Medieval Bioethics

WITH the collapse of the Roman Empire in the West, health care and the practice of medicine became increasingly associated with monasteries. The Rule of St. Benedict particularly emphasizes the care of the sick; and hospitality, including medical care, was freely offered to travellers and guests. The modern term “hospital” reflects the “hospitality” offered to the medieval hospes, the guest or traveller.

AT the Second and Fourth Lateran Councils the hierarchy of the Western Church expressed concern and disapproval over the large number of clergy and members of religious orders who were undertaking the practice of medicine. The bishops’ and pope’s concerns seem to have been twofold: first, the secular practice of charging a fee for caring for the sick seemed incompatible with the compassion and charity expected of priests and religious. Second, medieval surgery was brutal: it entailed agonizing pain for the patient and the deliberate (and sometimes copious) “shedding of blood” by the clerical medical-practitioner. The notion of clergy being involved in acts - whether judicial or medical - that directly caused agony or shed blood was deemed incompatible with the clerical and vowed state. Thus as the Middle Ages progressed, health care become more and more the exclusive province of secular physicians trained in newly-founded medical faculties of the burgeoning universities in Paris, Oxford, Cambridge, and - especially in the case of medicine - Salerno in Italy.



2.2. THE SECOND LATERAN COUNCIL, 1139 Pope Innocent III Dreams of St. Francis Supporting the Falling Lateran Basilica



[THE GENERAL and ECUMENICAL COUNCIL of the CATHOLIC CHURCH - THE SECOND LATERAN COUNCIL, 1139]	Concilia oecumenica et generalia Ecclesiae catholicae - Concilium Lateranense a. II 113



CANON 9.


Moreover, the evil and detestable practice has grown, so we understand, whereby monks and canons regular, after receiving the habit and making their profession, are learning [1] civil law and [2] medicine with a view to temporal gain, in scornful disregard of the rules of their blessed teachers Benedict and Augustine.	Prava autem consuetudo prout accepimus et detestabilis inolevit quoniam monachi et regulares canonici post susceptum habitum et professionem factam spreta beatorum magistrorum Benedicti et Augustini regula leges temporales et medicinam gratia lucri temporalis addiscunt.
[1] Inappropriate Practice of Civil Law
In fact, burning with the fire of avarice, they make themselves the advocates of suits; and since they have to neglect the psalmody and hymns, placing their trust in the power of fine rhetoric instead, they confuse what is right and what is wrong, justice and iniquity, by reason of the variety of their arguments. But the imperial constitutions testify that it is truly absurd and reprehensible for clerics to want to be experts in the disputes of law courts. We decree by apostolic authority that lawbreakers of this kind are to be severely punished.	Avaritiae namque flammis accensi se patronos causarum faciunt. Et cum psalmodiae et hymnis vacare debeant gloriosae vocis confisi munimine allegationum suarum varietate iustum et iniustum fas nefas que confundunt. Attestantur vero imperiales constitutiones absurdum immo et opprobrium esse clericis si peritos se velint disceptationum esse forensium. Huiusmodi temeratores graviter feriendos apostolica auctoritate decernimus.
[2] Inappropriate Practice of Medicine
There are also those who, neglecting the care of souls, completely ignore their state in life, promise health in return for hateful money and make themselves healers of human bodies. And since an immodest eye manifests an immodest heart, religion ought to have nothing to do with those things of which virtue is ashamed to speak.	Ipsi quoque neglecta animarum cura ordinis sui propositum nullatenus attendentes pro detestanda pecunia sanitatem pollicentes humanorum curatores se faciunt corporum. Cum que impudicus oculus impudici cordis sit nuntius illa de quibus loqui erubescit honestas non debet religio pertractare.
Therefore, we forbid by apostolic authority this practice to continue, so that the monastic order and the order of canons may be preserved without stain in a state of life pleasing to God, in accord with their holy purpose. Furthermore, bishops, abbots and priors who consent to and fail to correct such an outrageous practice are to be deprived of their own honours and kept from the thresholds of the church.	Ut ergo ordo monasticus et canonicus deo placens in sancto proposito inviolabiliter conservetur ne hoc ulterius praesumatur apostolica auctoritate interdicimus. Episcopi autem abbates et priores tantae enormitati consentientes et non corrigentes propriis honoribus spolientur et ab ecclesiae liminibus arceantur.



2.3. THE FOURTH LATERAN COUNCIL, 1215




CANON 18.


No cleric may pronounce a sentence of death, or execute such a sentence, or be present at its execution. If anyone in consequence of this prohibition (hujusmodi occasions statuti) should presume to inflict damage on churches or injury on ecclesiastical persons, let him be restrained by ecclesiastical censure. Nor may any cleric write or dictate letters destined for the execution of such a sentence. Wherefore, in the chanceries of the princes let this matter be committed to laymen and not to clerics. Neither may a cleric act as judge in the case of the Rotarrii, archers, or other men of this kind devoted to the shedding of blood. No subdeacon, deacon, or priest shall practice that part of surgery involving cauterization or cutting. Neither shall anyone in judicial tests or ordeals by hot or cold water or hot iron bestow any blessing; the earlier prohibitions in regard to dueling remain in force.	Sententiam sanguinis nullus clericus dictet aut proferat sed nec sanguinis vindictam exerceat aut ubi exercetur intersit. Si quis autem huiusmodi occasione statuti ecclesiis vel personis ecclesiasticis aliquod praesumpserit inferre dispendium per censuram ecclesiasticam compescatur nec quisquam clericus literas scribat aut dictet pro vindicta sanguinis destinandas unde in curiis principum haec solicitudo non clericis sed laicis committatur. Nullus quoque clericus rottariis aut balistariis aut huiusmodi viris sanguinum praeponatur nec illam chirurgiae artem subdiaconus diaconus vel sacerdos exerceant quae ad ustionem vel incisionem inducit nec quisquam purgationi aquae ferventis vel frigidae seu ferri candentis ritum cuiuslibet benedictionis aut consecrationis impendat salvis nihilominus prohibitionibus de monomachiis sive duellis antea promulgatis.

A LATER tradition represented by the Irish canons (late seventh century), the Bigotian Penitential (early eighth century) and the Old Irish Penitential (early ninth century) -made a distinction between penances depending on the age of the foetus. For example, the Old Irish Penitential gave three and a half years penance for abortion after the pregnancy had become established, but seven years if the flesh had formed and fourteen years if the soul had entered. Thus this tradition, in marked contrast to Basil [whose canons insist that there should be no distinction based on the stage of pregnancy], related penance directly to the stage of the embryo. It was also remarkable in reflecting not a two-stage but a three-stage process[:]

This threefold pattern is not found in Aristotle or the Septuagint, but something like it can be found in Hippocrates and there are parallels in the Talmud and in the Koran. It may simply reflect the re-emergence of the distinction between formation and quickening (the mother’s sense of inner movement). If this interpretation is correct then, for these writers, abortion was not true homicide if done before the first signs of movement of the child in the womb. Nevertheless, early abortion was still regarded as a serious sin and required three and a half years’ arduous penance.

The first Anglo-Saxon penitentials were written in the late seventh century and associated with Theodore, Archbishop of Canterbury. These also made a distinction depending on the age of the embryo: before 40 days the penance was one year; after 40 days it was the same as the penance for homicide - three years.

What gradually emerged in the Middle Ages was a two-tier system in which most sins were dealt with by private penance while a limited number of specified sins attracted public canonical penalties.

The development of canon law in the West from the eleventh century onwards looked not to the penitentials but to collections of early canons and to the Fathers of the Church. Opinions were taken from the letters, sermons and treatises of authorities such as Augustine, Jerome and Ambrose. On this basis there were three possible positions that could be held with respect to abortion:

[3] contraception was homicide as was abortion whatever the stage of pregnancy.





3.2. THE COUNCIL of ANCARA c. 314


Concerning women who commit fornication, and destroy what they have conceived	DE ²⁸⁰ MULIERIBUS, QUAE FORNICATAE PARTUS 281 SUOS NECANT
CANON 21. Concerning women who commit fornication, and destroy what they have conceived, or who compound drugs to cause abortion: an ancient decree excluded them from the Church until the end of their lives. However, in a spirit of greater leniency we decree that they must complete ten years of penance.	XXI ²⁸² De mulieribus, quae fornicantur et partus suos necant, sed et de his ²⁸³, quae agunt secum, ut utero ²⁸⁴ conceptos ²⁸⁵ excutiant, antiqua quidem definitio usque ad exitum vitae ²⁸⁶ eas ab ecclesia ²⁸⁷ removet ²⁸⁸. Humanius²⁸⁹ autem nunc definimus, ut eis decem annorum tempus poenitentiae tribuatur.





3.3. CÆSARIUS of ARLES c. 470–542


SERMON 44.2. (abortion & contraception) ed. G. Morin, Caesarii Arelatensis Opera I, 1, CCSL 103 (Turnhout, 1953), p. 196.	Caesarius Arelatensis. Sermones 44.2
No woman should [ever] take drugs to induce abortion, nor kill children she has conceived or borne. If anyone does this, she should know that before Christ's tribunal she will have to plead her case before those she has killed. Moreover, women should not take diabolical potions for the purpose of becoming unable to conceive children. A woman who does this must realize that she will be guilty of as many homicides as the number of children she might have borne	Nulla mulier potiones ad avorsum accipiat, nec filios aut conceptos aut iam natos occidat; quia, quaecumque hoc fecerit, ante tribunal Christi sciat se causam cum illis quos occiderit esse dicturam. Sed nec illas diabolicas potiones mulieres debent accipere, per quas iam non possint concipere. Mulier quaecumque hoc fecerit, quantoscumque parere potuerat, tantorum homicidiorum se ream esse cognoscat.





3.4. THE VISIGOTHIC LAWS 5^th-7^th century


Tr. based on: Amundsen, Visigothic Medical Legislation', pp. 568-69.	Zeumer, Leges Visigothorum
VI.3.2. Old law. If a free man causes a free woman to abort.	VI.3.2. Antigua. Si ingenuus ingenuam abortare fecerit.
If anyone strikes a pregnant woman by any blow whatever or through any circumstance causes a free woman to abort, and from this she dies, let him be punished for homicide. If, however, only the fetus is destroyed, and the woman is in no way debilitated, and a free man is recognized as having inflicted this to a free woman, if he has destroyed a formed infant, let him pay 150 solidi; if it is truly an unformed [infant], let him pay 100 solidi in restitution for the deed.	Si quis mulierem gravidam percusserit quocumque hictu aut per aliquam orrnsionem mulierem ingenuam abortare fecerit, et exinde mortua fuerit, pro homicidio puniatur. Si autem tantumodo partus excutiatur, et mulier in nullo debilitata fuerit, et ingenuus ingenue hoc intulisse cognoscitur, si firmatum infantem extincxit, CL solidos reddat; si vero infirmem, C solidos pro facto restituat.'

VI.3.7. King Chindasvind. Concerning those who kill their own children, either already having been born or in utero.	VI.3.7. Flavius Chindasvindus Rex. De his, qui filios suos aut natos aut in utero necant.
There is nothing worse than the depravity of those who, disregarding piety, become murderers of their own children. In as much as it is said that the crime of these has grown to such a degree throughout the provinces of our land that men as well as women are found to be the performers of this heinous action, we therefore, forbidding this dissoluteness, decree that, if a free woman or a female slave murders a son or a daughter which has been born, or, while having it still in utero, either takes a potion to induce abortion, or by any other means whatsoever presumes to destroy her own fetus, after the judge of the province or of the territory learns of such a deed, let him not only sentence the performer of this crime to public execution, or if he wishes to preserve her life, let him not hesitate to destroy the vision of her eyes, but also, if it is evident that the woman's husband ordered or permitted such things, let him not be reluctant to subject the same to a similar punishment.	Nihil est eorum pravitate deterius, qui, pietatis inmemores, filiorum suorum necatores existunt. Quorum quia vitium per provincias regni nostri sic inolevisse narratur, ut tam viri quam femine sceleris huius auctores esse repperiantur, ideo hanc licentiam proibentes decernimus, ut, seu libera seu ancilla natum filium filiamve necaverit, sive adhuc in utero habens, aut potionem ad avorsum acceperit, aut alio quocumque modo extinguere partum suum presumserit, mox provincie index aut territorii talem facturn reppererit, non solum operatricem criminis huius publica morte condemnet, aut si vite reservare voluerit, omnem visionem oculorum eius non moretur extinguere, sed etiam si maritum eius talia iussisse vel permisisse patuerit, eundem etiam vindicte simili subdere non recuset.2





3.5. THE PENITENTIAL of THEODORE of CANTERBURY 668-690


Leniency: Age of gestation, poverty

24. Women who commit abortion before [the fetus] has life, shall do penance for one year or for the three forty-day periods or for forty days, according to the nature of the offense; and if later, that is, more than forty days after conception, they shall do penance as murderesses, that is for three years on Wednesdays and Fridays and in the three forty-day periods. This according to the canons is judged [punishable by] ten years.

25. If a mother slays her child, if she commits homicide, she shall do penance for fifteen years, and never change except on Sunday.

26. If a poor woman slays her child, she shall do penance for seven years. In the canon it is said that if it is a case of homicide, she shall do penance for ten years.

27. A woman who conceives and slays her child in the womb within forty days shall do penance for one year; but if later than forty days, she shall do penance as a murderess.

IN the Middle Ages, the question of the moment of ensoulment was shaped by another important force: the rediscovery of Aristotle’s works and their introduction into the new university culture of the thirteenth century. In this context a potent new synthesis was developed between the (Christianized) philosophy of Aristotle and Latin theology. The most prominent architect of this synthesis was the theologian and philosopher Thomas Aquinas. Basing his account on that of Aristotle, Thomas argued that

The claim that the soul was created specially by God (not generated by the parents) and that this occurred after the embryo had been fully formed was the common teaching of the medieval scholastic theologians.




4.2 AQUINAS on THE BEGINNING (Embryonic Souls; Animation;	of LIFE Contraception)



THREE SUCCESSIVE KINDS of SOULS


4.2.1. THREE SUCCESSIVE KINDS	of SOULS


Sum.Theol. I, Q. 118, Art. 2	Articulus 2
Whether the Intellectual Soul Is Produced from the Semen?	See also 1.118.2.ad 2
Reply Obj. 2: Some say that the vital functions observed in the embryo are not from its soul, but from the soul of the mother; or from the formative power of the semen. Both of these explanations are false; for vital functions such as feeling, nourishment, and growth cannot be from an extrinsic principle.	a. 2 ad 2 Ad secundum dicendum quod aliqui dixerunt quod operationes vitae quae apparent in embryone, non sunt ab anima eius, sed ab anima matris; vel a virtute formativa quae est in semine. Quorum utrumque falsum est, opera enim vitae non possunt esse a principio extrinseco, sicut sentire, nutriri et augeri.
Consequently it must be said that the soul is in the embryo;	Et ideo dicendum est quod anima praeexistit in embryone
the nutritive soul from the beginning,	a principio quidem nutritiva,
then the sensitive,	postmodum autem sensitiva
lastly the intellectual soul.	, et tandem intellectiva.
[...] We must therefore say that since the generation of one thing is the corruption of another, it follows of necessity that both in men and in other animals, when a more perfect form supervenes the previous form is corrupted: yet so that the supervening form contains the perfection of the previous form, and something in addition. It is in this way that through many generations and corruptions we arrive at the ultimate substantial form, both in man and other animals. This indeed is apparent to the senses in animals generated from putrefaction	Et ideo dicendum est quod, cum generatio unius semper sit corruptio alterius, necesse est dicere quod tam in homine quam in animalibus aliis, quando perfectior forma advenit, fit corruptio prioris, ita tamen quod sequens forma habet quidquid habebat prima, et adhuc amplius. Et sic per multas generationes et corruptiones pervenitur ad ultimam formam substantialem, tam in homine quam in aliis animalibus. Et hoc ad sensum apparet in animalibus ex putrefactione generatis.
We conclude therefore that the intellectual soul is created by God at the end of human generation,	Sic igitur dicendum est quod anima intellectiva creatur a Deo in fine generationis humanae,
and this soul is at the same time sensitive and nutritive,	quae simul est et sensitiva et nutritiva,
the pre-existing forms being corrupted.	corruptis formis praeexistentibus.
THE SOUL of CHRIST


4.2.2. THE SOUL of CHRIST


Sum.Theol. III, Q. 33, Art. 2, ad 1	Articulus 2
Whether Christ’s Body Was Animated in the First Instant of Its Conception?
Reply Obj. 1: The beginning of the infusion of the soul may be considered in two ways. First, in regard to the disposition of the body. And thus, the beginning of the infusion of the soul into Christ’s body was the same as in other men’s bodies: for just as the soul is infused into another man’s body as soon as it is formed, so was it with Christ. Secondly, this beginning may be considered merely in regard to time. And thus, because Christ’s body was perfectly formed in a shorter space of time, so after a shorter space of time was it animated.	a. 2 ad 1 Ad primum ergo dicendum quod principium inspirationis animae potest considerari dupliciter. Uno modo, secundum dispositionem corporis. Et sic non ab alio principio inspirata est anima corpori Christi, et corporibus aliorum hominum. Sicut enim statim, formato corpore alterius hominis, infunditur anima, ita fuit in Christo. Alio modo potest considerari dictum principium solum secundum tempus. Et sic, quia prius tempore formatum fuit perfecte corpus Christi, prius tempore fuit etiam animatum.
T


4.2.3. SUCCESSIVE HUMAN	SOULS


Sum.Theol. I, Q. 118, Art. 2, ad 3	Articulus 2
Successive Souls in Human Beings - Not in Christ	See also 1.118.2.ad 2
Reply Obj. 3: What the Philosopher says is true in the generation of other men, because the body is successively formed and disposed for the soul: whence, first, as being imperfectly disposed, it receives an imperfect soul; and afterwards, when it is perfectly disposed, it receives a perfect soul. But Christ’s body, on account of the infinite power of the agent, was perfectly disposed instantaneously. Wherefore, at once and in the first instant it received a perfect form, that is, the rational soul.	a. 2 ad 3 Ad tertium dicendum quod in generatione aliorum hominum locum habet quod dicit philosophus, propter hoc quod successive corpus formatur et disponitur ad animam, unde primo, tanquam imperfecte dispositum, recipit animam imperfectam; et postmodum, quando perfecte est dispositum, recipit animam perfectam. Sed corpus Christi, propter infinitam virtutem agentis, fuit perfecte dispositum in instanti. Unde statim in primo instanti recepit formam perfectam, idest animam rationalem.
MALE EMBRYOS 40 DAYS; FEMALE 90


4.2.4. MALE EMBRYOS 40 DAYS;	FEMALE 90


Com.Sent. III, dist.3, q.5 art.2, co. resp.	Super Sent., lib. 3 dist. 3 q. 5 art. 2 co. Respondeo
But in others [i.e. human beings] the conception of the male is not complete until the fortieth day, nor the female until the ninetieth day, as Aristotle says in Book 9 of On Animals	In aliis autem haec successive contingunt, ita quod maris conceptio non perficitur nisi usque ad quadragesimum diem, ut philosophus in 9 de animalibus dicit, feminae autem usque ad nonagesimum.
UNINTENDED HOMICIDE (animated fetus)


4.2.5. UNINTENTIONAL HOMICIDE	(Animated Fetus)


Sum.Theol. II-II, Q. 64, Art. 8	Articulus 8
Whether One Is Guilty of Murder Through Killing Someone by Chance?
Obj. 2: Further, it is written (Ex. 21:22): “If . . . one strike a woman with child, and she miscarry indeed . . . if her death ensue thereupon, he shall render life for life.” Yet this may happen without any intention of causing her death. Therefore one is guilty of murder through killing someone by chance.	64 a. 8 arg. 2 Praeterea, Exod. XXI dicitur quod si quis percusserit mulierem praegnantem et aborsum fecerit, si mors eius fuerit subsecuta, reddet animam pro anima. Sed hoc potest fieri absque intentione occisionis. Ergo homicidium casuale habet homicidii reatum.
animated fetus
Reply Obj. 2: He that strikes a woman with child does something unlawful: wherefore if there results the death either of the woman or of the animated fetus, he will not be excused from homicide, especially seeing that death is the natural result of such a blow.	64 a. 8 ad 2 Ad secundum dicendum quod ille qui percutit mulierem praegnantem dat operam rei illicitae. Et ideo si sequatur mors vel mulieris vel puerperii animati, non effugiet homicidii crimen, praecipue cum ex tali percussione in promptu sit quod mors sequatur.
FORNICATION and MATRIMONY


4.2.6. SEX “CONTRA NATURAM”


Sum.Cont.Gent. III, 122	Caput 122
The Reason why Simple Fornication Is a Sin According to Divine Law, while Matrimony is Natural	Qua ratione fornicatio simplex secundum legem divinam sit peccatum: et quod matrimonium sit naturale
[5] It is evident from this that every emission of semen, in such a way that generation cannot follow, is contrary to the good for man. And if this be done deliberately, it must be a sin. Now, I am speaking of a way from which, in itself, generation could not result: such would be any emission of semen apart from the natural union of male and female. For which reason, sins of this type are called contrary to nature. But, if by accident generation cannot result from the emission of semen, then this is not a reason for it being against nature, or a sin; as for instance, if the woman happens to be sterile.	n. 5 Ex quo patet quod contra bonum hominis est omnis emissio seminis tali modo quod generatio sequi non possit. Et si ex proposito hoc agatur, oportet esse peccatum. Dico autem modum ex quo generatio sequi non potest secundum se: sicut omnis emissio seminis sine naturali coniunctione maris et feminae; propter quod huiusmodi peccata contra naturam dicuntur. Si autem per accidens generatio ex emissione seminis sequi non possit, non propter hoc est contra naturam, nec peccatum: sicut si contingat mulierem sterilem esse.
E


4.2.7. CONTRACEPTION and HOMICIDE


Sum.Cont.Gent. III, 122	Articulus 2
[9] Nor, in fact, should it be deemed a slight sin for a man to arrange for the emission of semen apart from the proper purpose of generating and bringing up children, on the argument that it is either a slight sin, or none at all, for a person to use a part of the body for a different use than that to which it is directed by nature (say, for instance, one chose to walk on his hands, or to use his feet for something usually done with the hands) because man’s good is not much opposed by such inordinate use. However, the inordinate emission of semen is incompatible with the natural good; namely, the preservation of the species.	n. 9 Nec tamen oportet reputari leve peccatum esse si quis seminis emissionem procuret praeter debitum generationis et educationis finem, propter hoc quod aut leve aut nullum peccatum est si quis aliqua sui corporis parte utatur ad alium usum quam ad eum ad quem est ordinata secundum naturam, ut si quis, verbi gratia, manibus ambulet, aut pedibus aliquid operetur manibus operandum: quia per huiusmodi inordinatos usus bonum hominis non multum impeditur; inordinata vero seminis emissio repugnat bono naturae, quod est conservatio speciei.
Hence, after the sin of homicide whereby a human nature already in existence is destroyed, this type of sin appears to take next place, for by it the generation of human nature is precluded.	Unde post peccatum homicidii, quo natura humana iam in actu existens destruitur, huiusmodi genus peccati videtur secundum locum tenere, quo impeditur generatio humanae naturae.
O2_2_64_7_SELF_DEFENSE_DOUBLE_EFFECT


4.3 AQUINAS on DOUBLE	EFFECT


Sum.Theol. II-II, Q. 64, Art. 7	Articulus 7
Whether It Is Lawful to Kill a Man in Self-defense?
On the contrary, It is written (Ex. 22:2): “If a thief be found breaking into a house or undermining it, and be wounded so as to die; he that slew him shall not be guilty of blood.” Now it is much more lawful to defend one’s life than one’s house. Therefore neither is a man guilty of murder if he kill another in defense of his own life.	64 a. 7 s. c. Sed contra est quod Exod. XXII dicitur, si effringens fur domum sive suffodiens fuerit inventus, et, accepto vulnere, mortuus fuerit, percussor non erit reus sanguinis. Sed multo magis licitum est defendere propriam vitam quam propriam domum. Ergo etiam si aliquis occidat aliquem pro defensione vitae suae, non erit reus homicidii.
I answer that, Nothing hinders one act from having two effects, only one of which is intended, while the other is beside the intention. Now moral acts take their species according to what is intended, and not according to what is beside the intention, since this is accidental as explained above (Q.43, A.3; I-II, Q.12, A.1).	64 a. 7 co. Respondeo dicendum quod nihil prohibet unius actus esse duos effectus, quorum alter solum sit in intentione, alius vero sit praeter intentionem. Morales autem actus recipiunt speciem secundum id quod intenditur, non autem ab eo quod est praeter intentionem, cum sit per accidens, ut ex supradictis patet.
Accordingly the act of self-defense may have two effects, one is the saving of one’s life, the other is the slaying of the aggressor. Therefore this act, since one’s intention is to save one’s own life, is not unlawful, seeing that it is natural to everything to keep itself in being, as far as possible. And yet, though proceeding from a good intention, an act may be rendered unlawful, if it be out of proportion to the end.	Ex actu igitur alicuius seipsum defendentis duplex effectus sequi potest, unus quidem conservatio propriae vitae; alius autem occisio invadentis. Actus igitur huiusmodi ex hoc quod intenditur conservatio propriae vitae, non habet rationem illiciti, cum hoc sit cuilibet naturale quod se conservet in esse quantum potest. Potest tamen aliquis actus ex bona intentione proveniens illicitus reddi si non sit proportionatus fini.
Wherefore if a man, in self-defense, uses more than necessary violence, it will be unlawful: whereas if he repel force with moderation his defense will be lawful [...]	Et ideo si aliquis ad defendendum propriam vitam utatur maiori violentia quam oporteat, erit illicitum. Si vero moderate violentiam repellat, erit licita defensio, [...]
END OF LIFE


4.4 AQUINAS on the END of LIFE (Killing the Innocent; Goods; Mutilation;Suicide)


KILLING INNOCENT


4.4.1. KILLING the INNOCENT	(e.g. unborn)


Sum.Theol. II-II, Q. 64, Art. 6	Articulus 6
Whether It Is Lawful to Kill the Innocent?
I answer that, [...] the life of righteous men preserves and forwards the common good, since they are the chief part of the community. Therefore it is in no way lawful to slay the innocent.	64 a. 6 co. Respondeo dicendum [..] Vita autem iustorum est conservativa et promotiva boni communis, quia ipsi sunt principalior pars multitudinis. Et ideo nullo modo licet occidere innocentem.
MUTILATION


4.4.2. MUTILATION	(e.g. surgery)


Sum.Theol. II-II, Q. 65, Art. 8	Q.65, Articulus 1
Whether in Some Cases It May Be Lawful to Maim Anyone?
I answer that, Since a member is part of the whole human body, it is for the sake of the whole, as the imperfect for the perfect. Hence a member of the human body is to be disposed of according as it is expedient for the body. Now a member of the human body is of itself useful to the good of the whole body, yet, accidentally it may happen to be hurtful, as when a decayed member is a source of corruption to the whole body. Accordingly so long as a member is healthy and retains its natural disposition, it cannot be cut off without injury to the whole body. [...]	65 a. 1 co. Respondeo dicendum quod cum membrum aliquod sit pars totius humani corporis, est propter totum, sicut imperfectum propter perfectum. Unde disponendum est de membro humani corporis secundum quod expedit toti. Membrum autem humani corporis per se quidem utile est ad bonum totius corporis, per accidens tamen potest contingere quod sit nocivum, puta cum membrum putridum est totius corporis corruptivum. Si ergo membrum sanum fuerit et in sua naturali dispositione consistens, non potest praecidi absque totius hominis detrimento.
Reply Obj. 3: A member should not be removed for the sake of the bodily health of the whole, unless otherwise nothing can be done to further the good of the whole.	Ad tertium dicendum quod membrum non est praecidendum propter corporalem salutem totius nisi quando aliter toti subveniri non potest.
GOODS NECESSARY for LIFE


4.4.3. GOODS NECESSARY for LIFE [e.g. nutrition, hydration, medicine]


Sum.Theol. II-II, Q. 126, Art. 1	Articulus 1
Whether Fearlessness Is a Sin?
I answer that, Since fear is born of love, we must seemingly judge alike of love and fear. Now it is here a question of that fear whereby one dreads temporal evils, and which results from the love of temporal goods. And every man has it instilled in him by nature to love his own life and whatever is directed thereto; and to do so in due measure, that is, to love these things not as placing his end therein, but as things to be used for the sake of his last end. Hence it is contrary to the natural inclination, and therefore a sin, to fall short of loving them in due measure.	a. 1 co. Respondeo dicendum quod, quia timor ex amore nascitur, idem iudicium videtur esse de amore et de timore. Agitur autem nunc de timore quo mala temporalia timentur, qui provenit ex temporalium bonorum amore. Inditum autem est unicuique naturaliter ut propriam vitam amet, et ea quae ad ipsam ordinantur, tamen debito modo, ut scilicet amentur huiusmodi non quasi finis constituatur in eis, sed secundum quod eis utendum est propter ultimum finem. Unde quod aliquis deficiat a debito modo amoris ipsorum, est contra naturalem inclinationem, et per consequens est peccatum.
[...]It may happen that a man fears death and other temporal evils less than he ought, for the reason that he loves [temporal things] less than he ought.	[...] Unde contingere potest quod aliquis minus quam debeat timeat, mortem et alia temporalia mala, propter hoc quod minus debito amet ea.
Reply Obj. 3: Temporal goods are to be despised as hindering us from loving and serving God, and on the same score they are not to be feared; wherefore it is written (Ecclus. 34:16): “He that feareth the Lord shall tremble at nothing.” But temporal goods are not to be despised, in so far as they are helping us instrumentally to attain those things that pertain to Divine fear and love.	a. 1 ad 3 Ad tertium dicendum quod bona temporalia debent contemni quantum nos impediunt ab amore et timore Dei. Et secundum hoc etiam non debent timeri, unde dicitur Eccli. XXXIV, qui timet Deum nihil trepidabit. Non autem debent contemni bona temporalia inquantum instrumentaliter nos iuvant ad ea quae sunt divini amoris et timoris.
SUICIDE


4.4.4. SUICIDE


Sum.Theol. II-II, Q. 64, Art. 5	Q. 64 Articulus 5
Whether It Is Lawful to Kill Oneself?
I answer that, It is altogether unlawful to kill oneself, for three reasons. First, because everything naturally loves itself, the result being that everything naturally keeps itself in being, and resists corruptions so far as it can. Wherefore suicide is contrary to the inclination of nature, and to charity whereby every man should love himself. Hence	64 a. 5 co. Respondeo dicendum quod seipsum occidere est omnino illicitum triplici ratione. Primo quidem, quia naturaliter quaelibet res seipsam amat, et ad hoc pertinet quod quaelibet res naturaliter conservat se in esse et corrumpentibus resistit quantum potest. Et ideo quod aliquis seipsum occidat est contra inclinationem naturalem, et contra caritatem, qua quilibet debet seipsum diligere.
[1] suicide is always a mortal sin, as being contrary to the natural law and to charity.	Et ideo occisio sui ipsius semper est peccatum mortale, utpote contra naturalem legem et contra caritatem existens.
[2] Secondly, because every part, as such, belongs to the whole. Now every man is part of the community, and so, as such, he belongs to the community. Hence by killing himself he injures the community, as the Philosopher declares (Ethic. v, 11).	Secundo, quia quaelibet pars id quod est, est totius. Quilibet autem homo est pars communitatis, et ita id quod est, est communitatis. Unde in hoc quod seipsum interficit, iniuriam communitati facit, ut patet per philosophum, in V Ethic.
[3] Thirdly, because life is God’s gift to man, and is subject to His power, Who kills and makes to live. Hence whoever takes his own life, sins against God, even as he who kills another’s slave, sins against that slave’s master, and as he who usurps to himself judgment of a matter not entrusted to him. For it belongs to God alone to pronounce sentence of death and life, according to Deut. 32:39, “I will kill and I will make to live.” [...]	Tertio, quia vita est quoddam donum divinitus homini attributum, et eius potestati subiectum qui occidit et vivere facit. Et ideo qui seipsum vita privat in Deum peccat, sicut qui alienum servum interficit peccat in dominum cuius est servus; et sicut peccat ille qui usurpat sibi iudicium de re sibi non commissa. Ad solum enim Deum pertinet iudicium mortis et vitae, secundum illud Deut. XXXII, ego occidam, et vivere faciam.
Reply Obj. 3: Man is made master of himself through his free-will: wherefore he can lawfully dispose of himself as to those matters which pertain to this life which is ruled by man’s free-will. But the passage from this life to another and happier one is subject not to man’s free-will but to the power of God. Hence it is not lawful for man to take his own life that he may pass to a happier life, nor that he may escape any unhappiness whatsoever of the present life, because the ultimate and most fearsome evil of this life is death, as the Philosopher states (Ethic. iii, 6). Therefore to bring death upon oneself in order to escape the other afflictions of this life, is to adopt a greater evil in order to avoid a lesser.	64 a. 5 ad 3 Ad tertium dicendum quod homo constituitur dominus sui ipsius per liberum arbitrium. Et ideo licite potest homo de seipso disponere quantum ad ea quae pertinent ad hanc vitam, quae hominis libero arbitrio regitur. Sed transitus de hac vita ad aliam feliciorem non subiacet libero arbitrio hominis, sed potestati divinae. Et ideo non licet homini seipsum interficere ut ad feliciorem transeat vitam. Similiter etiam nec ut miserias quaslibet praesentis vitae evadat. Quia ultimum malorum huius vitae et maxime terribile est mors, ut patet per philosophum, in III Ethic. Et ita inferre sibi mortem ad alias huius vitae miserias evadendas est maius malum assumere ad minoris mali vitationem.

MEDIEVAL canon lawyers were [...] faced with an apparent contradiction. Some canons implied that the destruction of an unformed embryo was actual homicide (Decretals V, tit. 12, can. 5), but others implied that the destruction of an unformed embryo was not actual homicide (Decretals V, tit. 12, can. 20). One way to resolve this contradiction was to say that the killing of an unformed embryo was not homicide in the strict and technical sense, but that it was ethically equivalent of homicide, and could be treated as homicide for some legal purposes. [...] Many authors took abortion of an embryo prior to formation and ensoulment to be just as serious a sin as abortion of an ensouled embryo. Those, such as Thomas Aquinas, who explicitly thought that contraception and early abortion were less serious sins than homicide, held that they were second only to homicide, ‘after the sin of murder, whereby a human nature already in actual existence is destroyed, this sort of sin seems to hold the second place, whereby the generation of human nature is precluded’ (Sum.Cont.Gent. III, Q. 122; see also Com.Sent. IV, D. 31, Q. 4). What was common to all the writers of this period was their classification of abortion of the early human embryo as mortal sin and as something at least analogous to homicide: intentional, moral or spiritual homicide.

The universal condemnation of the practice of abortion during this period was reflected in the imposition of excommunication for abortion by local synods in Riez (1234), Lille (1288), Avignon (1326) and Lavaur (1368) (see Connery 1977, p. 148). Excommunication had once been part of the discipline of penance (for penance was at first defined by time away from communion), but as reconciliation began to anticipate the completion of penance, excommunication ceased to be a normal element in the sacrament. It was reintroduced as part of the two-tier system of church discipline to emerge in the Middle Ages.

THE first Christians followed the Jewish ethical principle that ‘we do not set aside one life for another’ (Talmud, Mishnahh Oholot 7.6). However, they faced a difficulty in accepting that ‘her life takes precedence over its life, for they saw the life of the unborn child as equally inviolable. The practical question of what to do in a situation in which a woman’s life was threatened by her pregnancy was therefore extremely problematic for Christians. It is not altogether surprising that in the first thousand years of the Church’s history, theologians preferred to pass over this difficulty in silence and to speak of abortion in circumstances where they were clear that it was sinful. It was not until the late Middle Ages that Christian theologians begin to address directly the question of abortion to save the mother’s life.

ONE of the first to discuss this case was [St.] Antoninus of Florence (1389-1459). He declared that it was neither legitimate to kill the woman to save the child (by Caesarean section) nor to kill the infant to save the woman (by abortion). If the only way to save someone is by killing someone else, it is better to do nothing.

However, he made one exception to this rule. Citing fellow Dominican John of Naples, he argued that before the soul was infused into the embryo (which, following Thomas Aquinas, he regarded as occurring at 40 days for males and 80 days for females) it was legitimate to abort the embryo to save the mother’s life. This was not homicide, strictly speaking. However, an act that destroyed the early embryo and so prevented a child from coming to be was very close to homicide, therefore it could only be justified to save the mother’s life. Furthermore, if it were doubtful whether or not the embryo possessed a human soul then it was not to be harmed. Antoninus only permitted abortion of the pre-ensouled embryo to save the mother’s life. Nevertheless, it was very significant in explicitly allowing an exception to the traditional prohibition. Antoninus had great authority and was followed by several theologians such as Sylvester Prierias (d.1523) and Martin Aspilcueta (1493-1586), more commonly known as Doctor Navarrus.

EARLY in the sixteenth century a Franciscan theologian called Antonius of Cordoba (1485-1578) proposed a different distinction for understanding the ethics of abortion. He saw no ethical distinction between killing an embryo before or after ensoulment. Both acts were forms of homicide.

[a] treatments which directly aimed at causing the death of the unborn infant (de se mortifera)and

[b] medicines that were directly intended to help the woman but which had a possible side-effect of causing an abortion (de se salutifera).

[a] The former included taking poison, cutting up the embryo in the womb or hitting the woman to cause a miscarriage. These were forbidden.

[b] The latter included treatments such as bleeding, baths and purgatives. These were legitimate.

A woman had a duty to care for her child but she had a prior right (ius potius) to look after her own health. Nevertheless, this right would not justify a direct attack on the child who was an innocent and not an unjust aggressor.

PETER of Navarre (d. 1594) accepted this new distinction and gave the analogy of a pregnant woman fleeing from a wild bull. It was legitimate for her to run and leap to escape, even if this caused a miscarriage. The miscarriage is not her aim here, or even the means to an end, but is a tragic side-effect. It might be foreseen but it is not directly willed or intended. Peter also introduced another distinction. If the ensouled infant was capable of being born alive and baptized then he thought the woman should not take medicine that might cause a miscarriage, even where this would otherwise be legitimate. In his view, the spiritual welfare of the child was more important than the physical welfare of the woman. Baptizing a child, even if it died soon after birth, had great significance because of the received opinion that a child who died unbaptized could not enter heaven. This theme would recur in the tradition but it is important not to overstate its significance.

THE Jesuit theologian Gabriel Vasquez (1551-1604) followed Antonius of Cordoba in permitting medicina sanative that might indirectly cause abortion. However, he disagreed with Peter of Navarre about the requirement to forgo medical treatment because of the spiritual needs of the infant. The woman has no obligation to sacrifice her life for someone else’s spiritual benefit. She might choose to do so, but she has no duty to do so.

This Webpage was created for a workshop held at Saint Andrew's Abbey, Valyermo, California in 2002....x.... ’ “”.

Mar 15; July 15; Nov 14	(RM 70:3)
CHAPTER 36: THE SICK BROTHERS	XXXVI DE INFIRMIS FRATRIBUS
CARE of the sick must rank before and above everything, so that they may truly be served as Christ Himself, ²for He said: I was sick and you visited me (Matt 25:36) ³ and, What you did for one of these who are least, you did for me (Matt 25:40). ⁴ But let the sick are themselves to consider that they are served out of honor for God, and they are not to sadden their brothers who serve them with superfluous demands; ⁵ Yet they are to be patiently borne with, because from such as these a more abundant reward is acquired. ⁶ The abbot shall therefore exercise the greatest care that they not suffer any neglect.	¹ Infirmorum cura ante omnia et super omnia adhibenda est, ut sicut revera Christo ita eis serviatur, ² quia ipse dixit: Infirmus fui et visitastis me, ³ *et: Quod fecistis uni de his minimis mihi fecistis.* ⁴ Sed et ipsi infirmi considerent in honorem Dei sibi servire, et non superfluitate sua contristent fratres suos servientes sibi; ⁵ qui tamen patienter portandi sunt, quia de talibus copiosior merces acquiritur. ⁶ Ergo cura maxima sit abbati ne aliquam neglegentiam patiantur.
These brothers who are sick are to be assigned a separate room and a God-fearing attendant who is also diligent and solicitous. ⁸ Baths may be offered the sick whenever this is helpful, but those who are healthy, especially the young are to be allowed this less frequently. ⁹ Additionally, the sick who are very weak may be allowed to eat meat to recover their strength; but when they are better, all are to abstain from meat as usual.	⁷ Quibus fratribus infirmis sit cella super se deputata et servitor timens Deum et diligens ac sollicitus. ⁸ Balnearum usus infirmis quotiens expedit offeratur ‑ sanis autem et maxime iuvenibus tardius concedatur. ⁹ Sed et carnium esus infirmis omnino debilibus pro reparatione concedatur; at, ubi meliorati fuerunt, a carnibus more solito omnes abstineant.
¹⁰ Moreover the abbot is to maintain the greatest care that that the sick are not neglected by the cellarers or attendants. For he is responsible for whatever is lacking in his disciples.	¹⁰ Curam autem maximam habeat abbas ne a cellarariis aut a servitoribus neglegantur infirmi. Et ipsum respicit quicquid a discipulis delinquitur.




3. COUNCILS, BISHOPS, and PENITENTIALS on ABORTION and CONTRACEPTION




4. AQUINAS on LIFE, ABORTION, and ANIMATION St. Thomas Aquinas


2.1.2. Cautery for headache	Patients prepare for cautery


2.1.3. Cautery points 9v	Man Bitten by Rabid Dog 16r

	2.1.4. Surgery for Nasal Polyps
	Cataract Surgery


2.1.5. Surgical Instruments	Herbal Remedies 28v-29r

MUTILATION