a man considers his life as useless and no longer supportable, he could end it, he could commit suicide. That reasoning would practically justify almost all suicides. For, when people kill themselves, it is, in almost all cases, because they consider their lives useless and insupportable. Whether it results from physical or from moral causes that they consider their life a burden, cannot, it seems to me, make any material difference; grief, shame, despair are as terrible sufferings as bodily pains. If, then, we accept Dr. Bach's principle, we must be prepared for all its baneful consequences.
IV. But are there no exceptions to the general law, "Thou shalt not kill"? Are there no cases in which it is allowed to take another's life? What about justifiable homicide? There are three cases of this nature, gentlemen; namely, self-defence, capital punishment inflicted by the state, and active warfare. With only one of these can a physician, as such be concerned or think himself concerned. He is not a public hangman executing a sentence of a criminal court; nor is he acting as a soldier proceeding by public authority against a public foe. As to the plea of self-defence, it must be correctly understood, lest he usurp a power which neither human nor divine law has conferred upon him.
1. Self-defence. It is a dictate of common-sense, already quoted by Cicero as a universally received maxim of Jurisprudence in his day, that it is justifiable to repel violence by violence, even if the death of our unjust assailant should result. In such a case, let us consider what really takes place. A ruffian attempts to take away my life; I have a right to my life. I may, therefore, protect it against him; and, for that purpose, I may use all lawful means. A lawful means is one that violates no law, one that I may use without giving any one reasonable ground of complaint. Suppose I have no other means to protect my life than by shooting my aggressor; has he a right to complain of my conduct if I try to do so? No, because he forces me to the act; he forces me to choose between my life and his. Good order is not violated if I prefer my own life: well-ordered charity begins at home. But is not God's right violated? It is; for God has a right to my life and to that of my assailant. The ruffian who compels me to shoot him is to blame for bringing both our lives into danger; he is responsible for it to God. But the Creator will not blame me for defending my life by the only means in my power, and that when compelled by an unjust assailant, who cannot reasonably find fault with my conduct.
But it may be objected that no evil act may be done to procure a good result, that a good end does not justify a bad means. That is a correct principle, and we will consider it carefully some other day. But my act of necessary self-defence is not evil, and therefore needs no justification; for the means I employ are, under the circumstances, well-ordered and lawful means, which violate no one's rights, as has just been shown. Of course the harm I do to the aggressor is just only in as far as it is strictly necessary to defend the inalienable right I have to life or limb or very valuable property. Hence I must keep within the just limits of self-defence. To shoot an assailant, when I am in no serious danger, or when I can free myself some other way, or when I act through malice, would not be self-defence, but unjustifiable violence on my part.
2. The principles that make it lawful for a man to defend his own life with violence against an unjust assailant will also justify a parent in thus defending his children, a guardian his wards; and in fact any one may forcibly defend any other human being against unjust violence. A parent or guardian not only can, but he is in duty bound to, defend those under his charge by all lawful means. Similarly the physician would be obliged to defend his patient by the exercise of his profession in his behalf.
Now the only case in which the need of medical treatment against unjust aggression could become a matter for discussion in Jurisprudence is the case of a mother with child. Is the child under those circumstances really an unjust aggressor? Let us study that important case with the closest attention. Let all the rays of light we have gathered so far be focussed on this particular point. Can a physician ever be justified in destroying the life of a child, before or during its birth, by craniotomy or in any other manner, in order to save its mother's life, on the plea that the child is an unjust assailant of the life of its mother? Put the case in a definite shape before you. Here is a mother in the pangs of parturition. An organic defect, no matter in what shape or form, prevents deliverance by the ordinary channels. All that medical skill can do to assist nature has been done. The case is desperate. Other physicians have been called in for consultation, as the civil law requires before it will tolerate extreme measures. All agree that, if no surgical operation is performed, both mother and child must die. There are the Caesarian section, the Porro operation, laparotomy, symphysiotomy, all approved by science and the moral law. But we will suppose an extreme case; namely, the circumstances are so unfavorable for any of these operations—whether owing to want of skill in the Doctors present, or for any other reason—that none can safely be attempted; any of them would be fatal to the mother.
In this extreme case of necessity, can the Doctor break the cranium of the living child, or in any way destroy its life with a view to save the mother? If three consulting physicians agree that this is the only way to save her, he will not be molested by the law courts for performing the murderous operation. But will the law of nature and of nature's God approve or allow his conduct? This is the precise question under our consideration. We have seen that the infant, a true human being, has a right to live, as well as its mother. "All men are created equal, and have an equal right to life," declares the first principle of our liberty. The Creator, too, as reason teaches, has a clear right to the child's life; that child may answer a very special purpose of Providence. But whether it will or not, God is the supreme and the only Master of life and death, and He has laid down the strict prohibition, "Thou shalt not kill."
Now comes the plea of self-defence against an unjust aggressor. If the child is such, if it unjustly attacks its mother's life, then she can destroy it to save herself, and her physician can aid the innocent against the guilty party. But can it be proved that the infant is an unjust aggressor in the case? There can be no intentional or formal guilt in the little innocent babe. But can we argue that the actual situation of the child is an unjust act, unconsciously done, yet materially unjust, unlawful? Thus, if a madman would rush at me with a sharp sword, evidently intent on killing me, he may be called an unjust aggressor; though, being a raving maniac, he does not know what crime he is committing, and is formally innocent of murderous intent. Materially considered, the act is unjust, and I can defend myself lawfully as against any other unjust assailant. Such is the common teaching of moralists. But can the innocent babe be classed in the same category with the raving maniac? Why should it? It is doing nothing; it is merely passive in the whole process of parturition.
Will any one object that the infant has no right to be there at all? Who put it there? The only human agents in the matter were its parents. The mother is more accountable for the unfortunate situation than the child. Certainly you could not, to save the child, directly kill the mother, treating her as an unjust assailant of her child's life? Still less can you treat the infant as an unjust assailant of its mother's life.
The plea of self-defence against unjust aggression being thus ruled out of court in all such cases, and no other plea remaining for the craniotomist, we have established, on the clearest principles of Ethics and Jurisprudence, that it is never allowed directly to kill a child as a means to save its mother's life. It would be a bad means, morally evil; and no moral evil can ever be done that good may come of it; the end cannot justify an evil means. In theory all good men agree with us that the end can never justify the means. But in practice it seems to be different with some of the medical profession. Of late, however, the practice of craniotomy and all equivalent operations upon living subjects has gone almost entirely out of fashion among the better class of physicians.
Allow me, gentlemen, to conclude this lecture with the reading of two extracts from articles of medical writers on the present state of craniotomy in their profession. You will find them in accord with the conclusions at which we have arrived by reasoning upon the principles of Jurisprudence.
Dr. W. H. Parish writes ("Am. Eccles. Review," November, 1893, p. 364): "The operations of craniotomy and embryotomy are to-day of relatively infrequent occurrence, and many obstetricians of large experience have never performed them. Advanced obstetricians advocate the performance of the Cesarian section or its modification—the Porro operation—in preference to craniotomy, because nearly all the children are saved, and the unavoidable mortality among mothers is not much higher than that which attends craniotomy. Of one hundred women on whom Cesarian section is performed under favorable conditions and with attainable skill, about ninety-five mothers should recover and fully the same number of children. Of one hundred craniotomies, ninety-five mothers or possibly a larger number will recover, and of course none of the children. The problem resolves itself into this: Which shall we choose—Cesarian section with one hundred and ninety living beings as the result, or craniotomy with about ninety-five living beings?"
Even if a liberal deduction be made for unfavorable circumstances and deficient skill, the results, gentlemen, will still leave a wide margin in favor of Cesarian section. My second extract is from an article of Dr. M. O'Hara, and it is supported by the very highest authorities (ib. p. 361): "Recently [August 1, 1893] the British Medical Association, the most authoritative medical body in Great Britain, at its sixty-first annual meeting, held at Newcastle-upon-Tyne, definitely discussed the subject before us. In the address delivered at the opening of the section of Obstetric Medicine and Gynecology, an assertion was put forth which I regard as very remarkable, my recollection not taking in any similar pronouncement made in any like representative medical body. The authoritative value of this statement, accepted as undisputed by the members of the association, which counts about fifteen thousand practitioners, need not be emphasized.
"Dr. James Murphy ('British Medical Journal,' August 26, 1893), of the University of Durham, made the presidential address. He first alluded to the perfection to which the forceps had reached for pelves narrowed at the brim, and the means of correcting faulty position of the foetus during labor. He then stated: 'In cases of great deformity of the pelvis, it has long been the ambition of the obstetrician, where it has been impossible to deliver a living child per vias naturales, to find some means by which that child could be born alive with comparative safety to the mother; and that time has now arrived. It is not for me to decide,' he says, 'whether the modern Cesarian section, Porro's operation, symphysiotomy, ischiopubotomy, or other operation is the safest or most suitable, nor yet is there sufficient material for this question to be decided; but when such splendid and successful results have been achieved by Porro, Leopold, Saenger, and by our own Murdoch Cameron, I say it deliberately and with whatever authority I possess, and I urge it with all the force I can master, that we are not now justified in destroying a living child; and while there may be some things I look back upon with pleasure in my professional career, that which gives me the greatest satisfaction is that I have never done a craniotomy on a living child.'"
You will please notice, gentlemen, that when this distinguished Doctor said, "We are not now justified in destroying a living child," he was speaking from a medical standpoint, and meant to say that such destruction is now scientifically unjustifiable, is a blunder in surgery. From a moral point of view it is not only now, but it was always, unjustifiable to slay a child as a means to save the mother's life; a good end cannot justify an evil means, is a truth that cannot be too emphatically inculcated. This is one of the most important subjects on which Medical Jurisprudence has been improved, and most of its text-books are deficient. The improvement is explained with much scientific detail in an address of the President, Samuel C. Busey, M.D., before the Washington Obstetrical and Gynecological Society ("Am. Journal of Obstetrics and Diseases of Women and Children," vol. xvii. n. 2).
Abortion, gentlemen, is the theme of my present lecture.
I. An important point to be determined is the precise time when the human embryo is first animated by its own specific principle of life, its human soul. It is interesting to read what various conjectures have been ventured on this subject by the learned of former ages. They were totally at sea. Though gifted with keen minds, they had not the proper data to reason from. And yet some of those sages made very shrewd guesses. For instance, as early as the fourth century of our era, St. Gregory of Nyssa taught the true doctrine, which modern science has now universally accepted. He taught that the rational soul is created by Almighty God and infused into the embryo at the very moment of conception. Still, as St. Gregory could not prove the certainty of his doctrine, it was opposed by the majority of the learned.
The Schoolmen of the Middle Ages, while condemning abortion from the time of conception, preferred the opinion of Aristotle, that the rational soul is not infused till the foetus is sufficiently developed to receive it. The embryo lived first, they taught, with a vegetable life; after a few days an animal soul replaced the vegetative principle; the human soul was not infused into the tiny body till the fortieth day for a male, and the eightieth day for a female child. All this sounds very foolish now; and yet we should not sneer at their ignorance; had we lived in their times, we could probably have done no better than they.
It was not till 1620 that Fienus, a physician of Louvain, in Belgium, published the first book of modern times that came near the truth. He maintained that the human soul was created and infused into the embryo three days after conception. Nearly forty years later, in 1658, a religious priest, called Florentinius, wrote a book in which he taught that, for all we know, the soul may be intellectual or human from the first moment of conception; and the Pope's physician Zachias soon after maintained the thesis as a certainty that the human embryo has from the very beginning a human soul.
Great writers applauded Fienus and his successors; universities favored their views; the Benedictines, the Dominicans, and the Jesuits supported them. Modern science claims to have proved beyond all doubt that the same soul animates the man that animated the foetus from the very moment of conception. The "Medical Jurisprudence" of Wharton and Stille quotes Dr. Hodge of the Pennsylvania University as follows (p. 11): "In a most mysterious manner brought into existence, how wonderful its formation! Imperfect in the first instance, nay, even invisible to the naked eye, the embryo is nevertheless endowed, at once, with the principles of vitality; and although retained in the system of its mother, it has, in a strict sense, an independent existence. It immediately manifests all the phenomena of organic life; it forms its own fluids and circulates them; it is nourished and developed; and, very rapidly from being a rudis indigestaque moles, apparently an inorganic drop of fluid, its organs are generated and its form perfected. It daily gains strength and grows; and, while still within the organ of its mother, manifests some of the phenomena of animal life, especially as regards mobility. After the fourth month its motions are perceptible to the mother, and in a short period can be perceived by other individuals on close investigation.
"The usual impression," the authors add, "and one which is probably still maintained by the mass of the community, is that the embryo is perfected at the period of quickening—say the one hundred and twelfth or one hundred and twentieth day. When the mother first perceives motion, is considered the period when the foetus becomes animated—when it receives its spiritual nature into union with its corporeal.
"These and similar suppositions are, as has been already shown, contrary to all fact, and, if it were not for the high authorities—medical, legal, and theological—in opposition, we might add, to common-sense."
At present, gentlemen, there seems to be no longer any authority to the contrary. But many people, and some Doctors, seem to be several generations behind the times; for they still act and reason as if in the first weeks of pregnancy no immortal or human soul were in question.
Physicians worthy of their noble profession should strive to remove such gross and mischievous ignorance. In many of the United States the law casts its protection around an unborn infant from its first stage of ascertainable existence; no matter whether "quickening" has taken place or not, and consequently no matter what may be the stage of gestation, an indictment lies for its wilful destruction (Wharton and Stille, p. 861). "Where there has been as yet no judicial settlement of the immediate question, it may be reasonably contended that to make the criminality of the offence depend upon the fact of quickening is as repugnant to sound morals as it is to enlightened physiology" (ib.). "That it is inconsistent with the analogies of the law is shown by the fact that an infant, born even at the extreme limit of gestation after its father's death, is capable of taking by descent, and being appointed executor" (ib.). Dr. Hodge adds this sensible remark: "It is then only [at conception] the father can in any way exert an influence over his offspring; it is then only the female germ is in direct union with the mother—the connection afterwards is indirect and imperfect" (ib.). The fact, therefore, is now scientifically established that the embryo from the first moment of conception or fecundation is a human being, having a human immortal soul.
II. Now we come to the direct study of abortion. Abortion, or miscarriage, strictly means the expulsion of the foetus before it is viable, i.e., before it is sufficiently developed to continue its life outside of the maternal womb. The period of arrival at viability is usually after the twenty-eighth week of gestation. When birth occurs later than that period, and yet before the full term of nine months, it is called premature birth, which is altogether different from abortion; for it may save the life of the child, which abortion always destroys. "Premature labor is frequently induced in legitimate medical practice, for the purpose of avoiding the risks which in some cases attend parturition at term.... The average number of children saved by this means is rather more than one-half of the cases operated upon," say Wharton and Stille ("Parturition," p. 96). But they caution the physician against too ready recourse to this treatment; for, they add very truly, "The sympathetic phenomena of pregnancy are often more alarming in appearance than in reality, and will rarely justify any interference with the natural progress of gestation. In all cases the physician should consult with one or more of his colleagues before inducing premature labor; in this manner his humane intentions will not expose him, in case of failure, to reproach, suspicion, or prosecution."
The first time my attention was practically called to the case of a child in danger of dying before the time of delivery occurred over twenty years ago, when the mother of a highly respected family, then in my spiritual charge, was wasting away with consumption during her state of pregnancy. You know that we Catholics are very solicitous that infants shall not die without Baptism, because we believe that heaven is not promised to the unbaptized. I therefore directed the lady's husband to consult their family physician on the prospects of the case, and take timely precautions, so that, if death should come on the mother before her delivery, the infant might be reached at once and be baptized before it expired. The physician, a learned and conscientious practitioner, answered that we should not be solicitous; for that Nature had so provided that mothers in such cases rarely die before the child is born. He was right. The child was born and baptized; the mother died a few hours later; the little one lived several weeks before it went to join the angels in heaven. I learned from that occurrence the lesson which Wharton and Stille inculcate that "the phenomena of pregnancy are often far more alarming in appearance than in reality, and we are rarely justified in interfering with the natural progress of gestation."
To return to our subject. Abortion, or miscarriage, is often, as you know, gentlemen, the result of natural causes beyond human control; at other times it is brought on by unintentional imprudence on the part of the mother or her attendants. It is the duty of the family physician, when occasions offer, to instruct his pregnant patients and other persons concerned on the dangers to be avoided. A good Doctor should be to his patients what a father is to his children; very important matters are confided to him, and therefore grave responsibilities rest on his conscience.
III. We are now ready to consider the chief question of this lecture, namely, whether there can be any cases in which a physician is justified in bringing about an abortion, or in prescribing a treatment from which he knows an abortion is likely to result.
1. It is evident that, if he acts with due prudence, and yet, from some cause which he did not foresee and could not have been foreseen, his treatment brings about a miscarriage, he cannot justly be held accountable for what he could not help.
2. But what if he foresees that a drug or treatment, which, he thinks, is needed for the mother's health, may perhaps bring on a miscarriage? Can he still administer that drug or prescribe that treatment? Notice the question carefully. It is not supposed that he wants to bring on the miscarriage. He does not; he will do all he can to prevent it. Nor will his treatment or drug directly destroy the life or the organism of the embryo; but it is intended to affect favorably the system of the mother, and it is applied to her own organism. Still the Doctor knows that the prescription may indirectly bring about abortion. Can he prescribe the drug or treatment from which he knows the death of the foetus may indirectly result, the direct purpose being to remove an ailment of the mother's?
There is a sound moral principle bearing on such cases; it is universally admitted in Ethics and Jurisprudence, and its application is so extensive that it well deserves careful study. It is this: "He who wilfully puts a cause is answerable for the effect of that cause," causa causae est causa causati. Therefore, if the effect is evil, he is answerable for that evil. This, however, supposes that he could foresee the danger of such evil effect.
That evil effect is said to be indirectly willed; for it follows from a cause which is directly willed. If, then, you should give a dose to a pregnant mother which is intended to stop her fever or other ailment, but may also bring on abortion, the stopping of her fever is directly intended, and the abortion is said to be indirectly intended or willed. Those are the received terms in moral science. It were more correct to say that the abortion in this case is an effect not intended at all, but only permitted. That, then, which is permitted to result from our acts is said to be indirectly willed.
Are we then always responsible for evil effects permitted or indirectly willed? The principle laid down seems to say so. But then that principle admits of important exceptions. If we could never do an act from which we know evil consequences may follow, then we could scarcely do anything of importance; a young man could certainly not become a physician at all, for he is almost certain to injure some of his patients in the course of his professional life. But if we had no Doctors, such a loss would be a much greater evil to mankind than their occasional mistakes. Here then we seem to be in a dilemma, with evil on both sides of us. And then we are reminded of that other principle of which we spoke before, that we may never do evil at all that good may come of it. What shall we do? The solution is this: we should never do evil, but we are often justified in permitting evil to happen; in other words, we can never will evil directly, but we can often will it indirectly: we can do what is right in itself, even though we know or fear that evil will also result from our good act.
This conduct requires four conditions: 1. That we do not wish the evil itself, but make all reasonable effort to avoid it. 2. That the immediate effect we wish to produce is good in itself. 3. That the good effect intended is at least as important as the evil effect permitted. 4. That the evil is not made a means used to obtain the good effect.
Now let us apply these principles to the case in hand.
1. If the medicine is necessary to save the mother's life, and it is not certain to bring on abortion, though it is likely to do so, then the good effect is greater and more immediate or direct than the bad effect; then give the medicine to save the mother, and permit the probable death of the child.
2. If the medicine is not necessary to save the mother's life, though very useful, for the sake of such an advantage, you cannot justly expose the child's life to serious danger.
3. But if the danger it is exposed to is not serious but slight, and the remedy, though not necessary, is expected to be very useful to the mother, you may then administer the medicine; for a slight risk need not prevent a prudent man from striving to obtain very good results.
4. But what if the drug is necessary to save the mother, and as dangerous to the child as it is beneficial to her; can you then give the medicine with the moral certainty that it will save her and kill her child? When we know principles clearly we can apply them boldly. I answer then with this important distinction: you can give such medicine as will act on her system, her organs, in a manner to save her life, and you may permit the sad effects which will indirectly affect the child; but you cannot injure the child directly as a means to benefit her indirectly; that would be using a bad means to obtain a good end.
Suppose, then, what is said to be a real case of occasional recurrence in obstetrical practice, namely, that a pregnant mother is seized with violent and unceasing attacks of vomiting, so that she must die if the vomiting be not stopped; and you, as well as the consulting physician called in, can discover no means of relieving the vomiting except by procuring an abortion, by relieving the womb of its living burden. Abortion is then the means used to stop the vomiting. Are you justified in using that means? Abortion is the dislodging of the child from the only place where it can live and where nature has placed it for that purpose. Therefore abortion directly kills the child, as truly as plunging a man under water kills the man. Can you thus kill the child to save the mother? You cannot. Neither in this case nor in any other case can you do evil that good may come of it.
You notice, gentlemen, that I lay great stress on, this principle that the end can never justify the means. It is an evident principle, which all civilized nations acknowledge. Its opposite, that the end justifies the means, is so odious that the practice of it is a black stamp of ignominy on any man or any set of men that would be guilty of it. The Catholic Church has, all through her course of existence, taught the maxim that the end cannot justify the means. She has impressed it on the laws and hearts of all Christian peoples. She inculcates it in the teachings of all her theologians and moral philosophers and in all her channels of education. And since we Jesuits are among her leading educators and writers, we have maintained that thesis in thousands of printed volumes, as firmly as I am maintaining it before you to-day. No Jesuit ever, nor any Catholic theologian or philosopher, has taught the contrary. And yet even such pretentious works as the "Encyclopaedia Britannica" have carried all over the earth the slander that we teach the opposite maxim, that the end does justify the means, and the odious term Jesuitry has been coined to embody that slander.
Is it not strange then, very strange, that they who thus falsely accuse us are often the very men who will procure an abortion to save the mother's life, who will do wrong that good may come of it? And you find such men maintaining the lawfulness of abortion on the plea that the operation, whether licit or not, is a necessary means to obtain a good end.
IV. Gentlemen, if once you grant that grave reasons would justify abortion, there is no telling where you will stop in your career of crime. To-day, for instance, you are called to attend a mother, who, you think, must die if you do not bring on a miscarriage. You are urged to do it by herself and her husband, and perhaps by other physicians. There are money considerations too, and the possible loss of practice. Will you yield to the temptation? The next day you are visited by a most respectable lady; but she has been unfaithful to her marriage vow. The consequences of her fall are becoming evident. If her husband finds out her condition, he may wreak a terrible vengeance. Her situation is sadder than that of the sick mother of the preceding day. You can easily remove the proof of her guilt, we will suppose, and spare a world of woes. Will you withstand the temptation? The third day comes a young lady, a daughter of an excellent family; bright prospects lie before her; her parents' lives and happiness are wrapped up in that girl. But in an evil hour she has been led astray. Now she is with child. She begs, she implores you to save her from ruin, and her parents from despair. If you do not help her, some other Doctor or a quack will do it; but you could do it so much better. If you should have yielded on the two former occasions, if you have already stained your heart with innocent blood, will you now refuse? Where are you going to draw the line?
The passions of men are insatiate, even in modern society; the more you yield to them, the stronger grows their craving. Let me illustrate my meaning by a fact that happened a few years ago in Russia. It is just to our point. During a severe winter, a farmer, having his wife and children with him on a wagon, was driving through a wild forest. All was still as death except the howling of wolves in the distance. The howling came nearer and nearer. After a while a pack of hungry wolves was seen following in the track of the wagon. The farmer drove on faster, but they gained on him. It was a desperate race to keep out of their reach. At last they are just back of the wagon. What can be done? The next moment the wolves may jump on the uncovered vehicle. The children, horrified, crouch near their trembling mother. Suddenly the father, driven to despair, seizes one of the little children and flings it among the pack of wolves, hoping that by yielding them one he may save the rest. The hungry beasts stop a few moments to fight over their prey. But soon they are in hot pursuit again, fiercer because they have tasted blood. A second child is thrown to them, and after a while a third and a fourth.
Human society, gentlemen, in this matter of sacrificing foetal life is as insatiable as a pack of hungry wolves. Woe to any one of you if he begins to yield to its cravings; there is no telling where he will stop. In proof of my statement, let me read to you an extract from a lecture on Obstetrics, delivered by Doctor Hodge, of Philadelphia, to the medical students of the University of Pennsylvania: "We blush while we record the fact, that, in this country, in our cities and towns, in this city where literature, science, morality, and Christianity are supposed to have so much influence; where all the domestic and social virtues are reported as being in full and delightful exercise; even here individuals, male and female, exist who are continually imbruing their hands and consciences in the blood of unborn infants; yea, even medical men are to be found who, for some trifling pecuniary recompense, will poison the fountains of life, or forcibly induce labor, to the certain destruction of the foetus and not infrequently of the parent.
"So low, gentlemen, is the moral sense of the community on this subject, so ignorant are the greater number of individuals, that even mothers, in many instances, shrink not from the commission of this crime, but will voluntarily destroy their own progeny, in violation of every natural sentiment and in opposition to the laws of God and man. Perhaps there are few individuals in extensive practice who have not had frequent applications made to them by the fathers and mothers of unborn infants (respectable and polite in their general appearance and manners) to destroy the fruit of illicit pleasure, under the vain hope of preserving their reputation by this unnatural and guilty sacrifice.
"Married women, also, from the fear of labor, from indisposition to have the care, the expense, or the trouble of children, or some other motive equally trifling and degrading, have solicited that the embryo should be destroyed by their medical attendant. And when such individuals are informed of the nature of the transaction, there is an expression of real or pretended surprise that any one should deem that act improper, much more guilty; nay, in spite even of the solemn warnings of the physician, they will resort to the debased and murderous charlatan, who, for a piece of silver, will annihilate the life of the foetus, and endanger even that of its ignorant or guilty mother.