Western medicine was founded on our Judeo-Christian and Greco-Roman heritage, where the sanctity of life and the dignity of the human person are paramount for decision-making in patient care. Patients place their trust in physicians and nurses to care for them in a compassionate and ethical manner, and we have a moral obligation to properly fulfill that role. Although the majority of Americans remain Christian, our multicultural and secular environment has made it more difficult to maintain a universal sense of objective morality. Unanimous agreement on moral issues between physicians and patients is not always possible in our pluralistic society. It is essential to include their religious beliefs when one obtains the social history in order to relate to the patient.
The recent attack on life in the womb and other challenges to the natural law have necessitated the involvement of the biological sciences, especially embryology. The Federal Research Act of 1974 led to the Belmont Report of 1978 with the entry of bureaucratic and legal participation in the health sciences. The term Biomedical Ethics, or the common term Bioethics, arose to describe the application of secular and utilitarian thought on human life issues, where emphasis is also placed on what is good for society at large.
This article reaffirms the traditional moral viewpoint on medical care - the health of each individual human being. Links to individual topics follow this presentation.
There are seven principles of Medical Ethics: a Moral Code and moral justification; the Doctor-Patient Relationship; Patient Autonomy; Beneficence (the Good Samaritan); Do No Harm (or Nonmaleficence); Justice; and the Physician's moral integrity and virtuous character. All seven principles must be in harmony for ethical medical care.
First, there must be a moral code and moral justification to guide physicians, nurses, and health care professionals in their actions. We learn from Hebrew Scripture, our Old Testament of the Bible, the value of life. God said in the Book of Genesis, Let us make man in our image and likeness (Genesis 1:26). We learn that God instilled the "breath of life" in man (Genesis 2:7). Because all human beings are created according to God's image and given the breath of life, we have an ethical duty to respect life and the dignity of each human being.
Moses lived circa 1250 BC and was the originator of the Torah, the first five books of Hebrew Scripture. God gave Moses the Ten Commandments as noted in the Book of Exodus, the one concerning life stated in a clear and direct manner:
The Book of Leviticus is the third book of the Torah or Law of Moses where God tells his people "to love your neighbor as yourself" (Leviticus 19:18). The Ten Commandments are repeated in the Book of Deuteronomy 5:6-21.
The ancient philosophers of Greece were concerned with the principles of life, the body, soul, and spirit. Plato considered the soul to be trapped within the body, happily released upon death. Aristotle saw the body and soul as one unit, the soul being the "life principle" of the body. Every physician who graduates from a medical school in the United States takes the Oath of Hippocrates, the Father of Medicine, who lived in Greece from about 450-375 BC. The middle portion of the traditional Hippocratic Oath expressly forbids abortion and euthanasia:
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion. But I will preserve the purity of my life and my art.
Jesus Christ gave us the Beatitudes as recorded in the New Testament of the Bible. The Beatitudes are presented in a positive sense, virtues in life which will ultimately lead to reward in Heaven. He taught us the Golden Rule in the Sermon on the Mount: "Do unto others as you would have them do unto you" (Matthew 7:12). He taught us the two greatest commandments are to love God and to love your neighbor as yourself (Matthew 22:36-40, Mark 12:28-31, Luke 10:25-28). St. Paul taught us to respect the human body, for our bodies are temples of the Holy Spirit (First Corinthians 6:19); he incorporated the spirit, soul, and body all in one sentence (First Thessalonians 5:23).
Thus the tradition of Western Christian civilization and American medicine is founded upon the Biblical ethic and the traditions of our Greco-Roman heritage.
The second principle of medical ethics is the doctor-patient relationship. Essential to this relationship is the element of trust. This relationship has been described by Paul Ramsey as a Biblical covenant similar to the pact between God and his people as recorded in Hebrew Scripture. The patient trusts the physician to counsel him to make the right decision regarding his care, to ensure his privacy, and to be a patient advocate. The physician should be compassionate, truthful, and respect the personal dignity of the patient by giving him informed consent. Fidelity is required to fulfill his traditional role as healer and protector of the patient's life.
Free and informed consent is required for medical treatments and procedures, except in an emergency situation when informed consent cannot be obtained and there is no indication that a reasonable patient would refuse consent to the treatment, as, for example, an unconscious trauma patient from a motor vehicle accident that presents to the emergency department.
Free and informed consent requires that the person or person's surrogate (or proxy) receive all reasonable information about the essential nature of the proposed treatment and its benefits; its risks, side-effects, consequences, and cost; and any reasonable and morally legitimate alternatives, including no treatment at all.
If a patient is incapable of making medical decisions, a proxy or surrogate, as an eldest son or a daughter who may be living with the parent and is in a position to best know the patient's wishes, is called upon to make treatment decisions. Should the proxy utilize the concept of substitute judgement or of best interest? Substitute judgement is a preference the patient has expressed in the past, whereas best interest decisions consider what treatment or lack of treatment would benefit the patient at that particular time. A balance of the two concepts often occurs in the clinical setting. For example, the family may remember the patient was adamant about not having gastric tube placement. The physician honors this request and the family and physician may decide it is in the best interest to give the patient intravenous fluids during the patient's final hours. Hopefully dialogue among the physician and family members can resolve the appropriate course of action.
The third principle is patient autonomy. Individual self-determination is highly valued in our American tradition, and rightly so. Patients should have the right to accept or refuse treatment, or allow the natural course of events to take place. It is important to remember that one respects patient autonomy as long as we live in harmony with the first principle of the moral law - the sanctity of life.
The fourth principle of medical ethics is beneficence, or the act of helping others. Beneficence refers to the traditional role of the physician as the Good Samaritan. The compassionate physician performs acts of charity, kindness, and mercy; comes to the aid of the injured, the sick, and the dying; and relieves pain and suffering. Natural or comfort care, the offering of food and water and the maintenance of body temperature and cleanliness for the dying elderly patient is a form of beneficence, as well as comforting the patient through a loving presence, palliation, and prayer. Jesus gave us the Parable of the Good Samaritan, as recorded in the Gospel of Luke:
Jesus replied, "A man was going down from Jerusalem to Jericho, and he fell among robbers,
who stripped him and beat him and departed, leaving him half dead.
Now by chance a priest was going down that road; and when he saw him he passed by on the other side.
So likewise a Levite, when he came to the place and saw him, passed by on the other side.
But a Samaritan, as he journeyed, came to where he was; and when he saw him, he had compassion,
and went to him and bound up his wounds, pouring on oil and wine;
then he set him on his own beast and brought him to an inn, and took care of him.
And the next day he took out two denarii and gave them to the innkeeper, saying,
`Take care of him; and whatever more you spend, I will repay you when I come back.'
Which of these three, do you think, proved neighbor to the man who fell among the robbers?"
He said, "The one who showed mercy to him." And Jesus said to him,"Go and do likewise."
Gospel of Luke 10:29-37
The fifth principle of medical ethics is nonmaleficence. Nonmaleficence is the warning primum non nocere or "first do no harm." This speaks for itself! The physician must evaluate whether any particular treatment or procedure is clinically indicated, and whether the procedure will provide benefit or undue burden to the patient. When considering a medical treatment for a patient, one speaks of ordinary and proportionate care versus extraordinary and disproportionate care. For example, mechanical ventilation may be ordinary and proportionate for an otherwise healthy 25 year old who suffered a near-drowning accident, whereas a respirator for an 88 year-old near-terminal patient with cancer of the lung would be extraordinary and disproportionate. The reference point is the patient!
The sixth principle of medical ethics is justice. Justice means respecting the rights and dignity of each human being. The real purpose of civil law is to guarantee an ordered social coexistence in true justice, so that all may "lead a quiet and peacable life, godly and respectful in every way" (First Timothy 2:2).
The physician must be fair to his patient, respect his rights as a person, and give the patient proper access to health care.
Today the principles of social justice often impact upon health care, as the corporate world has engulfed the profession of medicine. Scripture firmly supports the concepts of social justice, such as the New Testament Letters of St. Paul: in his First Letter to the Corinthians 3:8, he states that "every man shall receive his own reward according to his own labour."
Pope John Paul II, in his encyclical Centesimus Annus, published May 1, 1991, referred to the 1891 encyclical Rerum Novarum of Pope Leo XIII, which contributed greatly to improved treatment of workers during the Industrial Revolution. John Paul II had a major impact in his call for social justice in the mistreatment of workers in Communist Poland, an event that ultimately led to the fall of the Iron Curtain. He warned corporations against treating workers as "units of production" in their quest for profit.
The seventh principle of medical ethics is the moral integrity of the physician. As a leader in the community, he must be professional in his conduct and diligent to develop a virtuous character. We have the best role model - the great Physician Jesus Christ (Luke 4:23, 5:31-32). Jesus manifested love in his miraculous healing of the sick, lame, and blind. In addition to observation of the moral law, love is central to Christian health care!
These seven principles of medical ethics play an important part in our daily practice of medicine, in life-and-death decisions, and on modern human life issues. A review of the natural law and Christian morality will provide background for a discussion of the primary principle of the sanctity of life.
The very fact that we exist and have a human nature places us in this world, and by our very existence we have relationships! We have a relationship to God, to others, to ourselves and to the world. We are judged by our actions and relationships.
God created the world, and He knows how it works. The Natural Law is the expression of God's Eternal Law. God is the one objective source of morality. The first principle of the Natural Law is to love God and our neighbor as ourselves. The Natural Law teaches us to do good and shun evil (First Peter 3:11). St. Peter reminds us in the Acts of the Apostles:
We must obey God rather than men.
Both the prophet Jeremiah in the Old Testament and St. Paul in the New Testament of the Bible refer to a natural law that God has written in the hearts of men:
I will put my law within them, and I will write it upon their hearts;
and I will be their God, and they shall be my people.
They show that what the law requires is written on their hearts,
while their conscience also bears witness and their conflicting thoughts accuse or perhaps excuse them
on that day when, according to my gospel, God judges the secrets of men by Christ Jesus.
St. Paul to the Romans 2:15-16
Cicero was a famous Roman orator who lived in the first century BC, and who recognized the existence of an eternal unchanging natural law:
"True law is right reason in agreement with nature, universal, consistent, everlasting, whose nature is to advocate duty by prescription and to deter wrongdoing by prohibition. Good men obey its prescriptions and prohibitions, but evil men disobey them. It is forbidden by God to alter this law, nor is it permissible to repeal any part of it, and it is impossible to abolish the whole of it. Neither the Senate nor the People can absolve us from obeying this law, and we do not need to look outside of ourselves for an expounder or interpreter of this law. There will not be one law at Rome and another law at Athens or different laws now and in the future. There is now and will be forever one law, valid for all peoples and all times. And there will be one master and ruler for all of us in common, God, who is the author of this law, its promulgator, and enforcing judge."
Cicero, On the Republic, Book III, 22-33, 51 BC
St. Augustine defined God's eternal law as "the reason or the will of God, who commands us to respect the natural order and forbids us to disturb it." St. Thomas Aquinas calls the natural law "the human participation in God's eternal law." Aquinas wrote about faith and reason, which are like two wings on which the human spirit rises to the contemplation of truth. Through faith we assent to Divine Revelation, and through reason people naturally understand some basic practical principles, which he calls the "primary principles of the natural law." Aquinas continues that "every law made by man can be called a law insofar as it is derived from the natural law. But if it is somehow opposed to the natural law, then it is not really a law, but a corruption of the law."
Our Declaration of Independence speaks of God our Creator and the Natural Law, that every man has certain unalienable rights, namely, Life, Liberty and the Pursuit of happiness. Thomas Jefferson recognized that we have freedom and dignity as human beings because we are creatures of God.
God created the world and we are made in his "image and likeness" (Genesis 1:26-28). Jesus Christ treasured every human being, for he said, "As you did it to the least one of these my brethren, you did it to me" (Matthew 25:40). Thus man has an innate dignity because we are creatures of God. The natural response to God's gift of love and life is gratitude and the obedience of faith to our Father (Romans 1:5)! Moral conduct therefore shows itself to be consent to God our Creator - it is the human response to the creative love of God.
But our first parents, Adam and Eve, led by the Temptor, were disobedient, and moral disarray entered the world. The creatures put themselves before God, "worshipping and serving the creature rather than the Creator (Romans 1:25)."
Following the fall of Adam and Eve, God sent his only Son, "that whoever believes in Him may have eternal life" (John 3:16). And Jesus was obedient to His Father and served as our model of moral behavior. Moral behavior is living in harmony with the will of God!
It is for us to "live in Christ." Because of our weak nature, it is easy for us to fall (Romans 6-8; Galatians 5). But God sent us grace through the Holy Spirit, to help us be obedient to the Father, to "free us from the law of sin and death" (Romans 8:2). Grace perfects nature, to help us live the Way (Acts 9:2, 19:23, 22:4) of Christ!
Grace is God's free gift of himself, and virtue is man's free response to God. The practice of virtue is essential to Christian morality, the profession of Medicine, and a stable society! There are seven virtues, the Theological virtues of faith, hope, and charity, and the Cardinal or moral virtues of prudence, justice, fortitude, and temperance. The virtues of Faith, Hope and Charity unite us to God, and are also essential in patient care, for it is important that our care be based on God's healing power, that we instill hope in our patients and are compassionate with them. The Cardinal or moral virtues guide us in our conduct and relationships during life, especially in the art of medicine. Faith is a personal commitment to God who reveals His saving truths and to those truths which he reveals. Hope is the desire for God and the trust we will receive the graces to be with Him in heaven. Charity leads us to love God above all things and our neighbor as ourselves. Prudence is a moral virtue which helps us make the right choice in every instance to allow us to properly treat our patients and accomplish our ultimate goal of union with God. Justice leads us to respect the rights of others and to give them their due. Fortitude gives us the courage to carry out what is right, and be a true patient advocate, even in the face of difficulty! Temperance gives us self-control over our desires and appetites.
Pope John Paul II published his encyclical on Christian morality in 1993, entitled The Splendor of Truth - Veritatis Splendor. It is the first encyclical ever in the 2000-year history of the Catholic Church on Christian morality. John Paul points out the natural law is unchanging and universal. He states that "the negative precepts of the natural law are universally valid." For example, the "negative" precept "Thou shalt not kill" is just as true today as it was 2000 years ago. Everyone is bound to observe at a minimum the precepts of the Ten Commandments. The Pope continues that while there is a minimum requirement, there is no limit to the greatest commandment, that you should love God and your neighbor as yourself. There is no limit to the amount of love and generosity one can bestow on your family or neighbor.
We have inner peace when we live in harmony with God our Creator and the Natural Law.
John Paul II continues in The Splendor of Truth to address the problems of modern morality or ethical relativism. Western society has been founded on objective sources of moral norms, on a covenant morality in the Ten Commandments of Divine Revelation and on the Natural Law. The Pope quotes the Gospel of Matthew (19:16) when the rich young man approaches Jesus, and asks him, "Teacher, what good must I do to inherit eternal life?" He instructs us to "turn to Christ once again in order to receive from him the answer to their questions about what is good and what is evil." He reminds us of the warning in Genesis 2:16-17 that man is "not to eat of the tree of knowledge of good and evil." He shows us that "with this imagery, Revelation teaches that the power to decide what is good and what is evil does not belong to man, but to God alone."
The Pope confirms that we are to seek the truth with our conscience, and live accordingly. For we truly have freedom from the tyranny of sin and death when we are living God's will. As the Gospel of John puts it,
You will know the truth and the truth will set you free.
Pope John Paul II points out that it is the object, or what is done, that primarily decides the morality of a particular act. One must also look at the intention, purpose, or motive and the circumstance or consequences. A good moral act requires that all three must be good.
Our freedom is truly safe when we accept God and his truth!
Modern trends, however, detach morality from any objective norm. John Paul II continues in Veritatis Splendor: "Currents of modern thought exalt freedom to such an extent that it becomes an absolute, and serves as a source of values." For man today, freedom becomes doing your own thing. Anything goes. When conscience is separated from truth, the person decides what is right and wrong. We now have the great American creative conscience.
The Reverend Billy Graham has written Storm Warning in 2010, an exceptional - and frightening - book that looks at the consequences of ethical relativism in our society today. The problem with ethical relativism is that a society loses its moral compass, when everyone can decide for themselves what is right and wrong. This is why the family and society as a whole are breaking down, because people engage in all sorts of outrageous behavior, thinking they can do as they please.
One must face the existence of modern challenges to the Natural Law in our technological society. Each new development in technology gives rise to new ethical questions, often in relation to the very nature of the human person.
What happens when a patient asks her doctor to prescribe or perform a controversial medical procedure? A recent New England Journal of Medicine survey suggested that physicians believe they have a moral responsibility and that it is ethically permissible to explain their objections to patients, and, should the patient insist, to consider referring the patient to a clinician who does not object to the requested procedure.
Proponents for abortion believe that the mother should have a choice if she wants to keep her baby, that it is for us to respect her rights and autonomy. There are two problems with this - first, this completely disregards the primary principle of the sanctity of life, and second, what about respect for the autonomy and civil rights of the unborn baby!
Proponents for euthanasia place patient autonomy as the highest guiding principle, even over respect for the sanctity of life. They argue that the patient should have a right to choose death rather than face a horrible and painful terminal illness. The problem with this is that if self-determination is the sole guiding principle, then why withhold the right to choose death for anyone!
We have only to look at Hitler's Nazi Germany to see what happens when governments separate freedom from truth and "do their own thing." It was in Nazi Germany that the physician first became a minister of death. Dr. Leo Alexander, after attending the Nuremberg trials, reported in the New England Journal of Medicine that at first there was a "subtle shift in emphasis" in the mindset of the physicians, such that the Nazis moved from the "small beginnings" of euthanasia for the incurably ill to mass genocide. The slaughter of six million Jews during the Holocaust first began with the "acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as a life not worthy to be lived." The state acquired the autonomy to choose death for anyone!
A damaging crisis recently unfolded when it was discovered that American military physicians directed psychological torture at Guantanamo!
Should these disturbing trends continue, it will forever shatter the very essence of our role as protector and patient advocate, and will destroy whatever trust patients have left for us. How will you know if your doctor has your best interest at heart when he recommends a treatment?
Even the dignity of human procreation within marriage between man and woman is now being challenged by recent advances in fertility research! Consider the moral implications of embryonic stem cell research, attempts at therapeutic cloning, and the practice of freezing thousands of embryos. Modern experiments at social engineering are opposed to the natural law and can only bankrupt the family and the health of our society.
In the concluding remarks of The Splendor of Truth, John Paul II cautions us "of the risk of an alliance between democracy and ethical relativism, which would remove any sure moral reference point from political and social life, and on a deeper level make the acknowledgement of truth impossible. If there is no ultimate truth to guide and direct political activity, then ideas and convictions can easily be manipulated to gain power. As history demonstrates, "a democracy without values can turn into open or thinly disguised totalitarianism." The links refer to Modern Challenges to the Natural Law.
Western medicine as described above has long upheld the primary concepts of the sanctity of life and respect for the dignity of the human person. Procreation within the intimately personal nature of marriage has always been held sacred. It is important to recognize that the vast majority of physicians exhibit respect for life in their practice of medicine.
St. Thomas Aquinas called the soul "the principle of life," and spoke of the operative powers of the soul, such as the mind or intellect, the will, imagination, and the higher emotions. The dramatic advances of modern medicine have in fact given us an unexpected glimpse of the transcendent through the phenomenon of Near-Death Experiences, as first described by Raymond Moody MD. Patients were able to describe events in their resuscitation that could only be explained by their being outside of their bodies. The neurosurgeon Wilder Penfield in his studies exhibited the difference between the mind and the brain. The pediatrician Melvin Morse, in his studies of children who described near-death experiences, presented the concept that the soul is the source of energy to the body.
Technologic advances in medical care have allowed physicians to sustain life by extraordinary means, such as mechanical ventilation, electrical cardioversion and defibrillation, and cardiopulmonary resuscitation. The decision to withhold or discontinue extraordinary measures has created new ethical problems. These issues first received public attention with Karen Ann Quinlan in 1976, an unconscious patient on a ventilator with little hope of regaining consciousness. The right to refuse life-sustaining treatment by the parents of the unconscious Nancy Cruzan reached the Supreme Court in 1990.
The modern utilitarian concept of brain death, partly developed in the interest of harvesting organs for transplantation, holds that the brain is the seat of the "integrative function" of the body, that the body cannot live more than a few days following brain death. Recently this has been challenged in the medical literature. The pediatric neurologist Alan Shewmon cites 175 cases where patients have lived longer than 1 week after being declared "brain dead," one child still alive 15 years later. Nearly everyone has forgotten that the first successful heart and liver transplant in 1967 occurred after the patient was in full cardiac arrest!
Traditionalists in the medical profession have been supported by Pope John Paul II, who published his landmark encyclical The Gospel of Life - Evangelium Vitae on March 25, 1995. The encyclical defined The Culture of Life, where every human being as a child of God has an innate dignity and thus is worthy of life, love, and respect. He contrasted this from The Culture of Death, where humans are to be used by the powerful few in the name of efficiency and choice.
The encyclical, which contains over 300 Biblical references, addresses the assault on life and dignity of the human person in our modern world. "Civil law must ensure that all members of society enjoy respect for certain fundamental rights which innately belong to the person, rights which every positive law must recognize and guarantee." The Gospel of Life could not have been more timely, and Newsweek magazine featured the March 25, 1995 publication as its cover story. Evangelium Vitae provided the direction America needed to combat a Michigan pathologist's unchecked practice of physician-assisted suicide and euthanasia.
John Paul II called the practice of Natural Family Planning, Organ Donation, Modern Pain Management in the Hospital, Home, or Hospice Setting, and Natural Death consistent with a Culture of Life, but condemned practices such as Abortion, Exploitation of the Embryo, and Euthanasia as symptomatic of a culture of death.
The Pope assailed modern trends that attack the dignity of life. "Choices once unanimously considered criminal and rejected by the common moral sense are now becoming socially acceptable. The end result of this is tragic: not only is the destruction of so many human lives extremely grave and disturbing, but no less grave and disturbing is the fact that conscience itself, darkened as it were by such widespread conditioning, is finding it increasingly difficult to distinguish between good and evil in what concerns the basic value of human life."
John Paul II called on people everywhere to become "children of the Light" (Ephesians 5:8) and build a culture of life in a Civilization of Love as an expression of God's plan for the human race. "Life is a gift from our Creator and it is a treasure to be given the utmost respect and dignity. Society must respect, defend, and promote the dignity of every human person at every moment and in every condition of that person's life."
The Pope recalls that Jesus is the Word of Life (1 John 1:1-4). "Truly great must be the value of human life if the Son of God has taken it up and made it the instrument of the salvation of all humanity."
John Paul II reached out to women who have had an abortion, urging them "not to lose hope, to face the situation honestly, and give themselves over with humility and trust to repentance." He pointed out that the "Father of Mercies is ready to give you his forgiveness and his peace in the Sacrament of Reconciliation." He made the perceptive observation that they "can be among the most eloquent defenders of everyone's right to life," and through their commitment to life, they can "become promoters of a new way of looking at human life."
In a foreboding ending to his encyclical, John Paul likened the culture of death's attack on human life to the dragon in Revelation 12:1-6:
"Life is always at the center of a great struggle between good and evil, between light and darkness. The dragon wishes to devour 'the child brought forth,' a figure of Christ, whom Mary brought forth 'in the fullness of time (Galatians 4:4).' But in a way that child is also a figure of every person, every child, especially every helpless baby whose life is threatened, because by his Incarnation the Son of God has united himself in some fashion with every human person. It is precisely in the flesh of every person that Christ continues to reveal himself and to enter into fellowship with us, so that rejection of human life, in whatever form that rejection takes, is really a rejection of Christ. This is the fascinating but also demanding truth which Christ reveals to us and which his Church continues untiringly to proclaim: "Whoever receives one such child in my name receives me" (Matthew 18:5); "Truly, I say to you, as you did it to the least of my brethren, you did it to me" (Matthew 25:40).
The Culture of Life was beautifully displayed in the suffering and death of Pope John Paul II, in contrast to the 13-day starvation of Terry Schiavo before her horrible death on March 31, 2005. The Pope joined his two-month suffering to that of Christ (Colossians 1:24), and was offered sustenance until his peaceful death on April 2, 2005.
The following are some Biblical sources that support a Culture of Life.
1 Ramsey P. The Patient as Person: Explorations in Medical Ethics. Yale University Press, New Haven, Connecticut, xi-11, 1970.
2 New American Bible, Revised Edition. Catholic Book Publishing, Totowa, New Jersey, 2011.
3 The Hippocratic Oath. Dorland's Illustrated Medical Dictionary, 30th Edition, Elsevier, Philadelphia, 854, 2003.
4 Marcus Tullius Cicero. "The Natural Law," from The Republic, in Catherine Cookson (ed): Encyclopedia of Religious Freedom. Routledge, London, 289, 2003.
5 Ashley B, DeBlois J, O'Rourke KD. Health Care Ethics, A Catholic Theological Perspective, Fifth Edition. Georgetown University Press, Washington, D. C., 2006.
6 Solomon WD, Baier K. "Moral Rules, Moral Justification, Deontology," in Reich WT (ed): Encyclopedia of Bioethics. MacMillan Free Press, 410-414, 1978.
7 Pope John Paul II. The Gospel of Life - the encyclical Evangelium Vitae, Times Books, Random House, New York, 1995.
8 May WE. Catholic Bioethics and the Gift of Human Life, Third Edition. Our Sunday Visitor, Huntington, Indiana, 2013.
9 Irving DN. "What is Bioethics?" in Koterski JW (ed): Life & Learning X: Proceedings - Tenth UFL Conference. University Faculty for Life, Washington DC, 1-84, 2002.
10 Purtilo RB. "The Physician-Patient Relationship," in Reich WT (ed): Encyclopedia of Bioethics, Revised Edition. MacMillan, New York, 2094-2103, 1995.
11 St. Augustine. Reply to Faustus the Manichaean, Book 22, Chapter 27, in Fathers of the Church, v. 56, Catholic University of America Press, Washington, D. C., 1968.
12 St. Thomas Aquinas. Summa Theologica I Q75-78; I-II Q94a2, Q100a1-3: trans: Fathers of the English Dominican Province, 1912. Christian Classics, Allen, Texas, 363-396, 1008-1039, 1981.
13 Pope John Paul II. Theology of the Body: Human Love in the Divine Plan, Pauline Books & Media, Boston, 1997.
14 Pope John Paul II. The Splendor of Truth - Veritatis Splendor and the Encyclicals of John Paul II. JM Miller (ed), Our Sunday Visitor, Huntington, Indiana, 1996.
15 Billy Graham. Storm Warning. Thomas Nelson Publishers, Nashville, 2010.
16 Leo Alexander MD. "Medical Science under Dictatorship." New England J Medicine 241:39-47, 1949.
17 Newsweek Cover Story. The Pope's Plea: Life, Death, and the Pope. April 10, 1995.
18 Muller GE. "Bioethics through the Eyes of Faith." National Catholic Bioethics Quarterly 13(2):277-285, Summer 2013.
19 Moody RA, MD. Life After Life: The Investigation of a Phenomenon - Survival of Bodily Death. Mockingbird Books, Marietta, Georgia, 1975.
20 Penfield W, MD. The Mystery of the Mind: A Critical Study of Consciousness and the Human Brain. Princeton University Press, Princeton, NJ, 1975.
21 Morse M, MD. "A Near-Death Experience in a 7-year-old child." American J Diseases Children 137:959-961, 1983.
22 Shewmon DA, MD. "Brainstem Death, Brain Death, and Death." Issues in Law and Medicine 14:125-145, 1998.
23 Pellegrino ED, MD. "Toward A Reconstruction of Medical Morality." American J Bioethics 6(2):65-71, 2006.
24 Sulmasy DP. "Spiritual Issues in the Care of Dying Patients." JAMA 296:1385-1392, 2006.
25 Xenakis SN, MD. "Doctors Must Be Healers." Seton Hall Law Review 37:703-710, 2007.
26 Curlin FA, MD, Lawrence RE, Lantos JD. "Religion, conscience, and controversial clinical practices." New England J Medicine 356:593-600, February 8, 2007.
27 Friend L, MN RN. "Ethical decision making in the emergency department: the Golden Rule." J Emergency Nursing 38(3):251-253, May 2012.
28 Way RM. "Engaging the culture of death with the Gospel of Life." The Linacre Quarterly 80(4):363-375, November 1, 2013.
29 Saguil A, Phelps K. "The Spiritual Assessment." American Family Physician 86(6):546-550, September 15, 2012.
30 Haddad LM, MD MA. Medical Ethics and The Art of Medicine. 16th Annual Intensive Review in Emergency Medicine, Medical University of South Carolina, Charleston, September, 2007.