Charter for Health Care Workers
Pontifical Council for Pastoral Assistance to Health Care Workers
In 2017 the Charter was superseded by the New Charter for Health Care Workers
35. "From the time that the ovum is fertilized, a life is begun which is
neither that of the father nor of the mother; it is rather the life of a new
human being with its own growth. It would never be made human if it were not
human already.... Right from the fertilization the adventure of a new life
begins, and each of its capacities requires time-a rather lengthy time-to
find its place and to be in a position to act."[87]
Recent advances in human biology have come to prove that "in the zygote
arising from fertilization, the biological identity of a new human
individual is already present."[88]
It is the individuality proper to an autonomous being, intrinsically
determined, developing in gradual continuity.
Biological individuality, and therefore the personal nature of the zygote
is such from conception. "How can anyone think that even a single moment of
this marvelous process of the unfolding of life could be separated from the
wise and loving work of the Creator, and left prey to human caprice?"[89]
As a result, it is erroneous and mistaken to speak of a pre-embryo, if by
this is meant a stage or condition of pre-human life of the conceived human
being.[90]
36. Prenatal life is fully human in every phase of its development. Hence
health care workers owe it the same respect, the same protection and the
same care as that given to a human person.
Gynecologists and obstetricians especially "must keep a careful watch
over the wonderful and mysterious process of generation taking place in the
maternal womb, to ensure its normal development and successful outcome with
the birth of the new child."[91]
37. The birth of a child is an important and significant stage in the
development begun at conception. It is not a "leap" in quality or a new
beginning, but a stage, with no break in continuity, of the same process.
Childbirth is the passage from maternal gestation to physiological autonomy
of life.
Once born, the child can live in physiological independence of the mother
and can enter a new relationship with the external world.
It may happen, in the case of premature birth, that this independence is
not fully reached. In this case health care workers are obliged to assist
the newborn child, making available to it all the conditions necessary for
attaining this independence.
If, despite every effort, the life of the child is at serious risk,
health care workers should see to the child's baptism according to the
conditions provided by the Church. If an ordinary minister of the sacrament
is unavailable-a priest or a deacon-the health care worker has the faculty
to confer it.[92]
38. The respect, protection and care proper to human life derives from
its singular dignity. "In the whole of visible creation it (human life) has
a unique value." "The human being, in fact, is the 'only creature that God
has wanted for its own sake. Everything is created for humans. The human
being
[93] alone, created in the image and likeness of God (cf. Gen
1:26-27) is not and cannot be for any other or others but for God alone, and
this is why he exists. The human being alone is a person: he has the dignity
of a subject and is of value in himself."[94]
39. Human life is irreducibly both corporeal and spiritual. "By virtue of
its substantial union with a spiritual soul, the human body cannot be
considered merely an amalgam of tissues, organs and functions, nor can it be
measured by the same standards as the body of animals, but it is a
constitutive part of the person who by means of it manifests himself and
acts."[95]
"Every human person, in his unrepeatable uniqueness, is made up not only of
spirit but also of a body, so that in the body and through it the person is
reached in his concrete reality."[96]
40. Every intervention on the human body "touches not only the tissues,
the organs and their functions, but involves also at various levels the
person himself."[97]
Health-care must never lose sight of "the profound unity of the human
being, in the obvious interaction of all his corporal functions, but also in
the unity of his corporal, affective, intellectual and spiritual
dimensions." One cannot isolate "the technical problem posed by the
treatment of a particular illness from the care that should be given to the
person of the patient in all his dimensions. It is well to bear this in
mind, particularly at a time when medical science is tending towards
specialization in every discipline."[98]
41. Revealing the person,[99]
the body, in its biological make-up and dynamic, is the foundation and
source of moral accountability. What is and what happens biologically is not
neutral. On the contrary it has ethical relevance: it is the
indicative-imperative for action.[100]
The body is a properly personal reality, the sign and place of relations
with others, with God and with the world.[101]
One cannot prescind from the body and make the psyche the criterion and
source of morality: subjective feelings and desires cannot replace or ignore
objective corporal conditions. The tendency to give the former pride of
place over the latter is the basis for contemporary psychologization of
ethics and law, which makes individual wishes (and technical possibilities)
the arbiter of the lawfulness of behavior and of interventions on life.
The health care worker cannot neglect the corporeal truth of the person
and be willing to satisfy desires, whether subjectively expressed or legally
codified, at variance with the objective truth of life.
42. "The inviolability of the person, a reflection of the absolute
inviolability of God himself, has its first and fundamental expression in
the inviolability of human life."[102]
"The question: 'What have you done?' (Gen 4:10), which God addresses to Cain
after he has killed his brother Abel, interprets the experience of every
person: in the depths of his conscience, man is always reminded of the
inviolability of life-his own life and that of others-as something which
does not belong to him, because it is the property and gift of God the
Creator and Father."[103]
The body, indivisibly with the spirit, shares in the dignity and human
worth of the person: body-subject not body-object, and as such is
indisposable and inviolable.[104]The
body cannot be treated as a belonging. It cannot be dealt with as a thing or
an object of which one is the owner and arbiter.
Every abusive intervention on the body is an insult to the dignity of the
person and thus to God who is its only and absolute Lord: "The human being
is not master of his own life: he receives it in order to use it, he is not
the proprietor but the administrator, because God alone is Lord of life."[105]
43. The fact that life belongs to God and not to the human being[106]
gives it that sacred character[107]
which produces an attitude of profound respect: "a direct consequence of the
divine origin of life is its indisposability, its untouchability, that is,
its sacredness."[108]
Indisposable and untouchable because sacred: it is "a natural sacredness,
which every right reason can recognize, even apart from religious faith."[109]
Medical health activity is above all a vigilant and protective service to
this sacredness: a profession which defends the non-instrumental value of
this good "in itself"-that is, not relative to another or others but to God
alone-which human life is.[110]"Man's
life comes from God; it is his gift, his image and imprint, a sharing in his
breath of life. God therefore is the sole Lord of this life: man cannot do
with it as he wills."[111]
44. This must be affirmed with particular rigor and received with
vigilant awareness at a time of invasive development in biomedical
technology, where the risk of abusive manipulation of human life is
increasing. The techniques in themselves are not the problem, but rather
their presumed ethical neutrality. Not everything which is technically
possible can be considered morally admissible.
Technical possibilities must be measured against ethical lawfulness,
which establishes their human compatibility, that is, their effective
employment in the protection of and respect for the dignity of the human
person.[112]
45. Science and technology "cannot by themselves give the meaning of
human existence and progress. Since they are ordained for the human being
from whom they receive their origin and increase, it is from the person and
his moral values that they draw direction for their finality and awareness
of their limits."[113]
This is why science and wisdom should go hand in hand. Science and
technology are extremist, that is, they are constantly expanding their
frontiers. Wisdom and conscience trace out for them the impassable limits of
the human.[114]
46. The divine lordship of life is the foundation and guarantee of the
right to life, which is not, however, a power over life.[115]
Rather, it is the right to live with human dignity,[116]
as well as being guaranteed and protected in this fundamental, primal and
unsuppressible good which is the root and condition of every other
good-right of the person.[117]
"The subject of this right is the human being in every phase of his
development, from conception to natural death; and in every condition,
either health or sickness, perfection or handicap, wealth or paupery "[118]
47. The right to life poses a two-fold question for the health care
worker. First of all, he must not think that he has a right-power over the
life he is caring for, something which neither he nor the patient himself
has. and therefore cannot be given by the latter.[119]
The right of the patient is not one of ownership nor absolute, but it is
bound up with and limited by the finality established by nature.[120]
"No one...can arbitrarily choose whether to live or die; the absolute master
of such a decision is the Creator alone, in whom 'we live and move and have
our being"' (Acts 17:28).[121]
Here-on the limits themselves of the right of the subject to dispose of
his own life-"arises the moral limit of the action of the doctor who acts
with the consent of the patient."[122]
48. Secondly, the health care worker effectively guarantees this right:
"the intrinsic finality" of his profession "is the affirmation of the right
of the human being to his life and his dignity."[123]
He fulfills it by assuming the corresponding duty of preventive and
therapeutic care of the health,[124]
and of the improvement, within the ambit and with the means at his disposal,
of the quality of life of the persons and their life environment.[125]
"On our journey we are guided and sustained by the law of love: a love which
has as its source and model the Son of God made man, who 'by dying gave life
to the world."[126]
49. The fundamental and primary right of every human being to life, which
is particularized as the right to protection of health, subordinates the
trade union rights of health care workers.
This means that any just claims of health workers must be processed while
safeguarding the right of the patient to due care, because of its
indispensability. Hence, if there is a strike, essential and urgent
medical-hospital services for the safeguarding of health should be provided
for-even by means of appropriate legal measures.
50. Safeguarding health commits the health care worker particularly in
the area of prevention. Prevention is better than cure, both because it
spares the person the discomfort and suffering from the illness, and because
it spares society the costs, and not only economic costs, of treatment.
51. Medical prevention, properly so called, which consists in
administering particular medicines, vaccination, screening tests to
ascertain predispositions, in prescribing behavior and habits to prevent the
occurrence, the spread and the worsening of the illness, essentially belongs
to health care workers. This might be for all the members of a society, for
groups of people or for individuals.
52. There is also medical prevention in the wider sense of the term, in
which the work of the health care worker is but a part of the preventive
commitment set in motion by society. This is the type of prevention used in
cases of so-called social illnesses, such as drug-dependency, alcoholism,
tobacco addiction, AIDS; of the problems of social sectors of individuals
such as adolescents, the handicapped, the aged; of risks to health tied up
with the conditions and ways of living nowadays, such as in food, the
environment, the work-place, sports, urban traffic, the use of
transportation means, of machines and domestic electrical appliances.
In these cases preventive intervention is the primary and most effective
remedy, if not, indeed, the only possible one. But it needs a concerted
effort from all sectors of a society. Prevention in this case is more than a
medical-health action. It involves a sensitizing of the culture, through a
recovery of forgotten values and education in them, to a more sober and
integral concept of life, information about risky habits, the formation of a
political consensus for supporting laws.
The effective and efficacious possibility of prevention is linked not
only, nor primarily, to the techniques adopted, but to the reasons behind it
and to their being made concrete and made known in that culture.
53. Although it shares in the transcendent value of the person, corporeal
life, of its nature, reflects the precariousness of the human condition.
This is shown especially in sickness and suffering, which affect the whole
person adversely. "Sickness and suffering are not experiences which affect
only the physical substance of the human being, but they affect him in his
entirety and in his somatic-spiritual unity."[127]
Sickness is more than a clinical fact, medically controlled. It is always
the condition of a human being, the sick person. It is with this holistic
human view of sickness that health care workers should relate to the
patient. It means that they have, together with the requisite
technical-professional competence, an awareness of values and meanings that
make sense of sickness and of their own work, and makes every individual
clinical case a human encounter.
54. The Christian knows by faith that sickness and suffering share in the
salvific efficacy of the Redeemer's cross. "Christ's redemption and its
salvific grace touches the whole person in his human condition and hence
also in sickness, suffering and death."[128]
"On the Cross, the miracle of the serpent lifted up by Moses in the desert
(Jn 3:14-15; cf. Num. 21:8-9) is renewed and brought to full and definitive
perfection. Today, too, by looking upon the one who was pierced, every
person whose life is threatened encounters the sure hope of finding freedom
and redemption."[129]
Borne "in close union with the sufferings of Jesus," sickness and
suffering assume "an extraordinary spiritual fruitfulness." So that the sick
person can say with the Apostle: "I fill up in my body what is wanting to
the sufferings of Christ, for the sake of his body which is the Church" (Col
1:24).[130]
From this new Christian meaning, the sick person can be helped to develop
a triple salutary attitude to the illness: an "awareness" of its reality
"without minimizing it or exaggerating it"; "acceptance," "not with a more
or less blind resignation" but in the serene knowledge that "the Lord can
and wishes to draw good from evil"; "the oblation," "made out of love for
the Lord and one's brothers and sisters."[131]
55. In the person of the patient, in any case, the family is always
affected. Helping the relatives, and their cooperation with health care
workers are a valuable component of health care.
The health care worker is called to give the family of the patient-either
individually or through membership in appropriate organizations-together
with the treatment also enlightenment, counsel, direction and support.[132]
56. Guided by this integrally human and properly Christian view of
sickness, the health care worker should seek, first and foremost, to find
the illness and analyze it in the patient: this is the diagnosis and related
prognosis.
A condition for any treatment is the previous and exact individuation of
the symptoms and causes of the illness.
57. In this, the health care worker will make his own the questions and
anxieties of the patient and he must guard himself from the twofold,
opposing pitfalls of "hopeless" and "tenacious" diagnosis.
In the first case the patient is forced to go from one specialist or
health care service to another, without finding the doctor or diagnostic
center capable and willing to treat his illness. Over-specialization and
fragmentation of clinical competencies and divisions, while ensuring
professional expertise, is damaging to the patient when health services in
the place prevent a caring and global approach to his illness.
In the second case, instead, one persists until some illness is found at
any cost. It may be through ignorance, laziness, for gain, or for rivalry
that an illness is diagnosed or problems are treated as medical when, in
fact, they are not medical-health in nature. In this case the person is not
helped to perceive the exact nature of their problem, thus misleading them
about themselves and their responsibilities.
58. The diagnosis does not pose, in general, problems of an ethical order
when these excesses are excluded and it is conducted in full respect for the
dignity and integrity of the person, particularly with regard to the use of
instrumentally invasive techniques. Of itself, its purpose is therapeutic:
it is an action to promote health.
However, particular problems are posed by predictive diagnosis, because
of the possible repercussions at a psychological level and the
discriminations it could lead to and to prenatal diagnosis. In the latter
case we are dealing with a substantially new possibility which is rapidly
developing, and as such merits separate treatment.
59. The ever-expanding knowledge of intrauterine life and the development
of instruments giving access to it make it possible nowadays to diagnose
prenatal life, thus opening the way for ever more timely and effective
therapeutic interventions.
Prenatal diagnosis reflects the moral goodness of every diagnostic
intervention. At the same time, however, it presents its own ethical
problems, connected with the diagnostic risk and the purpose for its request
and practice.
60. The risk factor concerns the life and physical integrity of the
embryo, and only in part that of the mother, relative to the various
diagnostic techniques and the perceptual risk which each presents.
Hence, there is need "to evaluate carefully the possible negative
consequences which the necessary use of a particular investigative technique
can have" and "avoid recourse to diagnostic procedures about which the
honest purpose and substantial harmlessness cannot be sufficiently
guaranteed." And if a certain amount of risk must be taken, recourse to
diagnosis should have reasonable indications, to be ascertained in a
diagnostic center.[133]
Consequently, "such diagnosis is licit if the methods used, with the
consent of the parents who have been adequately instructed, safeguard the
life and integrity of the embryo and its mother and does not subject them to
disproportionate risks."[134]
61. The objectives of prenatal diagnoses warranting their request and
practice should always be of benefit to the child and the mother; their
purpose is to make possible therapeutic interventions, to bring assurance
and peace to pregnant women who are anxious lest the fetus be deformed and
are tempted to have an abortion, to prepare, if the prognosis is an unhappy
one, for the welcome of a handicapped child.
Prenatal diagnosis "is gravely contrary to the moral law when it
contemplates the possibility, depending on the result, of provoking an
abortion. A diagnosis revealing the existence of a deformity or an
hereditary disease should not be equivalent to a death sentence."[135]
Equally unlawful is any directive or program of civil and health
authorities or of scientific organizations which support a direct connection
between prenatal diagnosis and abortion. The specialist who, in carrying out
the diagnosis and communicating the result, would voluntarily contribute to
the establishing and support of a connection between prenatal diagnosis and
abortion would be guilty of illicit collaboration.[136]
62. After diagnosis comes therapy and rehabilitation: the putting into
effect of those curative and medical interventions which lead to the cure
and personal and social reintegration of the patient.
Therapy is a medical action properly so-called, aimed at combating the
causes, manifestations and complications of the illness. Rehabilitation, on
the other hand, is an amalgam of medical, physiotherapeutic, psychological
measures and functional exercises, aimed at reviving or improving the
psychophysical efficiency of people in some way handicapped in their ability
to integrate, to relate and to work productively.
Therapy and rehabilitation "are aimed not only at the well-being and
health of the body, but of the person as such who is stricken by bodily
illness."[137]
All therapy aimed at the integral well-being of the person is not content
with clinical success, but views the rehabilitative action as a restoring of
the individual to his full self, through the reactivation or
re-appropriation of physical functions weakened by the illness.
63. The patient has a right to any treatment from which he can draw
salutary benefit.[138]
Responsibility for health care imposes on everyone "the duty of caring
for himself and of seeking treatment." Consequently, "those who care for the
sick should be very diligent in their work and administer the remedies which
they think are necessary or useful."[139]
Not only those aimed at a possible cure, but also those which alleviate pain
and bring relief in incurable cases.
64. The health care worker who cannot effect a cure must never cease to
treat.[140]
He is bound to apply all "proportionate" remedies. But there is no
obligation to apply "disproportionate" ones.
In relation to the conditions of a patient, those remedies must be
considered ordinary where there is due proportion between the means used and
the end intended. Where this proportion does not exist, the remedies are to
be considered extraordinary.
To verify and establish whether there is due proportion in a particular
case, "the means should be well evaluated by comparing the type of therapy,
the degree of difficulty and risk involved, the necessary expenses and the
possibility of application, with the result that can be expected, taking
into account the conditions of the patient and his physical and moral
powers."[141]
65. The principle here proposed of appropriate medical treatment in the
remedies can be thus specified and applied:
-"In the absence of other remedies, it is lawful to have recourse, with
the consent of the patient, to the means made available by the most advanced
medicine, even if they are still at an experimental stage and not without
some element of risk."
-"It is lawful to interrupt the application of such means when the
results disappoint the hopes placed in them," because there is no longer due
proportion between "the investment of instruments and personnel" and "the
foreseeable results" or because "the techniques used subject the patient to
suffering and discomfort greater than the benefits to be had."
-"It is always lawful to be satisfied with the normal means offered by
medicine. No one can be obliged, therefore, to have recourse to a type of
remedy which, although already in use, is still not without dangers or is
too onerous." This refusal "is not the equivalent of suicide." Rather it
might signify "either simple acceptance of the human condition, or the wish
to avoid the putting into effect of a remedy disproportionate to the results
that can be hoped for, or the desire not to place too great a burden on the
family or on society."[142]
66. For the restoration of the person to health, interventions may be
required, in the absence of other remedies, which involve the modification,
mutilation or removal of organs.
Therapeutic manipulation of the organism is legitimized here by the
principle of totality,[143]
and for this very reason also called the principle of therapeuticity, by
virtue of which "each particular organ is subordinated to the whole of the
body and should be subjected to it in case of conflict. Consequently, the
one who has received the use of the whole organism has the right to
sacrifice a particular organ if by keeping it, it or its activity might
cause appreciable harm to the whole organism, which cannot be avoided
otherwise."[144]
67. Physical life, although on the one hand manifesting the person and
sharing his worth, so that it cannot be disposed of as an object, on the
other hand it does not exhaust the value of the person nor does it represent
the greatest good.[145]
This is why part of it can be disposed of legitimately for the well-being
of the person. Just as it can be sacrificed or put at risk for a higher good
"such as the glory of God, the salvation of souls and service to one's
neighbor."[146]
"Corporeal life is a fundamental good, a condition here below of all the
others; but there are higher values for which it could be legitimate or even
necessary to expose oneself to the danger of losing it."[147]
68. Pain, on the one hand, has of itself a therapeutic function, because
"it eases the confluence of the physical and psychic reaction of the person
to a bout of illness,"[148]
and on the other hand it appeals to medicine for an alleviating and healing
therapy.
69. For the Christian, pain has a lofty penitential and salvific meaning.
"It is, in fact, a sharing in Christ's Passion and a union with the
redeeming sacrifice which he offered in obedience to the Father's will.
Therefore, one must not be surprised if some Christians prefer to moderate
their use of painkillers, in order to accept voluntarily at least part of
their sufferings and thus associate themselves in a conscious way with the
sufferings of Christ."[149]
Acceptance of pain, motivated and supported by Christian ideals, must not
lead to the conclusion that all suffering and all pain must be accepted, and
that there should be no effort to alleviate them.[150]
On the contrary this is a way of humanizing pain. Christian charity itself
requires of health care workers the alleviation of physical suffering.
70. "In the long run pain is an obstacle to the attainment of higher
goods and interests."[151]
It can produce harmful effects for the psycho-physical integrity of the
person. When suffering is too intense, it can diminish or impede the control
of the spirit. Therefore it is legitimate, and beyond certain limits of
endurance it is also a duty for the health care worker to prevent, alleviate
and eliminate pain. It is morally correct and right that the researcher
should try "to bring pain under human control."[152]
Anesthetics like painkillers, "by directly acting on the more aggressive
and disturbing effects of pain, gives the person more control, so that
suffering becomes a more human experience."[153]
71. Sometimes the use of analgesic and anaesthesic techniques and
medicines involves the suppression or diminution of consciousness and the
use of the higher faculties. In so far as the procedures do not aim directly
at the loss of consciousness and freedom but at dulling sensitivity to pain,
and are limited to the clinical need alone, they are to be considered
ethically legitimate.[154]
72. To intervene medically, the health care worker should have the
express or tacit consent of the patient.
In fact, he "does not have a separate and independent right in relation
to the patient. In general, he can act only if the patient explicitly or
implicitly (directly or indirectly) authorizes him."[155]
Without such authorization he gives himself an arbitrary power.[156]
Besides the medical relationship there is a human one: dialogic,
non-objective. The patient "is not an anonymous individual" on whom medical
expertise is practiced, but "a responsible person, who should be called upon
to share in the improvement of his health and in becoming cured. He should
be given the opportunity of personally choosing, and not be made to submit
to the decisions and choices of others."[157]
So that the choice may be made with full awareness and freedom, the
patient should be given a precise idea of his illness and the therapeutic
possibilities, with the risks, the problems and the consequences that they
entail.[158]
This means that the patient should be asked for an informed consent.
73. With regard to presumed consent, a distinction must be made between
the patient who is in a condition to know and will and one who is not.
In the former, consent cannot be presumed: it must be clear and explicit.
In the latter case, however, the health care worker can, and in extreme
situations must, presume the consent to therapeutic interventions, which
from his knowledge and in conscience he thinks should be made. If there is a
temporary loss of knowing and willing, the health care worker can act in
virtue of the principle of therapeutic trust, that is the original
confidence with which the patient entrusted himself to the health care
worker. Should there be a permanent loss of knowing and willing, the health
care worker can act in virtue of the principle of responsibility for health
care, which obliges the health care worker to assume responsibility for the
patient's health.
74. With regard to the relatives, they should be informed about ordinary
interventions, and involved in the decision making when there is question of
extraordinary and optional interventions.
75. A therapeutic action which is apt to be increasingly beneficial to
health is for that very reason open to new investigative possibilities.
These are the result of a progressive and ongoing activity of research and
experimentation, which thus succeeds in arriving at new medical advances.
To proceed by way of research and experimentation is a law of every
applied science: scientific progress is structurally connected with it.
Biomedical sciences and their development are subject to this law also. But
they operate in a particular field of application and observation which is
the life of the human person.
The latter, because of his unique dignity, can be the subject of research
and clinical experimentation with the safeguards due to a being with the
value of a subject and not an object. For this reason, biomedical sciences
do not have the same freedom of investigation as those sciences which deal
with things. "The ethical norm, founded on respect for the dignity of the
person, should illuminate and discipline both the research stage and the
application of the results obtained from it."[159]
76. In the research stage, the ethical norm requires that its aim be to
"promote human well-being."[160]
Any research contrary to the true good of the person is immoral. To invest
energies and resources in it contradicts the human finality of science and
its progress.[161]
In the experimental stage, that is, testing the findings of research on a
person, the good of the person, protected by the ethical norm, demands
respect for previous conditions which are essentially linked with consent
and risk.
77. First of all, the consent of the patient. He "should be informed
about the experimentation, its purpose and possible risks, so that he can
give or refuse his consent with full knowledge and freedom. In fact, the
doctor has only that power and those rights which the patient himself gives
him."[162]
This consent can be presumed when it is of benefit to the patient
himself, that is, when there is a question of therapeutic experimentation.
78. Secondly, there is the risk factor. Of its nature, every
experimentation has risks. Hence, "it cannot be demanded that all danger and
all risk be excluded. This is beyond human possibility; it would paralyze
all serious scientific research and would quite often be detrimental to the
patient.... But there is a level of danger that the moral law cannot allow."[163]
A human subject cannot be exposed to the same risk as beings which are
not human. There is a threshold beyond which the risk becomes humanly
unacceptable. This threshold is indicated by the inviolable good of the
person, which forbids him "to endanger his life, his equilibrium. his
health, or to aggravate his illness."[164]
79. Experimentation cannot be begun and generalized until every safeguard
has been put in place to guarantee the harmlessness of the intervention and
to lessen the risk. "The pre-clinical basic phase, carried out carefully,
should give the widest documentation and the most secure
pharmacological-toxicological guarantees and ensure operational safety."[165]
To acquire these assurances, if it be useful and necessary, the testing
of new pharmaceutical products or of new techniques should first be done on
animals before they are tried on humans. "It is certain that the animal is
for the service of man and can therefore be the object of experimentation.
However, it should be treated as one of God's creatures, meant to cooperate
in man's good but not to be abused."[166]It
follows that all experimentation "should be carried out with consideration
for the animal, without causing it useless suffering."[167]
When these guarantees are in place, in the clinical phase experimentation
on the human person must be in accord with the principle of proportionate
risk, that is, of due proportion between the advantages and foreseeable
risks. Here a distinction must be made between experimentation on a sick
person, for therapeutic reasons, and on a healthy person, for scientific and
humanitarian reasons.
80. In experimentation on a sick person, due proportion is attained from
a comparison of the condition of the sick person and the foreseeable effects
of the drugs or the experimental methods. Hence the risk rate which might be
proportionate and legitimate for one patient may not be so for another.
It is a valid principle-as already said-that "in the absence of other
remedies, it is licit to have recourse, with the consent of the patient, to
means made available by the most advanced medicine, even if they are still
at an experimental stage and are not without some risk. By accepting them
the patient might also give an example of generosity for the benefit of
humanity."[168]But
there must always be "great respect for the patient in the application of
new therapy still at the experimental stage...when these are still high-risk
procedures."[169]
"In desperate cases, when the patient will die if there is no
intervention, if there is a medication available, or a method or an
operation which, though not excluding all danger, still has some possibility
of success, any right-thinking person would concede that the doctor could
certainly, with the explicit or tacit consent of the patient, proceed with
the application of the treatment."[170]
81. Clinical experimentation can also be practiced on a healthy person,
who voluntarily offers himself "to contribute by his initiative to the
progress of medicine and, in that way, to the good of the community." In
this case, "once his own substantial integrity is safeguarded, the patient
can legitimately accept a certain degree of risk."[171]
This is legitimized by the human and Christian solidarity which motivates
the gesture: "To give of oneself, within the limits marked out by the moral
law, can be a witness of highly meritorious charity and a means of such
significant spiritual growth that it can compensate for the risk of any
insubstantial physical impairment."[172]
In any case, it is a duty to always interrupt the experimentation when
the results disappoint the expectations.
82. Since the human individual, in the prenatal stage, must be given the
dignity of a human person, research and experimentation on human embryos and
fetuses is subject to the ethical norms valid for the child already born and
for every human subject.
Research in particular, that is the observation of a given phenomenon
during pregnancy, can be allowed only when "there is moral certainty that
there will be no harm either to the life or the integrity of the expected
child and the mother, and on condition that the parents have given their
consent."[173]
Experimentation, on the other hand, is possible only for clearly
therapeutic purposes, when no other possible remedy is available. "No
finality, even if in itself noble, such as the foreseeing of a usefulness
for science, for other human beings or for society, can in any way justify
experimentation on live human embryos and fetuses, whether viable or not, in
the maternal womb or outside of it. The informed consent, normally required
for clinical experimentation on an adult, cannot be given by the parents,
who may not dispose either of the physical integrity or the life of the
expected child. On the other hand, experimentation on embryos or fetuses has
the risk, indeed in most cases the certain foreknowledge, of damaging their
physical integrity or even causing their death. To use a human embryo or the
fetus as an object or instrument of experimentation is a crime against their
dignity as human beings." "The practice of keeping human embryos alive,
actually or in vitro, for experimental or commercial reasons," is especially
and "altogether contrary to human dignity."[174]
83. The progress and spread of transplant medicine and surgery nowadays
makes possible treatment and cure for many illnesses which, up to a short
time ago, could only lead to death or, at best, a painful and limited
existence.[175]This
"service to life,"[176]
which the donation and transplant of organs represents, shows its moral
value and legitimizes medical practice. There are, however, some conditions
which must be observed, particularly those regarding donors and the organs
donated and implanted. Every organ or human tissue transplant requires an
explant which in some way impairs the corporeal integrity of the donor.
84. Autoplastic transplants, in which there is the explant and implant on
the same person, are legitimate in virtue of the principle of totality by
which it is possible to dispose of a part for the integral good of the
organism.
85. Homoplastic transplants, in which the transplant is taken from a
person of the same species as the recipient, are legitimized by the
principle of solidarity which joins human beings, and by charity which
prompts one to give to suffering brothers and sisters.[177]
"With the advent of organ transplants, begun with blood transfusions, human
persons have found a way to give part of themselves, of their blood and of
their bodies, so that others may continue to live. Thanks to science and to
professional training and the dedication of doctors and health care
workers...new and wonderful challenges are emerging. We are challenged to
love our neighbor in new ways; in evangelical terms-to love 'even unto the
end' (Jn 13:1), even if within certain limits which cannot be transgressed,
limits placed by human nature itself."[178]
In homoplastic transplants, organs may be taken either from a living
donor or from a corpse.
86. In the first case the removal is legitimate provided it is a question
of organs of which the explant would not constitute a serious and
irreparable impairment for the donor. "One can donate only what he can
deprive himself of without serious danger to his life or personal identity,
and for a just and proportionate reason."[179]
87. In the second case we are no longer concerned with a living person
but a corpse. This must always be respected as a human corpse, but it no
longer has the dignity of a subject and the end value of a living person. "A
corpse is no longer, in the proper sense of the term, a subject of rights,
because it is deprived of personality, which alone can be the subject of
rights." Hence, "to put it to useful purposes, morally blameless and even
noble" is a decision "not be condemned but to be positively justified."[180]
There must be certainty, however, that it is a corpse, to ensure that the
removal of organs does not cause or even hasten death. The removal of organs
from a corpse is legitimate when the certain death of the donor has been
ascertained. Hence the duty of "taking steps to ensure that a corpse is not
considered and treated as such before death has been duly verified."[181]
In order that a person be considered a corpse, it is enough that cerebral
death of the donor be ascertained, which consists in the "irreversible
cessation of all cerebral activity." When total cerebral death is verified
with certainty, that is, after the required tests, it is licit to remove
organs and also to surrogate organic functions artificially in order to keep
the organs alive with a view to a transplant.[182]
88. Ethically, not all organs can be donated. The brain and the gonads
may not be transplanted because they ensure the personal and procreative
identity respectively. These are organs which embody the characteristic
uniqueness of the person, which medicine is bound to protect.
89. There are also heterogeneous transplants, that is, with organs of a
different species than that of the recipient. "It cannot be said that every
transplant of tissues (biologically possible) between two individuals of
different species is morally reprehensible, but it is even less true that
every heterogeneous transplant biologically possible is not forbidden and
cannot raise objections. A distinction must be made between cases, depending
on which tissue or organ is intended for transplant. The transplant of
animal sexual glands to humans must be rejected as immoral; but the
transplant of the cornea of a non-human organism to a human organism would
not create any problem if it were biologically possible and advisable."[183]
Among heterogeneous transplants are also included the implanting of
artificial organs, the lawfulness of which is conditioned by the beneficial
effect for the person and respect for his dignity.
90. The medical intervention in transplants "is inseparable from a human
act of donation."[184]
In life or in death the person from whom the removal is made should be aware
that he is a donor, that is, one who freely consents to the removal.
Transplants presuppose a free and conscious previous decision on the part
of the donor or of someone who legitimately represents him, normally the
closest relatives. "It is a decision to offer, without recompense, part of
someone's body for the health and well-being of another person. In this
sense, the medical act of transplanting makes possible the act of donation
of the donor, that sincere gift of himself which expresses our essential
call to love and communion."[185]
The possibility, thanks to biomedical progress, of "projecting beyond
death their vocation to love" should persuade persons "to offer during life
a part of their body, an offer which will become effective only after
death." This is "a great act of love, that love which gives life to others."[186]
91. As part of this oblative "economy" of love, the medical act itself of
transplanting, of even just blood transfusion, "is not just another
intervention." It "cannot be separated from the donor's act of giving, from
life-giving love."[187]
Here the health care worker "becomes a mediator of something which is
particularly meaningful, the gift of self by a person-even after death-so
that another might live."[188]
92. Dependency, in medical-health terms, is an addiction to a substance
or product-such as drugs, alcohol, narcotics, tobacco-for which the
individual feels an uncontrollable need, and the privation of which can
cause him psycho-physical disorders.
The phenomenon of dependency is escalating in our societies, which is
disturbing and, under certain aspects, dramatic. This is related, on the one
hand, to the crisis of values and meaning which contemporary society and
culture[189]
is experiencing and, on the other hand, to the stress and frustrations
brought about by the quest for efficiency, by activism and by the high
competitiveness and anonymity of social interaction.
Doubtless, the evils caused by dependency and their cure are not a matter
for medicine alone. But it does have a preventive and therapeutic role.
93. Drugs and drug-dependency are almost always the result of an
avoidable evasion of responsibility, an aprioristic contestation of the
social structure which is rejected without positive proposals for its
reasonable reform, an expression of masochism motivated by the absence of
values.
One who takes drugs does not understand or has lost the meaning and the
value of life, thus putting it at risk until it is lost: many deaths from
overdose are voluntary suicides. The drug-user acquires a nihilistic mental
state, superficially preferring the void of death to the all of life.
94. From the moral viewpoint "using drugs is always illicit, because it
implies an unjustified and irrational refusal to think, will and act as free
persons."[190]
To say that drugs are illicit is not to condemn the drug-user. That
person experiences his condition as "a heavy slavery" from which he needs to
be freed.[191]
The way to recovery cannot be that of ethical culpability or repressive law,
but it must be by way of rehabilitation which, without condoning the
possible fault of the person on drugs, promotes liberation from his
condition and reintegration.
95. The detoxification of the person addicted to drugs is more than
medical treatment. Moreover, medicines are of little or no use.
Detoxification is an integrally human process meant to "give a complete and
definitive meaning to life,"[192]
and thus to restore to the one addicted that "self confidence and salutary
self-esteem" which help him to recover the joy of living.[193]
In the rehabilitation of a person addicted to drugs it is important "that
there be an attempt to get to know the individual and to understand his
inner world; to bring him to the discovery or rediscovery of his dignity as
a person, to help him to reawaken and develop, as an active subject, those
personal resources, which the use of drugs has suppressed, through a
confident reactivation of the mechanisms of the will, directed to secure and
noble ideals."[194]
96. Using drugs is anti-life. "One cannot speak of 'the freedom to take
drugs' nor of 'the right to drugs,' because a human being does not have the
right to harm himself and he cannot and must not ever abdicate his personal
dignity which is given to him by God,"[195]and
even less does he have the right to make others pay for his choice.
97. Unlike taking drugs, alcohol is not in itself illicit: "its moderate
use as a drink is not contrary to moral law."[196]
Within reasonable limits wine is a nourishment.
"It is only the abuse that is reprehensible":[197]alcoholism,
which causes dependency, clouds the conscience and, in the chronic stage,
produces serious harm to the body and the mind.
98. The alcoholic is a sick person who needs medical assistance together
with help on the level of solidarity and psychotherapy. A program of
integrally human rehabilitation must be put in place for him,[198]
99. With regard to tobacco also, the ethical unlawfulness is not in its
use but in its abuse. At the present time it is established that excessive
smoking damages the health and causes dependency. This leads to a
progressive lowering of the threshold of abuse.
Smoking poses the problem of dissuasion and prevention, which should be
done especially through health education and information, even by way of
advertisements.
100. Psycho-pharmaceuticals are a special category of medicines used to
counter agitation, delirium and hallucinations and to overcome anxiety and
depression.[199]
101. To prevent, contain and overcome the risk of dependency and
addiction, psycho-pharmaceuticals should be subject to medical control.
"Recourse to tranquilizing substances on medical advice in order to
alleviate-in well-defined cases-physical and psychological suffering should
be governed by very prudent criteria in order to offset dangerous forms of
addiction and dependency."[200]
It is the task of health authorities, doctors and those responsible for
research centers to apply themselves in order to reduce these risks to a
minimum through apt measures of prevention and information."[201]
102. Administered for therapeutic purposes and with due respect for the
person, psycho-pharmaceuticals are ethically legitimate. The general
conditions for lawfulness in remedial intervention applies to these also.
In particular, the informed consent of the patient is required and his
right to refuse the therapy must be respected, taking into account the
ability of the mental patient to make decisions. Also to be respected is the
principle of therapeutic proportionality in the choice and administration of
these medicines, on the basis of an accurate etiology of the symptoms and
the motives for the subject's requesting this medicine.[202]
103. Non-therapeutic use and abuse of psycho-pharmaceuticals is morally
illicit if the purpose is to improve normal performance or to procure an
artificial and euphoric serenity. This use of psycho-pharmaceuticals is the
same as that of any narcotic substance so the ethical verdict already given
in the case of drugs is valid also here.
104. There is already ample evidence that all bodily illness has a
psychological component, either as a co-efficient or as an after-effect.
This is what psychosomatic medicine is concerned with, where the therapeutic
value depends on the doctor-patient relationship.[203]
Health care workers should seek to relate to the patient in such a way
that their humanitarian attitude reinforces their professionalism and their
competence is more effective through their ability to understand the
patient.
A human and loving approach to the patient, required by an integrally
human view of illness and strengthened by faith,[204]is
the key to this therapeutic effectiveness of the doctor-patient
relationship.
105. Psychological disorders and illnesses can be dealt with and treated
through psychotherapy. This includes a variety of methods by which someone
can help another to be cured or at least to improve.
Psychotherapy is essentially a growing process, that is, a path of
liberation from childhood problems, or from the past, in any case, which
enables the individual to assume his identity, role and responsibilities.
106. Psychotherapy is morally acceptable as a medical treatment.[205]
But it must respect the person of the patient, who allows access into his
inner world.
This respect prohibits the psychotherapist from violating the privacy of
the other without his consent and obliges him to work within these limits.
"Just as it is unlawful to appropriate the goods of another or invade his
corporal integrity without his permission, so it is not permissible to enter
the inner world of another person against his wishes, whatever be the
techniques and methods employed."[206]
The same respect prohibits the influencing or forcing of the patient's
will. "The psychologist whose only desire is the good of the patient, will
be all the more careful to respect the limits to his action set down by the
moral code in that-in a manner of speaking-he holds in his hands the
psychological faculties of a person, his ability to act freely, to achieve
the noblest ideals which his personal destiny and his social calling imply."[207]
107. From the moral standpoint, logotherapy and counseling are privileged
forms of psychotherapy. But they are all acceptable, provided that they are
practiced by psychotherapists who are guided by a profound ethical sense.
108. Pastoral care of the sick consists in spiritual and religious
assistance. This is a fundamental right of the patient and a duty of the
Church (cf. Mt 10:8; Lk 9:2, 10:9). Not to assure it, not to support it, to
make it discretionary or to impede it is a violation of this right and
infidelity to this duty.
This is the essential and specific, though not exclusive, task of the
health care pastoral worker. Because of the necessary interaction between
the physical, psychological and spiritual dimension of the person, and the
duty of giving witness to their own faith, all health care workers are bound
to create the conditions by which religious assistance is assured to anyone
who asks for it, either expressly or implicitly.[208]
"In Jesus, the 'Word of life,' God's eternal life is thus proclaimed and
given. Thanks to this proclamation and gift, our physical and spiritual
life, also in its earthly phase, acquires its full value and meaning, for
God's eternal life is in fact the end to which our living in this world is
directed and called."[209]
109. Religious assistance implies that there be, within the health care
structure, the possibility and the means to carry this out.
The health care worker should be totally available to support and accede
to the patient's request for religious assistance.
Where such assistance, for general or particular reasons, cannot be given
by the pastoral worker, it should be given directly-within possible and
allowable limits-by the health care worker, respecting the freedom and the
religious affiliation of the patient and aware that, in doing so, he does
not detract from the rights of health care assistance properly so called.
110. Religious assistance to the sick is part of the wider vision of
medical-pastoral assistance, that is, of the presence and activity of the
Church which is meant to bring the word and the grace of the Lord to those
who suffer and to those who care for them.
In the ministry of those-priests, religious and laity-who individually or
as communities are engaged in the pastoral care of the sick, the mercy of
God lives on, who in Christ has bound to human suffering, and the task of
evangelization, sanctification and charity entrusted to the Church by the
Lord is carried out in a singular and privileged manner.[210]
This means that pastoral care of the sick has a special place in
catechesis, in the liturgy and in charity. Respectively, it is a matter of
evangelizing illness, helping a person to uncover the redemptive meaning of
suffering borne in communion with Christ; of celebrating the sacraments as
efficacious signs of the recreative and vitalizing grace of God; of
witnessing by means of the "diakonia" (service) and the "koinonia"
(communion) to the therapeutic power of charity.
111. In pastoral care of the sick, the love-full of truth and of grace of
God comes near to them in a special sacrament meant for them: the Anointing
of the Sick.[211]
Administered to any Christian who is in a life-threatening condition,
this sacrament is a remedy for body and spirit, relief and strength for the
patient in his corporeal-spiritual integrity casting light on the mystery of
suffering and death and bringing a hope which opens the human present to the
future of God. "The whole person receives help from it for his salvation; he
feels strengthened in his trust in God and he receives reinforcement against
the temptations of the devil and the fear of death."[212]
Since it has the efficacy of grace for the sick person, the Anointing of
the Sick "is not the sacrament of those only who are at the point of death."
Hence "the suitable time to receive it is when one of the faithful, either
from illness or old-age, begins to be in danger of death."[213]
As with all the sacraments, the Anointing of the Sick should also be
preceded by a suitable catechesis so that the recipient, the sick person, is
a conscious and responsible subject of the grace of the sacrament, and not
an unconscious object of the rite of imminent death.[214]
112. The proper minister of the Anointing of the Sick is the priest only,
and he should see that it is conferred "on those of the faithful whose state
of health is seriously threatened by old-age or illness." To evaluate the
seriousness of the illness it is sufficient "to have a prudent or probable
judgment."
Celebrating communal Anointing might help to overcome negative prejudices
against the Anointing of the Sick, and help to value the meaning of this
sacrament and the sense of ecclesial solidarity.
Anointing can be repeated if the sick person, having recovered from the
illness for which the sacrament was received, should again become ill, or if
in the course of the same illness his Condition should worsen.
It can be given before surgery if the reason for surgery is "a dangerous
illness."
Anointing may be conferred on the elderly "because of the notable
diminishing of their strength, even if they do not have any serious
illness."
If the conditions are present, it can also be conferred on children,
"provided they have sufficient use of reason."
In the case of sick people who are unconscious or deprived of the use of
reason, it is to be Conferred "if there is reason to believe that in
possession of their faculties they themselves, as believers, would have, at
least implicitly, requested holy Anointing."
"The sacrament cannot be conferred on a patient who is already dead."[215]
"When there is a doubt whether the sick person has attained the use of
reason, or whether the person is gravely ill or whether the person is dead,
this sacrament is to be conferred."[216]
113. The Eucharist, also, as Viaticum, has a special significance and
efficacy for the patient. "Viaticum of the body and blood of Christ
strengthens the believer and furnishes him with the pledge of resurrection,
as the Lord has said: The one who eats my flesh and drinks my blood has
eternal life, and I will raise him up on the last day" (Jn 6:54).[217]
For the sick person, the Eucharist is this viaticum of life and hope.
"Communion in the form of Viaticum is, in fact, a special sign of
participation in the mystery celebrated in the sacrifice of the Mass, the
mystery of the death of the Lord and of his passing to the Father."[218]
Therefore it is the duty of a Christian to request and receive Viaticum,
and the Church has a pastoral responsibility to administer it.[219]
The minister of Viaticum is a priest. But he may be substituted by a
deacon or an extraordinary minister of the Eucharist.[220]