charter for health care workers text

8/12/2019 Charter for Health Care Workers Text

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The Pontifical Council for Pastoral

Assistance to Health Care Workers

THE CHARTER FOR

HEALTH CARE WORKERS

Vatican City - 1995

The result of long, careful, and multidisciplinary preparation, The Charter forHealth Care Workers, has now been published, through the initiative of thePontifical Council for Pastoral Assistance to Health Care Workers.

t is certainly a source of satisfaction that the Congregation for the !octrine ofthe "aith has approved and confirmed, both fully and swiftly, the te#t of theCharter which was submitted to it $ one more reason to recogni%e its thoroughvalidity, as well as a concrete confirmation of the effectiveness of theinterdepartmental cooperation which was e#pressly desired by the &otu Proprioinstituting the Pontifical Council for Pastoral Assistance to Health Care Workers.

There are many reasons why we must know, disseminate, and apply thedirectives contained in this deontological code for health workers. This

publication fills a gap which has been clearly observed not only in the Church,but by all those identifying with the Church's primary task to advance and defendlife.

The e#traordinary progress of science and technology in the immense field ofhealth policy and care have made bioethics, or the ethics of life, a discipline in itsown right. Hence the need $ rigorously responded to by the Charter for

Health Care Workers $ to provide an organic, e#haustive summary of theChurch's position on all that concerns affirming the primary, absolute value oflife in the health field $ of all life and of the life of every human being.

Conse(uently, after an introduction on the figure and essential tasks of health

workers $ or, rather, )ministers of life) $ the Charter groups together its directivesaround the threefold sub*ect$matter of generation, living, and dying. And so thatsub*ective interpretation will not prevail over the ob*ective value of this content $as often happens $ in drafting the document there has almost invariably been a

preference for drawing upon the words of the +upreme Pontiffs or of theauthoritative te#ts published by the departments of the oman Curia. Thesereferences plainly demonstrate that the Church's position on fundamental

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problems in bioethics $ while maintaining the unalterable limits of advancing anddefending life $ is highly constructive and open to the true progress of scienceand technology, when firmly *oined to that of civili%ation.

At the beginning of the Charter it is stated that the health worker's activity is )aform of Christian witness.)

With humility $ but also with pride $ we can thus regard this Charter for HealthCare Workers as an integral part of the )new evangeli%ation,) which, in servinglife, particularly in those suffering, following the e#ample of Christ's ministry,encounters its decisive dimension.

t is hoped, then, that this tool will come to form part of the initial and ongoingtraining of health workers, so that their witness will be a demonstration that theChurch, in defending life, opens her heart and her arms to all men, for Christ'smessage is addressed to all.

CONTENTS

Preface ntroduction/ &inisters of 0ife 1

- P!OC!EATON

2enetic manipulation 34"ertility control 3Artificial procreation 45

- "#E

6eginning of life and birth 7-The value of life/ unity of body andsoul 74

ndisposability and inviolability of life 7ight to life 78Prevention -+ickness 3!iagnosis 7Prenatal diagnosis 9Therapy and rehabilitation 8

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Analgesia and anesthesia 93The informed consent of the patient 97esearch and e#perimentation 99!onation and transplant of organs 13!ependency/ drugs, alcoholism,smoking, psychopharmaceuticals 11Psychology and psychotherapy 84Pastoral care and the sacrament ofAnointing of the +ick 8

- $EATH

Terminal illnesses :4!eath with dignity :9

The use of pain$killers for theterminally ill ::Telling the truth to a dying person -53The moment of death -57eligious assistance for the dying -59The suppression of life -58Abortion ---;uthanasia --9Analytical nde# -3-

Cover Price/ -3 ;uro plus shipping costs.+pecial discounts are offered for large orders.

e(uests for the Charter and payment should be sent toThe Pontifical Councilfor Pastoral Assistance to Health Care Workers


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Car&inal #ioren'o An(elini

Presi&ent of the Pontifical Council for

Pastoral Assistance to Health Care WorkersAfter long, careful and multi?discipline preparation, the Charter for Health CareWorkers is now being published at the initiative of the Pontifical Council forPastoral Assistance to Health Care Workers.

@othing happens by chance in human affairs, and even chronologicalcoincidence can have symbolic meanings. n fact, the awaited document is being

published a few months after the institution "ebruary --, -::7B, by the Holy"ather, ohn Paul , of the Pontifical Academy for 0ife, which ideally, operativelyand in its statutary finality is closely associated with the tasks of the Dffice forPastoral Assistance to Health Care Workers.

And this Dffice cannot but feel flattered that the Congregation for the !octrineof the "aith approved and (uickly confirmed in its entirety the te#t of the Chartersubmitted to it/ another reason for its full validity and secure authority, but also aconcrete proof of the inter?dicastery cooperation e#pressly desired in the motu

proprio which set up the Pontifical Council for Pastoral Assistance to Health CareWorkers.

There are many reasons for recommending a knowledge, the divulgation and theapplication of the directives contained in this deontological code for those engagedin health care. ts publication fills a lacuna which was strongly felt not only in the

Church but also by all those who empathi%e with the primary task it fulfills ofpromoting and defending life.

The e#traordinary advances of science and technology in the very vast field ofhealth and medicine have produced an independent discipline called bioethics, orethics of life. This e#plains why, especially from Pius E onwards, themagisterium of the Church has intervened with increasing interest, with consistentfirmness and ever more e#plicit directives concerning all the comple# problemsarising from the indissoluble bond between medicine and morality. @one of these

problems can be considered neutral at this time in relation to Hippocratic ethics

and Christian morality. Hence the re(uirement, strictly respected in the Charter forHealth Care Workers, for an organic and e#haustive synthesis of the Church's

position on all that pertains to the affirmation, in the field of health care, of theprimary and absolute value of life/ of all life and the life of every human being.

Therefore, after an introduction on the figure and essential tasks of health careworkers, or better, of the )ministers of life,) the Charter gathers its directivesaround the triple theme of procreation, life and death. And so that F as often

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happens F doubtful interpretations may not prevail over the ob*ective worth of thecontents, in the redaction of the document the interventions of the +upremePontiffs and authoritative te#ts issued by the Dffices of the oman Curia havealmost always been (uoted directly. These interventions show conclusively that the

position of the Church on the fundamental problems of bioethics, whilesafeguarding the sacred limits imposed by the promotion and defense of life, ishighly constructive and open to true progress in science and technology, when this

progress is welded to that of civili%ation.At the beginning of the Charter the activity of the health care worker is said to

be )a form of Christian witness.)Humbly, but also proudly, we can say that this Charter for Health Care Workers

is part of the )new evangeli%ation) which, in service to life, especially for thosewho suffer, has, in imitation of Christ's ministry, its (ualifying moment.

The hope then is that this work$tool may become an integral part of the initialand ongoing formation of health care workers, so that their witness may be proofthat the Church, in its defense of life, opens its heart and its arms to all peoplesince Christ's message is addressed to all people.


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Charter For Health Care Workers:

)inisters Of "ife

1*The work of health care persons is a very valuable service to life. t e#presses aprofoundly human and Christian commitment, undertaken and carried out not onlyas a technical activity but also as one of dedication to and love of neighbor. t is )aform of Christian witness.)-)Their profession calls for them to be guardians andservants of human life) ;vangelium


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condition in this world. t is easy to see, therefore, how important in socio?medicalservice is the presence...of workers who are guided by an holistic human vision ofillness and hence can adopt a wholly human approach to the suffering patient.)9

n this way, the health care worker, if animated by a truly Christian spirit, willmore easily become aware of the demanding missionary dimension of his

profession/ )his entire humanity comes into play) here )and nothing less thancomplete commitment is re(uired of him.)1

To speak of mission is to speak of vocation/8the response to a transcendent callwhich takes shape in the suffering and appealing countenance of the patient in hiscare. )To care lovingly for a sick person is to fulfill a divine mission, which alonecan motivate and sustain the most disinterested, available and faithful commitment,and gives it a priestly value.):)When he presents the heart of his redemptive

mission, esus says/ ' came that they may have life, and have it abundantly' n-5/-5B.... t is precisely in this 'life' that all the aspects and stages of human lifeachieve their full significance) ;vangelium


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Church...has always seen medicine as an important support for its ownredeeming mission to humanity.) n fact, )service to man's spirit cannot

be fully effective e#cept it be service to his psycho?physical unity. TheChurch knows well that physical evil imprisons the spirit, *ust asspiritual evil sub*ects the body.)35

t follows that the of health care workers is a sharing in the pastoral3-andevangeli%ing33work of the Church. +ervice to life becomes a ministry of salvation,that is, a message that activates the redeeming love of Christ. )!octors, nurses,other health care workers, voluntary assistants, are called to be the living image ofChrist and of his Church in loving the sick and the suffering/)34witnesses of )thegospel of life.)37

.*+ervice to life is such only if it is faithful to the moral law, which e#presses

e#igently its value and its tasks. 6esides technico?professional competence, thehealth care worker has ethical responsibilities. )The ethical law, founded onrespect for the dignity of the person and on the rightsof the sick, should illuminateand govern both the research phase and the application of the findings.)3nfidelity to the moral law, the health care worker actuates his fidelity to the human

person whose worth is guaranteed by the law, and to 2od, whose wisdom ise#pressed by the law.

He draws his behavioral directives from that field of normative ethics whichnowadays is called bioethics. Here, with vigilant and careful attention, the

magisterium of the Church has intervened, with reference to (uestions and disputesarising from the biomedical advances and from the changing cultural ethos. This

bioethical magisterium is for the health care worker, Catholic or otherwise, asource of principles and norms of conduct which enlighten his conscience anddirect him F especially in the comple#ity of modern bio?technical possibilities Fin his choices, always respecting life and its dignity.

/*The continuous progress of medicine demands of the health careworker a thorough preparation and ongoing formation so as to ensure,also by personal studies, the re(uired competence and fitting

professional e#pertise.

+ide?by?side with this, they should be given a solid )ethico?religious formation,)39

which )promotes in them an appreciation of human and Christian values andrefines their moral conscience.) There is need )to develop in them an authentic

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faith and a true sense of morality, in a sincere search for a religious relationshipwith 2od, in whom all ideals of goodness and truth are based.)31

)All health care workers should be taught morality and bioethics.)38To achievethis. those responsible for their formation should endeavor to have chairs andcourses in bioethics put in place.

0*Health care workers, especially doctors, cannot be left to their owndevices and burdened with unbearable responsibilities when faced withever more comple# and problematic clinical cases arising from

biotechnical possibilities F many of which are at an e#perimental stageF open to modern medicine, and from the socio?medical import ofcertain (uestions.

To facilitate choices and to keep a check on them, the setting up of ethicalcommittees in the principal medical centers should be encouraged. n thesecommissions, medical competence and evaluation is confronted and integratedwith that of other presences at the patient's side, so as to safeguard the latter'sdignity and medical responsibility itself.3:

9*The sphere of action of health care workers consists, in general, ofwhat is contained in the terms and concepts of health and medicineespecially.

The term and concept of health embraces all that pertains to prevention, diagnosis,treatment and rehabilitation for greater e(uilibrium and the physical, psychic andspiritual well?being of the person. The term and concept of medicine, on the otherhand, refers to all that concerns health policy, legislation, programming andstructures.45

The full concept of health reflects directly on that of medicine. n fact, )institutionsare very important and indispensable however, no institution can of itselfsubstitute for the human heart, human compassion, human love, human initiative,when it is a (uestion of helping another in his suffering.)4-

The meeting and the practical synthesis of the demands and duties arising from theconcepts of health and medicine are the basis and way for medicine. This must be

present both at the personal?professional level F the doctor?patient relationshipF and at the socio?policy level so as to safeguard in institutional andtechnological structures the human?Christian interests in society and theinstitutional and technological infrastructures. The first but not without the second,

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since such humani%ation as well as being a love?charity task is )an obligation of*ustice.)43)IThis humani%ation strengthensJ the bases of the 'civili%ation of life andlove,' without which the life of individuals and of society itself loses its mostgenuinely human (uality) ;vangelium


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anomalies genetic therapyB, from manipulation altering the human geneticpatrimony. A curative intervention, which is also called )genetic surgery,) )will beconsidered desirable in principle. provided its purpose is the real promotion of the

personal well?being of the individual, without damaging his integrity or worseninghis condition of life.)4

1,*Dn the other hand, interventions which are not directly curative, thepurpose of which is )the production of human beings selected accordingto se# or other predetermined (ualities,) which change the genotype ofthe individual and of the human species, )are contrary to the personaldignity of the human being, to his integrity and to his identity. Thereforethey can be in no way *ustified on the prete#t that they will producesome beneficial results for humanity in the future,)49)no social orscientific usefulness and no ideological purpose could ever *ustify an

intervention on the human genome unless it be therapeutic, that is itsfinality must be the natural development of the human being.)41

1*n any case, this type of intervention )should not pre*udice thebeginnings of human life, that is, procreation linked to not only thebiological but also the spiritual union of the parents, united in the bondof matrimony.)48

The negative ethical evaluations outlined here apply to all genetic manipulatoryinterventions concerned with embryos. Dn the other hand there are no moral

ob*ections to the manipulation of human body cells for curative purposes and themanipulation of animal or vegetable cells for pharmaceutical purposes.

Fertility control

15*)Without intending to underestimate the other ends of marriage, itmust be said that true married love and the whole structure of family lifewhich results from it is directed to disposing the spouses to cooperatevaliantly with the love of the Creator and +avior, who through them willincrease and enrich his family from day to day.)4:)When a new personis born of the con*ugal union of the two, he brings with him into theworld a particular image and likeness of 2od himself/ the genealogy ofthe person is inscribed in the very biology of generation. n affirmingthat the spouses, as parents, cooperate with 2od the Creator inconceiving and giving birth to a new human being, we are not speaking

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merely with reference to the laws of biology.... 6egetting is thecontinuation of Creation.)75

)Those are considered to e#ercise responsible parenthood who prudently andgenerously decide to have a large family, or who, for serious reasons and with duerespect for the moral law, choose to have no more children for the time being oreven for an indeterminate period.)7-n the latter case there is the problem of birthcontrol.

1.*n evaluating behavior with regard to this control, the moral*udgment )does not depend solely on good intentions and on theevaluation of motives it is determined by ob*ective criteria, criteriadrawn from the dignity of the human person and human action.)73t is a(uestion of the dignityof the man and the woman and of their most

intimate relationship. espect for this dignity shows the truth of theirmarried love.

With regard to the marriage act, this e#presses )the indissoluble bond between thetwo meanings of the act/ the unitive meaning and the procreative meaning.)74nfact, the acts by which the partners fully e#press themselves and which intensifytheir union are the same ones that generate life and vice$versa.77

0ove which uses )body language) to e#press itself is at once unitive andprocreative/ )it clearly implies both spousal and parental significance.)7

This bond is intrinsic to the marriage act/ )man may not break it on his owninitiative,) without denying the dignity proper to the person and )the inner truth ofmarried love.)79

1/*Therefore, while it is lawful, for grave reasons, to take advantage ofa knowledge of the woman's fertility and forego the use of marriage inthe fertile periods, recourse to contraceptive practice is illicit.71

@atural methods imply a marriage act which, on the one hand does not result in a

new life and which, on the other hand, is still intrinsically life?directed.78)t isprecisely this respect which makes legitimate, at the service of responsibleprocreation, the use of natural methods of regulating fertility. "rom the scientificpoint of view, these methods are becoming more and more accurate and make itpossible in practice to make choices in harmony with moral values.)7:

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Artificial means contradict )the nature of the man and the woman and of their mostintimate relationship.)5Here se#ual union is separated from procreation/ the act isdeprived of its natural openness to life. )Thus the original import of humanse#uality is distorted and falsified, and the two meanings, unitive and procreative,inherent in the very nature of the con*ugal act, are artificially separated/ in this waythe marriage union is betrayed and its fruitfulness is sub*ected to the caprice of thecouple.)-

This occurs in )every action which, either in anticipation of the con*ugal act, or inits accomplishment, or in the development of its natural conse(uences, proposes,whether as an end or as a means, to render procreation impossible.)3

10*Here, then, is )the difference, both anthropological and moral,between contraception and recourse to the rhythm of the cycle.)4

)t is not a distinction simply of techni(ues or methods, where the decisive elementwould be the artificial or natural character of the procedure.)7t is a differenceinvolving )two irreconcilable concepts of the human person and of humanse#uality.)

The )difference,) then, must be recogni%ed and illustrated/ )The ultimate reason forevery natural method is not *ust its effectiveness or biological reliability, but itsconsistency with the Christian vision of se#uality as e#pressive of married love.)9)t is fre(uently asserted that contraception, if made safe and available to all, is the

most effective remedy against abortion.... When looked at carefully, this ob*ectionis clearly unfounded.... ndeed, the pro$abortion culture is especially strong

precisely where the Church's teaching on contraception is re*ected.)1

19*ather than directions for use, natural methods are in keeping withthe meaning of con*ugal love, which gives direction to the life of thecouple/ )The choice of the natural rhythms involves accepting the cycleof the person, that is the woman, and thereby accepting dialogue,reciprocal respect, shared responsibility and self?control.... n thisconte#t...con*ugal communion is enriched with those values oftenderness and affection which constitute the inner soul of humanse#uality, in its physical dimension also.)8

+*Health care workers can contribute, when opportunities occur intheir field, towards an acceptance of this human and Christian conceptof se#uality by making available to married people, and even before that

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to young people, the re(uired information for responsible behavior,respectful of the special dignity of human se#uality.:

This is why the Church appeals to their )responsibility) in )effectively helpingcouples to live their love with respect for the structures and finalities of thecon*ugal act which e#presses that love.)95

Artiicial procreation

+1*The application to humans of biotechnology learned from animalfertili%ation has made possible various interventions in human

procreation, giving rise to serious (uestions of moral lawfulness. )Thevarious techni(ues of artificial reproduction, which would seem to be atthe service of life and which are fre(uently used with this intention,

actually open the door to new threats against life.)

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The evaluative ethical criterion must take account of the originality of human

procreation, which )derives from the originality itself of the human person.)93)@ature itself dictates that the transmission of human life be a personal andconscious act and, as such, sub*ect to the most holy laws of 2od/ immutable andinviolable laws which must be acknowledged and observed.)94This personal act isthe intimate union of the love of the spouses who, in giving themselves completelyto each other, give life. t is a single, indivisible act, at once unitive and

procreative, con*ugal and parental.97

This act F )an e#pression of the reciprocal gift which, in the words of +cripture,brings about a union 'in one flesh')9F is the source of life.

++*Humans are not at liberty to be ignorant of and to ignore themeanings and values intrinsic to human life from its very beginning.)And therefore means cannot be used nor laws followed which may belicit in the transmission of animal or vegetable life.)99The dignity of thehuman person demands that it come into being as a gift of 2od and asthe fruit of the con*ugal act, which is proper and specific to the unitive

and procreative love between the spouses, an act which of its verynature is irreplaceable.

;very means and medical intervention, in the field of procreation, must always beby way of assistance and never substitution of the marriage act. n fact, )the doctoris at the service of people and human procreation/ he has no authority to do as hewills with them or to make decisions about them. &edical intervention respects the

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dignity of the persons when it aims at helping the marriage act.... Dn the contrary,sometimes medical intervention replaces the con*ugal act.... n this case, themedical action is not, as it should be, at the service of the marriage union, but itappropriates the procreative function and thus is contrary to the dignity andinalienable rights of the spouses and of the e#pected child.)91

+,*)The use of such artificial means is not necessarily forbidden if theirfunction is merely to facilitate the natural act, or to ensure that anormally performed act reaches its proper end.)98This is homologousartificial insemination, that is, within matrimony with the semen of the

partner, when this is obtained through a normal marriage act.

+*6ut homologous "


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+.*6esides these intrinsic reasons of the dignity of the person and itsconception, homologous "


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To implant in a woman's womb an embryo which is genetically foreign to her or*ust to fertili%e her with the condition that she hand over the newly born child to aclient means separating gestation from maternity, reducing it to an incubationwhich does not respect the dignity and right of the child to be )conceived, borne inthe womb, brought to birth and educated by its own parents.)8-

,*The verdict of moral unlawfulness obviously concerns the ways bywhich human fertili%ation takes place, not the fruit of these techni(ues,which is always a human being, to be welcomed as a gift of 2od'sgoodness and nurtured with love.83

,1*Artificial insemination techni(ues nowadays could open the way toattempts or pro*ects of fertili%ation between human and animal gametes,to gestation of human embryos in animal or artificial wombs, of se#less

reproduction of human beings through twinning fission, cloning,parthenogenesis.

+uch procedures are contrary to the human dignity of the embryo and ofprocreation, and thus they are to be considered morally reprehensible.84

,+*&edicine directed to the integral good of the person cannot prescindfrom the ethical principles governing human procreation.

Hence the )urgent appeal) to doctors and researchers to give )an e#emplary

witness of the respect due to the human embryo and to the dignity ofprocreation.)87

,,*&edical service to life accompanies the life of the person throughouttheir whole life?span. t is protection, promotion and care of health, thatis, of the integrity and psycho?physical well?being of the person, inwhom life )is enfleshed.)8

t is a service based on the dignity of the human person and on the right to life, andit is e#pressed not only in prevention, treatment and rehabilitation but also in an

holistic promotion of the person's health.

,*This responsibility commits the health care worker to a service tolife e#tending )from its very beginning to its natural end,) that is, )fromthe moment of conception to death.)89

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Charter For Health Care Workers:

"ife

!e"innin" o lie an# $irth

,5*)"rom the time that the ovum is fertili%ed, a life is begun which isneither that of the father nor of the mother it is rather the life of a newhuman being with its own growth. t would never be made human if itwere not human already.... ight from the fertili%ation the adventure ofa new life begins, and each of its capacities re(uires time F a ratherlengthy time F to find its place and to be in a position to act.)81

ecent advances in human biology have come to prove that )in the %ygote arisingfrom fertili%ation, the biological identity of a new human individual is already

present.)88t is the individuality proper to an autonomous being, intrinsicallydetermined, developing in gradual continuity.

6iological individuality, and therefore the personal nature of the %ygote is suchfrom conception. )How can anyone think that even a single moment of thismarvelous process of the unfolding of life could be separated from the wise andloving work of the Creator, and left prey to human capriceL)8:As a result, it iserroneous and mistaken to speak of a pre?embryo, if by this is meant a stage orcondition of pre?human life of the conceived human being.:5

,.*Prenatal life is fully human in every phase of its development.Hence health care workers owe it the same respect, the same protectionand the same care as that given to a human person.

2ynecologists and obstetricians especially )must keep a careful watch over thewonderful and mysterious process of generation taking place in the maternalwomb, to ensure its normal development and successful outcome with the birth ofthe new child.):-

,/*The birth of a child is an important and significant stage in the

development begun at conception. t is not a )leap) in (uality or a newbeginning, but a stage, with no break in continuity, of the same process.Childbirth is the passage from maternal gestation to physiologicalautonomy of life.

Dnce born, the child can live in physiological independence of the mother and canenter a new relationship with the e#ternal world.

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t may happen, in the case of premature birth, that this independence is not fullyreached. n this case health care workers are obliged to assist the newborn child,making available to it all the conditions necessary for attaining this independence.

f, despite every effort, the life of the child is at serious risk, health care workersshould see to the child's baptism according to the conditions provided by theChurch. f an ordinary minister of the sacrament is unavailable F a priest or adeacon F the health care worker has the faculty to confer it.:3

The %alue o lie: unity o $o#y an# soul

,0*The respect, protection and care proper to human life derives fromits singular dignity. )n the whole of visible creation it human lifeB hasa uni(ue value.) )The human being, in fact, is the 'only creature that

2od has wanted for its own sake. ;verything is created for humans. Thehuman being':4alone, created in the image and likeness of 2od cf. 2en-/39?31B is not and cannot be for any other or others but for 2od alone,and this is why he e#ists. The human being alone is a person/ he has thedignity of a sub*ect and is of value in himself.):7

,9*Human life is irreducibly both corporeal and spiritual. )6y virtue ofits substantial union with a spiritual soul, the human body cannot beconsidered merely an amalgam of tissues, organs and functions, nor canit 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 andacts.):);very human person, in his unrepeatable uni(ueness, is madeup not only of spirit but also of a body, so that in the body and throughit the person is reached in his concrete reality.):9

*;very intervention on the human body )touches not only the tissues,the organs and their functions, but involves also at various levels the

person himself.):1

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 hiscorporal, affective, intellectual and spiritual dimensions.) Dne cannot isolate )thetechnical problem posed by the treatment of a particular illness from the care thatshould be given to the person of the patient in all his dimensions. t is well to bearthis in mind, particularly at a time when medical science is tending towardsspeciali%ation in every discipline.):8

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1*evealing the person,::the body, in its biological make?up anddynamic, is the foundation and source of moral accountability. What isand what happens biologically is not neutral. Dn the contrary it hasethical relevance/ it is the indicative?imperative for action.-55The bodyis a properly personal reality, the sign and place of relations with others,with 2od and with the world.-5-

Dne cannot prescind from the body and make the psyche the criterion and sourceof morality/ sub*ective feelings and desires cannot replace or ignore ob*ectivecorporal conditions. The tendency to give the former pride of place over the latteris the basis for contemporary psychologi%ation of ethics and law, which makesindividual wishes and technical possibilitiesB 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 bewilling to satisfy desires, whether sub*ectively e#pressed or legally codified, atvariance with the ob*ective truth of life.

&n#isposa$ility an# in%iola$ility o lie

+*)The inviolability of the person, a reflection of the absoluteinviolability of 2od himself, has its first and fundamental e#pression inthe inviolability of human life.)-53)The (uestion/ 'What have you doneL'2en 7/-5B, which 2od addresses to Cain after he has killed his brother

Abel, interprets the e#perience of every person/ in the depths of hisconscience, man is always reminded of the inviolability of life F hisown life and that of others F as something which does not belong tohim, because it is the property and gift of 2od the Creator and"ather.)-54

The body, indivisibly with the spirit, shares in the dignity and human worth of theperson/ body?sub*ect not body?ob*ect, and as such is indisposable andinviolable.-57The body cannot be treated as a belonging. t cannot be dealt with asa thing or an ob*ect of which one is the owner and arbiter.

;very abusive intervention on the body is an insult to the dignity of the person andthus to 2od who is its only and absolute 0ord/ )The human being is not master ofhis own life/ he receives it in order to use it, he is not the proprietor but theadministrator, because 2od alone is 0ord of life.)-5

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,*The fact that life belongs to 2od and not to the human being-59givesit that sacred character-51which produces an attitude of profoundrespect/ )a direct conse(uence of the divine origin of life is itsindisposability, its untouchability, that is, its sacredness.)-58ndisposable and untouchable because sacred/ it is )a natural sacredness,which every right reason can recogni%e, even apart from religiousfaith.)-5:

&edical health activity is above all a vigilant and protective service to thissacredness/ a profession which defends the non?instrumental value of this good )initself) F that is, not relative to another or others but to 2od alone F which humanlife is.--5)&an's life comes from 2od it is his gift, his image and imprint, asharing in his breath of life. 2od therefore is the sole 0ord of this life/ man cannotdo with it as he wills.)---

*This must be affirmed with particular rigor and received withvigilant awareness at a time of invasive development in biomedicaltechnology, where the risk of abusive manipulation of human life isincreasing. The techni(ues in themselves are not the problem, but rathertheir presumed ethical neutrality. @ot everything which is technically

possible can be considered morally admissible.

Technical possibilities must be measured against ethical lawfulness, whichestablishes their human compatibility, that is, their effective employment in the

protection of and respect for the dignity of the human person.--3

5*+cience and technology )cannot by themselves give the meaning ofhuman e#istence and progress. +ince they are ordained for the human

being from whom they receive their origin and increase, it is from theperson and his moral values that they draw direction for their finalityand awareness of their limits.)--4

This is why science and wisdom should go hand in hand. +cience and technologyare e#tremist, that is, they are constantly e#panding their frontiers. Wisdom andconscience trace out for them the impassable limits of the human.--7

Ri"ht to lie

.*The divine lordship of life is the foundation and guarantee of theright to life, which is not, however, a power over life.--ather, it is theright to live with human dignity,--9as well as being guaranteed and

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protected in this fundamental, primal and unsuppressible good which isthe root and condition of every other good?right of the person.--1

)The sub*ect 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 )--8

/*The right to life poses a two$fold (uestion for the health careworker. "irst of all, he must not think that he has a right?power over thelife he is caring for, something which neither he nor the patient himselfhas. and therefore cannot be given by the latter.--:

The right of the patient is not one of ownership nor absolute, but it is bound upwith and limited by the finality established by nature.-35)@o one...can arbitrarily

choose whether to live or die the absolute master of such a decision is the Creatoralone, in whom 'we live and move and have our being') Acts -1/38B.-3-

Here F on the limits themselves of the right of the sub*ect to dispose of his ownlife F )arises the moral limit of the action of the doctor who acts with the consentof the patient.)-33

0*+econdly, the health care worker effectively guarantees this right/)the intrinsic finality) of his profession )is the affirmation of the right ofthe human being to his life and his dignity.)-34He fulfills it by assuming

the corresponding duty of preventive and therapeutic care of thehealth,-37and of the improvement, within the ambit and with the meansat his disposal, of the (uality of life of the persons and their lifeenvironment.-3)Dn our *ourney we are guided and sustained by the lawof love/ a love which has as its source and model the +on of 2od mademan, who 'by dying gave life to the world.)-39

9*The fundamental and primary right of every human being to life,which is particulari%ed as the right to protection of health, subordinatesthe trade union rights of health care workers.

This means that any *ust claims of health workers must be processed whilesafeguarding 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 thesafeguarding of health should be provided for F even by means of appropriatelegal measures.

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're%ention

5*+afeguarding health commits the health care worker particularly inthe area of prevention.

Prevention is better than cure, both because it spares the person the discomfort andsuffering from the illness, and because it spares society the costs, and not onlyeconomic costs, of treatment.

51*&edical prevention, properly so called, which consists inadministering particular medicines, vaccination, screening tests toascertain predispositions, in prescribing behavior and habits to preventthe 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.5+*There is also medical prevention in the wider sense of the term, inwhich the work of the health care worker is but a part of the preventivecommitment set in motion by society. This is the type of preventionused in cases of so?called social illnesses, such as drug?dependency,alcoholism, tobacco addiction, A!+ of the problems of social sectorsof individuals such as adolescents, the handicapped, the aged of risks tohealth tied up with the conditions and ways of living nowadays, such asin food, the environment, the work$place, sports, urban traffic, the use

of transportation means, of machines and domestic electrical appliances.

n these cases preventive intervention is the primary and most effective remedy, ifnot, indeed, the only possible one. 6ut it needs a concerted effort from all sectorsof a society. Prevention in this case is more than a medical?health action. tinvolves a sensiti%ing of the culture, through a recovery of forgotten values andeducation in them, to a more sober and integral concept of life, information aboutrisky 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 techni(ues adopted, but to the reasons behind it and to their beingmade concrete and made known in that culture.

Sickness

5,*Although it shares in the transcendent value of the person, corporeallife, of its nature, reflects the precariousness of the human condition.

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This is shown especially in sickness and suffering, which affect thewhole person adversely. )+ickness and suffering are not e#perienceswhich affect only the physical substance of the human being, but theyaffect him in his entirety and in his somatic?spiritual unity.)-31

+ickness is more than a clinical fact, medically controlled. t is always thecondition of a human being, the sick person. t is with this holistic human view ofsickness that health care workers should relate to the patient. t means that theyhave, together with the re(uisite technical?professional competence, an awarenessof values and meanings that make sense of sickness and of their own work, andmakes every individual clinical case a human encounter.

5*The Christian knows by faith that sickness and suffering share in thesalvific efficacy of the edeemer's cross. )Christ's redemption and its

salvific grace touches the whole person in his human condition andhence also in sickness, suffering and death.)-38)Dn the Cross, themiracle of the serpent lifted up by &oses in the desert n 4/-7?- cf.

@um. 3-/8?:B is renewed and brought to full and definitive perfection.Today, too, by looking upon the one who was pierced, every personwhose life is threatened encounters the sure hope of finding freedomand redemption.)-3:

6orne )in close union with the sufferings of esus,) sickness and suffering assume)an e#traordinary spiritual fruitfulness.) +o that the sick person can say with the

Apostle/ ) fill up in my body what is wanting to the sufferings of Christ, for thesake of his body which is the Church) Col -/37B.-45

"rom this new Christian meaning, the sick person can be helped to develop a triplesalutary attitude to the illness/ an )awareness) of its reality )without minimi%ing itor e#aggerating it) )acceptance,) )not with a more or less blind resignation) but inthe serene knowledge that )the 0ord can and wishes to draw good from evil) )theoblation,) )made out of love for the 0ord and one's brothers and sisters.)-4-

55*n the person of the patient, in any case, the family is alwaysaffected. Helping the relatives, and their cooperation with health careworkers are a valuable component of health care.

The health care worker is called to give the family of the patient F eitherindividually or through membership in appropriate organi%ations F together withthe treatment also enlightenment, counsel, direction and support.-43

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(ia"nosis

5.*2uided by this integrally human and properly Christian view ofsickness, the health care worker should seek, first and foremost, to findthe illness and analy%e it in the patient/ this is the diagnosis and related

prognosis.

A condition for any treatment is the previous and e#act individuation of thesymptoms and causes of the illness.

5/*n this, the health care worker will make his own the (uestions and an#ieties ofthe patient and he must guard himself from the twofold, opposing pitfalls of)hopeless) and )tenacious) diagnosis.

n the first case the patient is forced to go from one specialist or health care serviceto another, without finding the doctor or diagnostic center capable and willing totreat his illness. Dver?speciali%ation and fragmentation of clinical competenciesand divisions, while ensuring professional e#pertise, is damaging to the patientwhen health services in the place prevent a caring and global approach to hisillness.

n the second case, instead, one persists until some illness is found at any cost. tmay be through ignorance, la%iness, for gain, or for rivalry that an illness isdiagnosed or problems are treated as medical when, in fact, they are not medical$

health in nature. n this case the person is not helped to perceive the e#act nature oftheir problem, thus misleading them about themselves and their responsibilities.

50*The diagnosis does not pose, in general, problems of an ethical orderwhen these e#cesses are e#cluded and it is conducted in full respect forthe dignity and integrity of the person, particularly with regard to theuse of instrumentally invasive techni(ues. Df itself, its purpose istherapeutic/ 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 leadto and to prenatal diagnosis. n the latter case we are dealing with a substantiallynew possibility which is rapidly developing, and as such merits separate treatment.

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'renatal #ia"nosis

59*The ever?e#panding knowledge of intrauterine life and thedevelopment of instruments giving access to it make it possiblenowadays to diagnose prenatal life, thus opening the way for ever moretimely and effective therapeutic interventions.

Prenatal diagnosis reflects the moral goodness of every diagnostic intervention. Atthe same time, however, it presents its own ethical problems, connected with thediagnostic risk and the purpose for its re(uest and practice.

.*The risk factor concerns the life and physical integrity of the embryo, and onlyin part that of the mother, relative to the various diagnostic techni(ues and the

perceptual risk which each presents.

Hence, there is need )to evaluate carefully the possible negative conse(uenceswhich the necessary use of a particular investigative techni(ue can have) and)avoid recourse to diagnostic procedures about which the honest purpose andsubstantial harmlessness cannot be sufficiently guaranteed.) And if a certainamount of risk must be taken, recourse to diagnosis should have reasonableindications, to be ascertained in a diagnostic center.-44

Conse(uently, )such diagnosis is licit if the methods used, with the consent of theparents who have been ade(uately instructed, safeguard the life and integrity of the

embryo and its mother and does not sub*ect them to disproportionate risks.)-47

.1*The ob*ectives of prenatal diagnoses warranting their re(uest and practiceshould 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 womenwho are an#ious 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 handicappedchild.

Prenatal diagnosis )is gravely contrary to the moral law when it contemplates the

possibility, depending on the result, of provoking an abortion. A diagnosisrevealing the e#istence of a deformity or an hereditary disease should not bee(uivalent to a death sentence.)-4

;(ually unlawful is any directive or program of civil and health authorities or ofscientific organi%ations which support a direct connection between prenataldiagnosis and abortion. The specialist who, in carrying out the diagnosis and

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communicating the result, would voluntarily contribute to the establishing andsupport of a connection between prenatal diagnosis and abortion would be guilty ofillicit collaboration.-49

Therapy an# reha$ilitation

.+*After diagnosis comes therapy and rehabilitation/ the putting intoeffect of those curative and medical interventions which lead to the cureand 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. ehabilitation, on the other hand,is an amalgam of medical, physiotherapeutic, psychological measures andfunctional e#ercises, aimed at reviving or improving the psychophysical efficiency

of people in some way handicapped in their ability to integrate, to relate and towork productively.

Therapy and rehabilitation )are aimed not only at the well?being and health of thebody, but of the person as such who is stricken by bodily illness.)-41All therapyaimed 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 theillness.

.,*The patient has a right to any treatment from which he can drawsalutary benefit.-48

esponsibility for health care imposes on everyone )the duty of caring for himselfand of seeking treatment.) Conse(uently, )those who care for the sick should bevery diligent in their work and administer the remedies which they think arenecessary or useful.)-4:@ot only those aimed at apossible cure, but also thosewhich alleviate pain and bring relief in incurable cases.

.*The health care worker who cannot effect a cure must never cease to

treat.-75He is bound to apply all )proportionate) remedies. 6ut there isno obligation to apply )disproportionate) ones.

n relation to the conditions of a patient, those remedies must be consideredordinary where there is due proportion between the means used and the endintended. Where this proportion does not e#ist, the remedies are to be considerede#traordinary.

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To verify and establish whether there is due proportion in a particular case, )themeans should be well evaluated by comparing the type of therapy, the degree ofdifficulty and risk involved, the necessary e#penses and the possibility ofapplication, with the result that can be e#pected, taking into account the conditionsof the patient and his physical and moral powers.)-7-

.5*The principle here proposed of appropriate medical treatment in theremedies can be thus specified and applied/

F)n the absence of other remedies, it is lawful to have recourse, with the consentof the patient, to the means made available by the most advanced medicine, even ifthey are still at an e#perimental stage and not without some element of risk.)

F)t is lawful to interrupt the application of such means when the results

disappoint the hopes placed in them,) because there is no longer due proportionbetween )the investment of instruments and personnel) and )the foreseeableresults) or because )the techni(ues used sub*ect the patient to suffering anddiscomfort greater than the benefits to be had.)

F)t is always lawful to be satisfied with the normal means offered by medicine.@o 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 e(uivalent of suicide.) ather it might signify )either simple acceptanceof 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 toogreat a burden on the family or on society.)-73

..*"or the restoration of the person to health, interventions may bere(uired, in the absence of other remedies, which involve themodification, mutilation or removal of organs.

Therapeutic manipulation of the organism is legitimi%ed here by the principle oftotality,-74and for this very reason also called the principle of therapeuticity, byvirtue of which )each particular organ is subordinated to the whole of the body and

should be sub*ected to it in case of conflict. Conse(uently, the one who hasreceived the use of the whole organism has the right to sacrifice a particular organif by keeping it, it or its activity might cause appreciable harm to the wholeorganism, which cannot be avoided otherwise.)-77

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./*Physical life, although on the one hand manifesting the person and sharing hisworth, so that it cannot be disposed of as an ob*ect, on the other hand it does note#haust the value of the person nor does it represent the greatest good.-7

This is why part of it can be disposed of legitimately for the well$being of theperson. ust as it can be sacrificed or put at risk for a higher good )such as theglory of 2od, the salvation of souls and service to one's neighbor.)-79)Corporeallife is a fundamental good, a condition here below of all the others but there arehigher values for which it could be legitimate or even necessary to e#pose oneselfto the danger of losing it.)-71

Anal"esia an# anesthesia

.0*Pain, on the one hand, has of itself a therapeutic function, because

)it eases the confluence of the physical and psychic reaction of theperson to a bout of illness,)-78and on the other hand it appeals tomedicine for an alleviating and healing therapy.

.9*"or the Christian, pain has a lofty penitential and salvific meaning.)t is, in fact, a sharing in Christ's Passion and a union with theredeeming sacrifice which he offered in obedience to the "ather's will.Therefore, one must not be surprised if some Christians prefer tomoderate 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.)-7:

Acceptance of pain, motivated and supported by Christian ideals, must not lead tothe conclusion that all suffering and all pain must be accepted, and that thereshould be no effort to alleviate them.-5Dn the contrary this is a way of humani%ing

pain. Christian charity itself re(uires of health care workers the alleviation ofphysical suffering.

/*)n the long run pain is an obstacle to the attainment of higher goods andinterests.)--t 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 thespirit. Therefore it is legitimate, and beyond certain limits of endurance it is also aduty for the health care worker to prevent, alleviate and eliminate pain. t ismorally correct and right that the researcher should try )to bring pain under humancontrol.)-3

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Anesthetics like painkillers, )by directly acting on the more aggressive anddisturbing effects of pain, gives the person more control, so that suffering becomesa more human e#perience.)-4

/1*+ometimes the use of analgesic and anaesthesic techni(ues andmedicines involves the suppression or diminution of consciousness andthe use of the higher faculties. n so far as the procedures do not aimdirectly at the loss of consciousness and freedom but at dullingsensitivity to pain, and are limited to the clinical need alone, they are to

be considered ethically legitimate.-7

The inorme# consent o the patient

/+*To intervene medically, the health care worker should have the

e#press or tacit consent of the patient.n fact, he )does not have a separate and independent right in relation to the

patient. n general, he can act only if the patient e#plicitly or implicitly directly orindirectlyB authori%es him.)-Without such authori%ation he gives himself anarbitrary power.-9

6esides the medical relationship there is a human one/ dialogic, non?ob*ective.The patient )is not an anonymous individual) on whom medical e#pertise 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 theopportunity of personally choosing, and not be made to submit to the decisions andchoices of others.)-1

+o that the choice may be made with full awareness and freedom, the patientshould be given a precise idea of his illness and the therapeutic possibilities, withthe risks, the problems and the conse(uences that they entail.-8This means that the

patient should be asked for an informed consent.

/,*With regard to presumed consent, a distinction must be made

between the patient who is in a condition to know and will and one whois not.

n the former, consent cannot be presumed/ it must be clear and e#plicit.

n the latter case, however, the health care worker can, and in e#treme situationsmust, presume the consent to therapeutic interventions, which from his knowledge

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and in conscience he thinks should be made. f there is a temporary loss ofknowing and willing, the health care worker can act in virtue of the principle oftherapeutic trust, that is the original confidence with which the patient entrustedhimself to the health care worker. +hould there be a permanent loss of knowingand willing, the health care worker can act in virtue of the principle ofresponsibility for health care, which obliges the health care worker to assumeresponsibility for the patient's health.

/*With regard to the relatives, they should be informed about ordinaryinterventions, and involved in the decision making when there is(uestion of e#traordinary and optional interventions.

Research an# e)perimentation

/5*A therapeutic action which is apt to be increasingly beneficial tohealth is for that very reason open to new investigative possibilities.These are the result of a progressive and ongoing activity of researchand e#perimentation, which thus succeeds in arriving at new medicaladvances.

To proceed by way of research and e#perimentation is a law of every appliedscience/ scientific progress is structurally connected with it. 6iomedical sciencesand their development are sub*ect to this law also. 6ut they operate in a particularfield of application and observation which is the life of the human person.

The latter, because of his uni(ue dignity, can be the sub*ect of research and clinicale#perimentation with the safeguards due to a being with the value of a sub*ect andnot an ob*ect. "or this reason, biomedical sciences do not have the same freedomof 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.)-:

/.*n the research stage, the ethical norm re(uires that its aim be to)promote human well?being.)-95Any research contrary to the true good

of the person is immoral. To invest energies and resources in itcontradicts the human finality of science and its progress.-9-

n the e#perimental stage, that is, testing the findings of research on a person, thegood of the person, protected by the ethical norm, demands respect for previousconditions which are essentially linked with consent and risk.

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//*"irst of all, the consent of the patient. He )should be informed aboutthe e#perimentation, its purpose and possible risks, so that he can giveor refuse his consent with full knowledge and freedom. n fact, thedoctor has only that power and those rights which the patient himselfgives him.)-93

This consent can be presumed when it is of benefit to the patient himself, that is,when there is a (uestion of therapeutic e#perimentation.

/0*+econdly, there is the risk factor. Df its nature, everye#perimentation has risks. Hence, )it cannot be demanded that alldanger and all risk be e#cluded. This is beyond human possibility itwould paraly%e all serious scientific research and would (uite often bedetrimental to the patient.... 6ut there is a level of danger that the moral

law cannot allow.)-94

A human sub*ect cannot be e#posed to the same risk as beings which are nothuman. There is a threshold beyond which the risk becomes humanlyunacceptable. This threshold is indicated by the inviolable good of the person,which forbids him )to endanger his life, his e(uilibrium. his health, or to aggravatehis illness.)-97

/9*;#perimentation cannot be begun and generali%ed until everysafeguard has been put in place to guarantee the harmlessness of the

intervention and to lessen the risk. )The pre?clinical basic phase, carriedout carefully, should give the widest documentation and the most secure

pharmacological$to#icological guarantees and ensure operationalsafety.)-9

To ac(uire these assurances, if it be useful and necessary, the testing of newpharmaceutical products or of new techni(ues should first be done on animalsbefore they are tried on humans. )t is certain that the animal is for the service ofman and can therefore be the ob*ect of e#perimentation. However, it should betreated as one of 2od's creatures, meant to cooperate in man's good but not to beabused.)-99t follows that all e#perimentation )should be carried out withconsideration for the animal, without causing it useless suffering.)-91

When these guarantees are in place, in the clinical phase e#perimentation on thehuman person must be in accord with the principle of proportionate risk, that is, ofdue proportion between the advantages and foreseeable risks. Here a distinction

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must be made between e#perimentation on a sick person, for therapeutic reasons,and on a healthy person, for scientific and humanitarian reasons.

0*n e#perimentation on a sick person, due proportion is attained froma comparison of the condition of the sick person and the foreseeableeffects of the drugs or the e#perimental methods. Hence the risk ratewhich might be proportionate and legitimate for one patient may not beso for another.

t is a valid principle F as already said F that )in the absence of other remedies, itis 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 e#perimental stage andare not without some risk. 6y accepting them the patient might also give ane#ample of generosity for the benefit of humanity.)-986ut there must always be

)great respect for the patient in the application of new therapy still at thee#perimental stage...when these are still high?risk procedures.)-9:

)n desperate cases, when the patient will die if there is no intervention, if there is amedication available, or a method or an operation which, though not e#cluding alldanger, still has some possibility of success, any right$thinking person wouldconcede that the doctor could certainly, with the e#plicit or tacit consent of the

patient, proceed with the application of the treatment.)-15

01*Clinical e#perimentation can also be practiced , who voluntarily

offers himself )to contribute by his initiative to the progress of medicineand, in that way, to the good of the community.) n this case, )once hisown substantial integrity is safeguarded, the patient can legitimatelyaccept a certain degree of risk.)-1-

This is legitimi%ed by the human and Christian solidarity which motivates thegesture/ )To give of oneself, within the limits marked out by the moral law, can bea witness of highly meritorious charity and a means of such significant spiritualgrowth that it can compensate for the risk of any insubstantial physicalimpairment.)-13

n any case, it is a duty to always interrupt the e#perimentation when the resultsdisappoint the e#pectations.

0+*+ince the human individual, in the prenatal stage, must be given thedignity of a human person, research and e#perimentation on human

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embryos and fetuses is sub*ect to the ethical norms valid for the childalready born and for every human sub*ect.

esearch in particular, that is the observation of a given phenomenon duringpregnancy, can be allowed only when )there is moral certainty that there will be noharm either to the life or the integrity of the e#pected child and the mother, and oncondition that the parents have given their consent.)-14

;#perimentation, on the other hand, is possible only for clearly therapeuticpurposes, when no other possible remedy is available. )@o finality, even if in itselfnoble, such as the foreseeing of a usefulness for science, for other human beings orfor society, can in any way *ustify e#perimentation on live human embryos andfetuses, whether viable or not, in the maternal womb or outside of it. The informedconsent, normally re(uired for clinical e#perimentation on an adult, cannot be

given by the parents, who may not dispose either of the physical integrity or thelife of the e#pected child. Dn the other hand, e#perimentation on embryos orfetuses has the risk, indeed in most cases the certain foreknowledge, of damagingtheir physical integrity or even causing their death. To use a human embryo or thefetus as an ob*ect or instrument of e#perimentation is a crime against their dignityas human beings.) )The practice of keeping human embryos alive, actually or invitro, for e#perimental or commercial reasons,) is especially and )altogethercontrary to human dignity.)-17

(onation an# transplantin" o or"ans

0,*The progress and spread of transplant medicine and surgerynowadays 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 andlimited e#istence.-1This )service to life,)-19which the donation andtransplant of organs represents, shows its moral value and legitimi%esmedical practice. There are, however, some conditions which must beobserved, particularly those regarding donors and the organs donatedand implanted. ;very organ or human tissue transplant re(uires ane#plant which in some way impairs the corporeal integrity of the donor.

0*, in which there is the e#plant and implant on the same person, arelegitimate in virtue of the principle of totality by which it is possible todispose of a part for the integral good of the organism.

05*Homoplastic transplants, in which the transplant is taken from aperson of the same species as the recipient, are legitimi%ed by the

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principle of solidarity which *oins human beings, and by charity whichprompts one to give to suffering brothers and sisters.-11)With the adventof organ transplants, begun with blood transfusions, human personshave found a way to give part ofthemselves, of their blood and of their

bodies, so that others may continue to live. Thanks to science and toprofessional training and the dedication of doctors and health careworkers...new and wonderful challenges are emerging. We arechallenged to love our neighbor in new ways in evangelical termsMtolove 'even unto the end' n -4/-B, even if within certain limits whichcannot be transgressed, limits placed by human nature itself.)-18

n homoplastic transplants, organs may be taken either from a living donor or froma corpse.

0.*n the first case the removal is legitimate provided it is a (uestion of organs ofwhich the e#plant would not constitute a serious and irreparable impairment for thedonor. )Dne can donate only what he can deprive himself of without seriousdanger to his life or personal identity, and for a *ust and proportionate reason.)-1:

0/*n the second case we are no longer concerned with a living person but acorpse. This must always be respected as a human corpse, but it no longer has thedignity of a sub*ect and the end value of a living person. )A corpse is no longer, inthe proper sense of the term, a sub*ect of rights, because it is deprived of

personality, which alone can be the sub*ect of rights.) Hence, )to put it to useful

purposes, morally blameless and even noble) is a decision )not be condemned butto be positively *ustified.)-85

There must be certainty, however, that it is a corpse, to ensure that the removal oforgans does not cause or even hasten death. The removal of organs from a corpseis legitimate when the certain death of the donor has been ascertained. Hence theduty of )taking steps to ensure that a corpse is not considered and treated as such

before death has been duly verified.)-8-

n order that a person be considered a corpse, it is enough that cerebral death of thedonor be ascertained, which consists in the )irreversible cessation of all cerebralactivity.) When total cerebral death is verified with certainty, that is, after there(uired tests, it is licit to remove organs and also to surrogate organic functionsartificially in order to keep the organs alive with a view to a transplant.-83

00*;thically, not all organs can be donated. The brain and the gonad

charter for health care workers text

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