Chapter IV: Negative Duties in Regard to Life and Health

The life of the body is indeed a precious thing, but it is by no means the greatest of blessings,¹ and consequently the duty of preserving and safeguarding it does not bind absolutely. There are circumstances in which it may be necessary or advisable to sacrifice one's life. This is the case, for instance, when the duty of conserving life cannot be reconciled with some higher obligation, or when superior spiritual blessings must be purchased at the expense of life, either by the individual, or by the multitude. Hence man has the right, nay, under certain conditions he is in duty bound, to give up his life for the sake of a higher good.

¹ Cfr. Matt. X, 28, 39; XVI, 25 sq.; Mark VIII, 35–37; Luke IX, 24; XVII, 33; John XII, 25.

This duty must now be more closely determined, both negatively and positively.

No man is allowed without a just cause (sine iusta causa) to destroy his own life or health, or to expose himself to the danger of certain death, or seriously to mutilate his body. 1. SUICIDE (suicidium, αὐτοχειρία)² is the direct and intentional compassing of one's own death. This need not always be the immediate object of the will. If I will an action, I will its evident effect; and therefore, were I to refuse food, or, out of bravado, to leap from the top of a sky-scraper into the street below, I should be guilty of suicide, even though self-destruction was not my direct object. In suicide a man somehow aims at direct death.

² St. Thomas, Summa Theol., 2a 2ae, qu. 64, art. 5; Sporer-Bierbaum, Theol. Mor., Vol. II, 2nd ed., tr. 5. n. 366–407; St. Alphonsus, Theol. Mor., l. III, n. 366–374 (ed. Gaudé, Vol. I, pp. 622 sqq.); M. Inhofer, Der Selbstmord, Augsburg 1886; E. Federici, La Prevenzione del Suicidio, Venice 1901, pp. 37 sqq.; K. A. Geiger, Der Selbstmord im klassischen Altertum, Augsburg 1888; M. Cronin, The Science of Ethics, Vol. II, Dublin, 1917, pp. 52 sqq.; A. Van der Heeren in the Cath. Encyclopedia, Vol. XIV, pp. 326 sqq.; A. O'Malley, The Ethics of Medical Homicide and Mutilation, N. Y., 1919, pp. 7 sqq.

Suicide is plainly forbidden by the fifth commandment: 'Thou shalt not kill," ³ "either another or yourself," as St. Augustine explains; "for he who kills himself kills none other than a man." ⁴ The Lord God alone "has power of life and death." ⁵ Suicide is also forbidden indirectly because of the immoral motives that usually inspire it, e. g., unbelief, cowardice, false notions of honor, an excessive craving for glory, wealth, etc., or that dullness of mind which results from overindulgence in carnal pleasures and usually ends by making its victim incapable of further enjoyment.⁶ Seneca enumerates several causae frivolae that lead to suicide and mentions circumstances in which it is morally illicit to seek refuge in death.⁷ a) Suicide is diametrically opposed to the strongest instinct of nature, that of self-preservation. "The tendency to persevere in life," says Goyau, "is the necessary law of life, not of human life only, but of all life." ⁸ Hence it must always remain a difficult psychological problem why so many people commit this unnatural crime. In the light of recent investigations there can hardly be a doubt that most of those who compass their own death do so in a state of mental derangement. "Most suicides," says Dr. James J. Walsh, "are persons that have been recognized as paranoiacs and likely to do queer things for a long time beforehand. Indeed, some of the melancholic qualities on which the unfortunate impulse to self-murder depends are likely to have exhibited themselves in former generations.... As a matter of fact, suicides are not in possession of free will as a rule, but are the victims of circumstances and are unable to resist external influences." ⁹ However, it would be wrong to conclude from this that every case of suicide can be traced to some condition of organic disturbance in which the use of reason, and consequently responsibility, are suspended. Not every perturbation of the moral life springs from physical or physiological causes, and melancholia, idiosyncrasy, fixed notions, hallucinations or illusions do not always hinder the use of reason and destroy freedom of action. It would be equally wrong to ascribe every case of suicide to personal guilt, and positively foolish to adopt the Stoic view that suicide is not an act of cowardice, but rather a proof of courage, on the plea that by killing himself a man not only escapes evil and thereby follows an instinct implanted in his soul by God, but likewise relieves society of an intolerable burden, and, moreover, by an act of supreme self-sacrifice, atones for his crime and thus conciliates the eternal Judge.¹⁰ This view is radically false. For, in the first place, he who despairs in a difficult or hopeless situation and tries to escape the tribulations of life by committing suicide, does not display courage and strength of character, but the very opposite, and, secondly, all misfortunes, even those which a man incurs through his own guilt, must, from the Christian point of view, be regarded as trials in which he should exercise patience, faith, and confidence in God.¹¹ The decisive factor is not public opinion but the duty which the individual owes to society and which he is still able to fulfill, even though it be only by giving an example of Christian fortitude. Finally, for man to try to escape his judge instead of atoning for his sins in the way prescribed, namely, by contrition and penance, is a pagan, not a Christian motive. ¹²

³ Ex. XX, 13; cfr. Deut. XXXII, 39-

⁴ De Civitate Dei, l. I, c. 20: “It remains that we understand of man what was said: ‘You shall not kill’—therefore neither another nor yourself. For one who kills himself kills none other than a man.” (Migne, P. L., XLI, 35).

⁵ Wisd. XVI, 13.

⁶ A. Van der Heeren in the Cath. Encyclopedia, Vol. XIV, p. 328; H. Rost, Der Selbstmord als sozialstatistische Erscheinung, Cologne 1905, pp. 23 sqq.; H. A. Krose, S.J., Der Selbstmord im 19ten Jahrhundert, Freiburg, 1906, pp. 28 sqq. IDEM, Die Ursachen der Selbstmordhäufigkeit, Freiburg 1906.

⁷ Cfr. M. Baumgartner, L. A. Seneca und das Christentum, pp. 135 sqq.

⁸ M. Cronin, The Science of Ethics, Vol. II, p. 53 sq.; Vol. I, p. 90. The objection that it is incorrect to say that in committing suicide a person desires to compass his own destruction, because the soul does not disappear at death, while the body will rise again, and that, therefore, what is desired and accomplished in suicide is not annihilation, but a new life, more perfect than the present, and consequently suicide is not a violation of our natural appetite for continued existence and well-being, is refuted by Dr. Cronin as follows: "Natural tendencies are all tendencies to the well-being of the natural agent, the agent regarded as a product of nature. Nature could not set up in any thing a tendency towards a condition which is either unnatural or which is even above nature. But the natural constitution of man, from which spring all our natural powers and appetites, is that of a composite of body and soul combined to form one person. And, therefore, our natural desire for happiness is a desire for the happiness and well-being of the natural person, consisting of body and soul, In suicide, therefore, we use our natural powers for an end which is the frustration of their own natural purpose." (Ibid., Vol. II, p. 55).

⁹ O’Malley-Walsh, Essays in Pastoral Medicine, New York, 1906, p. 306.

¹⁰ K. Joest, Das Recht auf den Tod, Göttingen, 1895.

¹¹ St. Augustine, De Civ. Dei, l. I, c. 26: "This we say, this we assert, this we approve in every way: that no one ought to inflict voluntary death upon himself as though fleeing temporal troubles, lest he fall into everlasting ones; no one on account of another’s sins, lest he himself begin that most grave sin of his own when another’s sin did not defile him; no one on account of past sins, for which this life is all the more necessary so that they may be healed by penance; no one as though from desire of the better life hoped for after death, because the better life after death does not receive those guilty of their own death." (Migne, P. L., XLI, 39).

¹² Ps. XXXIII, 19; L, 19. —A. von Oettingen, Die Moralstatistik, 3rd ed., p. 761, says: "The Protestant misses the energetic spiritual leadership of the Church; when unhappy, he does not so readily find consolation because he must do without the human mediation of the priesthood (confession)."

According to the principles of Christian morality a person who commits suicide while in the full possession of his mental faculties is not only a murderer and a criminal, but renounces God and the hope of salvation and forfeits every right to the blessings of the Church, including that to a Christian burial.¹³ In denying any one the last-mentioned privilege the Church, of course, does not mean to pass judgment on his probable fate in the other world.

¹³ Codex Iuris Canonici, can. 1240, § 1, n. 3: "Those who have killed themselves by deliberate design are deprived of ecclesiastical burial unless before death they have given some signs of repentance...." —Cfr. Rit. Rom., tit. 6, c. 2, n. 3; S. Offic., d. 16 Maii 1866.

Does suicide always result from (temporary or permanent) insanity, or is it sometimes committed by persons who are quite sane? While some eminent scientists ¹⁴ hold that perfectly normal persons can and do commit suicide, others ¹⁵ adopt the theory of Esquirol, who nearly a century ago¹⁶ asserted that "suicide is a disease." No doubt suicide is very often due to dementia, but it is equally undeniable that many who compass their own death are impelled by pique, despair or anger, which usually involve malice or culpable cowardice.¹⁷

¹⁴ E. g., J. Maschka, Handbuch der gerichtlichen Medizin, Vol. I, Tübingen, 1881, p. 477.

¹⁵ For instance, R. Gaupp, Ueber den Selbstmord, 2nd ed., Munich, 1910, p. 32.

¹⁶ He died 1840.

¹⁷ "Despair and anger," rightly observes Van der Heeren (Cath. Encyclopedia, Vol. XIV, p. 328), "are not as a general thing movements of the soul which it is impossible to resist, especially if one does not neglect the helps offered by religion, confidence in God, belief in the immortality of the soul and in a future life of rewards and punishments."

Suicide is a moral, a social, a biological, and a psychological problem. Its frequency is governed by laws whose existence seems to be established by statistics, but whose nature we are but just beginning to surmise.¹⁸ b) As the theological notion of suicide implies the full use of reason and the deliberate intention, direct or indirect, of ending one's life, a man does not commit suicide if he kills himself accidentally, or through carelessness, or in order to escape certain danger of death, or when in a state of mental derangement, be it complete or partial, permanent or temporary; or indirectly by doing or omitting something the fatal consequences of which he might and should have foreseen, but does not advert to on account of their remoteness; e. g., leading a dissolute life, indulging in anger or intemperance, or mortifying his body beyond the bounds of reason. An act which is not in itself sinful and of which it cannot be foreseen that it will lead to the destruction of life (as, e. g., firing a gun, eating a food not known to be poisonous) is no sin. If death can be foreseen as the result of such a non-sinful act, the latter is forbidden, unless commanded by duty, as when a priest or a physician visits a patient who is suffering from a contagious disease or when a soldier goes into battle. If the act that results in self-destruction is in itself sinful, it is a voluntarium in causa with regard to such destruction, and may be imputed as a sin tending to self-destruction, which, however, is not suicide in the specific sense.

¹⁸ Cfr. Familler, Pastoralpsychiatrie, pp. 142 sqq.

The ecclesiastical penalty inflicted upon those who are guilty of direct suicide does not affect those who commit suicide indirectly. If direct suicide has been committed in a state of mental derangement, the victim should not be buried in the customary solemn manner, but quietly, i. e., without song, bell, or sermon; not as if the Church wished to judge the soul of the departed, but merely to indicate her sorrow at his misfortune and dreadful end. Where there is doubt as to the condition in which the act was committed, charity demands that the deceased be given the benefit of the doubt, and be buried with ecclesiastical honors. Mental alienation may be presumed, not only on the strength of expert opinion, but also on the testimony of trustworthy relatives or friends who were in personal touch with the deceased.¹⁹

¹⁹ Regulae Iuris in VIto Decret. Bonifat. VIII, n. 30: "In obscure matters the least burdensome course is to be followed." Ibid., n. 49: "In penalties the more favorable interpretation is to be made."

A point to which attention should be called is that the power of suggestion and example have much to do with the increase of suicide. Dymond, an authority in the matter, says: "The power of the example of the suicide is much greater than has been thought. Every act of suicide tacitly conveys the sanction of one more judgment in its favor. Frequency of repetition diminishes the sensation of abhorrence and makes succeeding sufferers, even of less degree, resort to it with less reluctance." Dr. Walsh, who quotes this passage, adds: "Our modern newspapers, by supplying all the details of every suicide that occurs, especially if it presents any criminally interesting features or morbidly sentimental accessories, familiarize the mind, particularly of the impressionable young, with the idea of suicide. When troubles come, lack of experience in life makes the youthful mind forecast a future of hopeless suffering. Love episodes are responsible for most of the suicides in the young, while sickness and physical ills are the causes in the old. In a certain number of cases, however, domestic quarrels, and especially the infliction of punishment on the young at an age when they are beginning to feel their independence and their right to be delivered from what they are prone to consider restriction, are apt to be followed in the morbidly unstable by thoughts of suicide." ²⁰ In order to forestall the putting into action of the suicidal impulse, Doctor Walsh suggests that those who are close to the patient should have some realization of the possibility of its occurrence. There are usually some previous indications of the suicidal trend. Many especially early suicides have distinct tendencies to and stigmata of hebephrenic melancholia. The best known symptoms of this condition are those described by Dr. Peterson in his book on mental diseases. The symptoms noted are extraordinarily rapid and paradoxical changes of disposition. Depressed ideas intrude themselves in the midst of boisterous gaiety, and untimely jocularity in the deepest depression, or at solemn moments. Then there is the paradoxical facial expression, the so-called paramimia, that is, a look of joy and pleasure when really mental depression is present, or a look of depression when joyful sentiments are being expressed.²¹

²⁰ Essays in Pastoral Medicine, p. 309.

²¹ Ibid., p. 309 sq.

The tendency of suicide to repeat itself in families is now well known and recognized. It is "not directly inherited, but there is a mental weakness that makes the individual incapable of withstanding the sufferings life may entail." ²² 2. SELF-MUTILATION. —As we are not masters of life, so neither are we owners of our limbs, and hence cannot dispose of them at will. A man is not justified in mutilating himself, but as the limbs of the body are subordinate to life, they may be sacrificed as parts for the whole if life can thereby be preserved. Hence the amputation of one or several limbs is permissible when it is the only means of preserving life. A sick man may allow an infected limb to be amputated in order to prevent infection of the whole body, and one who is handcuffed, e. g., in prison, may tear or cut off a hand or an arm, or both, in order to escape certain death, e. g., from fire.²³

²² Ibid., p. 310.

²³ Cfr. St. Thomas, Summa Theologica, 2a 2ae, qu. 65, art. 1: "Since a member is a part of the whole human body, it exists for the sake of the whole, as the imperfect exists for the perfect. Therefore a member of the human body is to be disposed of according as it benefits the whole. Now, a member of the human body is of itself useful for the good of the whole body; accidentally, however, it can happen that it is harmful—for example, when a putrid member is corruptive of the whole body." —IDEM, Summa contra Gent., l. III, c. 112, n. 5: "It is manifest that all the parts are ordered to the perfection of the whole; for the whole does not exist for the parts, but the parts exist for the whole." —Cfr. J. P. Gury, Comp. Theol. Mor., Lyons and Paris, 1850, Vol. I, n. 403, 9; H. Noldin, S.J., Summa Theol. Mor., Vol. II, 11th ed., Innsbruck, 1914, pp. 351 sq.

To mutilate oneself or to allow oneself to be mutilated for any other purpose than that of saving one's life, for instance, to escape military conscription, is not permissible.

Except as a remedy for diseased conditions of the body, castration or emasculation (eviratio) is never allowed, not even from religious motives, as, for instance, to preserve chastity or avoid temptations, because the operation is neither necessary nor useful for that purpose;²⁴ still less, of course, for minor ends, e. g., to keep the voice unbroken, because the preservation of a youthful voice is not a sufficient good to justify the commission of an act against nature. Following many censures of his predecessors, Leo XIII expressly forbade this practice for the singers of the Sistine Chapel.²⁵

²⁴ St. Jerome, Ep., 84 (al. 65), n. 8: "Origen fled pleasures to such an extent that, with zeal for God but not according to knowledge, he cut off his genital organs with a knife." (Migne, P. L., XXII, 750).—St. Thomas, Summa Theol., 2a 2ae, qu. 65, art. 1, ad 3: "A member is not to be cut off for the bodily health of the whole except when the whole cannot otherwise be helped. Spiritual health, however, can always be helped otherwise than by cutting off a member, because sin is subject to the will. Therefore in no case is it lawful to cut off a member in order to avoid any sin whatsoever." —J. P. Gury, Comp. Theol. Mor., Vol. I, n. 403, 10: "It is not lawful to castrate oneself in order to preserve chastity or to quiet temptations, because emasculation is wholly useless for that end: it does not remove the temptations of the flesh so as to avoid sin, but merely prevents generation." —Cfr. O'Malley and Walsh, Essays in Pastoral Medicine, p. 339.

²⁵ Decree of Feb. 3, 1902. —H. Noldin, S.J., Summa Theol. Mor., Vol. II, 11th ed., p. 352: "The supreme pontiffs never approved the castration of boys, nor ever declared it lawful; indeed, they declared irregular those who culpably made themselves or others eunuchs...." Cfr. Benedict XIV, De Syn. Dioec., l. XI, c. 7, n. 3; C. Richert, Die Anfänge der Irregularitäten, Freiburg, 1901, pp. 104 sqq.

Vasectomy and the excision of the uterus or ovaries are operations which, though permissible when necessary for the direct preservation of life or health, would be sinful if performed for the sole purpose of superinducing sterility.²⁶

²⁶ S. C. S. Off., 22 May, 1895: "Si sia lecita la practica sia attiva sia passiva di un procedimento il quale si propone intenzionalmente come fine espresso la sterilizzazione della donna. R. Negative." Sabetti-Barrett, Comp. Theol. Mor., n. 267. —Cfr. H. Noldin, S.J., Summa Theol. Mor., Vol. II, p. 352: “Vasectomy consists in cutting the man’s semen-bearing ducts, so that all communication between the testicles and the male organ is prevented. A vasectomized man who has undergone this operation can indeed perform sexual acts through carnal intercourse, but he is altogether incapable of fertilization, since he cannot emit true semen produced in the testicles. This operation, which is performed in a very short time and is furthermore neither dangerous nor very painful, must morally be called unlawful unless it is necessary to preserve life or health.” —On vasectomy, see A. O'Malley, The Ethics of Medical Homicide and Mutilation, pp. 244 sqq.

READINGS. —St. Thomas, Summa Theol., 2a 2ae, qu. 64, art. 5. —James J. Walsh, Essays in Pastoral Medicine, Ch. xxvii, New York 1906.—F. A. Göpfert, Moraltheologie, Vol. II, 6th ed., pp. 6 sqq., Paderborn 1909. —Thos. Slater, S.J., A Manual of Moral Theology, Vol. I, pp. 301 sqq., New York 1908. —Aug. Lehmkuhl, S.J., Theologia Moralis, Vol. I, 11th ed., pp. 403 sqq. —Ad. Tanquerey, S.S., Synopsis Theologiae Moralis et Pastoralis, Vol. III, pp. 124 sqq., Tournai 1904. —Westcott, Suicide, its History, Literature, etc., London 1885. —Bonomelli, Il Suicidio, Milan 1892. —E. Durckheim, Le Suicide, Paris 1897. —Masaryk, Der Selbstmord als soziale Massenerscheinung, Vienna, 1881. —J. E. Ross, C. S. P., Christian Ethics, New York 1919, pp. 178 sqq. —Austin O'Malley, The Ethics of Medical Homicide and Mutilation, New York 1919, pp. 7 sqq., 244, 260 sqq.