viva Vox Dei Sunday, April 04, 2021 Is Receiving Covid-19 Vaccines Derived from Aborted Fetal Cell-lines Morally Acceptable? A Coda to My Reply to Mohler. Pre-amble I am ardently pro-life. But as a medical professional in clinical practice and as an average Singaporean, I find it difficult to avoid aborted fetal cell-line-derived products, especially vaccines (both childhood and adult ones). For example, the MMR vaccine is in the national vaccination schedule and it is a requirement for all Singaporean children to take it prior to primary school admission. There are, unfortunately, no ethical alternatives for the MMR vaccine. In fact, many of our food additives, processed food, chewing gum, cosmetics, perfumes, even certain coffee creamers were produced with the usage of such cell lines at least in the research or testing phase. The less reflective person might consider that problems regarding cooperation with evil can - and perhaps should - be avoided by altogether avoiding cooperation. That, however, is virtually impossible and sometimes inconsistent with doing one’s duty. The average Sheng Siong employee materially cooperates with gluttonous eating, SingPost employees with the use of pornography, and so on; and in many cases, such people need their jobs to support themselves and their families. Within a sinful and fallen world, cooperation occurs even without our knowledge or choice. A doctor performing a health screening for a man wouldn't have realized that this person, albeit with a clean bill of health, would thereafter convince himself that he is healthy enough to father a child with his adulterous partner. The hardware shop owner would never have guessed that the tools he sold would be used for crimes. The little boy buying a toy from Toys-R-Us would not have known that the company that manufactures the toy funds abortionists. And the list can go on and on. That said, I am generally against the usage of any medical product that is unethically derived. This includes Covid-19 vaccines that were developed with aborted fetal cell lines, Genetech's Pulmozyme for cystic fibrosis, Amgen's Enbrel for Rheumatoid Arthritis, and Crucell's in-development Ebola vaccine - which by the way has no alternative product for replacement. On the flip side, I am not saying that a father treating his child with Pulmozyme for cystic fibrosis should stop using the product or be guilty of sin. Nor am I saying that despite all risk-benefit ratios, usage of such tainted products constitutes sin. This is a highly complex ethical matter, and all types of usages of fetal cell-line-derived products are not equal or similar in moral culpability. I can avoid or choose another soda if I know that one is tainted or tested with such cell lines. But when it comes to medical treatment, things can get emotionally charged as sometimes lives are at stake. In the current Covid-19 vaccine controversy, the moral implications of the remoteness of the original intrinsically evil act and the issue of duress must be taken into account. The following is just another perspective of the issue at hand. I am fully aware that many ethicists view the usage of vaccines tested with such cell lines as remote and mediate material cooperation. I believe that whatever convictions are held by Christians - be it mediate or immediate material cooperation - we can move away from products tested with such cell lines in order to discourage the future manufacturing of similar products and to encourage more ethical and less suspicious means of production. The Issue at Hand I have previously written a reply to Albert Mohler’s opinion piece on the SARS-CoV-2 vaccine. Both Dr Mohler and several other evangelical and Reformed pastors will likely argue that, as a recipient of the Covid-19 vaccine, the recipient’s act of being vaccinated with aborted fetal cell-lines-derived vaccines is regarded as mediate and remote material cooperation with the original intrinsically evil act of abortion. Therefore, it is morally acceptable for us to use such vaccines. In the pastoral letter by the Catholic Archbishop of Singapore where he encouraged “all the faithful to get vaccinated for the greater good of the community,” he likewise stated that “the connection of today’s [SARS-CoV-2] vaccines to the original abortions is fairly remote.” Again, in his letter , he wrote that the recipient’s “connection with the past wrongdoing of abortion is so distant that it is morally acceptable for us to use such vaccines if no other ethically-obtained vaccines are available, and if we have sufficiently serious or grave reasons.” Here, the word "distant" should refer to the concept of "remoteness" as well. But what is this concept of remoteness within the context of mediate material cooperation? In proximate mediate material cooperation, there is little causal distance from the immoral action, as when a pharmacy technician delivers the abortion pill, RU-486, to a patient’s room. In remote mediate material cooperation, there is significant causal distance from the immoral action, as when a janitor cleans the laboratory where he knows that in vitro fertilization takes place. Hence, with regard to proximity and remoteness in cooperation, we are more concerned with the moral concept of causal distance rather than the time of the original acts of intrinsic evil – in this case, the actual abortions. If we only consider the original intrinsically evil act of abortion of the fetuses where the cell-lines were derived, it is difficult to see why some of us are intuitively uncomfortable with the usage of aborted fetal cell-lines-derived vaccines. We may perhaps only consider the possibility of scandal. However, in order to produce viable fetal cell-lines, fetal cadavers, tissues, or body parts have to be obtained. Let us now consider the act of procurement of these fetal cadavers, body parts, and tissues . According to the 3 fonts of morality, this act has: 1) Evil intention – The purpose or intended goal of this act is likely to be that of financial expediency through scientific research using fetal body parts and tissues, and the production of viable and lucrative cell-lines. The agent of this act is at the very least implicitly agreeing that the act of abortion is beneficial for his own purpose – that of procuring fetal cadavers and body parts, and subsequent profits from appropriate research and development. This intention is evil because the procurement of fetal parts generates a market for abortionists to sell the cadavers of aborted babies, and finances the abortionists. It provides an attractive incentive for abortionists to perpetuate abortion as the medical procedure itself is not only profitable from the perspective of a medical service provider, but also highly lucrative from the perspective of a fetal body-parts supplier. 2) Evil moral object - Formal cooperation occurs when the act of the cooperator has the moral object of assisting the principal agent in attaining the moral object of his intrinsically evil act. By providing a profitable market for the sale of fetal cadavers for abortionists, and the further motivation for abortionists to deliver their abortion services and to subsequently sell fetal body tissues to the relevant buyers, the procurer of fetal tissue is either in:I. Explicit or at least implicit formal cooperation with the intrinsically evil act of abortion or,II. Immediate material cooperation because either a. the moral object of the act of procurement assists the principal agent in achieving the moral object of his act of abortion or, b. the consequences (hence, circumstance) of the act of procurement assists the principal agent in achieving the consequences of his evil act. Immediate material cooperation is an intrinsically evil act and many theologians would agree that it is morally equivalent to implicit formal cooperation. Either way, the procurement of fetal cadavers and tissues is an intrinsically evil act. 3) Evil circumstance - The act of procurement provides the motivation and the market for the sales of fetal products derived from abortions. In other words, this act of procurement fails on all three fonts of morality . Discussion It is notable that even the Catholic Archbishop of Singapore acknowledges that “the original production of these cell-lines involved a grave moral wrongdoing.” As explained above, the act of procurement of these fetal cadavers, body parts and tissues is an intrinsically evil act. If we support this act of fetal tissue procurement by indiscreetly using vaccines developed from fetal cell-lines thereby providing the market for and supporting the purpose or consequence of the original intrinsically evil act of fetal tissue procurement, we are not merely culpable of mediate material cooperation - which can always be argued as being remote and having proportionately serious reasons for the cooperation while avoiding the danger of scandal. With full informed consent and knowledge, we might be at least guilty of immediate material cooperation because the available market for such products is essential for the original intrinsically evil act of procurement of fetal parts to take place. Without this financial incentive and market for sales of developed products, there is no longer intent for the original procurement act. This lack of market and buyers deters and discourages the consequences (or circumstance) of the original intrinsically evil act of the procuring agent. With this said, we must also recognize that the act of immediate material cooperation (i.e. furnishing a market for the original intrinsically evil act) becomes complicated with the problem of duress . There has been in the Christian tradition a debate about the permissibility of immediate cooperation in immoral acts under "duress." Duress may alter the moral species of certain cooperative acts. When duress restricts the cooperator's autonomy, it reduces his culpability. When individuals are forced under duress (e.g. at gunpoint, threats of loss of job, loss of basic human rights and freedoms etc) to cooperate in the intrinsically evil action of another, they act with diminished freedom. Here, the matter of their action remains objectively evil, but they do not intend this object with true freedom. In such cases, the matter remains objectively evil as such, but the subjective culpability of the cooperator is diminished. The more the duress, the lesser the moral culpability of the cooperator. In our current discussion on the cooperator's contribution to the market which encourages the fetal parts procurement industry to continue and flourish, some may argue that the cooperator's act of receiving the vaccine propagates the market that allows such an illicit industry to continue. In this sense, the consequences of the cooperator's act contribute essentially to the principal agent's attainment of the consequences of his intrinsically evil act (i.e. that of fetal parts procurement). But we understand that the cooperator, under duress of loss of his livelihood and basic human rights, isn't cooperating with the fetal parts procurement industry so much as preserving his own livelihood and freedom. The cooperator under duress is confronted with a different and possibly greater evil than the procurement of fetal parts - that of loss of his job, freedom, and rights. Many Christian ethicists have argued that immediate material cooperation is excusable if it is commissioned under threat of greater harm than that threatening the so-called third party. The moral reasoning here is fairly straightforward: the "threat of greater harm or evil" often furnishes the cooperator with a legitimate moral object - and in the current issue at hand, that of self-preservation. The procurement of dead baby parts is morally repugnant, but the loss of one's livelihood, freedom, and rights is arguably a greater evil especially when the consequences of such a loss are tied to the loss of income, sustenance, and freedom for the cooperator's entire family. So when the cooperator is coerced into taking the vaccine, the moral object of his action is not that of assisting the fetal parts procurement industry; the moral object of his cooperative act is that of self-preservation and the preservation of his family. Another example of duress would be this: a military platoon commander is captured together with his platoon. The enemy demands that he kill his platoon sergeant with the threat that the entire platoon would be executed if he fails to do so. Under duress, the platoon commander pulls the trigger and kills the sergeant. He is morally culpable for the killing of the sergeant, but his culpability is significantly reduced, and within the court of law, his crime would likely be that of manslaughter instead of murder. Should we disagree with some of our brothers that this act of cooperation is merely mediate material cooperat