Challenges,Conflicts,and Opportunities

There is perhaps no greater challenge for Catholic bioethics these days than the need to integrate what science is teaching us about Creation (and God) into our understanding of the life of faith. Two events of the past month have brought that challenge—and the conflict it brings—into sharp focus for me.

The first was the controversy over Imane Khelif of Algeria and Lin Yu-ting of Taiwan, who participated in women's boxing during the Paris Olympics despite having failed gender tests in previous competitions. ¹ The other was a report in Nature ² documenting previously unrecognized cognitive activity in otherwise unresponsive patients. Both of these situations challenge Catholic physicians and ethicists to wrestle with new perspectives and new facts, ones that sometimes collide with some established notions about life, God, and relationships.

Perhaps equally as important, they underscore a woeful lack of understanding on the part of many nonmedical people, lay and clerical, about science in general and medicine in particular. Looking at what transpired during the Olympics and what is unfolding now as a result of the Nature report, there are both missed opportunities, which can show us as Catholic physicians how to be more attentive to situations in which we can provide helpful and sometimes healing insights; and opportunities not yet missed, for which we will prepare if we are wise.

Many of those who are most vocal on these issues, publicly and privately, are working from a perspective that is at once too simplistic and badly outdated. Forbes magazine estimated that almost 80% of Americans don’t have sufficient scientific literacy to read the science page of the New York Times ³ ; if the Covid epidemic taught us nothing else, it reinforced that dismal reality.

Catholic physicians can prompt a change in that statistic by being the bearers of essential information, and a reliable resource for consultation, not only for other Catholics but also for the secular world. Doing so requires us to be current, objective, curious, respectful, willing to learn from Creation, and scientifically literate, as well as to cultivate the knack for communicating complicated truths in a way that will be understood, and therefore received, by the less educated hearer. That can be a tall order, but one we can be prepared to accept. Opportunities abound, from letters to the editor to local speaking engagements to assisting in developing curricula and policies for both parochial and public schools.

In the case of the boxing controversy, following reports that Khelif failed gender tests in the past and on the heels of one of her opponents refusing to fight her, outrage abounded over her genotype. If my social media/news feed was any measure, initial reports branded her trans; later reports indicated that she may have a difference of sexual development that could result in her developing phenotypically as a female ⁴ while having an XY genotype. Her exact medical status remains uncertain.

It wasn’t long before pundits exploded with outrage. Their arguments often reflected an incomplete and therefore inadequate understanding of the complexity of human sex as it develops, not to mention being insufficient for sorting out what rules are needed for fairness and safety in a contact sport. Perhaps equally striking was the absence of what might be called Christian charity in the discussions of the situation, as was evident in the comment threads of so many of the social media posts. Mockery, anger, and derision were all too often the order of the day; little attention was paid to the person who, as one commentator put it, was subjected to the debacle of having her “chromosomes and genitals” discussed by all and sundry. Do we Christians not have a better way to approach difficult questions and vulnerable people who are not in our immediate presence?

Thankfully it wasn’t long before less strident articles emerged ⁵ in which the nuances of differences in sexual development were explored with varying degrees of success and cooler heads prevailed. By then, however, the controversy was already ignited and discussion already very heated. Some of these more rational voices were Catholic, many of them were not, but neither bishops nor Catholic medical professionals were prominent among them as far as I could tell. It was a missed opportunity.

Lest one believe that the Olympic boxing brouhaha involves a vanishingly rare abnormality, experience seems to indicate otherwise. While far from common, as we come to understand more about the interplay of genes, hormones, and environment in producing the individual body, we understand more and more how often these “intersex” situations occur. Many of us have personal experience with people whose physical sexual development doesn’t fit quite so neatly into the established male/female binary. I recently had occasion to consult with a counselor assisting a young woman—identified female at birth, confidently raised female all her life—who only found out that she has a difference in sexual development when she underwent a physical as part of an application process for a vocational training program ⁶ . The findings prompted a genetic test, and she was found to have androgen insensitivity syndrome. Her world was turned upside down on the basis of a genetic test that would have been generally unavailable as recently as 100 years ago, when her female identity would never have been questioned. Claims like XY are MALE, period! ring both hollow and hurtful in her hearing and she finds herself confronting cataclysmic changes in her (devoted) Catholic life, which have extended to something of a crisis of faith. Moreover, part of the fallout is that she is ineligible for the female-only program she desired and will also not be accepted by the male-only program; even her livelihood and future are affected.

It is important not to forget that these situations involve real people who are often very attuned to the public discussion and can be terribly hurt by its tone and tenor. To dismiss consideration of their real and often heart-rending situations as “incidental abnormalities,” or “the result of the fall” without addressing the immediate problems that living with a gender-nonconforming body presents is to fail to engage the person as person, and to fail to serve the needs of another. If we do not take a closer look at what we thought we knew, we fail to acknowledge the lessons inherent in the word around us. We fail to respect the dignity of the lives those to whom intersex bodies have been given. We fail to respond to the pain they suffer. And we can thereby foster a climate of discrimination and violence.

Intersex ⁷ individuals do experience an increase in both discrimination and violence compared with the general public. ⁸ The Catechism reminds us ⁹ that we are to stand up against unjust discrimination with respect to our gay brothers and sisters; there is no reason to believe that this prescription applies any less forcefully here.

The Olympic Opening Ceremony controversy elicited comments from all quarters of the Catholic blogosphere, but that there was relative silence on the rash judgment involved in so much commentary regarding these two boxers indicates that we missed another opportunity to demonstrate the respect for human dignity that the Catholic faith requires of us. And because so much of this discussion hinges on an understanding on complicated medical situations, Catholic physicians have an opportunity to witness both to the science and the faith when speaking up. Perhaps we could look for opportunities, small and large, to turn down the heat and provide a little light. We have the tools.

By contrast, the report in Nature provides us with opportunities not yet missed and new questions that must be addressed. If it proves reproducibly true that unresponsive patients still have cognitive faculties, what does that mean for how we manage these patients? It is a given that respect for their dignity means that such new, and in some ways unsettling, information must be integrated into how we both think about and relate to—medically and personally—patients who are no longer able to communicate with us. What is not a given, and what will require thought, investigation, more thought and a lot of conversation, are the answers to questions which bear on treating patients with the dignity due them:

Does respecting the dignity of the person require us to insist on treatment the patient may not have wanted based on their cognitive status?

It is my hope that the pages of The Linacre Quarterly will be a place that such discussion—about the evolving understanding of sex, about the workings of the brain (in many ways), and how they both interplay in medicine and in life—will occur. It is my hope it will be open, honest, respectful, and lively. There's a great deal to tackle and I suspect we have a lot to offer.

The Linacre Quarterly