Co-operation In Evil

CO-OPERATION IN EVIL Anthony Fisher, O.P.

"Catholic Medical Quarterly", 44(3) (February 1994), 15-22.

Introduction

To modern ears 'co-operation in evil' may sound like a rather sinister and abstract a subject. In fact, I would suggest, it is very much the everyday problem of the doctor and nurse. I will begin with an ostensive definition. I do a lot of talking at bioethics conferences, healthcare colleges, and so on. Commonly I am approached after my lecture by someone, especially a young doctor or a nurse. They will have a hard question which is troubling them. It will be something like: "I know that I cannot assist in an abortion: but I am part of a team or an institution that does good work but which does these kinds of things sometimes. Am I allowed to prepare the patient for the operation? Am I allowed to fill in their admission form? Am I allowed to assist in an abortion as part of my training? Am I allowed to care for them after the operation?" The list can go on and on, and often does....

We can notice a few things about this situation. First, this is a hard question. There does not seem to be a single, simple, right or wrong, black or white answer—even for someone with fairly traditional moral principles, respect for moral absolutes and so on. The person posing the question accepts that certain things like abortion, sterilization, IVF, euthanasia, violent or exploitative medicine of any kind, are out of bounds, or at least very morally dubious.

Secondly, the context is some kind of co-operative venture, some kind of team-work. This is essential to community and to any human life. We live and work with others, for particular projects and for the common good, in relationships of equals, or of authority and obedience, each person making a distinct and appropriate contribution in pursuit of common ends. Difficulties regarding co-operation often arise because one is expected to help family, friends, employers, fellow-workers, government or others toward whom one already has duties, a history and a future of relationship.

Thirdly, though co-operating in the project, the agent in question is not the one most directly involved, conceiving, instigating, directing, co- ordinating and actually engineering the operation or whatever. Rather she is in a secondary or subordinate rôle to the principal agent(s) and contributes something which facilitates the wrongdoing of the principal agent(s). What she wants to know is how close she can properly get to taking part, without becoming, as it were, an accessory, a conspirator. How involved can she be without becoming tainted by it?

Fourthly, the work of the person in question, and the team of which she is part, is in general good work. It is not the gas chamber of a concentration camp, or a clinic devoted to killing unborn babies. No, it is a hospital which engages in all sorts of medical procedures, including some morally dubious ones.

When should I co-operate with someone who is doing something wrong? The simplest answer is: never. I want to maintain clean hands and a pure heart. I scorn the company of evil-doers. I will not co-operate in their wickedness. I want to set a good example. So it is that some people went to the death camps rather than collaborate in any way with the Nazis. And some people have resigned from the health service, indeed from the healthcare professions, rather than have anything to do with some practice or other which they cannot condone. Others have taken a courageous stand in one way or another, perhaps at great cost in terms of their relationships with fellow healthcare workers, or cost to their career path. These people are either martyrs or fanatics. Those who are martyrs deserve our admiration and respect. But not everyone is called to be a martyr, or at least not all the time.

Co-operation in evil is, of course, unavoidable, especially for those who live 'in the world',[1] and sometimes it is our duty. Even Christ's little band paid taxes to Caesar. All sorts of wickedness go on in our society, and we finance it through our taxes, elect the leaders who decide it, fail to do very much to change things. More immediately, almost any good work we do can be an occasion, an opportunity, the means, for someone else to do something wrong.[2] To refuse to take part in government, health system, church and other institutions simply because they engage in some wrongful activities, might well be to sin by omission.[3]

Intentional co-operation

Those of you who were reared on the will be able to recite the nine ways of causing or sharing in the guilt of another's sin: by counsel, by command, by consent, by provocation, by praise or flattery, by concealment, by being a partner in the sin, by silence, and by defending the ill done. As if these were not enough, co-operation has traditionally been divided into two kinds: formal and material—what I will call intentional and unintentional. Material co-operation was in turn divided into two sorts: immediate and mediate material co-operation. Mediate material co-operation also came in two kinds: proximate and remote mediate material co-operation. Complicated as this system was, it did recognize the complexity of the problem; but I will not elaborate it all now. Let it here suffice to distinguish between intentional and unintentional co-operation. Here I will draw significantly upon the theory of intention developed by Grisez, Finnis and others—not, I admit, an uncontroversial theory—and articulated most recently in Grisez's masterly tome, .[4]

Intentional co-operation in another person's wrong acts is itself always wrong. This kind of co-operation might occur in either of two ways. First, where I share the principal agent's wrong purpose or aim: in this case my proposal, what I choose to do, includes something (and perhaps everything) objectively wrong in the other person's proposal. An example would be when a healthcare worker who favours abortion takes a job in an abortion clinic, in order to help women seeking abortions to get them. A second kind of intentional co-operation is where the other person's wrongdoing is the means to my successfully carrying out my own project. An example would be someone who directly profits from others doing some immoral operation. In both cases, I intend or will a moral evil, concur in another's sin, participate in the immoral act in such a way that it becomes, as it were, my own.[5]

A common situation where intentional co-operation arises is in the fulfilment of one's professional rôle. Grisez gives two examples: a hospital administrator who decides that her obstetrics department will offer sterilization and sees to it that all patients about to be sterilized fulfil the usual requirement to give their informed consent; and a legislator who supports the funding of abortion.[6] In doing so, Grisez argues, the administrator and the legislator intentionally co-operate with immoral sterilization and abortion, even if they disapprove of it, even publicly. Grisez apparently holds that the hospital administrator, who sees to it that each sterilization is both consented to and effectively carried out, is more likely to be guilty of intentional co-operation than an assisting nurse.[7] This fits in with the traditional position that "the one who commands or directs, the one who seduces others to join, and the one who actually and immediately executes or carries out the work, all contribute significantly as [formal] co-operators."[8]

We might note a few points about intentional co-operation here. First, it is very much a matter of what one chooses, what one makes one's own purposes or means to those purposes, and thus what one makes oneself. The self-creative effects of choices, which are central to the whole moral life, are crucial here: what is what I am doing making me and what is it saying about me? Second, even a person who finds the whole business repugnant, disapproves of it, even tries to dissuade patients and doctors and politicians from getting involved in it, can nonetheless intentionally co-operate and so engage in an evil act. Third, the claim that one does not approve of the procedure oneself, but that one wants to respect the consciences of others who think it is OK, is no justification for acting untruly with respect to one's own conscience. Fourth, neither is the claim that one was simply doing as one was told any excuse.[9]

Unintentional co-operation

The second kind of co-operation is unintentional. Now by unintentional I do not mean unplanned, lacking deliberation, unforeseeable, accidental or surprizing.[10] Rather, a person co-operates unintentionally when what she freely and deliberately does has the side-effect of facilitating another person's wrong act. Here the agent intends as her own end and chooses as her own means things which neither are nor include the immoral actions or proposals of the other(s); she does not, as it were, make that immoral act her own; rather she (at most) accepts those results as undesired side- effects of carrying out her own good choice. The difference between intending and not-intending-but-foreseeing has been covered at length by other authors. Suffice it here to say that it is crucial to Catholic teaching on direct and indirect abortion, self-defence, justice in war, killing and letting die, and apropriate terminal care. Examples of unintentional co-operation might include: a taxi-driver who brings people to, or an engineer who keeps the utilities working in, a hospital where abortions are done, where the driver or engineer only does this work to make a living and further the other good things done there. Certainly they co-operate in the wrongful activity; without them it might even be impossible; but they do not intend it and make it no part of their purposes.

We might note here that the difference between intentional and unintentional co-operation does not turn on how crucial one's act is to the morally wrong activity, or how proximate or remote it is to the causal chain, how aware one is that one is co-operating, or how good or bad one felt about it. Perhaps what the agent does is absolutely necessary for the principal(s) to carry out their intentions, and she knows that: but the wrongful act might still form no part of her intended ends or means and thus still be only unintentional or material.[11]

Unintentional co-operation is sometimes permissible. Other times it would be irresponsible for the agent to accept the side-effects of her acts. The taxi-driver and the engineer in my previous examples may well be justified in their unintentional co-operation in abortion. But what of the nurse who fills in the admission papers, or prepares the instruments, or administers pre-operative sedation, or hands the instruments to the surgeon, or does post-abortion aftercare? Assuming co-operation is unintentional and the act by which it is carried out otherwise would be morally good, the question is whether one has an adequate reason to do that act in view of its bad side- effects.[12]

How is one to balance up one's own interests in doing what constitutes unintentional co-operation with the interests of others who will suffer bad side-effects? Grisez suggests the Golden Rule (the do-unto-others principle) as a useful test.[13] In applying this test we try to eliminate bias or partiality by considering our proposed action from the point of view of all those affected, imagining oneself in the place of each, taking into account all the relevant benefits and harms.

Benefits and harms

What are the relevant benefits? One must examine these carefully and honestly. They will obviously include keeping one's job, supporting thereby a reasonable life-style for oneself and one's dependents,[14] and doing whatever good is possible through the job—and, if it is healthcare, a great deal of good is possible. This, more than income, is what attracts most people to the healthcare professions: the opportunity to serve, to heal, to save and nurture life and health. But security of job and income, and workplace harmony, are themselves important goods as well. Here ease or difficulty of finding alternative employment, and the needs of dependents will be important factors in assessing the relative benefit. There will be benefits particular to the particular act in which one is engaged, such as knowledge and skills gained.

Thus a person might ask herself: how important are the benefits expected from this activity, how extensive, how certain and for whom? Conversely, what kind of loss or harm will result from foregoing the otherwise good act, how extensive will that loss be, how certain, and who will suffer it? Someone with dependents, for instance, will have more to gain from getting her pay-packet and job-security and more reason not to endanger her job by refusing to take part in certain procedures than will someone who has no dependents. One might also ask: are the only options open to me doing this act and not doing it, which would mean giving up the important benefits—or is there some other way? Someone who cannot fulfil some important responsibility (such as healthcare worker, family provider) except by unintentionally co-operating with another's wrongdoing has more reason to do so than someone with a morally acceptable alternative.

What are the relevant harms? Again, one must examine these carefully and honestly, not ignoring them simply because they are unintended. We responsible for all the reasonably foreseeable effects of our choices, even the undesired, unintended ones, though we are responsible in a different way to the way we are responsible for the intended effects. So we must ask ourselves when engaging in unintentional co-operation: what kind of loss or harm will result from the wrong act itself in which one would co-operate, or from the side-effects of one's own act of co-operation? How extensive will the harm be, how certain is it to occur, and who will suffer it? How big a part does it play and how often will it be part of my overall work? Will my refusing to unintentionally co-operate prevent the wrong—or will it go on regardless? Am I in a position to stop it (e.g. an owner or manager) or not?[15] Is there some way in which I can express my disapproval which might help to reduce the harm done?

One bad side effect of some unintentional co-operation is the temptation to co-operate intentionally. There are two ways this might happen. First, one may so often, repeatedly, habitually and unreflectively engage in some act of unintentional co-operation that one becomes blasé about it, dulled to the evil side-effects, and happy enough to admit them as one's intention. Second, co-operation often involves engaging in a team relationship with the principal wrongdoer(s) and can thus lead to deeper involvement, including a sharing of purposes. For example, whenever healthcare teams materially co-operate, a sense of community and the technological imperative incline them to hope for the success of the wrongdoing which they are helping. Thus, merely material co-operation can easily become the occasion of intentional co-operation. This might explain the traditional advice has been that the more remote the co-operation, the easier it is to justify. A manufacturer of morphine could properly claim that the production of this drug which has appropriate medical uses is only unintentional participation in the evil of drug addiction, and rather remote co-operation at that; a chemist who dispenses the morphine to suspected addicts is more closely involved, and more likely to be engaging in a corrupting activity.

Another bad effect of some unintentional co-operation is the message it gives to on-lookers. A known Catholic who takes part in an abortion procedure may suggest by her actions that in her view or the view of her church, abortion is OK. Likewise a well-respected senior doctor or nurse. Or a Catholic hospital. All these might very well 'give scandal' to others who might not appreciate the distinctions between intentional and unintentional co-operation, intending and foreseeing, etc. This might seriously impair the witness they could and should be giving to others. And their example might encourage others not only to co-operate unintentionally, but even to co-operate intentionally, i.e. take part in the forbidden activity. Thus it will sometimes be required to take a stance against an activity by privately or even fairly publicly refusing to co- operate even unintentionally; to put one's job on the line; or, if one is co-operating unintentionally, to take as active a part as is practicable in protesting against the wrongful activities of the institutions in which one works or from which one benefits.

How is one to weigh these benefits and harms? Despite the pretensions of the utilitarians, there is no simple calculus possible.[16] You can't put them through a computer or on some kitchen scales. There may not be a single, simple, correct answer. Sometimes of two proposals all the goods and evils of one are included in the other, plus more; then such a balancing job might be possible. But usually it will not. Traditionalists might appeal to a hierarchy of goods[17] but this is also problematical. What we can say is that we are obliged as far as possible to avoid or minimize the harms. The graver or more probable or more proximate or more frequent or more preventable or more scandalous the harm of the side-effect the more correspondingly serious must be the reasons for engaging in the action.[18]

In some cases of unintentional co-operation, having judged that the action is not excluded on other grounds, and having carefully applied the Golden Rule, and concluded that neither doing nor foregoing the action would be wrong, one can conclude that both alternatives are good, insofar as they agree with right reason. Which to adopt is then a matter for discernment, love, prayer, one's particular temperament, commitments and vocation. And here two reasonable, good-willed people may sometimes take different courses of action.

Traditional wisdom Many Christian thinkers over the centuries have turned their minds to the problem of co-operation in evil, and even addressed particular practical problems. This kind of 'casuistry' can be a useful inheritance, if treated with care. After all, there is no need to reinvent the wheel. Some of the examples may seem a little arcane, quaint or simplistic. But perhaps we can see parallels with the particular problem of co-operation which we are faced with ourselves.

Here are some suggestions of what might be in medical areas according to traditional authors:[19]

* a physician gives merely passive assistance at the preliminary instruction and preparation for an illicit operation (abortion, sterilization, improper failure to treat or feed, etc.), remaining aloof from every appearance of approval of the procedure; * an intern, nurse or technician in an operating room performs her usual duties, such as the sterilization of instruments, the preparation of drugs, the administration of anaesthesia, the handing of instruments during the operation, even if the operation is illicit if it is exceptional and accidental in relation to her routine work; * a person whose livelihood depends on her job, because it is difficult to get another similar job, works for a hospital which performs abortions but does not approve or immediately co-operate with any abortions; * an engineer keeps utilities working in a hospital where abortions are done, only to make a living and further the other good works done there; * a doctor or agency distributes medicine for healing a venereal disease, taking care that this is no inducement or invitation to engage in a sinful practice; * a company manufactures a drug which has good uses knowing that some people will abuse the drug; * a legislator who, having tried and failed to exclude abortion funding from a general appropriation bill, then votes for the bill only to bring about the good things it will fund.

These are some suggestions of what might be permitted in non-medical areas according to traditional authors, from which one might draw certain analogies for healthcare:[20]

* a locksmith is forced at gunpoint to help robbers break into a bank's safe and carry out the money; * a butler, chauffeur or servant carries out her normal duties such as driving her boss on various trips, even though she believes this assists an improper liaison, having expressed in some manner her displeasure over any sinful relationship;

* a taxi-driver drives a fare to a specific address given to her, knowing or suspecting that the address is a brothel;

* a merchant or sales assistant sells a thing which has good or at least indifferent uses, knowing that it might also be misused;

* a cashier or wrapping clerk wraps or registers the sale of an immoral article than has already been purchased;

* a bartender serves someone who has 'had enough' so as to avoid a disturbing scene, violence, foul language or hostility;

* a carrier transports objects some of which might be pernicious, not knowing the contents of the packages transported.

The authors also listed various forms of licit and illicit co-operation in evil by judges, attorneys, publishers, editors, managers, advertizers, politicians, party workers, and worshippers, which I will not detail here.

Here are some examples of what traditional authors have regarded as and therefore forbidden co-operation in medical situations:[21]

* a physician, intern, nurse or technician assists in an illicit procedure, physically supporting every step of the principal physician or surgeon, and being ready to take over in case of necessity;

* a person who favours abortion volunteers her services to an abortion clinic, by for example helping people fill out forms, in order to help women seeking abortions to get them;

* a physician, intern, nurse or technician hands a surgeon an instrument which could only serve an immoral purpose;

* a hospital administrator decides that the obstetrics department will offer sterilization and sees to it that all patients about to be sterilized fulfil the usual consent requirements;

* a physician or counsellor refers someone for abortion;

* a pharmacist or sales assistant sells an object which by its very nature serves no other purpose but sin (contraceptives, abortifacients);

* an agency (e.g. the army) distributes or disseminates means of contraception.

Here are some examples of intentional and forbidden co-operation in non- medical situations from which one might be able to draw analogies for medical situations:[22]

* a counsellor encourages a person to commit some sin in the hope that this will lead to her growth, or to use contraception because this is 'the lesser evil';

* an inspector takes bribes to approve faulty construction, wishing the fraud to succeed so that the bribery will not be exposed;

* a police officer ignores criminal activities so as to benefit from the proceeds;

* a legislator supports what she recognizes to be an unjust war;

* associates of a criminal mob (such as accountants and lawyers) wish its enterprises to flourish but never carry out any of the mob's dirty work themselves;

* a bartender encourages someone who has 'had enough' to take another drink;

* a tavern-keeper, or proprietor or manager of a nightclub or dining place, offers the base attraction of lascivious entertainment or permits unseemly forms of dancing and deportment on the part of her patrons;

* a merchant openly provides and sells indecent clothing, pornography etc.;

* someone luridly advertises women's wear in shop window or in print;

* a barber attracts customers by means of indecent or pornographic material;

* an owner of a motion picture theatre bills an evil film;

* an owner rents rooms for sinful purposes such as prostitution, rendezvous for adultery, communistic cells, anti-Catholic propaganda etc.;

* a carrier knowingly transports pernicious newspapers, pornographic material etc.;

* a pharmacist sells poison to a murderer.

And here are some examples of what traditional authors have regarded as co-operation:[23]

* a nurse who is frequently asked to assist in illicit operations doing so rather than looking elsewhere for a job;

* a pharmacist sells a drug to someone she has reason to suspect is an addict;

* a religious takes part in an abortion;

* a Catholic hospital permits abortions to be performed on its premises;

* the owner of a gun store learns that a regular customer uses guns and ammunition purchased there to fulfil contracts for murder but continues to sell her the merchandise simply for the sake of profit;

* a butler, chauffeur or servant does more than the ordinary duties of a servant to assist her boss in some evil purpose;

* a taxi-driver directs an inquiring passenger to a brothel;

* a bartender serves all customers indiscriminately, whether they are drunk or not.

Having learnt the principles and reviewed the traditional cases one may or may not feel any the wiser on what to do in the here and now with the particular problem of co-operation I am faced with. I have not got space here to treat of 'the erroneous conscience' and 'the vexed conscience'. People will, with varying degrees of responsibility, sometimes without blame at all, make wrong decisions in this area. This emphasizes the need to seek counsel of the moral tradition, the teaching church, respected others and ultimately through prayer and the sacraments, the Holy Spirit. It also highlights the need to cultivate virtues in oneself such as prudence and courage. Sometimes it will take a great deal of both to work out what to do and to stand by that decision.

ENDNOTES

1. B. Haring , vol. 2 (1963) at 499-500 made the point that "it might be very easy for one who has withdrawn from the world and who is concerned only with the salvation of his own soul to condemn with smug horror every species of material co-operation. But one who 'in the world' wills to be active for the kingdom of God and the salvation of those who are in spiritual jeopardy will view the matter in quite a different light. He is faced with a serious problem. Any hyper-rigorous stance respecting material cooperation—instance the moral rigorism represented by Tertullian in the early Church—simply renders the exercise of the lay apostolate totally impossible. Anyone who sets up in his moral code the rigid principle forbidding any action which might be perverted by others must, to cite but one example, renounce politics entirely. He will be obliged to remain aloof from many significant areas of apostolic activity. As Christians we have a mission to sanctify all realms in the world..."

2. Haring (1963) at 494 put this point rather colourfully: "we all occasionally discover to our horror that our most exalted efforts sustained by the loftiest motives have served to lighten the task for others to carry out their nefarious designs!"

3. This point is well made by B. Ashley & K. O'Rourke, (1989) at 189. Haring (1963) at 494 noted that the exalted vocation of Christians requires them to engage in activities with "the occasional tragic connection with the machinations of the spirits of darkness".

4. G. Grisez, , vol. 2 (1993).

5. G. Grisez, , vol. 1: (1983) at 301-303.

6. G. Grisez, 'Public funding of abortion,' 85 (1985) at 46-47 & (1993) at 441. Grisez (1993) at 441 points out, on the other hand, that legislators who, having tried and failed to exclude abortion funding from a general appropriation bill, then vote for the bill only to bring about the good things it will fund co-operate not formally but only materially in the abortions the appropriation will pay for.

7. J. Finnis, J. Boyle & G. Grisez, (1987), ch. 13 offer a remarkably well-reasoned and practical guide to co- operation in a parallel area.

8. Haring (1963) at 495.

9. On this fourth point Haring (1963) at 503 spoke most strongly: "Any pharmacist, druggist, or clerk in a drugstore who... is quite aware of the immoral objects he is selling [Haring had in mind contraceptives]... is, in my opinion, guilty of formal co-operation in every instance of sale. He cannot be excused from guilt merely on the score of having no choice. The excuse that he does merely what he is told is vapid. Excuses of this kind have been alleged in defence of the most unheard of crimes. A conscience attuned to the divine law steers clear of such an evasion and of the evil deed. This is not to deny that the manager or owner of the store in question obviously must be charged with far greater guilt than a mere clerk."

10. Haring (1963) treated material co-operation as the rare, unexpected and indeed shocking perversion of one's own well-intended actions by others to an evil ('some nefarious design'). This seems to me to be a rather naive account of co-operation.

11. Traditional accounts, such as that of Ashley & O'Rourke (1989) at 188, hold that immediate material co-operation, such as nurses assisting in performing an abortion, is morally equivalent to ("amounts to the same as") formal co-operation. The reason they give, that "it is a direct contribution to an evil act in which the co-operator shares the responsibility for the act" seems rather to beg the question.

12. Ashley & O'Rourke (1989) at 188 conclude that "persons whose livelihoods depend on a job (because it is impossible or difficult to get another similar job) are justified in working for certain institutions where abortion is performed, provided they disapprove and do not immediately co-operate with an abortion. In such institutions there are many different degrees of co-operative proximity, ranging from the nurses whose co-operation is very proximate to the janitors of the building whose co-operation is very remote."

13. Grisez (1993) at 283ff & 442ff.

14. Contra Haring (1963) who at 499 declared dogmatically that "material gain may not be our motive for material co-operation, nor should it be in the first instance a dread of material loss or damage".

15. Haring (1963) at 502-503 said that it is unquestionably the case that an owner, manager or self-employed salesman who makes a sale of a contraceptive or abortifacient engages in formal and illicit co-operation. He notes the laxist view that an employed clerk or salesman may be in a different position, particularly if allowed very little freedom by his employer. He prefers the rigorist view that "any pharmacist, druggist, or clerk in a drugstore who...is quite aware of the immoral objects he is selling... is, in my opinion, guilty of formal co-operation in every instance of sale." The later Haring would undoubtedly repudiate this.

16. Haring (1963) at 499 already showed seeds of his later Christian utilitarianism when he says that "remote co-operation on which the execution of the evil deed in no way depends is permitted for any proportionately good reason". On the difficulties with the notion of proportionate reason see the works of Grisez, Finnis etc.

17. e.g. Haring (1963) at 499: "Merely material co-operation is lawful if through such co-operation a higher good is assured and safeguarded or a greater evil is averted."

18. Haring (1963) at 498-499.

19. Ashley & O'Rourke (1989) at 188; Grisez (1983) at 301 & (1993) at 441; Haring (1963) at 505-507; G. Kelly, (1958) at 332- 335; H. Peschke, , vol. 2 (1978) at 324.

20. Grisez (1983) at 301 & (1993) at 441; Haring (1963) at 501-509.

21. Grisez (1983) at 300-301 & (1993) at 440-441; Haring (1963) at 502-507.

22. Grisez (1983) at 301 & (1993) at 440-441; Haring (1963) at 506-509; D. Prümmer, (1956) at 103.

23. Ashley & O'Rourke (1989) at 188-189; Grisez (1993) at 442; Haring (1963) at 501-507; Peschke (1978) at 324-325.