While the Church takes clear-cut positions on a number of moral issues, such as the moment when life begins, and that intentional abortion is wrong, there are many grey areas where Christians must take decisions based on the scientific information available and their own ‘formed’ consciences.

This was one of the points stressed by Fr Martin Cilia, director of the Missionary Society of St Paul’s Birkirkara oratory, during a recent MSSP course entitled ‘Life: from conception to death’. Medical science in the past few decades has been advancing exponentially but Church teaching on the many ethical dilemmas raised by these advances is struggling to keep up, he said, adding however, that not everything that was scientifically possible was morally acceptable.

The medical possibilities and resulting moral complexities are immense. For example, on average between 10 to 15 per cent of couples are sterile, so there is a growing demand for in-vitro fertilisation (IVF), intra-uterine insemination (IUI) or intra-cytoplasmic sperm injection (ICSI). But each method offers couples not only a potential solution but also varying risks of children with birth defects, and in some cases, the possibility of unutilised embryos having to be discarded or frozen.

Moreover, procreation was now be­coming a business whereby it is possible to buy human eggs and sperm from different donors and rent the womb of a surrogate mother to bear a child for an infertile hetero­sexual or even gay couples.

Christians are also faced with moral dilemmas when they themselves or their loved ones approach the end of their life, when due to illness or old age the quality of their life deteriorates to such an extent that it hardly seems worthwhile prolonging life using expensive, modern medical care. Hence the rising demand for active or passive euthanasia and assisted suicide.

Fr Cilia said the Church’s moral teaching was constantly evolving, albeit slowly. Up to the 1960s the Church’s view was that the sole purpose of the act of sex, even in marriage, was to create children. But realising that many Christians were no longer adhering to this teaching, Pope Paul VI set up a commission of experts to advise him on the matter. Whereas the majority of the experts had recommended that the use of artificial contraceptives could be accep­table, the Pope agreed with the contrary views expressed in the minority report by four members of the commission. Subse­quently, in 1968, he issued the encyclical Humanae Vitae – on which the official Church position regarding married love, responsible parenthood and artificial contraception is still very much based.

In 1987 the Church’s position on bio­medical issues – Donum Vitae – the Church’s “instruction on respect for human life in its origin and on the dignity of pro­creation” – was issued. This was subse­quently updated in 2008, with the instruction Dignitas Personae.

One should not expect the Church to give ready-made answers to the complex realities of life

Fr Cilia said that while these official Church documents were widely seen as adopting rigid positions that upheld certain principles, the latter should be viewed as starting points; in real life, each situation was different and rather than being black or white there were many grey areas regarding ethics and morality on which even theologians – after entering into dialogue with doctors – will arrive at different, more flexible conclusions.

Fr Cilia said this is why in Amoris Laetitia, Pope Francis’ apostolic exhortation issued earlier this year following the Synods on the Family, stresses that one should not expect the Church to give ready-made answers to the complex realities of life but should adopt a more personalistic view. This is where moral principles and ethical decisions are focused on the human person/s involved, taking into consideration their specific realities and special cases.

Fr Emmanuel Agius, a bioethics expert and dean of the University’s Faculty of Theology, attended the final session of the course to answer participants’ questions.

Two teachers asked him what advice they should give to their secondary students, some of whom were sexually active. Fr Agius admitted that most teenagers may not be impressed by the usual arguments against engaging in premarital sex, and that in such situations it was morally justified to choose the lesser evil, such as the use of condoms, to prevent the spread of disease and avoid unwanted pregnancies. This was a similar rationale, he noted, to the free distribution of clean needles to drug addicts – the motivation was not to promote drug addiction but to preserve life.

But he echoed Pope Francis’s advice that in this day and age, priests should not be prescribing solutions applicable to every­one, but should offer personalised advice tailored to the individual, just as doctors are nowa­days increasingly able to offer their patients personalised medicine to treat their ailments based on in-depth knowledge of their patients’ condition and biological makeup.

Questioned about the Church’s position on same-sex couples and their adoption of children, Fr Agius said it was a positive step to introduce civil unions to recognise LGBT couples and to ensure they are not dis­criminated against. However, regarding gay couples adopting children Fr Agius said empirical studies on this subject were looking at the effect gay adoption has had on children, as it was too early to see what effect it has when these children were themselves adults. He said wherever there is doubt about what effect something might have on society he preferred to adopt the precautionary principle. If in future it results that gay adoption of children has no adverse effects on them when they grow up to be adults one should have no problem with it.

Regarding IVF, Fr Agius said that besides being guided by the Church’s official position on the subject, couples should also seek advice from their spiritual counsellor, but it should always remain their decision. He said when couples who sought his advice did not accept it he did not condemn them but continued to accompany them to enlighten their conscience just as a friend would.

He commented that the pastoral letter that the Maltese bishops had issued in 2012 re­garding this subject should have been less categorical and should not have called for parents of children born of IVF “to seek the road to self-reconciliation, in line with their call and mission as parents”.

Answering a pharmacist who asked about his views on the morning-after pill, Fr Agius said there were two types of such pill, with Ella 1 suspected to be more likely to be abortifacient. He said pharmacists have a right to refuse to dispense it.

“We should be educating people not on how to resolve ‘emergencies’ in life but teaching them values to guide them to live ‘normally’, he said.

In reply to a question regarding a particular end-of-life issue, Fr Agius said that one had to ask – is the medical intervention a cure or care, an ordinary or extraordinary treatment?

In cases where people are in a pure ‘persistent vegetative state’ he said there was consensus between theologians and doctors that if the food passed through a pipe into the patient’s stomach was not being absorbed, the patient should not continue to be fed and should be allowed to die so as not to prolong their suffering; however, if such patients were still able to communicate one should always respect their decision whether or not to refuse treatment.

The course was perhaps a most fitting concluding message of the Year of Mercy that in the fine balance between points of principle and people, and especially the penitent, the latter always has the upper hand in the eyes of the mother Church.