Ordinary and extraordinary means of preserving life

We are obliged to take ordinary means to preserve our lives, for to do otherwise would be virtually to commit suicide. There is no obligation to take extraordinary, unusual, or very painful or expensive means to preserve our lives. And so one in feeble health, who will probably die if he spends the winter in England, is not bound to expatriate himself and go and live in a milder climate. Nor am I bound to undergo a painful and costly operation in order to save my life; I may if I like choose rather to die, unless my life is of great importance for the common good, for then the public good must be considered first. Except in such a case as this, a superior could not oblige a subject to undergo a very painful operation or to submit to the amputation of a leg; obedience to human authority does not seem to extend to such matters as these.

352. Thesis II. Indirect killing of oneself is illicit, unless there accedes a just and proportionate cause, that is, a greater good which follows immediately from the action itself and not by means of the killing.

It is proved. For it is illicit by one's action or omission to cause an evil effect, unless four conditions are verified: a) that the action or omission in itself is not evil; b) that equally immediately from it there follows also a good effect, and that this is not obtained by means of the evil; c) that the good effect is proportionate to the evil; d) that only the good effect, not the evil, is intended. Therefore indirect killing of oneself will not be licit unless 1) the action or omission from which it follows is not evil in itself; 2) another effect, a good one, follows equally immediately, and this is not procured by means of the killing; 3) the good effect is greater than or equal to the danger of life and thus compensates it; whence it must be greater in proportion as that danger is greater, more certain, nearer; 4) death is not intended, but only the good effect.

The proportionate compensating good is threefold:

1. A public good, for the common good is preferable to a private good.

Thus even with proximate danger of death priests, physicians, and others upon whom it is incumbent can take care for the salvation, life, or security of others; soldiers can refuse to desert the assigned place, or burn a ship or blow up a citadel for submerging or destroying enemies, or lest the enemy obtain it with grave detriment of the republic; but not for avoiding captivity, since the public good does not require this.

2. The spiritual good of virtue, or of science and art, or the progress of culture.

Thus aviators or navigators with danger of life seeking new routes or exploring unknown regions. Likewise for the sake of faith, missionaries, even with danger of life, can preach the Gospel, if utility is hoped therefrom; and the faithful can not only bear death bravely, but even not flee, indeed present themselves before judges, if this is judged useful for confirming others in the faith, unless, however, greater evils are feared. Likewise from charity someone can expose himself to danger of death or offer himself to the blow of an assailant, or not take care for his own safety (for example, yield a plank in shipwreck), or not defend himself, in order to preserve, if it is hoped, the life of parents, spouse, friend, neighbor, a fortiori for their eternal salvation (indeed this can be a precept); but not cast himself into the sea or a river even for baptizing an infant, because evils are not to be done so that goods may come. Likewise from love of justice malefactors can offer themselves to be condemned and killed: for death is not from the omission of flight but from the sentence of the judge. And for protecting chastity a virgin, upon whom violence is actually being inflicted, can by fleeing throw herself down from a high rock or from a window with only danger of death, while there is some hope of escape; but not with certain death, because then it would be direct killing, which would be chosen as a means for avoiding another evil. But she can permit herself to be killed rather than violated, although she is not bound to this.

3. A bodily good resulting from the fact that a more certain danger of death or a more cruel kind is avoided.

Thus it is licit to cast oneself down from a tower for fleeing, not indeed captivity, but a certain capital sentence or a more atrocious death which malefactors are actually about to inflict; or to leap from a window for fleeing flames actually burning: provided, however, that there is hope of escape; otherwise it would be direct killing which would be chosen as a means for avoiding a greater evil, in the same way as the taking of poison. Namely, one thing is to expose oneself to certain danger of death, even proximate, another to incur certain death.

353. Corollaries. - From the doctrine set forth it is concluded:

1. for incurring a danger of death not certain, but probable or remote, a lesser cause suffices, yet always a grave one, especially if necessity is present; for example, it is licit to serve those laboring under a contagious disease, indeed from charity to visit them, even with great danger of contracting the plague, likewise to exercise a dangerous art (for example, to climb roofs) for the support of oneself and one's own or the utility of others;

2. for incurring a danger of indirectly shortening life even by several years, a less grave reason suffices: thus for the sake of exercising virtue it is licit to do moderate penances by fasts, vigils, mortifications; for the restraint of concupiscence presents compensation; likewise for one's own support or for the progress of an industrial or mechanical thing, it is licit for workers to blow glass, gild metals, handle fire daily, and exercise other arts shortening life, although as far as possible one must try that works committed to craftsmen be rendered less dangerous;

3. nevertheless, for incurring a danger of death a futile reason does not suffice, for example, to fight because of vain glory, bear extraordinary burdens, let oneself down, or prolong a very long fast for the sake of a wager alone;

4. a fortiori it is not licit to procure the utility of others or one's own gain from a sought-out danger of death, but only to expose oneself to danger, by doing an act useful otherwise and of itself.

Hence they sin gravely a) who for light causes throw themselves into danger of death, as any rash tightrope walkers, gladiators, body-tumblers, bullfighters, showmen who tame wild beasts or take poisons, unless by long experience or suitable preparation they are certain concerning their dexterity or the efficacy of the remedies;

b) who gravely harm health or notably hasten death for themselves by gluttony, drunkenness, immoderate passion of lust, by abuse of morphine, cocaine, opium, or by immoderate penances;

c) who refuse to take ordinary means for recovering health or preserving life safe; but not those who are unwilling to employ extraordinary, refined, unusual, more costly, very difficult means, as to leave one's country and seek a healthier region, to undergo a very laborious or dangerous operation, or a notable amputation: for the law of prolonging life does not obligate with so great an inconvenience. Today, however, several operations which formerly were considered difficult and dangerous are accomplished very easily and safely, and thus have already become ordinary means;

d) a fortiori those who abstain from taking necessary foods, even for an excellent end, for example, the liberation of the fatherland. For this is direct killing, for, as St. Thomas says, q. 69, a. 4, ad 2: "not to take food... would be to kill oneself." And the good is hoped for from an evil means; but evils are not to be done so that goods may come.

354. Observations. - 1) The principles are clear and there is no difficulty in them; but in fact, in the application of principles, namely, whether in a case such killing is direct or indirect, there can be room for doubt or even subtle consideration, because a priori it is not always easy to determine this. But the various modes indicated among authors (cf. Tanquerey, n. 304 sq.; Billuart, diss. X, a. 3) can be held as only indirect killing, or at least are not certainly proved to be direct killing; and consequently in practice they can be considered as licit, because probably and from the common apprehension of men they are only indirect killing. But if to someone they evidently seem to be direct killing, from this he could not extend the principles and say that direct killing is licit also in other similar cases; but he could only conclude that the application of principles is not being made rightly, and in the case the killing action is also direct and therefore illicit.

2. The desire of one's own death is not necessarily unjust toward God, because he who wishes death for himself can await it as to be inflicted on him by God. Indeed such a desire can be ordered and in conformity with reason, if it arises from a motive of obtaining a good which is better than life, or of escaping an evil which is worse than death. Hence the desire:

a) is licit if it arises from the motive of a better good, for example, of desiring conjunction with God, of loving God more perfectly, of sinning no more, etc., as in the Apostle, Phil. I, 23;

b) is illicit if it arises from a wicked motive, for example, because with rebellion against the divine will someone wishes death or from impatience does not wish to tolerate the ordinary troubles of the present life. This of itself is gravely evil if it is done from perfect deliberation; often, however, it is not sufficiently deliberate because of disturbance or anger, or is not seriously willed;

c) of itself it is not sinful if someone so abhors a grave earthly evil, for example, grave disease, hard imprisonment, a very hard state of life, troublesome vexations and snares, that he would prefer death, because, as Scripture says (Ecclus. XXX, 17), death is better than bitter life; nevertheless it is imperfect, because man, by patiently tolerating most grave evils, will obtain a precious reward which by premature death he loses.

Question 1. Is someone held to use extraordinary remedies for preserving life?

Response. Negatively, and the reason is that an affirmative precept is not necessarily to be fulfilled in every possible way, but only in that way which is obvious and common; whence there is no obligation of preserving life except by ordinary means, namely those which neither bring great inconveniences, nor demand expenses immense according to the varied condition of each one, nor cause very bitter pains, etc. Thus, for example, you are not held, for the sake of preserving life, to suffer amputation of a leg or arm, or incision of the belly for extracting a stone. Nor is a virgin held to suffer an operation by the hands of a physician, even if life is endangered, when on account of shame this happens to her as something most grave, and instills in her a greater horror than death itself. - Cf. St. Alphonsus, n. 372; and Hom. Ap., n. 2.

Question 2. Can a girl expose herself to danger of death for preserving virginity?

Response. Affirmatively, at least if death is not certainly going to follow, and this both on account of love of virginity and on account of the danger of sin which is often present in such an occasion. Indeed still more probably it must be affirmed, although death is certainly going to follow, and there is no proximate danger of consent, because even integrity of the body alone is valued very highly, and is a sufficient reason that some girl can permit herself to be killed. - I said can and not ought, because a girl of this kind is not held to undergo death for such a good, and therefore she could also permit her own violation, provided she resists positively by the will, and proximate danger of consent is absent. The reason is that this permission is not formal cooperation in the sin of another, but only material, and a just cause of permission is present, namely danger of death. - Cf. St. Alphonsus, n. 368. - Baller., note (b), p. 371.

Question 3. Is it licit to set fire to a ship or tower, so that enemies may suffer grave damage, but with certain loss of one's own life?

Response. Affirmatively, at least more probably, because it is expedient that public harm be avoided or the common good procured even with the most certain harm of private persons. - Lugo, Lessius. - St. Alphonsus, n. 367.

Question 4. Can a guilty person, ordered by a judge, licitly inflict death upon himself?

Response. It is controverted. The common opinion denies. 1st. Because man would dispose of his life without the consent of the Lord, who gave the faculty of killing a man only in the cause of defense and in the cause of punishment; but the guilty person does not defend himself, nor can he exercise punitive justice toward himself; therefore he cannot kill himself. 2nd. Nature abhors this, since it is inhuman and cruel. - Cf. Lugo, disp. 10, n. 13. - Lessius, lib. 2, 19, nn. 25 and 26.

The other opinion probably affirms: both because the judge can entrust execution to whomever he wishes, and because no convincing contrary reason is brought forward: in the case he does not kill an innocent person, nor himself by his own authority. What prevents someone from bearing a twofold person, of the one punishing and the one punished? Certainly it is opposed to natural inclination, but this has force rather against the judge than against the guilty person. Even if the thing is cruel, it can often happen that by this death becomes easier; and surely it is difficult to prove conclusively that the guilty person in the case cannot inflict death upon himself. - Cf. Victoria, Relect. de homicidio. - St. Alphonsus III, n. 367. - Lehmkuhl, 733. - Ball.-Palm., vol. 2, p. 608.

Question 5. Is it licit for a woman to undergo ovariotomy, or for a man to undergo vasectomy?

Response. 1st. Affirmatively, in either case, if those operations are necessary for the health of the whole subject; for the member is for the subject. Thus commonly.

2nd. Negatively, in either case, if it is done precisely so that offspring may not be born. For thus the Sacred Congregation of the Holy Office responded on May 22, 1895: "Whether the practice, whether active or passive, of a procedure is licit which intentionally proposes as its express end the sterilization of the woman. Response. Negatively"; therefore although the response concerns the woman, it certainly has force also for the man.

To induce sterility, or thus to deprive oneself of the power of generating and to impede the conception of offspring, or to effect that the semen is not prolific, is opposed to the principal intrinsic end of marriage, and to its good, namely offspring, to the natural end of the conjugal contract itself, to the intrinsic end of semen, and therefore is repugnant to the natural law, so that it cannot be made honorable by any good end. And hence Bossius: "Thirdly it is gathered that a husband or wife taking, or administering to them, a poison or potion of sterility, so that the man cannot generate or the woman conceive offspring, is a mortal sin against nature and the institution and law of marriage, so that it cannot be made honorable by any good end. ... The same is clear from the Bull of Sixtus V, Effrenatam; in which Bull Sixtus extended all penalties laid against those procuring abortion against all those who shall have given to women potions and poisons of sterility, and shall have furnished an impediment so that they not conceive offspring." Whence from the fact that a woman can no longer give birth, it is not thereby licit for her to take care that the tubes be cut or tied, and by equal reason it is not licit for a man unwilling to have offspring more numerous, or weak offspring, or any offspring at all, to undergo double vasectomy. - Nouvelle Revue Theol., v. 9, p. 432; v. 29, 367. - Diana, t. 5, tr. 6, 36, 2, 37. - Sylvius on 2-2, q. 64, a. 7, quest. 4, c. 3. - Sanchez, De Matrimonio, lib. IX, disp. 20, n. 2. - Azor, Ins. Mor., p. 3, lib. 11, chap. 4, q. 2. - St. Thomas, 2-2, q. 65, a. 1, ad 3. - Tabiena, Summa, v. uxor. - Turrianus, t. 2, disp. 26, nn. 46 and 47. - Eschbach, Disput. Phys. Theol., p. 371. The question is very ancient and the negative opinion was altogether most common.