Don O’Leary, Biomedical Controversies in Catholic Ireland (Eryn Press: Cork, 2020).
Reviewed by Olivia Dee

Don O’Leary writes in his introduction that ‘in states with Catholic majorities, such as the Republic of Ireland, the question arises as to whether or not Catholic moral beliefs should be upheld by state law’(p.x). In this extensive and intricately detailed book, O’Leary explores not only the obvious conflicts between Catholic morality and medical progress, but the nuances within each case study and the complexities of definition and language of reproductive health. Biomedical Controversies in Catholic Ireland is both a fascinating introduction to the subject overall and an examination of the detailed conflicts between Catholic moral thought and the realities of reproductive medicine.

In Chapter One, ‘Papal Pronouncements’, O’Leary establishes useful context for his later case study chapters, analysing the reaction to the Pill from the hierarchy and Humanae Vitae, the, to some, surprising encyclical letter on birth control and abortion. Here he establishes several key concepts that will feature in later chapters that are crucial to understanding the nuances of the relationship between technology and religion. The first of these concepts is O’Leary’s observance that technological progress moves so fast that ethics and moral thinking can rarely keep up, which he argues leads to ‘an ethical vacuum’(p.27). A second key concept was that in relation to sexual intercourse the Roman Catholic Church believed ‘it was morally permissible to assist or enhance the act – but not to replace it’ and that there were inseparable connections between sex and reproduction (p.27). O’Leary emphasises that this applied equally to both contraception and to artificial reproductive technologies. The debate around abortion in Ireland is often heavily publicised, and represents perhaps the most black and white, right and wrong Catholic directive in relation to reproductive medicine. Yet this book makes it clear that all aspects of progressive reproductive medicine present conflicts, and that complex theological debate goes into every Catholic regulation on each new development. Finally, a crucial concept is the position of the foetus in Catholic moral thought vs its status in medicine. An area of bitter debate and a stalwart of modern Catholic theology is the belief that ‘a fertilised egg- a zygote – was to be treated as if it was a person with full human rights’(p.37). It is from this that so many of the conflicts in the book arise, and O’Leary does an excellent job of explaining the difficulty of isolating the exact moment at which life is created: the stages of development, the issue of discarded biological material, and even the ethical dilemma of freezing embryos. 

Chapters 2-10 are studies of different reproductive technologies and procedures which conflict in varying degrees with Catholic moral teaching on birth and pregnancy. This book emphasises the important idea that the decisions of the Catholic hierarchy are not necessarily reflected in the everyday lives of Catholic lay people, and that as medicine develops, Irish Catholics will make decisions about their reproductive health based on ‘the complex interplay between religious faith, rational choices and personal needs’(p.327). In addition, O’Leary underlines that people will leave Catholicism if it doesn’t adapt to consider the evolution of public opinion and the resulting changes in state law. The case studies focus on chronological development and the Catholic response. 

Chapters 2-4 concern embryonic technologies, stem cell research, assisted human reproduction (AHR), frozen embryo and stem cell research, embryos, and the right to life, spanning the time period 2000-2011. These chapters portray the complexity of language and definition in the debate around reproductive rights. These chapters are incredibly dense, but then so is the subject matter, and O’Leary provides both an excellent introduction to the subject, in addition to a much deeper analysis, which is rare. With regards to stem cell research and associated technologies, there is intricate balance between what is and isn’t considered acceptable in Catholic theology, but O’Leary also acknowledges other factors, like the gap between the rich and the poor in accessing these technologies, and the postcode lottery that often goes hand in hand with IVF and other medical treatments. Chapter four is perhaps the most complex of this set of chapters, looking in detail at the concept of ‘right to life’ and the status of embryos inside and outside the womb, but by including case studies like the Roche v Roche case, O’Leary does manage to simply it somewhat.  It is an excellent summation of the subject, especially for those new to the intersection of Catholicism and medicine, and who might find other texts much less accessible. 

Chapters 5 and 6 deal with assisted suicide, and assisted human reproduction (AHR) in more recent years. The former offers an excellent summary of three key arguments against euthanasia, which demonstrates, in context, the conflict between medical possibility and Catholic theology. Similarly, Chapter 6 also demonstrates both the clear cut and the muddier aspects of Catholic perspectives on right and wrong by considering surrogacy, same-sex marriage and AHR, and examining the overall conclusion that there exists, in Catholic moral thought, an ‘ideal’ family. In many ways, progressive reproductive technology allows us to deviate from that ideal, and to the Catholic hierarchy, this renders them unusable and even immoral. 

The final section of the book looks at the subject of abortion. As one of the more publicised political battles in recent history, abortion has consistently been rejected in Catholic morality as an absolute sin, with little of the grey area or nuance that surrounded the previous topics. By examining it through the lens of the recent and successful ‘Repeal the Eighth’ campaign, O’Leary is able to demonstrate his thesis, that state law will evolve with public opinion over religious opinion, even in Catholic majority countries, and that Catholicism in practice is more flexible and accommodating than the directives from the hierarchy and even the pulpits.  

The only area of improvement suggested would have been the addition of more in-depth conclusions at the end of every chapter. The material is so complex that it could have benefitted from designated conclusions at the end of each section in order to ensure that all the key arguments were emphasised and that the author’s final reflections were given adequate space. The complex nature of the subject matter meant I often finished a chapter and had to reread it, for clarity.

Biomedical Controversies in Catholic Ireland is an excellent book, and one that I wish I had had access to sooner, because it delivers a detailed examination of highly complex and emotionally charged subjects in a nuanced and articulate manner, but remains highly accessible. For that reason, it would be an excellent book to include in undergraduate course guides, but would also be crucial reading for PhD’s and beyond. 

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Olivia Dee is a Research Associate in Oral History at Newcastle University on the AHRC-funded Wastes and Strays project. She is an oral historian of gender, women, politics and reproductive rights in C20 England and Northern Ireland. Her publications include The Anti-Abortion Campaign in England 1966-1989 (Routledge, 2019). She has conducted previous oral history research on reproductive rights in England, and worked as a Research Fellow on the Northern Ireland Mother and Baby Home Project at Queen’s University, Belfast.