Question 2: On narcosis and total or partial deprivation of consciousness
Your second question concerned narcosis and the total or partial deprivation of consciousness in comparison with Christian morals. You stated it as follows: “the complete abolition of the sensitivity in all its forms (general anesthesia), or the more or less large reduction of the painful sensitivity (hypo and analgesia), is always respectively accompanied by the disappearance or the reduction of consciousness and of the highest intellectual faculties (memory, processes of association, critical faculties, etc.) : are these phenomena, which occur within the usual framework of surgical narcosis and pre and postoperative analgesia compatible with the spirit of the Gospel? “
The Gospel reports that immediately before the crucifixion, they offered to the Lord wine mixed with gall, undoubtedly to attenuate his sufferings. After having tasted it, he did not want to drink it (Matth. xxvii, 34), because he wanted to suffer in full knowledge, thus fulfilling what he had said to Peter during the arrest: ” The chalice which my Father hath given me, shall I not drink it? “(John xviii, 11). The bitter chalice that Jesus had begged with the anguish of his heart: “My Father, if it is possible, let this chalice pass from me! Nevertheless not as I will, but as Thou wilt!” (Matth. xxvi, 38-39; Luke xxii, 42-44). Does the attitude of Christ towards his passion, such as this account reveals it and other passages of the Gospel (Luke xii, 50), make it possible for the Christian to accept total or partial narcosis?
Since you consider the question under two aspects, We will examine successively the suppression of pain and the diminution or total suppression of consciousness and of the use of higher faculties.
1. Suppression of the pain
The suppression of pain depends, as you see it, either on the suppression of the general sensitivity (general anesthesia), or on a more or less marked lowering of the capacity to suffer (hypo and analgesia). We have already said the essential on the moral aspect of the suppression of pain; In relation to the religious and moral judgment, it matters little whether it is caused by a narcosis or by other means. Within the indicated limits it raises no objection and remains compatible with the spirit of the Gospel. In addition to this, it should not be denied and underestimated that the fact that the voluntary acceptance (obligatory or not) of physical pain, even at the time of surgical operations, can manifest a high degree of heroism, and indeed often testifies of a heroic imitation of the passion of Christ. However this does not mean that it is an essential element. It is not rare that anesthesia is essential for other reasons, such as when the surgeon or the patient could do without it without failing in Christian prudence. The same applies to pre and postoperative analgesia.
2. Suppression or reduction of consciousness and of the use of higher faculties
You speak then of the reduction or the suppression of consciousness, and of the use of higher faculties, as some phenomena accompanying the loss of senses. Usually, what you want to have is precisely this loss of sensitivity; but often it is impossible to cause it without producing at the same time total or partial unconsciousness. Outside the surgical domain, this relation is often reversed, not only in the medical field, but also in psychology and in criminal investigations. In these other domains,, one pretends to determine a fall of the consciousness and, thus, of higher faculties, so as to paralyze the psychic mechanisms of control, that man continually uses to control and direct himself. Then, he is given up without resistance to the play of associations of ideas, feelings and volitive impulses. The dangers of such a situation are obvious; it can even happen that his immoral instinctive impulses are let loose. These manifestations of the second stage of narcosis are well known. Actually one endeavors to prevent them by the preliminary application of narcosis. The stopping of the control faculties proves to be particularly dangerous, when it causes the divulgation of secrets of the private, personal or familial, and of social life. It is not enough that the surgeon and all his assistants be bound with the natural secrecy (secretum naturale), and with the professional secrecy (secretum officiale, secretum commissum) with regard to all that occurs in the operating room. There are certain secrets, which should be revealed to nobody, not even, as the technical formula says: uni viro prudenti and silentii tenaci. We have already underlined this in our allocution of April 13, 1953, on clinical psychology and psychoanalysis. We can also approve the use of narcotics in preoperative medication in order to avoid these inconveniences.
Let us note initially that during sleep, nature itself stops more or less completely the mental activity. In a sleep not too deep, the use of reason (uses rationis) is not entirely eliminated and the individual can still enjoy his higher faculties – which St. Thomas d’ Aquinas had already affirmed (S.Th. Ia, q. 84, a. 8). However, sleep excludes the dominium rationis, in virtue of which reason commands freely the human activity. It does not follow that if man gives himself up to sleep, he acts against the moral order while being deprived of consciousness and self-control by the use of higher faculties. But it is certain also that there can be cases (and it happens often times), in which man cannot go to sleep, but must remain in possession of his higher faculties, to discharge a moral duty, which befalls on him. Sometimes, without being held by a strict duty, man renounces sleep to render nonobligatory services or to deny himself for higher moral interests. Thus the suppression of consciousness by natural sleep does not offer in itself any difficulty. However it is illicit to accept it, when it blocks the accomplishment of a moral duty. To renounce natural sleep can be in the natural order of things an expression and voluntary execution of a tendency towards moral perfection.
3. Hypnosis
But consciousness can also be affected by artificial means. That one may obtain this result by the application of narcotics or by hypnosis (which one can call a psychic analgesic) that does not make any essential difference in the moral point of view. Hypnosis however, even considered only in itself, is subject to certain rules. may We be allowed on this matter to recall Our short allusion to the medical use of hypnosis which We made at the beginning of the allocution of January 8, 1956 on painless natural childbirth.
The issue which occupies us now concerns hypnosis practiced for clinical purposes by the doctor, while keeping the precautions that medical science and ethics require from the doctor who employs it as well as from the patient who subjects himself to it. On this given use of hypnosis, will apply the moral judgment, which We will formulated on the suppression of consciousness.
But we do not want that We extend purely and simply to hypnosis in general what We are saying on hypnosis at the service of the doctor. This, in as much as it is a scientific object of research, cannot be studied by any person indiscrimately, but only by a serious scientist within the moral boundaries valid for any scientific activity. It is not the case of any circle of laymen or ecclesiastics, who would occupy themselves with it as with interesting subject by way of pure experiment, or even by simple pastime.
4. On the liceity of the suppression and the reduction of consciousness
To appreciate the liceity of the suppression and the reduction of consciousness, it should be considered that to act reasonably and freely towards an end constitutes the characteristic of the human being. The individual will not be able, for example, to complete his daily work, if he remains constantly plunged in a twilight state. Moreover, he is bound to conform all his actions to the exigencies of the moral order. Given that the natural dynamism and blind instincts are powerless by themselves to ensure an ordered activity, the use of reason and higher faculties proves to be essential, both for the perception of the precise standards of the obligation, and for their application to particular cases. From there rises the moral obligation not to be deprived of consciousness without true need.
It follows that the consciousness cannot be disturbed or suppressed merely with the aim of enjoying pleasures while devoting oneself to intoxication and by absorbing poisons intended to arrive at that state, even if one only seeks a certain euphoria. Beyond a determined quantity, these poisons cause a more or less remarkable disorder on the consciousness and even its complete obscuration. Facts show that the abuse of drugs leads to the total forgetfulness of the most fundamental exigencies of personal and family life. It is not thus without reason that the authorities intervene to regulate the sale and the use of these drugs, in order to keep society from serious physical and moral damage.
Is surgery found in the practical necessity to cause a diminution and even a total suppression of consciousness by narcosis? From the technical point of view, the answer to this question comes under your responsibility. From the moral point of view, the principles formulated previously in answer to your first question apply essentially as well to narcosis and to the suppression of the pain. What counts most for the surgeon in the very first place is the suppression of the painful sensation, not that of consciousness. When one is awake, violent painful sensations easily cause reactions and reflexes which are often involuntary. They may bring about undesirable difficulties and lead even to mortal cardiac attack. To preserve the psychic and organic balance, to prevent him to be violently traumatized, constitutes for the surgeon as well as for the patient an objective importance, that only narcosis makes possible to obtain. It is hardly necessary to point out that, if others intervened in an immoral way while the patient is unconscious, narcosis would cause serious difficulties, which would impose adequate measurements.
5. Lesson from the gospel
Does the Gospel add further details and requirements to these rules of natural morality? If Jesus-Christ on Calvary refused the wine mixed with gall, because he wanted to drink in full knowledge to the dregs the chalice which the Father presented to him, it follows that man must accept and drink the chalice of pain every time God wishes it. But one must not believe that God wishes it each time a suffering arises, whatever the causes and circumstances. The words of the Gospel and the behavior of Jesus do not indicate that God wants that for all men and at all times and by no means has the Church given them such an interpretation. But the facts and actions of the Lord keep a profound significance for all. Numberless are in this world those who are oppressed by sufferings (diseases, accidents, wars, natural plagues), of which they cannot alleviate the bitterness. The examples of Christ on Golgotha, his refusal to soften his pains, are for them a source of consolation and force. Moreover, the Lord has warned his disciples that this chalice awaits them all as well. The Apostles, and after them the martyrs by thousands, testified to this and continue to testify gloriously unto this day. Often however the acceptance of suffering without lessening is not obligatory and does not signify a higher perfection. The case arises regularly, when there are some serious reasons for that and the circumstances do not impose the opposite. One can then avoid pain, without putting himself at all in contradiction with the doctrine of the Gospel.
Conclusion and answer to the second question
The conclusion of the preceding considerations can thus be formulated as follows: within the indicated limits and if one observes the proper requirements, narcosis involving a decrease or a suppression of consciousness is allowed by the natural moral law, and is compatible with the spirit of the Gospel.
