Samuel Berendes

Defining and applying ‘futility’ has proven to be a contentious endeavor within bioethics. So contentious that our vocabulary about and conceptualization of futility have shifted to the use of ‘potentially inappropriate’ or ‘non-beneficial’ treatment. A longstanding concern has been that futility determinations are in no way objective and are instead a subjective, values-based determination. Recent scholarship has highlighted the relation of the undecided nature of futility to the problem of values imposition. Specifically, Autumn Fiester has argued that futility laws and policies can become an exercise of the ‘tyranny of the majority’; the values system(s) of physicians become pitted against the values system(s) of normative minorities. In light of such critiques, I argue that futility determinations are more properly seen as an exercise of a professional objection to non-beneficence. Such a framework is distinct from conscientious objection, which generally centers an individual, as it takes into account the particular moral community(-ies) that shape understandings of futility. That is, I consider whether what is happening in futility determinations, and any subsequent disputes, is best described as a result of the medical profession’s values system(s) and the moral significance of such a system. I further consider how specific institutions may legitimately give rise to divergent, localized understandings of futility that may provide a path forward in navigating futility disputes. Overall, I argue for a reframing of futility that seeks to recognize the practice for what it is and allows for a path forward without concealed values impositions.

The Catholic Church’s rejection of direct sterilization and acceptance of indirect sterilization has led to complex dialogue on what separates the two. Central to Catholic thought’s ability to parse the difference between direct and indirect sterilization is an understanding of pathology. Increasing data and literature on the pathogenesis of disease, both in terms of the specific risks associated with pregnancy as well as in the more general context of female reproductive health, complicate these questions. Given these findings, I argue that Church teaching on sterilization relies on an unnecessarily narrow standard of pathology. I rely on debate around risk-reducing salpingectomy and the application of these principles in the conditions surrounding placenta accreta spectrum and preeclampsia to articulate a broader understanding of pathology. I argue that pathology should account for the potentially pathological interaction between reproductive organs and other parts of the body. This expanded definition gives rise to potentially broader applications of indirect sterilization that could prove more responsive to a broader range of reproductive health risks.

Death by neurological criteria, often referred to as “brain death,” has been the source of significant controversy in the past decades. The legal definition of brain death focuses on the irreversible loss of all brain function, including the brain stem, leading to an understanding of whole-brain death. Of particular importance for the brain death debate, the American Academy of Neurology has recently asserted that the loss of neuroendocrine function is not necessary for brain death determination. The question becomes whether it is consistent with a sound anthropology to accept brain death despite continuing neuroendocrine function. I argue that it is, as neuroendocrine function depends on the brain as a whole. This will be shown through engaging with the writings of Thomas Aquinas, especially as they relate to a hylomorphic understanding of the human person. Additionally, I will engage with understandings of brain death as the loss of the integrative unity of the human organism, particularly with Maureen Condic's distinction between integration and coordination. Through this, I will demonstrate that arguments that neuroendocrine functions do not in themselves constitute a vital function but, rather, depend on the brain as a whole.

Death by neurological criteria has been at the center of ethical debates. I argue that brain death is a valid determination of death. This follows from an understanding that the brain is the effective integrator of the body and that following the death of the brain the body stops functioning as an integrated whole. Questions regarding this certainty have been reignited, however, by a study out of Yale that demonstrated synthetic perfusates, such as the compounds dubbed BrainEx and OrganEx, could restore cellular and even organ function in a porcine body and brain after death. Through analyzing medical, scientific, and theological literature I argue that even in the face of developing scientific technology moral certitude in brain death determinations is secure.