During the 1920s, the practice of compulsory sterilization in the United States became commonplace. The Supreme Court even went so far as declaring the constitutionality of the sterilization laws in the 1927 decision in the case of Buck v. Bell. In the majority brief written by Oliver Wendell Holmes, the Court argued in favor of this practice by saying that “(It) is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes…Three generations of imbeciles are enough.” The Church for her part vehemently opposed the practice by appealing to the principle of totality. Because this principle is often cited in support of Catholic Moral teaching related to medical ethics it is instructive to examine it in some detail.
In its simplest form, the principle of totality holds that that under certain circumstances it is morally permissible to sacrifice the good of a part for the sake of the whole. However, this needs further qualification in order to see why something like the Eugenics program of the 1920s was morally wrong. Justice Holmes in his argument thought that for the sake of the whole of society, it would be better to sterilize some of the members.
Clearing Up Confusion
In a speech given to the “Leaders and Members of the Italian Association of Cornea Donors and Italian Association for the Blind,” Pope Pius XII hoped to clear up some of the confusion related to this principle. There were those who argued that the principle of totality justified the removal of vital organs from the dying in order to transplant them into the bodies of those who had a better chance of survival. While he lauds the intention to alleviate suffering he rejects this argument as erroneous by appealing to the “essential difference between a physical organism and a moral organism.” The organs of the body exist solely for the sake of the body while each human person does not exist for the sake of the whole of humanity. Instead each human person has intrinsic worth and thus cannot be coercively sacrificed for the sake of the whole (Pope Pius XII, “Speech to Leaders and Members of the Italian Association of Cornea Donors and Italian Association for the Blind”).
We see then just how important the distinction between a physical organism and a moral organism is in determining the application of this principle. A physical organism is one in which there is a unity on the level of essence. Thus, the relationship of part to whole exists if the part by its very nature has no finality outside the whole. A moral organism however is a group of individuals that are bound together in some unity of action. Each member of the group has a value that is intrinsically bound up with what (or more accurately who) they are rather than what they contribute to the community.
In this way then the Principle of Totality serves a limiting function on medical practice. For the sake of a physical whole, one may sacrifice a part of oneself assuming that the choice does not do harm to an authentic human good. However, if there is a moral unity then there is a limit on the activities of the individual at the service of the community.
It is also important to mention the fact that despite the fact that it applies to a physical organism, the principle is not merely physicalist in nature. It is meant to serve the integral good of the person by creating a harmonious relationship between the physical and spiritual elements. To emphasize this point some authors have referred to it as the principle of “Totality and Integrity.” Fr. Benedict Ashley, one such author, states the principle as follows: “Except to save life itself, the fundamental functional capacities which constitute the human person should not be destroyed, but preserved, developed, and used for the good of the whole person and of the community.”
An Example
If we examine one of the most common procedures that involve the principle of totality, organ donation and transplantation, we can further illuminate this principle and its use in medical ethics. In applying this principle, we are able to find justification for organ donation and transplantation. Provided that the functional integrity of the donor is maintained then living organ donation is morally justifiable. Ashley et al present four related principles that show how the principle of totality might be maintained. There should be a serious need faced by the patient, which can only be satisfied by organ donation. Although it might reduce “anatomical integrity” it should not diminish the “functional integrity” of the person. Thirdly the risk of donation should be viewed as “an act of charity proportionate to the good resulting for the recipient.” Finally there should be “free and informed consent” by the donor.
Many try to justify freely consented sterilization by appealing to the principle of totality. They argue that if a marriage is in general open to children then each act of sexual intercourse need not be. They argue that if the marriage would be harmed in some way by having children, the good of procreation may be sacrificed for the total good of the marriage itself.
The problem with this argument is that it violates the principle that one may never perform an intrinsically evil act (such as contraception) so that good may come about. However, there is a flaw in the logic as well. As was mentioned, the principle of totality actually applies to physical organisms (like organs) and not moral organisms (i.e. persons). The conjugal act has an intrinsic value in itself and it is not just as part of the whole that it gains its value (Pius XII, “Speech to the Twenty-Sixth Congress of the Italian Association of Urology”)..
The problem with appealing to the principle of totality in this manner is that it can lead to justifying nearly anything. For example, there is no reason why an act of infidelity, especially if it might “help” the marriage, would be wrong as long as the totality of the marriage is faithful.
In conclusion, the principle of totality is an important principle in medical ethics because it promotes authentic human good. This may require at times the sacrifice of a physical part for the integral good of the person, but it also serves to limit the activities that may be performed on a person.