Brian Kane, professor of moral theology at De Sales University, calls his book a ‘theological attempt’ to train clinical professionals in systems of thought that will ‘help them to clarify issues at stake and to think logically and consistently’ (p. viii). Setting bioethics in the context of moral theology seems not only laudable but also particularly pressing given, as Kane notes, the dominance of utilitarianism in bioethical literature. While he suggests his book is for clinicians, it is accessible to all who are interested in the subject. The book has a noticeable North-American flavour particularly in the chapter on the social dimensions of healthcare where there is an insightful section from the American bishops on healthcare reform. Nevertheless this American leaning does not detract from its overall usefulness as a starting point for thinking about Catholic bioethics. However, what may deter some readers is the amount of space Kane gives to what some may see as unnecessary historical information in a fairly short book and a consequent lack of depth in other areas.
Kane's approach is ambitious and wide ranging. As a result his argument risks getting lost in the detail. This is evident in his first chapter. The subsections particularly significant for Catholic bioethics on the natural law and Catholic morality, the principle of double effect (though he uses what many now regard as the unhelpful example of giving pain relief to a terminally-ill patient) and conscience are sandwiched between on the one hand a broad discussion on philosophy, theology, ancient anthropology, polytheism and monotheism and the development of the natural law defined as ‘different theories about human nature’ (p. 9), and on the other hand Kantian ethics and an uncritical view of utilitarianism. Kane wishes to assert that there are real differences in the assumptions that lie behind differing conclusions. However by placing Catholic moral theology in a historical timeframe in the early traditional strand of natural law where he mentions Aristotle and ancient Roman practices to the neglect of traditional Christian thinkers such as St Paul, St Augustine and St Thomas Aquinas, Kane gives the impression that this strand of natural law has been superseded by other ethical theories. A more rigorous explanation of the natural law and its abiding significance for moral theology would not only have remedied this but would also have indicated that Catholic bioethics has theological as well as philosophical appeal. Kane is however to be commended for reminding albeit briefly that the sources of moral theology lie in revelation, reason, magisterium and scripture (p. 13), for noting the importance of prayerful reflection, for giving an analysis of the moral act in terms of object, intention and circumstance and in differentiating between an objectively good or bad act and subjective culpability (p. 15).
Kane's discussion on professionalism in healthcare stretches from the ancient Greeks all the way to modern nursing practice. Significantly for Catholic bioethics Kane gives thoughtful consideration to the moral implications of formal and material co-operation (pp. 41–43). Similarly Kane offers a broad history of dissection in his chapter on invasive procedures before getting down to the theological issue of the principle of totality in the context of surgical mutilation and organ donation. Although Kane refers to Archbishop Murphy-O'Connor's brief in the case of conjoined twins, Jodie and Mary, Kane's suggestion that double effect can be applied fails to engage with the reasoned argument offered by the Archbishop against its application in a situation where one human being is sacrificed for another.
Kane's chapter entitled the sanctity of life seems misnamed. Rather than reflecting on a principle that can give guidance on cherishing life as well as recognising that life has limits, Kane discusses the nature of personhood, the Church's opposition to in vitro fertilisation and contraception. He studiously avoids any talk of abortion (though later he suggests that his analysis of double effect in the Jodie and Mary case could apply in cases where ‘the continuation of the pregnancy causes a threat to the life of the mother’, p. 115). Certainly Kane offers a useful exposition of on the one hand personhood as something that one has and may lose and on the other hand being a person. However, curiously, for a book on Catholic bioethics and given his liking for historical detail, Kane does not mention the theological provenance of the term ‘person’. Nor does he offer a way of discerning between the two views of personhood. Perhaps a reference to Church teaching would help here. Still, Kane gives a detailed and sensitive commentary on in vitro fertilisation and other reproductive techniques as well as the alternative NaPro technology and he briefly includes embryo stem cell research. His focus on procreation as an act that cannot be reduced to a technology and as one that concerns the dignity of the couple and the resulting child offers an informed and credible explanation of the Catholic position. Significantly Kane places contraception not only in its historical context of the goodness of procreation in Judeo-Christian thinking but also in the fuller Christian sacramental context of baptism and marriage where these sacraments express the response of the Christian to live a life of complete gift of self and parenthood as the ‘acceptance of a gift that comes from God’ (p. 67).
In his final chapter Kane places end of life ethics in the context of the Christian understanding of death and care for the dying where patients should be active participants in treatment decisions yet not in absolute control of the dying process. Kane notes the uncertainty that still surrounds the notion of whole brain death. However he accepts uncritically the 1994 Multi-Society Task Force interpretation of PVS as ‘complete unawareness of the self’ when even Drs Plum and Jennett, credited with bringing the condition to public attention, have admitted that technology is not sophisticated enough to detect awareness rather than there is no awareness present. Kane also presents the contrasting arguments of Fr O'Rourke and Pope John Paul II on the provision of artificial nutrition and hydration for PVS patients. He describes O'Rourke's view, first published in 2006, that artificial nutrition and hydration may be extraordinary treatment, as an attempt to clarify Pope John Paul's view given in 2004 that in principle, artificial nutrition and hydration is ordinary and proportionate care. It may have been worthwhile adding at least a reference to the Congregation for the Doctrine of the Faith's response to the American Catholic Bishops in 2007 that dealt with ‘clarifications’ in terms of the traditional moral theological distinction between physical and moral impossibility with regard to positive precepts. The book ends rather abruptly with a comment on Dr Kevorkian and physician-assisted suicide.
As the title of the book explains, this is ‘An Introduction to Catholic Bioethics’. As such an account of the context of Catholic moral theology in bioethics and more broadly in philosophical ethics seems entirely appropriate. However in the effort to cover perhaps too much ground Kane defines or interprets certain terms such as the natural law and conscience either rather loosely or reductively; he deals all too briefly with important issues for moral theology such as the place of scripture; his generalisations are at times sweeping and appear confusing, for instance he says that ‘it is clear that the cause of death for most people is related to their choices’ and that ‘although we could theoretically make all the right choices…we still cannot stop the eventual deterioration of our bodies’ (p. 76). This could have been partially remedied by greater attention to footnotes. For instance, in Chapter 1 footnote 2 speaks in general terms on the interpretation of scripture, footnote 13 gives a more than hazy account of infallibility. In both cases some direction towards a source seems required. Some of the footnotes do not seem to fit: for instance footnote 10 of Chapter 1 suggests a note on the practice of abandoning female children that, Kane says ‘continues today in cultures that are polytheistic’ (p. 11). The note gives a reference to sources on abandonment in late antiquity. Footnote 29 (p. 94) refers to an address by Pope John Paul that Kane entitles ‘Amados hermanos’ (Beloved brothers). Its more accepted title is the speech to the Third General Conference of the Latin American Episcopate. Moreover frequent references to the Judeo-Christian context seem to detract from a distinctively Christian and Catholic bioethics. Curiously Kane does not mention Pope John Paul's 1995 encyclical Evangelium vitae. This encyclical places the blessing of life in the deeper context of a fullness that exceeds earthly existence, a point that is hugely significant for a Catholic bioethics.
