For human beings, doing good means choosing a good moral object for the sake of a good end. If a man chooses something morally bad as a means to achieving something morally good, his action is bad altogether. Likewise, if a man chooses something morally good as a means to something morally bad, his action is bad altogether. We considered examples of these kinds of choices in our last reflection. The woman who stole money in order to repay her debts acted wrongly. When the same woman earned money honestly in order to fund terrorism, she also acted wrongly. In the first case her morally good end did not justify her choice of a morally bad object as a means to that end. In the second case, her choice of a morally good object did not justify the bad purpose for which she chose it. For a person to act rightly, doing good and avoiding evil, he must both choose a morally good object and choose it for the sake of a morally good end. As Saint Thomas Aquinas puts it, “For a thing . . . to be good simply, it is not enough for it to be good in one point only, it must be good in every respect” (ST I-II q.20 a.2).
So far, so good. But there are some situations when it seems like the good thing to do involves choosing to bring about bad things. Suppose, for example, that a pregnant woman has been diagnosed with uterine cancer. She will likely die if her uterus is not surgically removed, but removing her uterus would cause the death of her unborn child. The woman and her doctors want to achieve the good result of removing the cancerous uterus, but doing that would bring about the bad result of causing the child’s death. What is to be done? How can that woman and her doctors do good and avoid evil in this situation?
In order to begin answering these questions, let us return to the concept of the moral object. A moral object is what a person chooses to bring about in order to achieve his intended goal. In our example, the woman and her doctors could choose to bring about the removal of her cancerous uterus in order to achieve the goal of saving the woman’s life. The death of the child would not be chosen for the sake of any goal, but permitted as a regrettable consequence. We might say that the removal of the deadly cancer is the direct object of their choice. It is what they want to do. Causing the child’s death is not what they want to do. Nevertheless, causing the child’s death is included in the object of their choice, it is part of what they would knowingly bring about if they choose to remove the woman’s uterus in this situation.
Would the object of their choice in this case be a good moral object? Or would the permission of the child’s death make the choice of that object morally bad? The answer is that it depends. And it depends, ultimately, on what it is that they are choosing.
Let us suppose that the unborn child in this case has developed to the extent that she could be kept alive and nurtured in a neonatal unit. In that case, the right choice would be clear. The woman and her doctors should choose to save the life of the child by removing her from her mother’s uterus, then save the life of the mother by removing the cancerous uterus from her body. Choosing to remove the cancerous uterus without saving the child would, in this case, be bad. It would be bad, not because the death of the child would be chosen as a means to an end, but because it would be needlessly permitted. The woman and her doctors would be choosing to permit the child’s death rather than prevent it, which would be a bad thing to choose.
Now let us suppose that the woman’s unborn child will not be able to viably survive outside the womb for several weeks, but her cancer is slow growing and unlikely to spread. Again the right choice is clear. The woman and her doctors should wait for the child to be viable and safely removed from her mother’s uterus before removing the cancerous uterus from the woman’s body. Choosing to remove the cancerous uterus without waiting for the child to be viable, would be a bad choice. It would be bad because the benefit of removing the cancer earlier would be insufficient to justify causing the child’s death. The woman and her doctors would be choosing to permit the child’s death rather than permitting a minimal risk to the woman’s health, which would again be a bad thing to choose.
But suppose that the woman’s cancer is likely to kill her and her child long before her child will be viable. She and her doctors could choose not to intervene in hope that, contrary to the woman’s prognosis, her child might be saved before the cancer takes the lives of mother and child. Or they could choose to remove the woman’s uterus as a means of saving her life, knowing that the surgery will cause her child’s death. The latter choice, in this case, would be good. The woman and her doctors would not be choosing the child’s death directly, as something they want to bring about as a means to an end. They would be choosing to remove the deadly cancer and to permit the child’s death rather than permitting the likely deaths of both mother and child.