Freedom vs autonomy

By Tanya Connor

WORCESTER – Many poor decisions people make about health care – and life – come from a misunderstanding of freedom, which many people equate with autonomy.
This point, applicable to physician-assisted suicide and other issues, was made by Father Mark Yavarone at the Divine Mercy medical conference at the College of the Holy Cross last week. An Oblate of the Virgin Mary and professor of moral theology at Pope St. John XXIII National Seminary, he spoke about health care decision-making May 7 and May 8.
Studying the example of Pope Francis, he advocated dialog, evangelization and advancing the notion of freedom which perfects you, in place of autonomy.
Father Yavarone said the definition of “freedom” that is winning, but hasn’t won, is: the ability to do what you want to when you want to. A richer definition is: “the power and the privilege to do good, that which will help you flourish.” Much of what the world calls freedom is what Christians call slavery to sin, he said.
Most of the U.S. founding fathers understood the second definition, he said. The song “America the Beautiful” says, “America! America! God mend thine every flaw, confirm thy soul in self control, thy liberty in law!” A person without self control is not free; good laws promote freedom, he said.
Father Yavarone quoted from Pope John Paul II’s encyclical “The Gospel of Life,” #19 and #21: “such a culture of death, taken as a whole, betrays a completely individualistic concept of freedom, which ends up by becoming the freedom of ‘the strong’ against the weak who have no choice but to submit. …
“In seeking the deepest roots of the struggle between the ‘culture of life’ and the ‘culture of death,’ we cannot restrict ourselves to the perverse idea of freedom mentioned above. We have to go to the heart of the tragedy being experienced by modern man: the eclipse of the sense of God and of man. ...”
Father Yavarone said “autonomous” – from the Greek “auto” (self) and “nomos” (law) – means being a law unto oneself. It is not a “dirty word,” but when separated from a sense of God and man, it can lead to “dirty things,” he said.
He said Bernard Nathanson, abortionist turned pro-lifer, said the root of crimes against life was a deifying of autonomy. Father Yavarone said one shouldn’t be surprised at getting abuse for protesting abortion; to a society that values choice above life, an “anti-choice” person is worse than a murderer.
He quoted from a 1979 book “Principles of Biomedical Ethics,” by Tom L. Beauchamp and James F. Childress, which lists principles of biomedical ethics as autonomy, beneficence, nonmaleficence and justice.
It says autonomy is a form of liberty individuals choose, and to respect them is to recognize their value judgments even when it is believed those judgments are mistaken, he said. One is therefore to respect the permissibility of their actions, to say they are entitled to autonomous determination without others limiting their liberty.
But Father Yavarone said this makes autonomy trump the other principles of biomedical ethics. For example, the book says, “Thus, if a suicide were genuinely autonomous and there were no powerful utilitarian reasons or reasons of human worth and dignity standing in the way, then we ought to allow the person to commit suicide, because we would otherwise be violating the person’s autonomy.”
To show why autonomy has trumped everything else in health care, Father Yavarone used the article “Autonomy Trumps All,” by Dominican Sister Mary Diana Dreger, MD, from the National Catholic Bioethics Quarterly, Winter 2012.
The emphasis on autonomy was a reaction to the disregard for the autonomy of human beings Nazis and U.S. scientists experimented on between the 1930s and the 1970s, he said.
Adding to the emphasis on autonomy were: doctors encouraging patients to be the decision-makers, as medical malpractice suits rose in the 1950s, and suspicion of authorities, including the medical establishment, in the 1960s and 1970s, he said.
It is even considered a violation of autonomy for a medical professional to counsel against high-risk sexual behavior. Father Yavarone cited the double standard of suggesting “safer sex” with a condom to a promiscuous bisexual, but not telling smokers, “Just use cigarettes with a filter.”
No one believes in total autonomy, he said; you wouldn’t excuse the driver of an 18-wheeler for running you off the road by saying he was practicing his autonomy.
But, he said, “I don’t think reason is enough; I think we’re at a point in our society where we need conversion.”
Father Yavarone spoke about such conversion in his second talk, which addressed procedures the Catholic Church opposes, including embryonic stem cell harvesting, in vitro fertilization and euthanasia.
There is no problem with using adult stem cells to treat patients, as long as the proper consent is obtained from the donor, he said.
He told about Dr. Shinya Yamanaka  winning the Nobel Prize for reprogramming mature cells into stem cells. He said Dr. Yamanaka may not be Catholic, but he had the light of conscience; he started this research after thinking embryos created in a lab weren’t much different from his daughters. He figured there must be a way to treat patients besides destroying embryos.
Speaking of in vitro fertilization, Father Yavarone said the most basic reason not to use it is that it replaces the conjugal act with a technical procedure. Every child has the right to be conceived through his parents’ conjugal love.
IVF treats children as products, not equals, he said. About seven embryos are discarded for every baby born, IVF creates ethical problems concerning frozen embryos, and there are higher rates of birth defects and handicaps with IVF.
There is a difference between replacing the conjugal act, as IVF does, and assisting it in moral ways such as natural family planning, fertility drugs and surgery to correct reproductive organ defects, he said.
Looking at euthanasia, Father Yavarone called it an action or omission which of itself and by intention causes death. He said it is basically morally equivalent to physician-assisted suicide.
Arguments against euthanasia and assisted suicide include erosion of patients’ trust in doctors as caregivers, pressure on the sick and aged “to get out of the way,” and the slide from assisted suicide into involuntary euthanasia, he said.
Euthanasia is a grave violation of God’s law, he said. But some figure if they can live according to their own truth, they should be able to choose how to die. Father Yavarone countered that choosing something doesn’t mean it’s good, and often people who choose physician-assisted suicide are depressed.
Citing autonomy as a justification for physician-assisted suicide doesn’t make sense, he said; if you kill someone, you put an end to his autonomy.
He advocated dialog, evangelization and advancing the notion of perfective freedom (choosing what perfects us) rather than autonomy.
He said if he was pope he would encourage those who already believe the Gospel to deepen their faith and emphasize the value this personal conversion has in evangelizing others; the moral theology will follow. And he would prepare the hearts of those outside the Church to accept the Gospel by encouraging believers to practice charity toward the poor.
Pope Francis is doing all this, he said. He’s providing the context for the moral theology.