What is Natural Law and What is its Bearing on Obstetrics and
THE FUTURE OF OBSTETRICS AND GYNAECOLOGY: The Fundamental Right To
Practice and be Trained According to Conscience: An International Meeting
of Catholic Obstetricians and Gynaecologist
Organised by the World Federation of Catholic Medical Associations
and by MaterCare International (MCI)
Sponsored by the Pontifical Council for the Health Pastoral Care
ROME, June 17th-20th, 2001
Reproduced with permission
"God created man in the image of Himself" (1).
By reason of this inherent dignity we are persons
endowed with certain faculties, not least, the use
of reason and freedom of choice.
The Book of Ecclesiasticus, written two centuries
before Christ, tells us "If you will, you can keep
the commandments, and to act faithfully is a matter
of your own choice.
Before a man are life and death and whichever he
chooses will be given to him" (2).
Against the Protestant denial of human free
choice at the Reformation, the Council of Trent
solemnly pronounced that humans are able to make
free choices (3).
In our own time, the Second Vatican Council
declared free choice to be "an exceptional sign of
the divine image within man" (4)
and that our power of free choice, "is in accordance
with" our "dignity as persons &endash; that is being
endowed with reason and free will and therefore
privileged to bear personal responsibility (5).
Clearly, we are free to choose good or evil.
Natural Law is rooted in history. To understand
it fully and to appreciate its significance, it is
necessary to trace its development from its origin
in ancient Greek philosophy.
Plato defined "good" as the harmonious unity of
all that is, and the "moral good "as a harmony of
all the virtues under the rule of reason He believed
that in knowing the "good" one would desire it for
its own sake and to be virtuous one had to be aware
of the "good".
This concept was developed by Aristotle who,
while recognising two branches of law -- natural law
on one hand and man-made law on the other ---
maintained that natural law was everywhere in force.
His theory was adopted by the Stoics and, in turn,
by the early Roman jurists, notably Cicero who, in
the 1st. century B.C. gave the clearest definition
of classical natural law, when he wrote &endash;
"True law is right reason in agreement with nature;
it is of Universal application, unchanging and
everlasting; it summons to duty by its commands, and
averts from wrongdoing by its prohibitions... One
eternal and unchangeable law will be valid for all
times, and there will be one Master and one ruler,
that is, God, over all of us, for he is the author
of this law, its promulgator and its enforcing
As Roman civilisation expanded so did its laws,
culminating in the codifying of Roman law by the
emperor Justinian into the Corpus Juris Civilis
(A.D.534), arguably the most important contribution,
after the Bible, to Western thought.
While the jus civile was the law which
Romans applied exclusively to themselves and the jus gentium generally to foreigners, the latter
was gradually subsumed, in great part, into the
third branch of law, the jus naturalis, as
the basis of a practical law applying to all
freemen, based on their freedom, and common to all
However, in the early Christian era, emperors had
but scant respect for the authority of the Popes as
spiritual leaders, resulting in constant friction
between Church and State --- a state of affairs
which persisted until the accession of Charlemagne
in the eighth Century.
During the early centuries of the first
Millennium the Church, for its part, was beset by a
number of heresies and schisms --- notably the Arian
and Pelagian --- challenging Doctrine and Scripture.
Hence much of the activity of the early Doctors of
the Church, Ambrose and Augustine for example, was
devoted to combating and correcting error.
In addition there were problems relating to the
constitution and government of the Church. New
canons, binding on the faithful, were promulgated at
each Ecumenical Council or Synod convened to
adjudicate upon the particular heresy or schism in
Thus the Council of Nicea, in addition to
proclaiming the Divinity of Jesus in the new Creed,
issued twenty canons relating to Church discipline
containing, inter alia, rules for the ordination of
clergy and bishops, clerical celibacy, clerical
usury and the proper posture at prayer (7).
It was only after the crowning of Charlemagne as
Holy Roman Emperor by Pope Leo III (A.D.780), and
with the Emperor's tacit approval, that centralised
church authority, descending through the Pope to the
bishops, evolved. There was as yet, however, no
complete code of canon law.
The twelfth century brought about a major revival
in the study of Roman law, especially in the
University of Bologna. This led a monk of the
University, John Gratian, to make a collection of
the Church canons which he entitled Concordantia
Discordantum Canonum ---- a "Harmony of
Discordant Canons" (8).
This, the Decretum Gratiani, formed the basis of
the Corpus Juris Canonici, which has remained
as the law governing the Church down to the present
day, albeit subject to amendments in 1917 and 1983.
Describing Natural Law as the "Golden Rule"
Gratian wrote -- "Mankind is ruled by two laws:
Natural and Custom. Natural Law is that which is
contained in the Scriptures and the Gospel. Natural
Law absolutely prevails in dignity over customs and
constitutions. Whatever has been recognised by
usage, or laid down in writing, if it contradicts
Natural Law, must be considered null and void". Not
only did Natural Law overrule all other laws but it
was antecedent to them because "it came into
existence with the very creation of man as rational
being, nor does it vary in time but remains
It was not surprising therefore, that in the
Middle Ages, the doctrine and principles of Natural
Law, in the understanding of the day, should have
been embodied in the Code of Canon Law even though
there was, as yet, no clear definition of law in
general, or of Natural Law in particular. Religious
thought had been dominated by the writings of St.
Augustine, for example De Civitatis Dei,
where in contrast with the "Heavenly City" the
Christian could see in the earthly city only a world
It was into this milieu of pessimism ---- the
"Dark Ages " ------ that St. Thomas Aquinas was born
in 1224. At the age of twenty he joined the Order of
St. Dominic, studying especially theology and
philosophy, before reconciling Aristotelian
philosophy, as expressed in the Ethics and
the Politics, with Christian belief, reaching
fulfilment in the Summa Theologiae, wherein
he set down a series of questions which he answered
in the light of philosophy and theology, maintaining
throughout that the testimony of reason did not
conflict with the truths revealed by Christian
doctrine, and the grace did not abolish nature but
perfected it. (9)
Not without significance, at the very beginning
of the Summa he first poses the question ----
Does God Exist ? ----- answering in the affirmative
in five different ways.
Defining Law as nothing else but a rational
ordering of things which concern the common good,
promulgated by whoever is charged with the care of
the Community, he described the nature of Law and
its object which, in essence, was the well-being of
the whole community. He held that there were three
different types of Law: Eternal Law, Natural Law and
Of Eternal Law he said --- "The rational guidance
of created things on the part of God, as the Prince
of the Universe, has the quality of law. .. this we
can call the Eternal Law", adding, "all laws, so far
as they accord with right reason, derive from
Eternal law" (9).
In recent times the Second Vatican Council
declared that "the highest norm of human life is the
divine law --- eternal, objective and universal ---
whereby God orders, directs and governs the entire
universe and all the ways of the human community
according to a plan conceived in wisdom and love" (10)
"Rational creatures", Aquinas maintained, "have a
certain share in the divine reason itself, deriving
therefrom a natural inclination to such actions and
ends as are fitting. This participation in the
eternal law by rational creatures is called the
Vatican II referred to Natural Law also, in Gaudium et Spes. --- "Deep within his conscience
man discovers a law which he has not laid upon
himself but which he must obey. The voice of this
law, ever calling him, to love and to do what is
good and to avoid evil, tells him inwardly at the
right moment, do this, shun that. For man has in his
heart a law written by God. His dignity lies in
observing this law, and by it he will be judged.
His conscience is man's most secret core, and his
sanctuary. There he is alone with God, whose voice
echoes in his depths." (4)
Acknowledging the necessity for human laws, Aquinas
said "The validity of all law depends upon its
justice. But in human affairs a thing is said to be
just when it accords aright with the rule of reason
and as we have seen the first rule of reason is the
Natural Law. If human law was at variance in any
particular with Natural Law it was no longer legal
but rather a corruption of law". The primary precept
of the Law, which is universal, everlasting and
immutable -- the first principle of practical reason
-- was that Good should be done and pursued and Evil
avoided. .. "and in this are found all the other
precepts of the Law of Nature" (9).
These, in the order of man's natural
inclinations, he listed as:
- 1. Preservation of Human
Life and opposition to its dissolution
- 2 Procreation and the Rearing of Offspring
- 3. Knowing the Truth about God
- 4. Living in Society in harmony with others.
- 5. Avoiding Ignorance.
All basic, or fundamental human rights, such as
the right to life, to procreation, to a livelihood,
to bodily integrity, derive from the intrinsic
inalienable dignity of the human person as a
gift from God; they are not bestowed by any human
agency and, like Natural Law, are antecedent to all
The "Charter of Fundamental Rights of the
European Union", adopted last December deals at the
outset with Human Dignity, and states "Human dignity
is inviolable. It must be respected and protected.
Everyone has the right to life". These are noble
aspirations but, are they just pious platitudes? (11)
To return to the original question ---- what is
It has been defined as "the participation of the
eternal law in rational creatures" (9).
Through the use of reason, people can discover that
part of the eternal law which governs human
Their formulation of the results of this "Natural
Law"; as professor d'Entreves explains "Reason is
the essence of man, the divine spark which makes for
his greatness. It is the 'light of reason' which
enables us 'discern good from evil'. (12)
Natural Law, however, is not just a theory of
natural rights. It is the Golden Rule which
"contains all that makes for the preservation of
human life, and all that is opposed to its
As we have seen, men and women enjoy freedom of
choice but this is not the same as the "right to
choose" as, for example, in the case of procured
abortion. There can be no right to choose if, in
exercising that right, one deliberately kills an
innocent human being.
There are practices in Obstetrics and Gynaecology
which offend against Natural Law --- I shall
consider just two of them --- emergency
contraception and procured abortion.
Emergency contraception, so-called, involves the
administration of two doses of 100 mcg of
Ethinyloestradiol and 1 mg of norgestrel, 12 hours
apart, to women who had had unprotected intercourse
in the previous 72 hours, the Yuzpe regimen.
There are differing views as to its precise mode of
While it has generally been accepted that when
administered before ovulation an oestrogen /
progestogen combination may inhibit ovulation, an
anti-ovulation effect has been found in less than 30
per cent of women.
Studies involving the administration of
ethinyloestradiol and levonorgestrol at or before
the LH peak showed significant alterations in
endometrial development with dissociation of the
glandular and stromal components indicating that
post-coital contraception prevents implantation of
the fertilised ovum.
Most researchers support the view that the
morning - after pill acts through modification of
Schering AG, the manufacturer of Schering PC4,
concede that it "prevents pregnancy by producing
transient changes in the endometrium, making it
unsuitable for a fertilised ovum to implant.
Ovulation may be delayed if the pills are given in
the first half of the menstrual cycle, or the corpus
luteum function may be altered if given after
ovulation. There is no evidence that Schering PC 4
is abortifacient (13).
The data sheet accompanying the preparation
states "Schering PC4 is primarily aimed to prevent
implantation of the fertilised ovum in the
The claim that the morning-after pill is not
abortifacient is spurious. In 1963 the United States
Department of Health, Education and Welfare
described abortion as "all the measures which impair
the viability of the zygote at any time between the
instant of fertilisation and the completion of
With the shift from contraceptive to
abortifacient methods of birth control it became
expedient to change the definition of "conception"
from fertilisation to implantation. The change was
endorsed by the American College of Obstetrics and
Gynaecology (ACOG), which stated in 1965 --
"Conception is the implantation of a fertilised
Accordingly, relying on this terminology, those
advocating emergency contraception deny its
Recently Schering has produced a preparation
containing 750 micrograms of levonorgestrel, where
one tablet is to be taken within 72 hours of
unprotected intercourse, to be followed within 12
hours by a second. Schering estimates that such
dosage "prevents 85% of expected pregnacies." (Data
Schering is more circumspect about its mode of
action than in the case of PC 4 --- "It may also
cause endometrial changes that discourage
implantation" (Data sheet)
However, almost certainly, it acts in exactly the
same manner as the combined ethinyloestradion /
norgestrel preparation. The Irish Medicines Board
--- the Government drug regulating agency --- has
declared it to be abortifacient.
The scientific evidence is that human life begins
at conception. I believe that emergency
contraception prevents the continuation of pregnancy
because it hinders implantation of the fertilised
ovum and hence it has to be abortifacient.
Notwithstanding, the morning-after pill is now
widely available, in the United Kingdom at any rate,
over the counter in pharmacies, to all women over
sixteen years of age.
Certain actions are intrinsically evil. As
the Church teaches -- "there exist acts which per
se, and in themselves, independent of
circumstances, are always seriously wrong by reason
of their object" (16) .
Deliberate, intentional destruction of unborn human
life, i.e. procured abortion is one such act., and
is never morally justifiable.
As Pope Paul VI stated in Humanae Vitae
"though it is true that sometimes it is lawful to
tolerate a lesser moral evil in order to avoid a
greater evil or in order to promote a greater good,
it is never lawful, even for the gravest reasons, to
do evil that good may come of it" (17).
Pope John Paul II reminds us in Evangelium Vitae
"The second Vatican Council defines abortion
together with infanticide as an 'unspeakable
crime' (G.S. 51) (17) .
The pro-choice, pro-abortion lobby, while not
admitting that its real aim is abortion on demand,
argues that abortion is necessary in certain
circumstances, especially where it is claimed that
for the pregnancy to continue, the mother's life
would be endangered.
Unfortunately, in many predominantly Catholic
countries, the myth persists that pregnancy may pose
a risk to the mother's life, and legislation to
permit of procured abortion in such circumstances,
been enacted, ignoring completely the question of
Leaving morality aside for a moment however, one
may ask "is procured abortion ever necessary?" ---
in other words "are there any medical indications
for procured abortion?"
I firmly believe that the honest answer has to be
After forty years as a Consultant Obstetrician /
Gynaecologist in major teaching hospitals I cannot
recollect a single instance where a mother's life
could only be saved through the deliberate
destruction of her unborn child.
Statistics support this view. In Ireland, where
abortion is illegal, the question of procuring an
abortion so as to protect the mother's life does not
arise, and yet Ireland, together with Malta, I
believe, has the lowest maternal mortality in the
world, at less than four maternal deaths for every
Furthermore, in over three - and - half million
successive abortions carried out in England and
Wales under the Abortion Act, 1967, in barely 150
cases was risk to the mother's life the indication
for the abortion. This means that only one abortion
in every 23,000 was carried out because it was felt
that the mother's life was in danger (18).
Recent figures from the United Kingdom are even
more convincing ----- of 5.3 million abortions
performed since 1967 only 212, i.e 1 in 25,000,
invoked danger to the life of the mother as the
indication (19) .
There can be no doubt, whatever, that almost all
abortions are carried out for quasi-social reasons;
in effect, abortion on demand.
But then, procured abortion is big business and
is an "economic service" under European Union law.
It is worth recalling that the World Medical
Association Declaration of Geneva in 1948, which was
adopted by successive World Assemblies in 1968, 1983
and 1994, states &endash; "I SOLEMNLY PLEDGE myself
to consecrate my life to the services of humanity:
"I WILL MAINTAIN the utmost respect for human life
from its beginning even under threat and I will not
use my medical knowledge contrary to the laws of
humanity" (20) .
While procured abortion is to be condemned, on no
account should an expectant mother be denied all
necessary treatment during pregnancy in the fear
that it might kill or damage her child. To withhold
such treatment is unethical.
Obstetricians have responsibility for the well-being
of two persons, the mother and her unborn child. In
protecting one, they may not deliberately... destroy
the other ----- "primum non nocere".
George Bush, in a message to the annual March for
Life in Washington, shortly after his inauguration
as President of the United States of America, said
that they shared a common goal "to work toward a day
when every child is welcomed in life and protected
by law. This will not come easily, or all at once,
but the goal leads us onward to build a culture of
life, affirming that every person, at every stage
and season of life, is created equal in "God's
image" (21) .
Has the time not come -- indeed is it not long
overdue ? -- when we obstetricians, should let our
voices be heard, collectively, in promoting the
culture of life, and in defence of the unborn?
We have remained silent for far too long.
I would like to see emerge from this meeting the
acceptance of MaterCare International, in witness to
Pope John Paul II's Encyclical Evangelium Vitae,
as the authority in matters relating to the practice
and training in obstetrics and gynaecology.
1. Genesis 1.27
2. Ecclesiasticus 15 11. 20
3. Denziger - Schonmetze 1955 /
815 cited by Grisez G. The Way of the Lord Jesus
Vol. 1 p. 43, Franciscan Herald Press, Chicago
4. Second Vatican Council ----
Gaudium et Spes 12
5. Second Vatican Council ----
Dignitatis Humanae 2
6. Cited by Finnis J. Natural Law and Natural Rights (1980) Clarendon
Law Series. Oxford University Press
7. Alzog J. Universal Church
History (1874) Vol 1 p. 452 et seq. Gill &
8. Coriden J. A. An
Introduction to Canon Law (1990) Geoffrey
9. Summa Theologiae 1 -- 11 q.
2 a 3
10. Second Vatican Council ----
11. Charter of Fundamental
Rights of the European Union (2000)
12. D'Entreves A.P. Natural
Law, an Introduction to Legal Philosophy p. 40
Hutchinson University Library, London
13. Schering Ltd. --- Personal Communication
14. Public Health Services
Leaflet No. 1066 U.S Department of Health,
Education and Welfare 1963 p. 27
15. American College of
Obstetrics and Gynecology Terminology Bulletin --
Terms used in Reference to the Fetus Chicago,
A.C.O.G. September 1965
16. Pope John Paul 11 Veritatis Splendor (1993) 80
17. Pope John Paul 11 Evangelium Vitae (1995) 58
18. Hansard, May 13,
19. Northern Ireland Assembly Debates June 20, 2000
20. World Medical Association
Declaration, Geneva (1948)
21. President George Bush -- Message to Annual March for Life Washington,