How to vaccinate like a Catholic

In season 3 of The Good Place, the protagonists discover that no one has actually made it to the good place in roughly 500 years. Initially suspicious that the demons of the bad place have rigged the system, our heroes eventually find the explanation for the problem is actually much less perfidious, though no more comforting. The modern world, it seems, has become so morally complex that virtually every action is morally compromised.

While a medieval European peasant could eat a vegetable without any moral qualms, her modern counterpart doing the same seemingly benign act is caught in a moral web well beyond her own capacity to calculate or even imagine: Where did the seeds come from? Were the workers who planted, tended, and harvested the produce treated justly? What is the carbon footprint of transportation and refrigeration? Does the supermarket chain that sold it provide financial or moral support to unethical causes?

The conceit of the show is the often hilarious, if thoroughly un-Christian, notion that one gets to the good place by achieving a certain point total over the course of one’s earthly life and that every action gains or loses one points. And so, while the medieval peasant might get 20 points for eating a carrot, the modern person ends up losing thousands of points for the same action. A person familiar with Catholic teaching about cooperation with evil could be excused for wanting to shout at their screen: “We know how to do this, people!”

The brilliance of the TV show’s dilemma, however, is that we feel instinctively both that it is wrong to cooperate with evil and that it is profoundly unfair to be judged so harshly for matters over which one has so little control, or even knowledge. What is one to do?

A common knee-jerk response is to suggest that it is simply never morally licit to cooperate with evil and that any moral analysis that purports to demonstrate otherwise is simply a matter of complicity and moral laziness: in short, excuse making. This response has shown itself recently in several popular social media responses to sundry declarations by individual Catholic bishops, the USCCB, various pro-life ethics institutes, and, most recently, the Congregation for the Doctrine of the Faith that the first two vaccines out of the gate, those produced by Pfizer and Moderna, pose no real moral difficulty for Catholics.

The trouble with saying it is never licit to cooperate with evil is that, when you scratch the surface, no one actually believes it. At least, not consistently. Every one of us cooperates with evil every single day. And very few of us lose sleep over it. We cooperate with evil when we shop and when we vote, when we invest, when we watch movies, when we pay taxes, and when we post on social media. We might even cooperate with evil when we recycle!

Should we lose sleep over it? On occasion, yes. But mostly, no. Which is to say, some of these instances of cooperation with evil are not permissible, though the vast majority are.[1] How can we tell the difference? Catholic teaching on this sounds highly technical and abstract, and in a way it is, but it is also little more than a careful and precise spelling out of what most of us already intuitively understand: namely, that it is generally wrong to cooperate with evil, but that certain instances of cooperation under certain circumstances may be justified and even unavoidable.

To begin: there is, according to Catholic teaching, only one category of cooperation with evil that is ever permissible. And even that one, known as “remote material cooperation with evil,” may only be justified by proportionate reasons. If this sounds highly technical, folk wisdom encapsulates the basic premise in the idea of “the lesser of two evils.”

Remote material cooperation with evil has two basic distinguishing features. First, it is material. This means that the cooperating agent does not intend the evil with which they are cooperating. I may vote for someone who will do some evil that I do not intend. Or, I may give someone money, by paying their wage or buying their product or giving alms, without intending the evil they will do with that money. That is material cooperation. But were I to vote for someone who will do some evil that I do support and intend, or give someone money with the intention of him spending it in evil ways, that would be formal cooperation, and that is never permissible.

Second, it is remote. Technically, this means that the cooperation does not lead directly to the perpetration of the evil. If it did, it would be proximate. The lines here are a little fuzzier and ethicists will sometimes disagree about whether a given act of cooperation is remote or proximate. This is because cooperation is not simply remote or proximate, but may be more or less remote (and correspondingly less or more proximate). There is still a hard line on the spectrum to be drawn, but it can require a high degree of expertise to know where to draw it in this or that difficult case. This should not distract us from the fact that, in the vast majority of cases, ethicists agree on whether a given act of cooperation is remote or proximate.

But the fact that remote and proximate cooperation exist on a kind of spectrum (albeit one with a clear dividing line in the middle of it) is very important. It means that acts of cooperation that are technically remote, according to the definition, can still be more or less remote relative to one another. And because remote material cooperation with evil is not necessarily justified, but must be justified by proportionate reasons, just how remote the cooperation is comes in to play. The more remote the cooperation, the lower the bar for proportionate reasons. Less remote cooperation, though still possibly justifiable, needs to clear a higher bar.

Which brings us to the first two vaccines which have been shown to be safe and effective in Phase 3 trials, which have received regulatory approval in an increasing number of jurisdictions, which have begun to be distributed and administered, and the use of which is considered by the overwhelming majority of Catholic ethicists and bishops to be clearly and easily justifiable. How was this assessment made?

It is emphatically not the case, as many who reject the Church’s position have falsely claimed, that Church teaching allows for vaccines that use “aborted fetal cells” in testing but not in production. Such false framing—sometimes innocently, sometimes intentionally—makes Church teaching look arbitrary and inconsistent. But, aside from the fact that terms like “aborted fetal cells” are misleading (a point to which we shall return), it must be said that, according to Church teaching, both types of vaccines constitute remote material cooperation with evil.

That is to say, the use of either kind of vaccine could be justified, given proportionate reasons. In fact, the CDF’s recent Note on the morality of using some anti-Covid-19 vaccines does not even distinguish between the two, saying simply that:

There is a distinction to be made, though. But the salient point is not that testing is OK and production is not, but that testing is a more remote form of cooperation with evil than production is. Testing sets the bar lower in terms of the proportionate reasons necessary to justify use. But, as the CDF’s response makes clear, a worldwide pandemic killing nearly two million people and counting, and making tens of millions more extremely sick, also justifies the use of vaccines that had recourse to cell lines derived from fetal tissue in production.

But let me add one caveat. The existence and availability of safe and effective vaccines that are less morally problematic—i.e., those that used the compromised cell lines only in testing—raises the ethical bar for other vaccines. In other words, the proportionate reasons needed for using less ethical alternatives are correspondingly greater when more ethical options exist. And so, given the opportunity to choose (though let us remember it is often the poor who have the least freedom here), one should opt for the less compromised option. While they are not quite “ethically irreproachable,” Catholics should actually be very grateful that the first vaccines out of the gate are much less problematic than they might have been.

But just how compromised are they? That is to say, just how remote is the remote cooperation with evil in question? Catholic ethicist and Legionary priest Matthew Schneider writes that:

Note that the first two steps he mentions would also apply to vaccines that use these cell lines in production. It is steps three and four that distinguish the two.

All of this should help us understand why the CDF can say that these vaccines “can be used in good conscience with the certain knowledge that the use of such vaccines does not constitute formal cooperation with the abortion from which the cells used in production of the vaccines derive” (§3). It is not that there is no level of cooperation with evil. It is that the very remote degree of what the CDF calls in this case “passive material cooperation” (§3) makes, as Fr. Schneider argues, receiving the vaccine a more remote cooperation with evil than buying products from companies that donate to Planned Parenthood, but with a much greater proportionate reason.

When we understand both the actual scientific processes in question (very poorly represented by exaggerated and inflammatory phrases like “made with the body parts of aborted babies”) and the ethical framework the Church uses to assess such matters, it becomes clear why the chorus of those with the relevant expertise is so unanimous. The degree of remoteness is so great, and the proportionate reason bar so correspondingly low, that it would be easily cleared by diseases much less devastating than COVID-19.

Nevertheless, it is certainly the case that there is great potential for misunderstanding here, and on several points. And it is incumbent upon those with the authority and expertise to teach to offer as much clarity on such points as possible. Let us explore these dangers of misunderstanding in turn.

Some Catholics have expressed the concern that Church approval of these vaccines, even if the moral calculus is granted, may have the unintended effect of giving the impression that abortion is not really as gravely immoral as the Church has always maintained. They are not wrong. This is why the CDF was careful to teach that, “in fact, the licit use of such vaccines does not and should not in any way imply that there is a moral endorsement of the use of cell lines proceeding from aborted fetuses” (§4).

There are those who imagine that the Church has had to fudge on its convictions about abortion to come to the politically necessary conclusion that these vaccines are acceptable. It is, perhaps, telling that this group includes folks who think it is good that the Church has fudged, and others who think it an abomination. This oddly constituted group certainly does need to hear—for a variety of reasons, given their differences—that the Church continues to teach what it has always taught about abortion and that the approval of these vaccines is perfectly consistent with the Church’s tradition of ethical reflection on these questions.

The great irony here is that the language preferred by those expressing concern that vaccine approvals mean the Church has abandoned its defense of the unborn often contributes to the very problem they rightly perceive. Because they tend to be skeptical of these vaccines in the first place, they are tempted to use graphic language in their descriptions of vaccine testing and production to make the cooperation seem much more proximate than it really is, maybe even technically proximate and therefore impermissible.

But talk of vaccines made out of body parts or of the presence of the DNA of aborted children (an impossibility with mRNA vaccines, which contain no DNA whatsoever) paradoxically makes it sound like Church approval of these vaccines actually does ignore the seriousness of abortion. We cannot disavow the results of sound ethical reasoning because of any dangers attendant on the misunderstanding of that reasoning. But we must be very cautious in how we communicate about the issue. What is most needed to mitigate the impression that the Church is neglecting its duty to speak on behalf of the unborn is not dishonest and inflammatory language, but, rather, clear, measured, and precise language. Those who choose overwrought and inaccurate rhetoric in their attempts to emphasize the gravity of abortion are contributing to the confusion they are ostensibly trying to clear up.

Another concern that has been expressed is that Church approval of these first two vaccines, however technically correct, is imprudent because it will dissuade scientists and governments from the research and development necessary to develop truly uncompromised vaccines. Such voices suggest that what is needed from the Church now is not the approval of imperfect vaccines, but loud calls for ethical ones.

It is certainly the case that the Church must continue to lead the world in the call for ethical vaccines. And the CDF’s Note does just this, stating, “both pharmaceutical companies and governmental health agencies are therefore encouraged to produce, approve, distribute and offer ethically acceptable vaccines that do not create problems of conscience for either health care providers or the people to be vaccinated” (§4).

But the suggestion that approval take a back seat to such exhortation fails largely due to impracticality. In the first instance, the Church cannot simply abandon its duty to speak about the permissibility of receiving the only two safe, effective, and available vaccines in the midst of a worldwide pandemic. That would constitute an inexcusable dereliction of duty.

Second, this objection ignores the timeline for vaccine development. The fact is that dozens of vaccines are currently under development, many of which have not had recourse to compromised cell lines in testing or production. This is in significant part due to the Church’s and its allies’ consistent teaching and advocacy on this issue over decades. These vaccine developers are not going to stop their work now because the Church has said that use of the first two vaccines is justified. Nor will such approval lead governments to reject any of these vaccines, should they prove safe and effective. Let us all, by all means, pray for the success of these vaccines and promote them vigorously should they succeed, but let us not perpetuate the suffering and death brought by this pandemic by refusing to approve vaccines whose use is clearly justified.

The recent Note of the Congregation for the Doctrine of the Faith on this matter is clear that Catholics may refuse these, or any other vaccines, for reasons of conscience.[2] That something is permissible does not make it mandatory. That said, the Congregation does remind us that we remain responsible for one another and that those declining vaccination should take their responsibility to protect the vulnerable in their communities by their other actions very seriously.

So, no, refusal of these vaccines for reasons of conscience is not dissent. But, while refusing vaccination is not dissent, teaching that other Catholics must refuse vaccination is. In fact, it is more than dissent, which is not itself sinful; it is causing scandal, which certainly is.

When one finds one’s conscience unswayed by Church teaching, this is not sinful, but it comes with certain obligations. Even if we cannot will ourselves to believe things that we do not believe or find arguments that do not compel us compelling (just try it), we must sincerely attempt to understand Church teaching and keep open the possibility of learning something that will change our mind. This entails an open and curious spirit, not a querulous and combative one. Moreover, we must not use our platforms to bring Church teaching into disrepute, let alone to misrepresent it to others, but rather humbly and discreetly seek clarification and understanding. It is just possible that our own honest questions may help the Church to learn something, but it is much more likely that it is we who have something to learn.

To publicly denounce or reject Church teaching, whether by misrepresenting it, dismissing it, mocking it or its representatives, or teaching others they cannot follow it, is to cause scandal, to damage the unity of Christ’s body, and to compromise the mission of the Church in the world. It is, in short, deadly serious. And there are not a few Catholic social media personalities who should undertake a serious examination of conscience in this respect post haste.

It is worth noting that the vast majority of our moral calculation on this question is on the “how remote is the cooperation” side of the equation. This seems reasonable when we consider that the population is much more familiar with the devastation wrought by COVID than with the degrees of remoteness involved in vaccine testing and production. But it is important to recognize that a moral calculation also needs to happen on the “proportionate reasons” side of the equation.

While it may seem that it should suffice to say “worldwide pandemic,” and move on, it is important to recognize that many people with questions about Church teaching on this matter are not convinced of the gravity of the pandemic. This generally takes the form of highlighting the relatively low death rates of COVID-19 for young and healthy segments of the population.

But the death rate is not a good proxy for the seriousness of the pandemic for at least two reasons. First, many more people get very sick than die, and many of those who get sick face long-term complications that we are only beginning to understand. The impact of the virus is far beyond the death count. We get flu shots because being laid low by the flu for a week is a huge difficulty for many of us, in addition to being a grave threat to a few of us. A disease does not need to kill to have a major negative impact. Even in terms of the economic impact of hospitalization, missed work, and other kinds of collateral damage, COVID-19 is a very serious disease for many many people, even if others are asymptomatic.

Second, there is an epidemiological paradox in the fact that the low death rates for COVID are a big part of what makes the disease so deadly. Viruses with very high death rates generally burn out before they conquer the globe. It is precisely COVID’s low death rate among the young, healthy, and mobile that has led to its dramatic spread and therefore to its enormous death count. And the fact that it has managed to reach this count in the face of massive social mobilization to limit that spread tells us just how deadly this virus is.

Moreover, however low the death rate is for many of us, it is quite high for some of us. The easiest, and perhaps the only, way to really protect the most vulnerable is to drive the prevalence of the virus in the general population down dramatically. There is no way to do that without vaccines.

Lastly, the fact that the most widespread current version of the COVID virus has a low death rate does not guarantee that every future version will. The sheer number of individual viruses in the world means that mutations are happening constantly, and, as our newsfeeds indicate, more and more of the mutants are successful enough to survive and reproduce. And with every successful mutation comes the possibility of a deadlier version of the virus, or one on which our vaccines are less effective. Driving down the prevalence of the virus in the general population with vaccines is not only the best way to protect the vulnerable. It is also our best bet against subsequent waves of a more virulent COVID.

A final concern registered by those hesitant to accept Church approval of these vaccines is that teaching that the use of these vaccines is justified ends up appearing to justify abortion. The CDF’s Note responds to this concern as well:

Here is a place where we need to be extremely precise in our language. We must only and ever say that the use of the vaccine is justified, never that the abortion is justified. In fact, the only reason the use of these vaccines even needs justifying in the first place is because abortion is never justified. And, indeed, the same applies to the use of the compromised cell lines in development or production. If the use of these cell lines were justified, there would be no need to justify the use of the vaccines produced with them.

Think of it as a chain: if the abortion was justified, then the testing (or production) needs no justification and neither does using the vaccine. But if we posit that abortion is never justified, but that the testing is justified, we still do not need to justify the use of the vaccine. The use of the vaccine only needs justifying because the means of abortion and the use of cell lines derived from the bodies of unborn children are never justified by the ends to which they are put, no matter how good.

Continue reading here: Church Life Journal ( University of Notre Dame)