Scholion. On the Use of Some Harmful Things

I. The use of chloroform, ether, and other things by which the use of reason is removed, is of itself illicit, but lawful on account of a proportionate cause. It is said:

1. It is of itself illicit, because it not only deprives one of the actual use of reason without any utility that will follow of itself, but also of the proximate faculty of using it for a sudden necessity, as was said about drunkenness (n. 320; St. Alphonsus, V, 73).

2. It is lawful on account of a proportionate cause; this follows from what has been said about an act with a double effect. But the avoiding of pains in a surgical operation constitutes a proportionate cause; likewise the forestalling of extraordinary pains of childbirth;¹ but the avoiding of ordinary pains does not seem to suffice.

Corollary. More probably, it is lawful for a dying person, by means for example of chloroform, to deprive himself of the use of reason, so that he may die without very acute pain. The things opposed by authors to this doctrine prove at most that a graver reason is required in the article of death than in the course of life. But the relief of very acute pains seems to involve a sufficient reason, although it is better to endure them patiently; indeed, the spread of a practice of this sort would give occasion to consequences to be disapproved. Yet it is supposed that the dying person is sufficiently prepared for death; nor is it lawful for another to deprive a dying person of the use of reason without his consent.

Objection 1. If ever, at such a time it is necessary that the faculty of meriting be preserved for man.

Response. Why would it not be lawful, on account of a graver cause, to deprive oneself of the faculty of meriting in the article of death, just as the same thing is permitted on account of a lesser cause in the course of life?

Objection 2. Privation of the use of reason would then be entirely equivalent to abbreviation of life.

Response. It would be equivalent to abbreviation of moral life, I concede; but that seems lawful on account of a graver cause, just as outside the article of death it is lawful, on account of a lesser cause, to take away something from moral life.

II. The infrequent use of morphine, opium, and cocaine in small quantity is not harmful, and therefore is lawfully employed for alleviating pains or driving away sleeplessness. But there is easily danger lest use pass over into abuse and habit (morphinomania), which produces the worst consequences and therefore must be put away with all one's strength. These things noted generally, receive these special points, especially from Antonelli.²

1. The external causes which induce morphinomania can be: 1. physicians who abuse morphine, either by administering too great a quantity or by too frequently prescribing injections for the calming of pains; 2. the sick themselves, who, after they have once known this solace of pains, ask the physician that they may be able to use morphine more often; and he, either because the disease is chronic, or to avoid troublesome complaints, or because the sick person is poor and is no longer able to pay for medical visits, not only permits it, but hands over the prescription into his hands, to be renewed at his discretion; 3. directors and attendants in hospitals, who, for procuring the quiet of the sick who are too talkative or too affected by pains, admit too many injections; 4. pharmacists who, either from excessive love of profit, or from fear lest those clients desert them, or for shamefully capturing the pleasures of women, sell morphinic solutions without caution; 5. writings which treat of the morphinic matter, examples, and persuasions of others. But once the passion has been contracted, it is altogether incredible how many means, how many pretexts, and how much cunning morphine addicts employ in practice for making injections as often as they wish, wherever they stay.

2. The consequences that will follow from a habit contracted and continued are: memory is weakened; the will grows sluggish and gradually lacks every force; whence it happens that the morphine addict is incapable of correcting himself and very quickly rushes into his own ruin; the individual character is changed; instability of spirit, irascibility, and impotence occur; the moral sense is diminished and can even be wholly lost; then the way is opened to crimes of every kind, for thefts and carnal crimes occur very frequently; women often forget modesty; like those affected by hysteria, morphine addicts continually lie so that their habit may remain hidden; they frequently suffer hallucinations and illusions in the same way as those who are affected by alcoholism; sexual excitations at first are increased, but generally for a short time; in those who labor under chronic morphinomania, they are absent; infants who are born from a morphinomanic mother sometimes die immediately because of the lack of morphine which they were drawing in the womb through the maternal placenta. Nor is this enough; since the nervous system is especially badly affected, sleeplessness occurs with headaches, tremors of the hands and tongue, and disturbances in the pronunciation of words. The heat of the body also is increased, about 38 degrees C., bringing on fever, which presents the same characters as malarial and typhoid fever.

3. The sole and necessary remedy is placed in this, that they be deprived of the faculty of procuring new morphine for themselves, and be subjected to diligent custody. It is better to send them to hospices established for this purpose. But if this can be obtained, within a few weeks they obtain restoration of health; nevertheless after the cure it must greatly be guarded against and feared lest they fall again into abuse, which indeed certainly occurs unless they are most vigilantly guarded in all things.

¹ For the infant - thus Aertnys-Damen, relying on the testimony of a specialist concerned only with giving narcosis - harmful consequences from the mother's narcosis are not to be feared, provided that the narcosis is not too deep and does not last too long; this also holds concerning the narcotic which is called chloroforme a la reine (Theologia Moralis, I, 259).

² Medicina Pastoralis, I, n. 354 sq.