Biomedicine and Beatitude

Readers of the first edition of Nicanor Pier Giorgio Austriaco's Biomedicine and Beatitude: An Introduction to Catholic Bioethics will be delighted to hear a new edition has been released. This second edition revises and expands the first, adding a new chapter on bodily modification and a conclusion. In total, this edition adds over 150 pages of new content, so perhaps readers will be less excited to make room for it on the shelf. Austriaco clearly brings his experience and expertise as a Dominican priest, molecular biologist, and researcher to bear in his introduction to Catholic bioethics.

Austriaco introduces his book with the Church's primary vocation: calling us all to holiness. He emphasizes how Catholic bioethics distinguishes itself by relating the morality of human acts to beatitude, requiring us to inculcate and apply virtue in moral reasoning. In short, “this book narrates a bioethics that emphasizes the pursuit of beatitude in the lives of those who are confronted by the moral questions raised by the biomedical and the other life sciences, and the dynamic interplay of faith and reason that characterizes the Catholic tradition” (1).

Drawing from St. Thomas Aquinas, Austriaco’s first chapter outlines the moral framework of the book, according to which the intellect and will together give rise to a unified human act centered around a singular purpose, such as satiating hunger (14). When navigating complex biomedical questions, prudence and moral virtue are central, enabling us to pursue beatitude and imitate Christ. He reminds us that the virtues “are interconnected, because it is not the single virtue in isolation but the charitable and prudent person in his integrity who is acting” (6). But virtuous action requires the work of moral analysis. The book’s structure reflects this commitment. Moral analysis takes up the bulk of the text, while the end of each chapter reflects on how a particular virtue can play out in living up to the demands of the moral life.

Chapters 2 through 5—and also 7—cover standard Catholic bioethical topics: beginning of life, procreation, reproductive technologies, physician-patient relationships, organ donation, and end-of-life care. Austriaco’s act-morality approach imitates the typical Catholic model, utilizing Church magisterial documents, principles like double effect, and concepts like human dignity. Yet the book offers original argumentation regarding disputed cases. In ectopic pregnancies, Austriaco argues that “the trophoblast is an essential organ of the developing embryo,” concluding that its destruction by salpingostomy or MTX “is comparable to acts that destroy the heart of an adult human being,” constituting a direct and lethal attack on an innocent human life (83).

In chapter 7, Austriaco challenges death by neurological criteria (DNC) by outlining Pope St. John Paul II’s emphasis on a biological definition of death and an anthropological framework where the loss of the soul constitutes the loss of integrative functions within the human organism (291, 295). After problematizing the accuracy of clinical tests for DNC, Austriaco declares that the entire nervous system—which “innervates every tissue of the whole human being”—is both necessary and sufficient for sentience and therefore only the loss of the human organism, observed through the loss of bodily integrity, indicates death (299). But it is here that Austriaco may overstate his point. The entire nervous system is not necessary for sentience, otherwise the loss of an arm or leg would deprive us of our sentient state. Further, Austriaco is somewhat inconsistent. To establish that DNC tests are inadequate, he willingly admits one patient received a false-positive diagnosis of DNC (298) yet insists that another patient was “totally brain dead” (300) to establish that true DNC patients may not lose bodily integrity and be biologically—or anthropologically—alive.

Chapter 6 diverges most from traditional Catholic bioethical discussions and provides the bulk of this edition’s new content. Mobilizing the principle of totality, Austriaco explores the two human identity disorders: body integrity identity disorder (BIID) and gender dysmorphia (GD). The central question is whether psychological distress can justify the mutilation of healthy body parts. Austriaco asserts that in theory it can. When surgical modification, amputation, or mutilation alleviates psychological distress and prevents harmful attempts at self-alleviation (e.g., self-mutilation or suicide), “menacing” but otherwise healthy parts may be sacrificed by excision or modification to maintain or restore the integrity of the whole. In practice, Austriaco accepts amputation as a last resort in select, extreme cases of BIID, but rejects it for GD because available evidence suggests sex-reassignment surgeries do not enhance physiological or psychological wellbeing. Yet an important question remains unanswered. To analyze whether a surgical procedure would be justified under the principle of totality, the surgeries must have already been performed and assessed for efficacy. How does the principle of totality apply when therapies are novel, experimental, or understudied?

Chapters 8 and 9 discuss research ethics and the struggle of conducting Catholic bioethics in a pluralistic society, respectively. Chapter 8 may be the book’s strongest, where Austriaco’s experience as a molecular biologist and researcher shine through. While medical care is ordered primarily toward the patient’s good, research and experimental regimens are “ordered primarily toward the common good” (316). The whole chapter is motivated by a desire to maintain the integrity of human nature. Austriaco rejects germ-line editing that may permanently reshape human DNA in unknown ways, first because it is impossible to determine whether it is safe and effective in humans, and second because such practices may be inherently eugenic (321). Drugs that alter brain function are also rejected when used to enhance normal function, as they also may lead to unfair and unequal outcomes between the haves and the have-nots (327). Beyond human subjects, the chapter speaks to animal and crop research and manipulation. Chapter 9 attempts to offer guidance for navigating the complex relationships that exist for Catholics in a pluralistic society. Drawing from Alasdair MacIntyre and liberal democratic ideals, Austriaco supports a right to conscientiously avoid instances of formal—or even material—cooperation with evil.

Thoughtful and critical throughout, this book serves as an excellent introduction to the multifaceted approach to Catholic bioethical thought. The second edition certainly improves upon the first and offers up-to-date engagement with many major topics of bioethical debate. The book concludes with some thoughts on the future of Catholic bioethics. While the 20^th century was occupied by questions of human dignity, Austriaco believes the twenty-first century will “struggle primarily with questions regarding human identity” (402). He may very well be right, and his work here serves to begin that discussion.

Samuel Deters is a PhD student at the Saint Louis University Albert Gnaegi Center for Health Care Ethics.

Samuel Deters

Date Of Review:

August 27, 2022