THE CHARTER FOR HEALTH CARE WORKERS Vatican City - 1995 The result of long, careful, and multidisciplinary preparation, The Charter for Health Care Workers, has now been published, through the initiative of the Pontifical Council for Pastoral Assistance to Health Care Workers. t is certainly a source of satisfaction that the Congregation for the !octrine of the "aith has approved and confirmed, both fully and swiftly, the te#t of the Charter which was submitted to it $ one more reason to recogni%e its thorough validity, as well as a concrete confirmation of the effectiveness of the interdepartmental cooperation which was e#pressly desired by the &otu Proprio instituting the Pontifical Council for Pastoral Assistance to Health Care Workers. There are many reasons why we must know, disseminate, and apply the directives 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 defend life. The e#traordinary progress of science and technology in the immense field of health policy and care have made bioethics, or the ethics of life, a discipline in its own right. Hence the need $ rigorously responded to by the Charter for Health Care Workers $ to provide an organic, e#haustive summary of the Church's position on all that concerns affirming the primary, absolute value of life 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 directives around the threefold sub*ect$matter of generation, living, and dying. And so that sub*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 the authoritative te#ts published by the departments of the ,oman Curia. These references plainly demonstrate that the Church's position on fundamental - problems in bioethics $ while maintaining the unalterable limits of advancing and defending life $ is highly constructive and open to the true progress of science and 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 )a form of Christian witness.) With humility $ but also with pride $ we can thus regard this Charter for Health Care Workers as an integral part of the )new evangeli%ation,) which, in serving life, 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 ongoing training of health workers, so that their witness will be a demonstration that the Church, in defending life, opens her heart and her arms to all men, for Christ's message is addressed to all. CONTENTS Preface . ntroduction/ &inisters of 0ife 1 - P!OC!EATON 2enetic manipulation 34 "ertility control 3. Artificial procreation 45 - "#E 6eginning of life and birth 7- The value of life/ unity of body and soul 74 ndisposability and inviolability of life 7. ,ight to life 78 Prevention .- +ickness .3 !iagnosis .7 Prenatal diagnosis .9 Therapy and rehabilitation .8 3 Analgesia and anesthesia 93 The informed consent of the patient 97 ,esearch and e#perimentation 99 !onation and transplant of organs 13 !ependency/ drugs, alcoholism, smoking, psychopharmaceuticals 11 Psychology and psychotherapy 84 Pastoral care and the sacrament of Anointing of the +ick 8. - $EATH Terminal illnesses :4 !eath with dignity :9 The use of pain$killers for the terminally ill :: Telling the truth to a dying person -53 The moment of death -57 ,eligious assistance for the dying -59 The suppression of life -58 Abortion --- ;uthanasia --9 Analytical 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 to The Pontifical Council for Pastoral Assistance to Health Care Workers <atican City Tel/ =4:$59.9:884-48, 9:887135, 9:8871:: $ "a#/ =4:$59.9:884-4: ;$&ail/ opersanit>htlhwork.va
Charter For Health Care Workers: Preface%ntro&uction 4 Car&inal #ioren'o An(elini Presi&ent of the Pontifical Council for Pastoral Assistance to Health Care Workers After long, careful and multi?discipline preparation, the Charter for Health Care Workers is now being published at the initiative of the Pontifical Council for Pastoral Assistance to Health Care Workers. @othing happens by chance in human affairs, and even chronological coincidence can have symbolic meanings. n fact, the awaited document is being published a few months after the institution A"ebruary --, -::7B, by the Holy "ather, Cohn Paul , of the Pontifical Academy for 0ife, which ideally, operatively and in its statutary finality is closely associated with the tasks of the Dffice for Pastoral Assistance to Health Care Workers. And this Dffice cannot but feel flattered that the Congregation for the !octrine of the "aith approved and (uickly confirmed in its entirety the te#t of the Charter submitted to it/ another reason for its full validity and secure authority, but also a concrete proof of the inter?dicastery cooperation e#pressly desired in the motu proprio which set up the Pontifical Council for Pastoral Assistance to Health Care Workers. There are many reasons for recommending a knowledge, the divulgation and the application of the directives contained in this deontological code for those engaged in 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 of promoting and defending life. The e#traordinary advances of science and technology in the very vast field of health and medicine have produced an independent discipline called bioethics, or ethics of life. This e#plains why, especially from Pius E onwards, the magisterium of the Church has intervened with increasing interest, with consistent firmness and ever more e#plicit directives concerning all the comple# problems arising 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 for Health 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 the primary 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 care workers, or better, of the )ministers of life,) the Charter gathers its directives around the triple theme of procreation, life and death. And so that F as often 7 happens F doubtful interpretations may not prevail over the ob*ective worth of the contents, in the redaction of the document the interventions of the +upreme Pontiffs and authoritative te#ts issued by the Dffices of the ,oman Curia have almost always been (uoted directly. These interventions show conclusively that the position of the Church on the fundamental problems of bioethics, while safeguarding the sacred limits imposed by the promotion and defense of life, is highly 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 those who 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 initial and ongoing formation of health care workers, so that their witness may be proof that the Church, in its defense of life, opens its heart and its arms to all people since Christ's message is addressed to all people. . 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 a profoundly human and Christian commitment, undertaken and carried out not only as a technical activity but also as one of dedication to and love of neighbor. t is )a form of Christian witness.) - )Their profession calls for them to be guardians and servants of human life) A;vangelium <itae G8:B. 0ife is a primary and fundamental good of the human person. Caring for life, then, e#presses, first and foremost, a truly human activity in defense of physical life. t is to this that professional or voluntary health care workers devote their activity. These are doctors, nurses, hospital chaplains, men and women religious, administrators, voluntary care givers for those who suffer, those involved in the diagnosis, treatment and recovery of human health. The principal and symbolic e#pression of )taking care) is their vigilant and caring presence at the sickbed. t is here that medical and nursing activity e#presses its lofty human and Christian value. +* Health care activity is based on an interpersonal relationship of a special kind. t is )a meeting between trust and conscience.) 3 The )trust) of one who is ill and suffering and hence in need, who entrusts himself to the )conscience) of another who can help him in his need and who comes to his assistance to care for him and cure him. This is the health care worker. 4
"or him )the sick person is never merely a clinical case) F an anonymous individual on whom to apply the fruit of his knowledge F )but always a 'sick person,' towards whom) he shows a sincere attitude of )sympathy,) in the ethymological sense of the term. 7
This re(uires love/ availability, attention, understanding, sharing, benevolence, patience, dialogue. )+cientific and professional e#pertise) is not enoughH what is re(uired is )personal empathy with the concrete situations of each patient.) .
,* To safeguard, recover and better the state of health means serving life in its totality. n fact, )sickness and suffering are phenomena which, when e#amined in depth, ask (uestions which go beyond medicine to the essence of the human 9 condition in this world. t is easy to see, therefore, how important in socio?medical service is the presence...of workers who are guided by an holistic human vision of illness 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, will more easily become aware of the demanding missionary dimension of his profession/ )his entire humanity comes into play) here )and nothing less than complete commitment is re(uired of him.) 1
To speak of mission is to speak of vocation/ 8 the response to a transcendent call which takes shape in the suffering and appealing countenance of the patient in his care. )To care lovingly for a sick person is to fulfill a divine mission, which alone can 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, Cesus says/ ' came that they may have life, and have it abundantly' ACn -5/-5B.... t is precisely in this 'life' that all the aspects and stages of human life achieve their full significance) A;vangelium <itae G-B. The health care worker is the good +amaritan of the parable, who stops beside the wounded person, becoming his )neighbor in charity Acf. 0k -5/3:?41B. -5
-* This means that health?care is a ministerial instrument of 2od's outpouring love for the suffering personH and, at the same time, it is an act of love of 2od, shown in the loving care for the person. "or the Christian, it is an actuali%ed continuation of the healing love of Christ, who )went about doing good and healing everyone) AActs -5/48B. -- And at the same time it is love for Christ/ he is the sick person F ) was sick) F who assumes the face of a suffering brotherH since he considers as done to himself F )you did it to me) F the loving care of one's brother Acf. &t 3./ 4-75B. -3
Profession, vocation and mission meet and, in the Christian vision of life and health, they are mutually integrated. +een in this light, health care assumes a new and more e#alted meaning as )service to life) and )healing ministry.) -4 &inister of life, -7 the health care worker is )the minister of that 2od, who in +cripture is presented as 'a lover of life') AWis --/39B. -. To serve life is to serve 2od in the person/ it is to become )a collaborator with 2od in restoring health to the sick body) -9 and to give praise and glory to 2od in the loving welcome to life, especially if it be weak and ill. -1
5* The Church, which considers )service to the sick as an integral part of its mission,) -8 assumes it as an e#pression of its ministry. -: )The 1 Church...has always seen medicine as an important support for its own redeeming mission to humanity.) n fact, )service to man's spirit cannot be fully effective e#cept it be service to his psycho?physical unity. The Church knows well that physical evil imprisons the spirit, *ust as spiritual evil sub*ects the body.) 35
t follows that the of health care workers is a sharing in the pastoral 3- and evangeli%ing 33 work 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 of Christ and of his Church in loving the sick and the suffering/) 34 witnesses of )the gospel 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, the health care worker has ethical responsibilities. )The ethical law, founded on respect for the dignity of the person and on the rightsof the sick, should illuminate and govern both the research phase and the application of the findings.) 3. n fidelity 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 is e#pressed by the law. He draws his behavioral directives from that field of normative ethics which nowadays is called bioethics. Here, with vigilant and careful attention, the magisterium of the Church has intervened, with reference to (uestions and disputes arising from the biomedical advances and from the changing cultural ethos. This bioethical magisterium is for the health care worker, Catholic or otherwise, a source of principles and norms of conduct which enlighten his conscience and direct him F especially in the comple#ity of modern bio?technical possibilities F in his choices, always respecting life and its dignity. /* The continuous progress of medicine demands of the health care worker 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 and refines their moral conscience.) There is need )to develop in them an authentic 8 faith and a true sense of morality, in a sincere search for a religious relationship with 2od, in whom all ideals of goodness and truth are based.) 31
)All health care workers should be taught morality and bioethics.) 38 To achieve this. those responsible for their formation should endeavor to have chairs and courses in bioethics put in place. 0* Health care workers, especially doctors, cannot be left to their own devices and burdened with unbearable responsibilities when faced with ever more comple# and problematic clinical cases arising from biotechnical possibilities F many of which are at an e#perimental stage F open to modern medicine, and from the socio?medical import of certain (uestions. To facilitate choices and to keep a check on them, the setting up of ethical committees in the principal medical centers should be encouraged. n these commissions, medical competence and evaluation is confronted and integrated with that of other presences at the patient's side, so as to safeguard the latter's dignity and medical responsibility itself. 3:
9* The sphere of action of health care workers consists, in general, of what is contained in the terms and concepts of health and medicine especially. The term and concept of health embraces all that pertains to prevention, diagnosis, treatment and rehabilitation for greater e(uilibrium and the physical, psychic and spiritual well?being of the person. The term and concept of medicine, on the other hand, refers to all that concerns health policy, legislation, programming and structures. 45
The full concept of health reflects directly on that of medicine. n fact, )institutions are very important and indispensableH however, no institution can of itself substitute 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 the concepts 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 relationship F and at the socio?policy level so as to safeguard in institutional and technological structures the human?Christian interests in society and the institutional and technological infrastructures. The first but not without the second, : 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 and love,' without which the life of individuals and of society itself loses its most genuinely human (uality) A;vangelium <itae G31B. 11* The present charter wants to guarantee the ethical fidelity of the health care worker/ the choices and behavior enfleshing service to life. This fidelity is outlined through the stages of human e#istence/ procreation, living, dying, as reference points for ethical?pastoral reflections. 11* )n the biblical narrative, the difference between man and other creatures is shown above all by the fact that only the creation of man is presented as the result of a special decision on the part of 2od, a deliberation to establish a particular and specific bond with the Creator/ '0et us make man in our image, after our likeness' A2en -/39B. The life which 2od offers to man is a gift by which 2od shares something of himself with his creature.) 44
)2od himself who said, 'it is not good for man to be alone' A2en 3/-8B and 'who made man from the beginning male and female' A&t -:/7B, wished to share with man a certain participation in his own creative work. Thus he blessed male and female saying/ 'ncrease and multiply' A2en -/38B. The generation of a new human being is therefore )an event which is deeply human and full of religious meaning, insofar as it involves both the spouses, who form 'one flesh' A2en 3/37B, and 2od who makes himself present.) 47
Health care workers lend their service whenever they help the parents to procreate responsibly, supporting the conditions, removing obstacles and protecting them from invasive techni(ues unworthy of human procreation. Genetic manipulation 1+* The ever?widening knowledge of the human genetic patrimony AgenomeB, the individuation and mapping of the activity of the genes, with the possibility of transferring them, modifying them or substituting them, opens up untold prospects to medicine and at the same time creates new and delicate ethical problems. n moral evaluation a distinction must be made between strictly therapeutic manipulation, which aims to cure illnesses caused by genetic or chromosome -5 anomalies Agenetic therapyB, from manipulation altering the human genetic patrimony. A curative intervention, which is also called )genetic surgery,) )will be considered desirable in principle. provided its purpose is the real promotion of the personal well?being of the individual, without damaging his integrity or worsening his condition of life.) 4.
1,* Dn the other hand, interventions which are not directly curative, the purpose of which is )the production of human beings selected according to se# or other predetermined (ualities,) which change the genotype of the individual and of the human species, )are contrary to the personal dignity of the human being, to his integrity and to his identity. Therefore they can be in no way *ustified on the prete#t that they will produce some beneficial results for humanity in the future,) 49 )no social or scientific usefulness and no ideological purpose could ever *ustify an intervention on the human genome unless it be therapeutic, that is its finality must be the natural development of the human being.) 41
1-* n any case, this type of intervention )should not pre*udice the beginnings of human life, that is, procreation linked to not only the biological but also the spiritual union of the parents, united in the bond of matrimony.) 48
The negative ethical evaluations outlined here apply to all genetic manipulatory interventions concerned with embryos. Dn the other hand there are no moral ob*ections to the manipulation of human body cells for curative purposes and the manipulation of animal or vegetable cells for pharmaceutical purposes. Fertility control 15* )Without intending to underestimate the other ends of marriage, it must be said that true married love and the whole structure of family life which results from it is directed to disposing the spouses to cooperate valiantly with the love of the Creator and +avior, who through them will increase and enrich his family from day to day.) 4: )When a new person is born of the con*ugal union of the two, he brings with him into the world a particular image and likeness of 2od himself/ the genealogy of the person is inscribed in the very biology of generation. n affirming that the spouses, as parents, cooperate with 2od the Creator in conceiving and giving birth to a new human being, we are not speaking -- merely with reference to the laws of biology.... 6egetting is the continuation of Creation.) 75
)Those are considered to e#ercise responsible parenthood who prudently and generously decide to have a large family, or who, for serious reasons and with due respect for the moral law, choose to have no more children for the time being or even for an indeterminate period.) 7- n the latter case there is the problem of birth control. 1.* n evaluating behavior with regard to this control, the moral *udgment )does not depend solely on good intentions and on the evaluation of motivesH it is determined by ob*ective criteria, criteria drawn from the dignity of the human person and human action.) 73 t 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 their married love. With regard to the marriage act, this e#presses )the indissoluble bond between the two meanings of the act/ the unitive meaning and the procreative meaning.) 74 n fact, the acts by which the partners fully e#press themselves and which intensify their 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 and procreative/ )it clearly implies both spousal and parental significance.) 7.
This bond is intrinsic to the marriage act/ )man may not break it on his own initiative,) without denying the dignity proper to the person and )the inner truth of married love.) 79
1/* Therefore, while it is lawful, for grave reasons, to take advantage of a knowledge of the woman's fertility and forego the use of marriage in the 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 is precisely this respect which makes legitimate, at the service of responsible procreation, the use of natural methods of regulating fertility. "rom the scientific point of view, these methods are becoming more and more accurate and make it possible in practice to make choices in harmony with moral values.) 7:
-3 Artificial means contradict )the nature of the man and the woman and of their most intimate relationship.) .5 Here se#ual union is separated from procreation/ the act is deprived of its natural openness to life. )Thus the original import of human se#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 way the marriage union is betrayed and its fruitfulness is sub*ected to the caprice of the couple.) .-
This occurs in )every action which, either in anticipation of the con*ugal act, or in its 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 element would be the artificial or natural character of the procedure.) .7 t is a difference involving )two irreconcilable concepts of the human person and of human se#uality.) ..
The )difference,) then, must be recogni%ed and illustrated/ )The ultimate reason for every natural method is not *ust its effectiveness or biological reliability, but its consistency 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*ection is 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 with the meaning of con*ugal love, which gives direction to the life of the couple/ )The choice of the natural rhythms involves accepting the cycle of the person, that is the woman, and thereby accepting dialogue, reciprocal respect, shared responsibility and self?control.... n this conte#t...con*ugal communion is enriched with those values of tenderness and affection which constitute the inner soul of human se#uality, in its physical dimension also.) .8
+1* Health care workers can contribute, when opportunities occur in their field, towards an acceptance of this human and Christian concept of se#uality by making available to married people, and even before that -4 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 helping couples to live their love with respect for the structures and finalities of the con*ugal act which e#presses that love.) 95
Artiicial procreation +1* The application to humans of biotechnology learned from animal fertili%ation has made possible various interventions in human procreation, giving rise to serious (uestions of moral lawfulness. )The various techni(ues of artificial reproduction, which would seem to be at the service of life and which are fre(uently used with this intention, actually open the door to new threats against life.) 9-
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 and conscious act and, as such, sub*ect to the most holy laws of 2od/ immutable and inviolable laws which must be acknowledged and observed.) 94 This personal act is the intimate union of the love of the spouses who, in giving themselves completely to 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') 9. F is the source of life. ++* Humans are not at liberty to be ignorant of and to ignore the meanings and values intrinsic to human life from its very beginning. )And therefore means cannot be used nor laws followed which may be licit in the transmission of animal or vegetable life.) 99 The dignity of the human person demands that it come into being as a gift of 2od and as the 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 very nature is irreplaceable. ;very means and medical intervention, in the field of procreation, must always be by way of assistance and never substitution of the marriage act. n fact, )the doctor is at the service of people and human procreation/ he has no authority to do as he wills with them or to make decisions about them. &edical intervention respects the -7 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, the medical action is not, as it should be, at the service of the marriage union, but it appropriates the procreative function and thus is contrary to the dignity and inalienable rights of the spouses and of the e#pected child.) 91
+,* )The use of such artificial means is not necessarily forbidden if their function is merely to facilitate the natural act, or to ensure that a normally performed act reaches its proper end.) 98 This is homologous artificial insemination, that is, within matrimony with the semen of the partner, when this is obtained through a normal marriage act. +-* 6ut homologous "<;T A"ertili%ation in vitro with embryo transferB is illicit because conception is not the result of a con*ugal act F )the fruit of the con*ugal act specific to the love between the spouses) 9: F but outside it/ in vitro through techni(ues which determine the conditions and decide the effect. 15 This is not in accord with the logic of )donation,) proper to human procreation, but )production) and )dominion,) proper to things and effects. n this case the child is not born as a )gift) of love, but as a laboratory )product.) 1-
Df itself, "<;T )separates the acts which are destined for human procreation in the con*ugal act,) an act which is )indissolubly corporeal and spiritual.) "ertili%ation takes place outside the bodies of the spouses. t is not )actually effected nor positively willed as an e#pression of and fruit of the specific act of con*ugal union,) but as a )result) of a technical intervention. 13 )I&anJ no longer considers life as a splendid gift of 2od, something 'sacred' entrusted to his responsibility and thus also to his loving care and 'veneration.' 0ife itself becomes a mere 'thing,' which man claims as his e#clusive property, completely sub*ect to his control and manipulation.) 14
+5* The desire for a child, sincere and intense though it be, by the spouses, does not legitimi%e recourse to techni(ues which are contrary to the truth of human procreation and to the dignity of the new human being. 17
The desire for a child gives no right to have a child. The latter is a person, with the dignity of a )sub*ect.) As such, it cannot be desired as an )ob*ect.) The fact is that the child is a sub*ect of rights/ the child has the right to be conceived only with full respect for its personhood. 1.
-. +.* 6esides these intrinsic reasons of the dignity of the person and its conception, homologous "<;T is also morally inadmissible because of the circumstances and conse(uences of its present?day practice. n fact, it is effected at the cost of numerous embryonal losses, which are procured abortions. t could also involve congealment, which means suspension of life, of the so?called )spare) embryos, and often even their destruction. 19
Knacceptable is )post mortem) insemination, that is, with semen, given during his lifetime, by the deceased spouse. These are aggravating factors in a technical procedure already morally illicit in itself, and which remains such even without these factors. 11
+/* Heterologous techni(ues are )burdened) with the )ethical negativity) of conception outside of marriage. ,ecourse to gametes of people other than the spouses is contrary to the unity of marriage and the fidelity of the spouses, and it harms the right of the child to be conceived and born in and from a marriage. )Procreation then...e#presses a desire, or indeed the intention, to have a child 'at all costs,' and not because it signifies the complete acceptance of the other and therefore an openness to the richness of life which the child represents.) 18
These techni(ues, in fact, ignore the common and unitary vocation of the partners to paternity and maternity F to )become father and mother only through one another) F and they cause )a rupture between genetic parenthood, gestational parenthood and educational responsibility,) which, from the family, has repercussions in society. 1:
A further reason for unlawfulness is the commerciali%ation and eugenic selection of the gametes. +0* "or the same reasons, aggravated by the absence of the marriage bond, artificial insemination of the unmarried and cohabitants is morally unacceptable. 85
+9* ;(ually contrary to the dignity of the woman, to the unity of marriage and to the dignity of the procreation of a human person is )surrogate) motherhood. -9 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 a client means separating gestation from maternity, reducing it to an incubation which does not respect the dignity and right of the child to be )conceived, borne in the womb, brought to birth and educated by its own parents.) 8-
,1* The verdict of moral unlawfulness obviously concerns the ways by which 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's goodness and nurtured with love. 83
,1* Artificial insemination techni(ues nowadays could open the way to attempts 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 of procreation, and thus they are to be considered morally reprehensible. 84
,+* &edicine directed to the integral good of the person cannot prescind from 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 of procreation.) 87
,,* &edical service to life accompanies the life of the person throughout their whole life?span. t is protection, promotion and care of health, that is, of the integrity and psycho?physical well?being of the person, in whom life )is enfleshed.) 8.
t is a service based on the dignity of the human person and on the right to life, and it 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 to life e#tending )from its very beginning to its natural end,) that is, )from the moment of conception to death.) 89
-1 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 is neither that of the father nor of the motherH it is rather the life of a new human being with its own growth. t would never be made human if it were not human already.... ,ight from the fertili%ation the adventure of a new life begins, and each of its capacities re(uires time F a rather lengthy 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 arising from fertili%ation, the biological identity of a new human individual is already present.) 88 t is the individuality proper to an autonomous being, intrinsically determined, developing in gradual continuity. 6iological individuality, and therefore the personal nature of the %ygote 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 capriceL) 8: 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. :5
,.* 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. 2ynecologists 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.) :-
,/* 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 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. Dnce born, the child can live in physiological independence of the mother and can enter a new relationship with the e#ternal world. -8 t may happen, in the case of premature birth, that this independence is not fully reached. 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 workers should see to the child's baptism according to the conditions provided by the Church. f an ordinary minister of the sacrament is unavailable F a priest or a deacon 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 from its singular dignity. )n the whole of visible creation it Ahuman lifeB has a 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. The human being' :4 alone, created in the image and likeness of 2od Acf. 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 the dignity of a sub*ect and is of value in himself.) :7
,9* Human life is irreducibly both corporeal and spiritual. )6y 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.) :. );very human person, in his unrepeatable uni(ueness, 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.) :9
-1* ;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 his corporal, affective, intellectual and spiritual dimensions.) Dne 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. t is well to bear this in mind, particularly at a time when medical science is tending towards speciali%ation in every discipline.) :8
-: -1* ,evealing the person, :: 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. Dn the contrary it has ethical relevance/ it is the indicative?imperative for action. -55 The body is 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 source of morality/ sub*ective feelings and desires cannot replace or ignore ob*ective corporal conditions. The tendency to give the former pride of place over the latter is the basis for contemporary psychologi%ation of ethics and law, which makes individual wishes Aand 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 be willing to satisfy desires, whether sub*ectively e#pressed or legally codified, at variance 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 absolute inviolability of 2od himself, has its first and fundamental e#pression in the inviolability of human life.) -53 )The (uestion/ 'What have you doneL' A2en 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 his conscience, man is always reminded of the inviolability of life F his own life and that of others F as something which does not belong to him, 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 the person/ body?sub*ect not body?ob*ect, and as such is indisposable and inviolable. -57 The body cannot be treated as a belonging. t cannot be dealt with as a 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 and thus to 2od who is its only and absolute 0ord/ )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 2od alone is 0ord of life.) -5.
35 -,* The fact that life belongs to 2od and not to the human being -59 gives it that sacred character -51 which produces an attitude of profound respect/ )a direct conse(uence of the divine origin of life is its indisposability, its untouchability, that is, its sacredness.) -58
ndisposable and untouchable because sacred/ it is )a natural sacredness, which every right reason can recogni%e, even apart from religious faith.) -5:
&edical 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) F that is, not relative to another or others but to 2od alone F which human life is. --5 )&an's life comes from 2odH it is his gift, his image and imprint, a sharing in his breath of life. 2od therefore is the sole 0ord of this life/ man cannot do with it as he wills.) ---
--* 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 techni(ues in themselves are not the problem, but rather their presumed ethical neutrality. @ot 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. --3
-5* +cience and technology )cannot by themselves give the meaning of human e#istence and progress. +ince 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.) --4
This is why science and wisdom should go hand in hand. +cience and technology are e#tremist, that is, they are constantly e#panding their frontiers. Wisdom and conscience 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 the right to life, which is not, however, a power over life. --. ,ather, it is the right to live with human dignity, --9 as well as being guaranteed and 3- protected in this fundamental, primal and unsuppressible good which is the 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 deathH 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 care worker. "irst 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. --:
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. -35 )@o one...can arbitrarily choose whether to live or dieH the absolute master of such a decision is the Creator alone, in whom 'we live and move and have our being') AActs -1/38B. -3-
Here F on the limits themselves of the right of the sub*ect to dispose of his own life F )arises the moral limit of the action of the doctor who acts with the consent of 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 of the human being to his life and his dignity.) -34 He fulfills it by assuming the corresponding duty of preventive and therapeutic care of the health, -37 and of the improvement, within the ambit and with the means at his disposal, of the (uality of life of the persons and their life environment. -3. )Dn our *ourney we are guided and sustained by the law of love/ a love which has as its source and model the +on of 2od made man, 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, subordinates the trade union rights of health care workers. This means that any *ust 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 F even by means of appropriate legal measures. 33 're%ention 51* +afeguarding 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* &edical 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. 5+* 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, A!+H of the problems of social sectors of individuals such as adolescents, the handicapped, the agedH 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. n these cases preventive intervention is the primary and most effective remedy, if not, indeed, the only possible one. 6ut it needs a concerted effort from all sectors of a society. Prevention in this case is more than a medical?health action. t involves a sensiti%ing 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 techni(ues adopted, but to the reasons behind it and to their being made concrete and made known in that culture. Sickness 5,* Although it shares in the transcendent value of the person, corporeal life, of its nature, reflects the precariousness of the human condition. 34 This is shown especially in sickness and suffering, which affect the whole person adversely. )+ickness and suffering are not e#periences which affect only the physical substance of the human being, but they affect him in his entirety and in his somatic?spiritual unity.) -31
+ickness is more than a clinical fact, medically controlled. t is always the condition of a human being, the sick person. t is with this holistic human view of sickness that health care workers should relate to the patient. t means that they have, together with the re(uisite 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. 5-* The Christian knows by faith that sickness and suffering share in the salvific efficacy of the ,edeemer'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.) -38 )Dn the Cross, the miracle of the serpent lifted up by &oses in the desert ACn 4/-7?-.H 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 person whose life is threatened encounters the sure hope of finding freedom and redemption.) -3:
6orne )in close union with the sufferings of Cesus,) 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 the sake of his body which is the Church) ACol -/37B. -45
"rom 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 minimi%ing it or e#aggerating it)H )acceptance,) )not with a more or less blind resignation) but in the serene knowledge that )the 0ord can and wishes to draw good from evil)H )the oblation,) )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 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 F either individually or through membership in appropriate organi%ations F together with the treatment also enlightenment, counsel, direction and support. -43
37 (ia"nosis 5.* 2uided by this integrally human and properly Christian view of sickness, the health care worker should seek, first and foremost, to find the 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 the symptoms and causes of the illness. 5/* n this, the health care worker will make his own the (uestions and an#ieties of the 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 service to another, without finding the doctor or diagnostic center capable and willing to treat his illness. Dver?speciali%ation and fragmentation of clinical competencies and divisions, while ensuring professional e#pertise, is damaging to the patient when health services in the place prevent a caring and global approach to his illness. n the second case, instead, one persists until some illness is found at any cost. t may be through ignorance, la%iness, 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. n this case the person is not helped to perceive the e#act nature of their problem, thus misleading them about themselves and their responsibilities. 50* The diagnosis does not pose, in general, problems of an ethical order when these e#cesses are e#cluded and it is conducted in full respect for the dignity and integrity of the person, particularly with regard to the use of instrumentally invasive techni(ues. Df 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. n the latter case we are dealing with a substantially new possibility which is rapidly developing, and as such merits separate treatment. 3. 'renatal #ia"nosis 59* The ever?e#panding 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 re(uest and practice. .1* 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 techni(ues and the perceptual risk which each presents. Hence, there is need )to evaluate carefully the possible negative conse(uences which the necessary use of a particular investigative techni(ue 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. -44
Conse(uently, )such diagnosis is licit if the methods used, with the consent of the parents 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 practice should always be of benefit to the child and the motherH their purpose is to make possible therapeutic interventions, to bring assurance and peace to pregnant women who 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 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 e#istence of a deformity or an hereditary disease should not be e(uivalent to a death sentence.) -4.
;(ually unlawful is any directive or program of civil and health authorities or of scientific organi%ations which support a direct connection between prenatal diagnosis and abortion. The specialist who, in carrying out the diagnosis and 39 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. -49
Therapy an# reha$ilitation .+* 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. ,ehabilitation, on the other hand, is an amalgam of medical, physiotherapeutic, psychological measures and functional e#ercises, 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.) -41 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. .,* The patient has a right to any treatment from which he can draw salutary benefit. -48
,esponsibility for health care imposes on everyone )the duty of caring for himself and of seeking treatment.) Conse(uently, )those who care for the sick should be very diligent in their work and administer the remedies which they think are necessary or useful.) -4: @ot only those aimed at apossible cure, but also those which alleviate pain and bring relief in incurable cases. .-* The health care worker who cannot effect a cure must never cease to treat. -75 He is bound to apply all )proportionate) remedies. 6ut there is no obligation to apply )disproportionate) ones. n 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 e#ist, the remedies are to be considered e#traordinary. 31 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 e#penses and the possibility of application, with the result that can be e#pected, taking into account the conditions of the patient and his physical and moral powers.) -7-
.5* The principle here proposed of appropriate medical treatment in the remedies can be thus specified and applied/ F)n 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 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 proportion between )the investment of instruments and personnel) and )the foreseeable results) or because )the techni(ues used sub*ect the patient to suffering and discomfort 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 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.) -73
..* "or the restoration of the person to health, interventions may be re(uired, in the absence of other remedies, which involve the modification, mutilation or removal of organs. Therapeutic manipulation of the organism is legitimi%ed here by the principle of totality, -74 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 sub*ected to it in case of conflict. Conse(uently, 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.) -77
38 ./* Physical life, although on the one hand manifesting the person and sharing his worth, so that it cannot be disposed of as an ob*ect, on the other hand it does not e#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 the person. Cust as it can be sacrificed or put at risk for a higher good )such as the glory of 2od, the salvation of souls and service to one's neighbor.) -79 )Corporeal life is a fundamental good, a condition here below of all the othersH but there are higher values for which it could be legitimate or even necessary to e#pose oneself to 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 the person to a bout of illness,) -78 and on the other hand it appeals to medicine 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 the redeeming sacrifice which he offered in obedience to the "ather'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.) -7:
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. -.5 Dn the contrary this is a way of humani%ing pain. Christian charity itself re(uires of health care workers the alleviation of physical suffering. /1* )n the long run pain is an obstacle to the attainment of higher goods and interests.) -.- 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 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. t is morally correct and right that the researcher should try )to bring pain under human control.) -.3
3: 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 e#perience.) -.4
/1* +ometimes the use of analgesic and anaesthesic techni(ues and medicines involves the suppression or diminution of consciousness and the use of the higher faculties. n 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. -.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 Adirectly or indirectlyB authori%es him.) -.. Without such authori%ation he gives himself an arbitrary 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 the opportunity of personally choosing, and not be made to submit to the decisions and choices of others.) -.1
+o 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 conse(uences that they entail. -.8 This 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 who is 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 situations must, presume the consent to therapeutic interventions, which from his knowledge 45 and in conscience he thinks should be made. f 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. +hould 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. /-* With regard to the relatives, they should be informed about ordinary interventions, 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 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 e#perimentation, which thus succeeds in arriving at new medical advances. To proceed by way of research and e#perimentation is a law of every applied science/ scientific progress is structurally connected with it. 6iomedical sciences and their development are sub*ect to this law also. 6ut they operate in a particular field 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 clinical e#perimentation with the safeguards due to a being with the value of a sub*ect and not an ob*ect. "or 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.) -.:
/.* n the research stage, the ethical norm re(uires that its aim be to )promote human well?being.) -95 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. -9-
n the e#perimental 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. 4- //* "irst of all, the consent of the patient. He )should be informed about the e#perimentation, its purpose and possible risks, so that he can give or refuse his consent with full knowledge and freedom. n fact, the doctor has only that power and those rights which the patient himself gives 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, every e#perimentation has risks. Hence, )it cannot be demanded that all danger and all risk be e#cluded. This is beyond human possibilityH it would paraly%e all serious scientific research and would (uite often be detrimental 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 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 e(uilibrium. his health, or to aggravate his illness.) -97
/9* ;#perimentation cannot be begun and generali%ed 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$to#icological guarantees and ensure operational safety.) -9.
To ac(uire these assurances, if it be useful and necessary, the testing of new pharmaceutical products or of new techni(ues should first be done on animals before they are tried on humans. )t is certain that the animal is for the service of man and can therefore be the ob*ect of e#perimentation. However, it should be treated as one of 2od's creatures, meant to cooperate in man's good but not to be abused.) -99 t follows that all e#perimentation )should be carried out with consideration for the animal, without causing it useless suffering.) -91
When these guarantees are in place, in the clinical phase e#perimentation 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 43 must be made between e#perimentation on a sick person, for therapeutic reasons, and on a healthy person, for scientific and humanitarian reasons. 01* n e#perimentation 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 e#perimental methods. Hence the risk rate which might be proportionate and legitimate for one patient may not be so for another. t is a valid principle F as already said F 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 e#perimental stage and are not without some risk. 6y accepting them the patient might also give an e#ample of generosity for the benefit of humanity.) -98 6ut there must always be )great respect for the patient in the application of new therapy still at the e#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 a medication available, or a method or an operation which, though not e#cluding all danger, still has some possibility of success, any right$thinking person would concede 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 medicine and, in that way, to the good of the community.) n this case, )once his own substantial integrity is safeguarded, the patient can legitimately accept a certain degree of risk.) -1-
This is legitimi%ed 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.) -13
n any case, it is a duty to always interrupt the e#perimentation when the results disappoint the e#pectations. 0+* +ince the human individual, in the prenatal stage, must be given the dignity of a human person, research and e#perimentation on human 44 embryos and fetuses is sub*ect to the ethical norms valid for the child already born and for every human sub*ect. ,esearch 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 e#pected child and the mother, and on condition that the parents have given their consent.) -14
;#perimentation, on the other hand, is possible only for clearly therapeutic purposes, when no other possible remedy is available. )@o 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 *ustify e#perimentation on live human embryos and fetuses, whether viable or not, in the maternal womb or outside of it. The informed consent, 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 the life of the e#pected child. Dn the other hand, e#perimentation 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 ob*ect or instrument of e#perimentation is a crime against their dignity as human beings.) )The practice of keeping human embryos alive, actually or in vitro, for e#perimental or commercial reasons,) is especially and )altogether contrary to human dignity.) -17
(onation an# transplantin" o or"ans 0,* 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 e#istence. -1. This )service to life,) -19 which the donation and transplant of organs represents, shows its moral value and legitimi%es medical practice. There are, however, some conditions which must be observed, particularly those regarding donors and the organs donated and implanted. ;very organ or human tissue transplant re(uires an e#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, 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. 05* Homoplastic transplants, in which the transplant is taken from a person of the same species as the recipient, are legitimi%ed by the 47 principle of solidarity which *oins human beings, and by charity which prompts one to give to suffering brothers and sisters. -11 )With the advent of organ transplants, begun with blood transfusions, human persons have 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 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 waysH in evangelical termsMto love 'even unto the end' ACn -4/-B, even if within certain limits which cannot be transgressed, limits placed by human nature itself.) -18
n homoplastic transplants, organs may be taken either from a living donor or from a corpse. 0.* n the first case the removal is legitimate provided it is a (uestion of organs of which the e#plant would not constitute a serious and irreparable impairment for the donor. )Dne can donate only what he can deprive himself of without serious danger 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 a corpse. This must always be respected as a human corpse, but it no longer has the dignity of a sub*ect and the end value of a living person. )A corpse is no longer, in the 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 but to be positively *ustified.) -85
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.) -8-
n 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 re(uired 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. -83
00* ;thically, not all organs can be donated. The brain and the gonads may not be transplanted because they ensure the personal and 4. procreative identity respectively. These are organs which embody the characteristic uni(ueness of the person, which medicine is bound to protect. 09* There are also heterogeneous transplants, that is, with organs of a different species than that of the recipient. )t cannot be said that every transplant of tissues Abiologically possibleB 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 ob*ections. A distinction must be made between cases, depending on which tissue or organ is intended for transplant. The transplant of animal se#ual glands to humans must be re*ected as immoralH 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.) -84
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. 91* The medical intervention in transplants )is inseparable from a human act of donation.) -87 n 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. )t is a decision to offer, without recompense, part of someone's body for the health and well?being of another person. n this sense, the medical act of transplanting makes possible the act of donation of the donor, that sincere gift of himself which e#presses our essential call to love and communion.) -8.
The possibility, thanks to biomedical progress, of )pro*ecting 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.) -89
91* As part of this oblative )economy) of love, the medical act itself of transplanting, of even *ust blood transfusion, )is not *ust another intervention.) t )cannot be separated from the donor's act of giving, from life?giving love.) -81
49 Here the health care worker )becomes a mediator of something which is particularly meaningful, the gift of self by a person F even after death F so that another might live.) -88
(epen#ency 9+* !ependency, in medical?health terms, is an addiction to a substance or product F such as drugs, alcohol, narcotics, tobacco F 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 -8: is e#periencing and, on the other hand, to the stress and frustrations brought about by the (uest for efficiency, by activism and by the high competitiveness and anonymity of social interaction. !oubtless, the evils caused by dependency and their cure are not a matter for medicine alone. 6ut it does have a preventive and therapeutic role. (ru"s 9,* !rugs and drug?dependency are almost always the result of an avoidable evasion of responsibility, an aprioristic contestation of the social structure which is re*ected without positive proposals for its reasonable reform, an e#pression of masochism motivated by the absence of values. Dne 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 ac(uires a nihilistic mental state, superficially preferring the void of death to the all of life. 9-* "rom the moral viewpoint )using drugs is always illicit, because it implies an un*ustified and irrational refusal to think, will and act as free persons.) -:5
To say that drugs are illicit is not to condemn the drug$user. That person e#periences his condition as )a heavy slavery) from which he needs to be freed. -:-
The way to recovery cannot be that of ethical culpability or repressive law, but it 41 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 deto#ification of the person addicted to drugs is more than medical treatment. &oreover, medicines are of little or no use. !eto#ification is an integrally human process meant to )give a complete and definitive meaning to life,) -:3 and thus to restore to the one addicted that )self confidence and salutary self?esteem) which help him to recover the *oy of living. -:4
n 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 worldH to bring him to the discovery or rediscovery of his dignity as a person, to help him to reawaken and develop, as an active sub*ect, 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.) -:7
9.* Ksing drugs is anti?life. )Dne 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 2od,) -:. and even less does he have the right to make others pay for his choice. Alcoholism 9/* Knlike taking drugs, alcohol is not in itself illicit/ )its moderate use as a drink is not contrary to moral law.) -:9 Within reasonable limits wine is a nourishment. )t is only the abuse that is reprehensible)/ -:1 alcoholism, which causes dependency, clouds the conscience and, in the chronic stage, produces serious harm to the body and the mind. 90* 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. -:8
48 Smokin" 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 e#cessive smoking damages the health and causes dependency. This leads to a progressive lowering of the threshold of abuse. +moking poses the problem of dissuasion and prevention, which should be done especially through health education and information, even by way of advertisements. 'sycho*pharmaceuticals 111* Psycho?pharmaceuticals are a special category of medicines used to counter agitation, delirium and hallucinations and to overcome an#iety and depression. -::
111* To prevent, contain and overcome the risk of dependency and addiction, psycho?pharmaceuticals should be sub*ect to medical control. ),ecourse to tran(uili%ing substances on medical advice in order to alleviate F in well?defined cases F physical and psychological suffering should be governed by very prudent criteria in order to offset dangerous forms of addiction and dependency.) 355
t 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. 35-
11+* 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. n particular, the informed consent of the patient is re(uired 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 sub*ect's re(uesting this medicine. 353
11,* @on?therapeutic use and abuse of psycho?pharmaceuticals is morally illicit if the purpose is to improve normal performance or to 4: 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. 'sycholo"y an# psychotherapy 11-* 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. 354
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, re(uired by an integrally human view of illness and strengthened by faith, 357 is the key to this therapeutic effectiveness of the doctor?patient relationship. 115* 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. 11.* Psychotherapy is morally acceptable as a medical treatment. 35. 6ut 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. )Cust 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 techni(ues and methods employed.) 359
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 F in a manner of speaking F he holds in his hands the psychological faculties of a 75 person, his ability to act freely, to achieve the noblest ideals which his personal destiny and his social calling imply.) 351
11/* "rom the moral standpoint, logotherapy and counseling are privileged forms of psychotherapy. 6ut they are all acceptable, provided that they are practiced by psychotherapists who are guided by a profound ethical sense. 'astoral care an# the Sacrament o Anointin" o the Sick 110* of the sick consists in spiritual and religious assistance. This is a fundamental right of the patient and a duty of the Church Acf. &t -5/8H 0k :/3, -5/:B. @ot 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 e#clusive, task of the health care pastoral worker. 6ecause 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 e#pressly or implicitly. 358 )n Cesus, the 'Word of life,' 2od's eternal life is thus proclaimed and given. Thanks to this proclamation and gift, our physical and spiritual life, also in its earthly phase, ac(uires its full value and meaning, for 2od's eternal life is in fact the end to which our living in this world is directed and called.) 35:
119* ,eligious 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 re(uest for religious assistance. Where such assistance, for general or particular reasons, cannot be given by the pastoral worker, it should be given directly F within possible and allowable limits F 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. 111* ,eligious 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 0ord to those who suffer and to those who care for them. 7- n the ministry of those F priests, religious and laity F who individually or as communities are engaged in the pastoral care of the sick, the mercy of 2od lives on, who in Christ has bound to human suffering, and the task of evangeli%ation, sanctification and charity entrusted to the Church by the 0ord is carried out in a singular and privileged manner. 3-5
This means that pastoral care of the sick has a special place in catechesis, in the liturgy and in charity. ,espectively, it is a matter of evangeli%ing illness, helping a person to uncover the redemptive meaning of suffering borne in communion with ChristH of celebrating the sacraments as efficacious signs of the recreative and vitali%ing grace of 2odH of witnessing by means of the )diakonia) AserviceB and the )koinonia) AcommunionB to the therapeutic power of charity. 111* n pastoral care of the sick, the loveMfull of truth and of grace of 2od comes near to them in a special sacrament meant for them/ the Anointing of the +ick. 3--
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 2od. )The whole person receives help from it for his salvationH he feels strengthened in his trust in 2od and he receives reinforcement against the temptations of the devil and the fear of death.) 3-3
+ince it has the efficacy of grace for the sick person, the Anointing of the +ick )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.) 3-4
As with all the sacraments, the Anointing of the +ick should also be preceded by a suitable catechesis so that the recipient, the sick person, is a conscious and responsible sub*ect of the grace of the sacrament, and not an unconscious ob*ect of the rite of imminent death. 3-7
11+* The proper minister of the Anointing of the +ick 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 *udgment.) 73 Celebrating communal Anointing might help to overcome negative pre*udices against the Anointing of the +ick, 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. t 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.) f the conditions are present, it can also be conferred on children, )provided they have sufficient use of reason.) n 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, re(uested holy Anointing.) )The sacrament cannot be conferred on a patient who is already dead.) 3-.
)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.) 3-9
11,* The ;ucharist, also, as <iaticum, has a special significance and efficacy for the patient. )<iaticum of the body and blood of Christ strengthens the believer and furnishes him with the pledge of resurrection, as the 0ord has said/ The one who eats my flesh and drinks my blood has eternal life, and will raise him up on the last day) ACn 9/.7B. 3-1
"or the sick person, the ;ucharist is this viaticum of life and hope. )Communion in the form of <iaticum is, in fact, a special sign of participation in the mystery celebrated in the sacrifice of the &ass, the mystery of the death of the 0ord and of his passing to the "ather.) 3-8
Therefore it is the duty of a Christian to re(uest and receive <iaticum, and the Church has a pastoral responsibility to administer it. 3-:
74 The minister of <iaticum is a priest. 6ut he may be substituted by a deacon or an e#traordinary minister of the ;ucharist. 335
Charter For Health Care Workers: $eath 11-* "or the health care worker, serving life means assisting it right up to its natural completion. 0ife is in 2od's hands/ He is the 0ord, He alone decides the final moment. ;very faithful servant guards this fulfillment of 2od's will in the life of every person entrusted to his care. He does not consider himself the arbiter of death, *ust as and because he does not consider himself the arbiter of anyone's life. Terminal illnesses 115* When the state of one's health deteriorates to an irreversible and fatal condition, a person enters into a terminal state of earthly e#istence. "or him life is particularly and progressively precarious and painful. To illness and physical suffering is added the psychological and spiritual drama of detachment which death signifies and implies. As such, the terminally ill patient is one who needs human and Christian accompaniment, and it is here that doctors and nurses are called on to make their e#pert and unrenounceable contribution. What is in (uestion is special medical assistance for the dying person, so that also in dying he must know and will as a living human being. )@ever more than in the pro#imity of death and in death itself is life to be celebrated and e#tolled. This must be fully respected, protected and assisted even in one who is e#periencing its natural end.... The attitude to the terminally ill is often the acid test of a sense of *ustice and charity, of the nobility of mind, of the responsibility and professional ability of health care workers, beginning with doctors.) 33-
11.* !ying is part of life as its ultimate phase. t should be cared for, then, as belonging to it. Hence it calls for the therapeutic responsibility of the health care worker *ust as much and no less than every other moment in human life. The dying person should not be dismissed as incurable and abandoned to his own resources and those of the family, but should be re?entrusted to the care of doctors and nurses. These, interacting and integrating with the assistance given by 77 chaplains, social workers, relatives and friends, allow the dying person to accept and live out his death. 333 To help one to die means to help him to live intensely the final e#perience of his life. Where possible and when the one concerned wishes, he should be given the opportunity of spending his last days at home with suitable medical assistance. 11/* A terminally ill person should be given whatever medical assistance helps to alleviate the pain accompanying death. This would include the so$called palliative or symptomatic treatment. The most important assistance is )loving presence) at the bedside of the dying person. 334 There is a proper medical?health presence which, though not deceiving him, makes him feel alive, a person among persons, because he is receiving, like every being in need, attention and care. This caring attention gives confidence and hope to the patient and makes him reconciled to death. 337 This is the uni(ue contribution which doctors and nurses, by their being human and Christian F more than by their e#pertise F can and should make to the dying person, so that re*ection becomes acceptance and anguish gives way to hope. n this way human dying is withdrawn from the phenomenon of )being overly medicali%ed,) in which the terminal phase of life )takes place in crowded and activity?dominated environments, controlled by medical health personnel whose principal concern is the biophysical aspect of the illness.) All of this )is being seen increasingly as disrespectful to the comple# human state of the suffering person.) 33.
110* )6efore the mystery of death we are powerlessH human certainties waver. 6ut it is precisely in the face of such a checkmate that Christian faith...becomes a fount of serenity and peace.... What seems meaningless takes on meaning and worth.) 339
When this )checkmate) takes place in the life of a person, in this decisive hour of his e#istence, the witness of the health care worker's faith and hope in Christ has a determining role. t displays new hori%ons of meaning, that is, of resurrection and life, to the one who sees the prospects of earthly e#istence being closed to him. )Dver and above all human consolations, no one can be blind to the enormous help given to the dying and to their families by faith in 2od and the hope of eternal life.) 331 To make faith and hope present is for doctors and nurses the highest form of humani%ing death. t is more than alleviating a suffering. t means applying one's skills in order to )make going to 2od easy for the patient.) 338
7. (eath +ith #i"nity 119* The right to life is specified in the terminally ill person as )a right to die in total serenity, with human and Christian dignity.) 33:
This cannot be interpreted as the power to kill oneself or to give this power to others, but to e#perience dying in a human and Christian way and not flee from it )at any cost.) This right is being e#plicitly e#pressed by people today in order to safeguard themselves at the point of death against )the use of techni(ues that run the risk of becoming abusive.) 345
Contemporary medicine, in fact, has at its disposal methods which artificially delay death, without any real benefit to the patient. t is merely keeping one alive or prolonging life for a time, at the cost of further, severe suffering. This is the so? called )therapeutic tyranny,) which consists )in the use of methods which are particularly e#hausting and painful for the patient, condemning him in fact to an artificially prolonged agony.) 34-
This is contrary to the dignity of the dying person and to the moral obligation of accepting death and allowing it at last to take its course. )!eath is an inevitable fact of human life)/ 343 it cannot be uselessly delayed, fleeing from it by every means. 344
1+1* Aware that he is )neither the lord of life nor the con(ueror of death,) the health care worker, in evaluating means, )should make appropriate choices, that is, relate to the patient and be guided by his real condition.) 347
Here he will apply the principle F already stated F of )appropriate medical treatment,) which can be specified thus/ )When inevitable death is imminent, despite the means used, it is lawful in conscience to decide to refuse treatment that would only secure a precarious and painful prolongation of life, but without interrupting the normal treatment due to the patient in similar cases. Hence the doctor need have no concernH it is not as if he had failed to assist the person in danger.) 34.
The administration of food and li(uids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him/ their undue suspension could be real and properly so?called euthanasia. 79 1+1* "or the doctors and their assistants it is not a (uestion of deciding the life or death of an individual. t is simply a (uestion of being a doctor, that is, of posing the (uestion and then deciding according to one's e#pertise and one's conscience regarding a respectful care of the living and the dying of the patient entrusted to him. This responsibility does not always and in all cases involve recourse to every means. t might also re(uire the renunciation of certain means to make way for a serene and Christian acceptance of death which is inherent in life. t might also mean respect for the wishes of the patient who refuses the use of such means. 349
The use o painkillers or the terminally ill 1++* Among the medicines administered to terminally ill patients are painkillers. These, which help to make the course of the illness less dramatic, contribute to the humani%ation and acceptance of death. 341
This, however, does not constitute a general norm of behavior. 348 )Heroic behavior) cannot be imposed on everyone. 34: And then, very often, )pain diminishes the moral strength) of the person/ 375 sufferings )aggravate the state of weakness and physical e#haustion, impeding the impulse of the spirit and debilitating the moral powers instead of supporting them. The suppression of pain, instead, brings organic and psychic relief making prayer easier and enabling one to give oneself more generously.) 37-
)Human and Christian prudence suggests the use for most patients of medicines which alleviate or suppress pain, even if this causes torpor or reduced lucidity. With regard to those who are unable to e#press their wishes, one can reasonably suppose that they wish to take painkillers and these can be administered according to medical advice.) 373
The use of painkillers with the dying, however, is not without its problems. 1+,* "irst, their use might have the effect, of not only alleviating pain, but also of hastening death. When )proportionate reasons) so re(uire, )it is permitted to use with moderation narcotics which alleviate suffering, but which also hasten death.) 374 n this case )death is not intended or sought in any way, although there is a risk of it for a reasonable cause/ what is intended is simply the alleviation of pain in an effective way, using for that purpose those painkillers available to medicine.) 377
71 1+-* There is also the possibility that painkillers will cause unconsciousness in the dying person. This use must receive special consideration. 37.
)Without serious reasons, the dying person must not be deprived of consciousness.) 379 +ometimes the systematic use of narcotics which reduce the consciousness of the patient is a cloak for the fre(uently unconscious wish of the health care worker to discontinue relating to the dying person. n this case it is not so much the alleviation of the patient's suffering that is sought as the convenience of those in attendance. The dying person is deprived of the possibility of )living his own life,) by reducing him to a state of unconsciousness unworthy of a human being. 371 This is why the administration of narcotics for the sole purpose of depriving the dying person of a conscious end is )a truly deplorable practice ) 378
t is a different matter when there is a serious clinical case for the administration of analgesics which suppress consciousness, as when there is violent and unbearable pain. n this case the anesthetic is said to be licit, provided certain conditions are fulfilled/ that the dying person has fulfilled or could still fulfill his moral, family and religious obligations. 37:
Tellin" the truth to a #yin" person 1+5* Telling the truth about the diagnosis and prognosis to the dying person, and more generally to those suffering from an incurable illness, poses a problem of communication. To inform someone that they are dying is difficult and dramatic, but this is not an e#emption from being truthful. Communication between a dying person and those in attendance cannot be based on pretense. This is never a human possibility for the dying person and does not contribute to the humani%ation of dying. The person has a right to be informed of their condition. This right is not lessened where there is a diagnosis and prognosis of a terminal illness, rather, it is heightened. This information, in fact, is linked to important responsibilities which cannot be delegated to another. There are responsibilities bearing on the treatment to be applied with the informed consent of the patient. With the approach of death comes the responsibility to fulfill certain duties in one's relationship with the family, settling possible legal matters, resolving obligations to 78 a third party. "or a believer the approach of death re(uires that he be fully aware when he performs certain actions, especially the reconciling encounter with 2od in the sacrament of Penance. The person cannot be abandoned to unconsciousness in the decisive )hour) of his life, taking him away from himself and from his final and most important decisions. )!eath is too essential a moment for its prospect to be avoided.) 3.5
1+.* The duty of being truthful with the terminally ill patient demands discernment and human tact on the part of medical personnel. t cannot consist of a detached and indifferent communication of the diagnosis and relevant prognosis. The truth must not remain unspoken, but neither must it be given in all its bare, crude reality. t should be given in line with love and charity, calling all those who assist the patient in various ways to be attuned to this communion. There is the need to establish a relationship of trust, receptivity and dialogue with the patient, seeking the appropriate time and words. There is a way of speaking that is discerning and respectful of the patient's moods, and it should be in harmony with these. There is a form of conversation wherein (uestions are tactfully handled and even provoked, so that the patient is gradually brought to an awareness of his condition. f one tries to be present to the patient and sensitive to his lot one will find the words and the replies which make it possible to communicate in truth and in charity/ )giving the truth in love) A;ph 7/-.B. 1+/* );ach case has its own re(uirements, depending on the sensitivity and ability of each person, of his or her relationship with the patient and the patient's conditionH to provide for the patient's possible reactions Arebellion, depression, resignation, etc.B, one will prepare oneself to face them calmly and tactfully.) 3.- t is not the e#actness of what is said that is important, but the relationship of solidarity with the patient. t is not simply a matter of giving clinical facts, but of meaningful communication. n this relationship the prospect of death is not presented as inescapable, and it loses its anguishing power/ the patient does not feel isolated and condemned to death. When the truth is presented to him in this way he is not left without hope, because it makes him feel alive in a relationship of sharing and communion. He is not alone with his illness/ he feels truly understood, and he is at peace with himself and with others. He is himself as a person. His life, despite everything, has meaning, and dying unfolds with optimistic and transcendent meaning. 7: The moment o #eath 1+0* The use of resuscitative technology and the need for vital organs for transplant operations pose anew today the problem of diagnosing when death occurs. !eath is seen and e#perienced by people as a decomposition, a dissolution, a rupture. 3.3 t comes when the spiritual principle which governs the unity of the individual is no longer able to e#ercise its functions on and in the organism and the elements of the latter, left to themselves, dissociate. Certainly, this destruction does not effect the entire human being. The Christian faith F and not it alone F affirms the continuance, beyond death, of man's spiritual principle.) "aith nourishes in the Christian the hope of again finding his personal integrity transfigured and definitively possessed in Christ) A- Cor -./33B. 3.4
This faith filled with hope does not prevent )death IfromJ being a painful rupture.) 6ut )the moment of this rupture is not directly perceptible, and the problem is to identify the signs.) 3.7 To ascertain and interpret these signs is not a matter for faith or morals but for medical science/ )it is for the doctor...to give a clear, precise definition of death and of the moment of death.) 3.. )+cientists, analysts and scholars must continue their research and their studies to determine in the most precise way possible the e#act moment and the irrefutable sign of death.) 3.9
Dnce this determination has been achieved, in its light the (uestions and moral conflicts arising from new technologies and new therapeutic possibilities can be resolved. &oral theology, in fact, cannot but acknowledge the biomedical determination as the decisive criterion. 1+9* With regard to this determination, the Pontifical Academy of +ciences has made an authoritative contribution. "irst with regard to the biomedical definition of death/ )a person is dead when he has irreversibly lost all ability to integrate and coordinate the physical and mental functions of the body.) +econd, with regard to the precise moment of death/ )death comes when/ aB the spontaneous functions of the heart and breathing have definitively ceased, or bB the irreversible arrest of all brain activity.) n reality )brain death is the true criterion of death, although the definitive arrest of cardio?respiratory activity very (uickly leads to brain death.) 3.1
.5 "aith and morals accept these findings of science. However, they demand of health care workers the most accurate use of the various clinical and instrumental methods for a certain diagnosis of death so that a patient is not declared dead and treated as such when in fact he is not dead. Reli"ious assistance or the #yin" 1,1* The crisis which the approach of death involves prompts the Christian and the Church to be a bearer of the light of truth which faith alone can cast on the mystery of death. !eath is an event which brings one into the life of 2od, and revelation alone can pronounce a word of truth about it. This truth must be brought in faith to the dying person. The annunciation )full of grace and truth) ACn -/-7B of the 2ospel accompanies the Christian from the beginning to the end of life. The last word of the 2ospel is the word of life that con(uers death and opens up the greatest hope to the dying person. 1,1* !eath, then, must be evangeli%ed/ the 2ospel must be announced to the dying person. t is a pastoral duty of the ecclesial community in each one of its members, according to the responsibilities of each. The hospital chaplain has a special obligation here, since he is called to minister to the dying within the broader limits of the pastoral care of the sick. "or him this duty implies not only the role he personally carries out at the side of the dying entrusted to his care, but also the promotion of this pastoral activity, through organi%ing religious services, forming and sensiti%ing health care workers and involving relatives and friends. The announcement of the 2ospel to the dying finds especially e#pressive and effective forms in charity, prayer and the sacraments. 1,+* Charity means that giving and receptive presence which establishes with the dying person a communion born of attention, comprehension, concern, patience, sharing and selflessness. Charity sees in the dying person, as in no other, the face of the suffering and dying Christ calling out for love. Charity to the dying person F this )poor one) who is renouncing all the goods of this world F is a privileged e#pression of love of 2od in one's neighbor Acf. &t 3./4-?75B. .- 0oving the dying with Christian charity is helping them to recogni%e and feel vividly the mysterious presence of 2od at their side/ in the charity of a brother the love of 2od becomes visible. 1,,* Charity enables the relationship with the dying person to e#pand in prayer, that is, in communion with 2od. n this communion one relates to 2od as the "ather who welcomes his children returning to Him. To help the dying person to pray and to pray with him means opening up to him the hori%ons of divine life. t means, at the same time, entering into that )communion of saints) in which all the relationships, which death seems to break irreparably, are re?knit in a new way. 1,-* A privileged moment of prayer with the dying person is the celebration of the sacraments/ the grace?filled signs of 2od's salvific presence. "oremost is the sacrament of the Anointing of the +ick through which the Holy +pirit, completing in the Christian his assimilation to Christ begun in baptism, makes him participate definitively in the paschal triumph over sickness and death. <iaticum is eucharistic nourishment, the bread of communion with Christ which gives the dying person the strength to face the final and decisive stage of life's *ourney. Penance is the sacrament of reconciliation/ at peace with 2od, the dying person is at peace with himself and with his neighbor. 1,5* n this faith, filled with charity the powerlessness e#perienced when faced with the mystery of death is not agoni%ing and paraly%ing. The Christian finds hope and in it the possibility, despite everything, to live and not suffer death. The suppression o lie 1,.* The inviolability of human life means and implies in the last analysis the unlawfulness of every act which directly suppresses human life. )The inviolability of the right to life of the innocent human being from conception to death is a sign and a re(uirement of the very inviolability of the person, to whom the Creator has given the gift of life.) 3.8
.3 2od himself )is the vindicator of every innocent life.) )He will call man to account for the life of man/ each one will have to answer for his brother) A2en :/.H cf. &t -:/-8H ,om -4/:B. And his commandment is categorical/ )Thou shalt not kill) A;# 35/-4B/ )!o not kill the innocent or the *ust one because will not absolve the guilty one) A;# 34/1B. 3.:
1,/* This is why )no one can make an attempt on the life of an innocent person without opposing 2od's love for that person, without violating a fundamental, unrenouncable and inalienable right.) 395
This is a right that one has come directly from 2od Anot from others/ parents, society, human authorityB. )Hence there is no one, no human authority, no science, no medical, eugenic, social, economic or moral 'indicator' which can show or give a valid *uridical *ustification for direct, deliberate disposal of an innocent human life, that is, a disposal aimed at its destruction, either as an end or as a means to another end which in itself may not be at all illicit.) 39-
n particular )nothing and no one can authori%e the killing of an innocent human being, whether it is a fetus or an embryo, a child or an adult, elderly, ill, incurable or dying. &oreover, no one can re(uest this homicidal act for themselves or for another for whom they are responsible, nor can they consent to it e#plicitly or implicitly. @o authority can legitimately impose it or permit it. t is, in fact, a violation of divine law. an insult to the dignity of the human person, a anti$life crime, an attempt on humankind ) 393
1,0* )&inisters of life and never agents of death,) 394 it is for health care workers )to safeguard life, to be watchful over its evolution and development throughout its whole e#istence, respecting the plan drawn up by the Creator.) 397
This vigilant ministry of safeguarding human life re*ects homicide as a morally grave act, contrary to the medical mission, and opposes voluntary death, suicide, as )unacceptable,) dissuading anyone tempted to do so from carrying it out. 39.
Among the modalities of the suppression of life, homicide or suicide, there are two F abortion and euthanasia F against which this ministry should be particularly vigilant and in a certain way prophetic, due to the cultural and legislative conte#t which is rather fre(uently insensitive if not, indeed, favorable to their propagation. .4 A$ortion 1,9* The inviolability of the human person from conception prohibits as the suppression of prenatal life. This is )a direct violation of the fundamental right to life of the human being) 399 and is )an abominable crime.) 391
There is need to make e#plicit reference to suppression of life by abortion and its moral gravity because of the ease of recourse to this homicidal practice today and the ethical indifference towards it induced by a hedonistic and utilitarian culture F offspring of theoretical and practical materialism F which has spawned a truly abortionist mentality. The elimination of the unwanted pregnancy has become a wide$spread phenomenon, financed by ta#payer's money and facilitated by permissive and guaranteed legislation. 398 All of this is the fatal cause for many people to avoid taking responsibility for the e#pected child and so to banali%e a serious sin. 39:
)Knfortunately, this disturbing state of affairs, far from decreasing, is e#panding.... At the same time a new cultural climate is developing and taking hold, which gives crimes against life a new and F if possible F even more sinister character, giving rise to further grave concern/ broad sectors of public opinion *ustify certain crimes against life in the name of the rights of individual freedom, and on this basis they claim not only e#emption from punishment but even authori%ation by the state, so that these things can be done with total freedom and indeed with the free assistance of health care systems.) 315
1-1* The Church, like every person who holds life dear, cannot become accustomed to this mentality, and she raises her voice in defense of life, especially that of the defenseless and unknown, which embryonic and fetal life is. +he calls health care workers to professional loyalty, which does not tolerate any action which suppresses life, despite )the Ask of incomprehension, misunderstanding, and serious discrimination) which this consistency might cause. 31- "idelity to medical health de?legitimi%es every intervention, surgical or pharmaceutical, intended to interrupt the pregnancy at any stage. 1-1* t is also true that in certain cases, by refusing an abortion, other important goods F which it is only normal that one would want to safeguard F are put in *eopardy. These could be/ danger to the mother's .7 health, the burden of another child, a serious malformation of the fetus, a pregnancy caused by rape. These problems cannot be ignored or minimi%ed, nor the reasons supporting them. 6ut it must also be affirmed that none of them can ob*ectively give the right to dispose of another's life, even in the initial phase. )0ife, in fact, is too fundamental a good for it to be compared with certain disadvantages, even if they be very great.) 313
1-+* ;thical delegitimi%ation applies to all forms of direct abortion, since it is an intrinsically blameworthy act. The use of substances or means which impede the implantation of the fertili%ed embryo or which cause its premature detachment is also an act of abortion. A doctor who would knowingly prescribe or apply such substances or means would cooperate in the abortion. f the abortion follows as a foreseen but nor intended or willed but merely tolerated conse(uence of a therapeutic act essential for the mother's health, this is morally legitimate. The abortion in this case is the indirect result of an act which is not in itself abortive. 314
1-,* f the health care worker is faced with legislation favorable to abortion he )must refuse politely but firmly.) 317 )Dne can never obey a law that is intrinsically immoral, and this is so in the case of a law which admits, in principle, the lawfulness of abortion.) 31.
As a result, doctors and nurses are obliged to be conscientious ob*ectors. The great, fundamental value of life makes this obligation a grave moral duty for medical personnel who are encouraged by the law to carry out abortions or to cooperate pro#imately in direct abortion. Awareness of the inviolable value of life and of 2od's law protecting it, is antecedent to all positive human law. When the latter is contrary to 2od's law, conscience affirms its primary right and the primacy of 2od's law/ )Dne must obey 2od rather than men) AActs ./3:B. )t is not always easy to follow one's conscience in obedience to 2od's law. t may entail sacrifice and disadvantages, and one can in no way discount this costH sometimes heroism is called for if one is to be faithful to these demands. @evertheless, it must be clearly stated that the road of genuine progress for the human person passes through this constant fidelity to a conscience upholding rectitude and truth.) 319
.. 1--* As well as being a mark of professional loyalty, conscientious ob*ection on the part of the health care worker, for the right reasons, is highly meaningful as a social condemnation of a legal in*ustice against innocent and defenseless life. 1-5* The gravity of the sin of abortion and the ease with which it is carried out, supported by law and the modern mentality, prompts the Church to threaten the penalty of e#communication for the Christian who procures it/ )Dne who procures an effective abortion incurs latae sententiae e#communication.) 311
The e#communication has an essentially preventative and pedagogical significance. t is a forceful call from the Church, meant to arouse insensitive consciences, to dissuade people from an act which is absolutely incompatible with 2ospel demands, and to awaken unreserved fidelity to life. Dne cannot be in ecclesial communion and at the same time disregard the 2ospel of life through the practice of abortion. The protection and acceptance of the e#pected child, its preference to all other values, is a decisive and credible witness which the Christian must give no matter what. 1-.* Health care workers have special obligations with regard to aborted fetuses. An aborted fetus, if it is still alive, should be bapti%ed if at all possible. 318
A dead aborted fetus must be given the same respect as a human corpse. This means that it cannot be disposed of as *ust another item of rubbish. f at all possible it should be appropriately interred. 0ikewise, the fetus cannot be used for e#perimentation or transplant if the abortion was caused voluntarily. To do so would be an unworthy instrumentali%ation of a human life. Euthanasia 1-/* A mentality ever less ready to recogni%e life as a value in itself, relative to 2od alone, independent of how it came into beingH a concept of the (uality of life in terms of efficiency and psychophysical satisfaction, incapable of seeing any meaning in suffering and handicap, .9 and hence to be avoided at any cost and by every meansH a vision of death as an absurd end to a life still to be en*oyed, or as a liberation from an e#istence already considered meaninglessH all of this F within a culture which, leaving 2od aside, makes man responsible to himself alone and to freely established laws of society F is the soil of the euthanasia culture. Where these convictions are disseminated )it could seem logical and 'human' to end one's own life or that of another 'peacefully', when all that is left to it is suffering and serious impairment.) 31:
)6ut this is really absurd and inhuman.) 385 ;uthanasia is a homicidal act, which no end can *ustify. 6y euthanasia is meant an action or omission which of its nature or by intention causes death, in order that all suffering may be eliminated. ;uthanasia's terms of reference, therefore, are to be found in the intention of the will and in the methods used. 38- The pity aroused by the pain and suffering of terminally ill persons, abnormal babies, the mentally ill, the elderly, those suffering from incurable diseases, does not authori%e any form of direct euthanasia, active or passive. This is not a (uestion of helping a sick person, but rather the intentional killing of a person. 1-0* &edical and paramedical personnel?faithful to the task of )always being at the service of life and assisting it to the end) 383 cannot cooperate in any euthanistic practice even at the re(uest of the one concerned, and much less at the re(uest of the relatives. n fact, the individual does not have the right to euthanasia, because he does not have a right to dispose arbitrarily of his own life. Hence no health care worker can be the e#ecutive guardian of a non$e#istent right. t is a different matter when there is (uestion of the right, already mentioned, of dying with human and Christian dignity. This is a real and legitimate right which medical personnel are called on to safeguard by caring for the patient and accepting the natural termination of life. There is a radical difference between )death dealing) and )consent to dying)/ the former is an act suppressing life, the latter means accepting life until death. 1-9* )The pleas of gravely ill persons who sometimes ask for death are not to be understood as implying a true desire for euthanasiaH in fact it is almost always a case of an anguished plea for help and love. What a sick person needs, besides medical care, is love, the human and supernatural warmth with which the sick person can and ought to be .1 surrounded by those close to him or her, parents and children, doctors and nurses.) 384
The sick person who feels surrounded by a loving human and Christian presence does not give way to depression and anguish as would be the case if one were left to suffer and die alone and wanting to be done with life. This is why euthanasia is a defeat for the one who proposes it, decides it and carries it out. "ar from being an act of mercy to the patient, euthanasia is a gesture of individual and social self$pity and an escape from an unbearable situation. 151* ;uthanasia upsets the doctor?patient relationship. Dn the part of the patient, because he relates to the doctor as one who can assure him of death. Dn the part of the doctor, because he is no longer the absolute guarantor of life/ the sick person will be afraid that the doctor may cause his death. The doctor?patient relationship is a life?trusting one and this is how it should remain. ;uthanasia is a )crime) in which health care workers, who are always and only guardians of life, can in no way cooperate. 387 "or medical science it marks )a backward step of surrender, as well as an insult to the personal dignity of the one who is dying.) 38. ts being depicted as a )further harbor of death after abortion) should be understood as a )dramatic appeal) for effective, unreserved fidelity to life. 389
Charter For Health Care Workers: En¬es 1 John Paul II, during his visit to Mercy Maternity Hospital in Melbourne, Nov. 28, 198, in Insegna!enti I"#2 $198% 1&'(, n. ). *+i,e and physical health are precious gi,ts entrusted to us by -od. .e !ust ta/e reasonable care o, the!, ta/ing into account the needs o, others and the co!!on good* $000 2288%. 12ac/3 2 John Paul II, 4o the participants at t5o congresses o, !edicine and surgery, 6ct. 2&, 1987, in Insegna!enti #p. 1717, n. . 12ac/3 ' *In e8ercising your pro,ession, you are al5ays dealing 5ith the hu!an person, 5ho entrusts his body to you, con,ident o, your co!petence as 5ell as your solicitude and concern. It is the !ysterious and 5onder,ul reality o, the li,e o, a hu!an being, 5ith his su,,ering and his hope, that you are dealing 5ith.* John Paul II, 4o the participants at a surgery congress, 9eb. 19, 198&, in Insegna!enti "#1 $198&% '&(, n. 2. 12ac/3 .8 ( 0,. John Paul II, 4o the participants at a !edical congress on tu!or therapy, 9eb. 2), 1982 in Insegna!enti :#1, 98. 0,. also John Paul II; *None o, you can be !erely a doctor o, an organ or an apparatus, but you !ust loo/ to the 5hole person,* 4o the .orld 0ongress o, 0atholic <octors, 6ct. ', 1982, in Insegna!enti :#', pp. &'*&(, n. (. 12ac/3 ) 0,. John Paul II, 4o the 0ongress o, Italian 0atholic <octors, 6ss. =o!. 6ct. 18,1988. 12ac/3 John Paul II, Motu Proprio *<olentiu! ho!inu!,* 9eb. 11,198), in Insegna!enti :III#1, p. (&(, n. 2. *0are ,or the health o, its citi>ens re?uires that society help in the attain!ent o, living conditions that allo5 the! to gro5 and reach !aturity; ,ood and clothing, housing, health care, basic education, e!ploy!ent, and social assistance* $000 2288%. 12ac/3 & John Paul II, 4o the participants at a !edical congress on tu!or therapy, 9eb. 2), 1982, in Insegna!enti :#1, p. 98, n. (. 0,. 4o the participants at a scienti,ic congress, May 21, 1982, in Insegna!enti :#2, p. 1&92, n. ). 12ac/3 8 *@s I have said !any ti!es in !y !eetings 5ith health care 5or/ers, your vocation is one 5hich co!!its you to the noble !ission o, service to people in the vast, co!ple8 and !ysterious ,ield o, su,,ering* John Paul II, 4o representatives o, the Italian 0atholic <octors, March (,1989, in Insegna!enti "II#1, p. (87, n. 2.% 12ac/3 9 John Paul II, 4o the @ssociation o, Italian 0atholic <octors, <ec. 28. 19&8, in Insegna!enti I, p. ('. *Aou are a5are o, the close relationship, the analogy, the interaction bet5een the !ission o, the priest on the one hand and that o, the health care 5or/er on the other; all are devoted, in di,,erent 5ays, to the salvation o, the person, and care ,or his health, to ,ree hi! ,ro! illness, su,,ering and death, to pro!ote in hi! li,e 5ellBbeing and happiness* $John Paul II, *<iscourse ,or the 127th anniversary o, the ,oundation o, the C2a!bin -esuC hospital,* March 18, 1989, in Insegna!enti "II#1, 7)*78, n. 2%. 12ac/3 17 0,. John Paul II, @post. +etter Dalvi,ici doloris, in Insegna!enti :II#1, ')'*')8, nn. 28B'7E 4o an international group o, scientists, @pril 2&, 198(, in Insegna!enti :II#1, 11''B11'), n. 2; 4o the 0atholic health organi>ations o, the Fnited Dtates, Dept. 1(, 198&, in Insegna!enti "#' $198&% )7. 12ac/3 11 *4he very personal relationship o, dialogue and trust established bet5een you and the patient re?uires o, you a level o, hu!anity 5hich, ,or the believer, is ,ound in the richness o, 0hristian charity. 4his is the divine virtue 5hich enriches all your actions and gives to your gestures, even the si!plest o, the!, the po5er o, an act per,or!ed by you in inner co!!union 5ith 0hrist*; John Paul II 4o the @ssociation o, <ental <octors, <ec. 1(, 198(, in Insegna!enti :II#2, 1)92B1)9(, n. (. *Aou bring to the sic/Broo! and to the operating table so!ething o, -odCs .: charity, o, the love and tenderness o, 0hrist, the great <octor o, the soul and the body*; John PaulII, 4o the C9atebene,ratelliC hospital, @pril ), 1981, in Insegna!enti I:#1, p. 89), n. '. 12ac/3 12 0,. John Paul II, 4o the C@r!ida 2arelliC training school ,or pro,essional nurses, May 2&, 1989, in Insegna!enti "II#1, p. 1'(, n. '. *.hat a sti!ulus ,or the desired Cpersonali>ationC o, !edicine could co!e ,ro! 0hristian charity, 5hich !a/es it possible to see in the ,eatures o, every sic/ person the adorable ,ace o, the great, !ysterious Patient, 5ho continues to su,,er in those over 5ho! your pro,ession bends, 5isely and providentlyG* $John Paul II, 4o the participants at t5o congresses o, !edicine and surgery, 6ct. 2&, 1987, in Insegna!enti III#2, p. 1717, n. &%. 12ac/3 1' 0,. John Paul II, 4o the @ssociation o, Italian 0atholic <octors, <ec. 28, 19&8, in Insegna!enti 1, ('&H('8. 12ac/3 1( 0,. John Paul II, 4o the sta,, o, the C9atebene,ratelliC hospital, @pril ), 1981, in Insegna!enti I:#1, p. 89). n. '. 12ac/3 1) John Paul II, 4o the @ssociation o, Italian 0atholic <octors, <ec. 28, 19&8, in Insegna!enti 1, p. ('&. 12ac/3 1 John Paul II, 4o the Italian 9ederation o, 6rthopedic 4echnology .or/ers, Nov. 19, 19&9, in Insegna!enti II#2, p. 127&, n. (E c,. 4o the participants at a scienti,ic congress, May 21, 1982, in Insegna!enti :#2, p. 1&92, n. ). 12ac/3 1& *Aour 5or/...can beco!e a religious act* $John Paul II, 4o the participants at a surgery congress, 9eb. 19, 198&, in Insegna!enti "#1 $198&% '&), n. 'E c,. Paul :I, Insegna!enti di Paolo :I, vol. 1, 19', p. 1(1%. 12ac/3 18 John Paul II, Motu Proprio *<olentiu! ho!inu!,* 9eb. 11, 198), in Insegna!enti :III#1 $198)% p. (&). 12ac/3 19 *Ivery concern ,or illness and su,,ering is part o, the li,e and the !ission o, the 0hurch* $John Paul II, 4o the 0atholic health organi>ations o, the Fnited Dtates o, @!erica, Dept. 1(, 198&, in Insegna!enti "#' 1198&3 )72H)7', n. '%. *@llo5ing hersel, to be guided by the e8a!ple o, Jesus the C-ood Da!aritanC $c,. +/ 17;29'&% and upheld by his strength, the 0hurch has al5ays been in the ,ront line in providing charitable help; so !any o, her sons and daughters, especially !en and 5o!en religious, in traditional and ever ne5 ,or!s, have consecrated and continue to consecrate their lives to -od, ,reely giving o, the!selves out o, love ,or their neighbor, especially ,or the 5ea/ and needy* $John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. 2&%. 12ac/3 27 0,. John Paul II, 4o the 5orld 0ongress o, 0atholic doctors, 6ct. ' 1982, in Insegna!enti :#', p. &, n. '. *4he +ord Jesus 0hrist physician o, our souls and bodies, 5ho ,orgave the sins o, the paralytic and restored hi! to bodily health, has 95 5illed that his 0hurch continue, in the po5er o, the Holy Dpirit, his 5or/ o, healing and salvation even a!ong her o5n !e!bers. 4his is the purpose o, the t5o sacra!ents o, healing; the sacra!ent o, Penance and the sacra!ent o, @nointing o, the Dic* $000 1(21%. 12ac/3 21 *Aour presence at the sic/Bbed is bound up 5ith that o, those J priests, religious and laity J 5ho are engaged in apostolate to the sic/. Kuite a nu!ber o, the aspects o, that apostolate coincide 5ith the proble!s and tas/s o, the service to li,e rendered by !edicine. 4here is a necessary interaction bet5een the e8ercise o, the !edical pro,ession and pastoral 5or/, because the one obLect o, both is the hu!an person, seen in his dignity o, a child o, -od, a brother or sister needing, Lust li/e ourselves, help and co!,orting* $John Paul II, 4o the .orld 0ongress o, 0atholic <octors, 6ct. ' 1982, in Insegna!enti :#', p. &, n. %. 12ac/3 22 *Aou, 5hile you alleviate su,,erings and try to cure the!, at the sa!e ti!e are 5itnesses o, the 0hristian vie5 o, su,,ering and o, the !eaning o, li,e and death, in the 5ay it is taught by your 0hristian ,aith* $John Paul II, 4o the 0atholic Health 6rgani>ations o, the Fnited Dtates o, @!erica, Dept. 1(, 198&, in Insegna!enti "#' 1198&3 pp. )72 and )7).% 12ac/3 2' John Paul II, @post. I8hort. 0hristi,ideles laici, <ec. '7, 1988, in Insegna!enti "I#(, p. 217, n. )'. 12ac/3 2( 0,. John Paul II, 4o the participants at the International 0ongress ,or @ssistance to the <ying, in 6ss. =o!. March 18, 1992, n. . *Ivery individual, precisely by reason o, the !ystery o, the .ord o, -od 5ho 5as !ade ,lesh $c,. Jn 1; 1(%, is entrusted to the !aternal care o, the 0hurch* John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. '%. 12ac/3 2) John Paul II, 4o the participants at a surgery congress, 9eb. 19,198& in Insegna!enti "#1, p. '&), n. '. *4he advance o, science and technology, this splendid 5itness o, the hu!an capacity ,or understanding and ,or perseverance, does not dispense hu!anity ,ro! the obligation to as/ the ulti!ate religious ?uestions. =ather it spurs us on to ,ace the !ost pain,ul and decisive o, struggles, those o, the heart and o, the !oral conscience* John Paul II, Incyclical :eritatis splendor, n. 1%. 12ac/3 2 0,. John Paul II, Motu Proprio *<olentiu! ho!inu!,* 9eb. 11, 198), in Insegna!enti :III#1 $198)% p. (&). *Ispecially signi,icant is the rea5a/ening o, an ethical re,lection on issues a,,ecting li,e. 4he e!ergence and ever !ore 5idespread develop!ent o, bioethics is pro!oting !ore re,lection and dialogueMbet5een believers and nonHbelievers, as 5ell as bet5een ,ollo5ers o, di,,erent religionsMon ethical proble!s, including ,unda!ental issues pertaining to hu!an li,e* $John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. 2&%. 12ac/3 9- 2& 0,. John Paul II, 4o the @ssociation o, 0atholic health care 5or/ers, 6ct. 2(, 198, in Insegna!enti I"#2, p. 11&1, n. '. *In todayCs cultural and social conte8t, in 5hich science and the practice o, !edicine ris/ losing sight o, their inherent ethical di!ension, healthHcare pro,essionals can be strongly te!pted at ti!es to beco!e !anipulators o, li,e, or even agents o, death* John Paul II Incyclical Ivangeliu! vitae, March 2), 199), n. 89%. 12ac/3 28 Dynod o, 2ishops, special @sse!bly ,or Iurope, 0oncluding Dtate!ent, in 6ss. =o!. <ec. 27, 1991, n. 17. *It is illusory to clai! that scienti,ic research and its applications are !orally neutral. 6n the other hand, guiding criteria cannot be deduced ,ro! !erely technical e,,icacy, nor ,ro! the use,ulness to so!e to the detri!ent o, others, nor, 5orse still, ,ro! the do!inant ideologies. Dcience and technology re?uire, by their very inner signi,icance, unconditional respect ,or the ,unda!ental criteria o, !oralityE they !ust be at the service o, the hu!an person, o, his inalienable rights, o, his true and integral good, in con,or!ity 5ith -odCs plan and 5ill* 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% Introduction, 2, p. &' $c,. 000 229(%. 12ac/3 29 Ithical co!!ittees, co!posed o, specialists in the !edical and !oral nerds, are also established by govern!ents, 5hich give the! consultative and supervisory roles. *4he 0hurch is a5are that the issue o, !orality is one 5hich deeply touches every personE it involves all people, even those 5ho do not /no5 0hrist and his -ospel or -od hi!sel,. Dhe /no5s that it is precisely on the path o, the !oral li,e that the 5ay o, salvation is open to all* John Paul II, Incyclical :eritatis splendor, n. '. *...No dar/ness o, error or o, sin can totally e8tinguish in the hu!an person the light o, -od the 0reator. In the depths o, his heart there al5ays re!ains a yearning ,or absolute truth and a thirst to attain ,ull /no5ledge o, it.* 4his is elo?uently proved by !anCs tireless research in all ,ields and in every sector. His search ,or the !eaning o, li,e proves it even !ore $ibid., n. 1%. 0,. John Paul II, Incyclical Ivangeliu! vitae, March 2), 199). n. (. 12ac/3 '7 0,. John Paul II, 4o the plenary asse!bly o, the Ponti,ical 0ouncil ,or Pastoral @ssistance to Health 0are .or/ers, 9eb. 9,1997, in Insegna!enti "III#2, p. (7), n. (. 12ac/3 '1 John Paul II, @post. +etter Dalvi,ici doloris, in Insegna!enti :II#1, 2)(H'), n. 29. 12ac/3 '2 0,. 4o scientists and health care 5or/ers, Nov. 12, 198&, in Insegna!enti "#' $198&% 1788; *4he hu!ani>ation o, !edicine is a duty o, Lustice, and its i!ple!entation cannot be entirely delegated to others, since it re?uires the co!!it!ent o, all. Its operative ,ield is very vast; it goes ,ro! health education to the creation o, greater sensitivity in those in public authorityE ,ro! direct involve!ent in oneCs o5n 5or/place to ,or!s o, cooperation J local, national and 93 international J 5hich are !ade possible by the e8istence o, so !any organi>ations and associations 5hich have a!ong their purposes the call, direct or indirect, ,or a need to !a/e !edicine ever !ore hu!an.* 12ac/3 '' John Paul II, Incyclical Ivangeliu! vitae, March 2).199). n. '(. 12ac/3 '( Ibid., n. ('. 12ac/3 ') John Paul II, 4o the .orld Medical @ssociation, 6ct. 29, 198', in Insegna!enti :I#2, 921. 0,. @llocution to the participants at a congress o, the Ponti,ical @cade!y o, Dciences, 6ct. 2', 1982, in Insegna!enti :#', 89)H898. 12ac/3 ' 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% 8). 0,. John Paul II, @post. I8hort. 0hristi,deles laici, <ec. '7, 1988, in Insegna!enti "I#(, pp. 21''H21'), n. '8E c,. Holy Dee, 0harter o, the =ights o, the 9a!ily, 6ct. 22, 198', art. (. 12ac/3 '& John Paul II, 4o the Fnion o, Italian Jurists, <ec. ), 198&, in Insegna!enti "#', $198&% 129). *4he 0hurch re!ains deeply conscious o, her Cduty in every age o, e8a!ining the signs o, the ti!es and interpreting the! in the light o, the -ospel, so that she can o,,er in a !anner appropriate to each generation replies to the continual hu!an ?uestionings on the !eaning o, this li,e and the li,e to co!e and on ho5 they are related*C $John Paul II, Incyclical :eritatis splendor, n. 2%. 12ac/3 '8 John Paul II, 4o the .orld Medical @ssociation, 6ct. 29 198', in Insegna!enti :I#2,921H92'. 0,. 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% 97H92. 12ac/3 '9 0,. Icu!. 0oun. :atican II, Past. 0onstit. -audiu! et spes, n. )7E Paul :I, Incyclical Hu!anae vitae, in @@D 7 $198% p. (8&. 12ac/3 (7 John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. ('. 12ac/3 (1 0,. Paul :I, Incyclical Hu!anae vitae, in @@D 7 $198% p. (8&, n. 17. 12ac/3 (2 Icu!. 0oun. :atican II, Past. 0onstit. -audiu! et spes, n. )1. 12ac/3 (' 0,. Paul :I, Incyclical Hu!anae vitae, in @@D 7 $198% p. (88, n. 12. 12ac/3 (( *4he inner structure o, the !arriage act is such that, 5hile it pro,oundly unites the partners, it ,its the! ,or the generation o, ne5 li,e, according to la5s inscribed in the very being o, the !an and the 5o!an* $Paul :I, Incyclical Hu!anae vitae, in @@D 7 11983 pp. (88H(89, n. 12%. 12ac/3 () 0,. 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% 91. 12ac/3 ( 0,. Paul :I, Incyclical Hu!anae vitae, n. 12E John Paul II, @postol. I8hort. 9a!iliaris consortio, in @@D &( $1982% p. 118, n. '2. *0onse?uently, Cthe one 5ho 5ishes to understand hi!sel, thoroughly J and not Lust in accordance 5ith i!!ediate, partial, o,ten super,icial, and even illusory standards and !easures o, 94 being J !ust 5ith his unrest, uncertainty and even his 5ea/ness and sin,ulness, 5ith his li,e and death, dra5 near to 0hrist....*C $John Paul II, Incyclical :eritatis splendor, n. 8%. 12ac/3 (& Natural !ethods *are diagnostic !eans ,or the ,ertile periods o, the 5o!an, 5hich !a/e it possible to re,rain ,ro! se8ual relations 5hen legiti!ate !otives o, responsibility dictate the avoidance o, conception* $John Paul II, 4o the participants at a course ,or teachers o, natural !ethods, Jan. 17, 1992, in 6ss. =o!. Jan. 11, 1992, n. '%. 12ac/3 (8 0,. Paul :I, Incyclical Hu!anae vitae, in @@D 7 $198% p. (88, n. 11 and p. (92, n. 1. 12ac/3 (9 John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. 9&. 12ac/3 )7 0,. Paul :I, Incyclical Hu!anae vitae, in @@D 7 $198% p. (89, n. 1'E c,. also John Paul II, @postol. I8hort. 9a!iliaris consortio, in @@D &( $1982% p. 118, n. '2. 12ac/3 )1 John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. 2'. 12ac/3 )2 0,. Paul :I, Incyclical Hu!anae vitae, in @@D 7 $198% p. (97, n. 1(. 12ac/3 )' 0,. John Paul II, @postol. I8hort. 9a!iliaris consortio, in @@D &( $1982% p. 118, n. '2. 12ac/3 )( John Paul II, 4o the participants at a course ,or teachers o, natural !ethods, Jan. 17, 1992, in 6ss. =o!. Jan. 11, 1992, n. '. 12ac/3 )) 0,. John Paul II, @postol. I8hort. 9a!iliaris consortio, in @@D &( $1982% p. 118, n. '2. 12ac/3 ) John Paul II, 4o the participants at t5o congresses on the proble!s o, !atri!ony, the ,a!ily and ,ertility, June 8, 198(, in Insegna!enti :II#1, 1(H 1). *6n the innate !eaning 5hich is that o, !utual, total donation by the partners, contraception i!poses an obLectively contradictory !eaning, na!ely that o, not giving onesel, co!pletely to the other* $@post. I8hort. 9a!iliaris consortio, '2%. 12ac/3 )& John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. 1'. 12ac/3 )8 John Paul II, @post. I8hort. 9a!iliaris consortio, in @@D &( $1982% p. 127, n. '2. 12ac/3 )9 0,. ibid, p. 122, n. ''. 12ac/3 7 Ibid, p. 12), n. '). 12ac/3 1 John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. 1(. 12ac/3 2 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% &. 12ac/3 97 ' John ""III, Incyclical Mater et Magistra, III, in @@D )' $191% ((&. 0,. Pius "II, 4o the participants at a congress o, the Italian 0atholic Fnion o, 6bstetricians, 6ct. 29, 19)1, in @@D (' $19)1% 8)7. 12ac/3 ( 0,. John Paul II, -eneral @udience, Jan. 1, 1987, in Insegna!enti III#1 $1987% 1(8H1)2. 12ac/3 ) 0,. Pius "II, 4o the participants at a congress o, the Italian 0atholic Fnion o, 6bstetricians, 6ct. 29, 19)1, in @@D (' $19)1% 8)7. 12ac/3 John ""III, Incyclical Mater et Magistra, III, in @@D )' $191% ((&. 12ac/3 & 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% 9. 12ac/3 8 Pius "II, 4o the participants at the I: International 0ongress o, 0atholic <octors, Dept. '7, 19(9, in @@D (1 $19(9% )7. 12ac/3 9 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% 92. 12ac/3 &7 *Ho!ologous 9I:I4 ta/es place outside the bodies o, the partners through the actions o, third parties 5hose co!petence and technical activity deter!ine the success o, the interventionE it entrusts the li,e and identity o, the e!bryo to the po5er o, doctors and biologists and gives technology do!inion over the origin and destiny o, the hu!an person* $ibid., p. 9'%. 12ac/3 &1 0,. ibid., @@D 87 $1988% pp. 8)H8,91H92,9H9&. *4he origin o, a hu!an person is really the result o, a donation. 4he conception should be the ,ruit o, the love o, its parents. It cannot be desired nor conceived as the product o, the intervention o, !edical or biological techni?ues; this 5ould be to reduce it to beco!ing the obLect o, scienti,ic technology. No one can subLect the arrival o, a child into the 5orld to conditions o, technical e,,iciency 5hich can be evaluated according to para!eters o, control and do!inion* $ibid, p. 92%. 12ac/3 &2 0,. ibid, @@D 87 $1988% pp. 91, 92H9(. 12ac/3 &' John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. 22. 12ac/3 &( 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988%, p. 9'. 12ac/3 &) 0,. ibid., p. 9&. *@ child is not so!ething o5ed to one, but is a gi,t. 4he Csupre!e gi,t o, !arriageC is a hu!an person. @ child !ay not be considered a piece o, property, an idea to 5hich an alleged Cright to a childC 5ould lead. In this area, only the child possesses genuine rights; the right Cto be the ,ruit o, the speci,ic act o, the conLugal love o, his parents,C and Cthe right to be respected as a person ,ro! the !o!ent o, his conception*C $000 2'&8%. 12ac/3 & 0,. ibid., p. 8) and 8(. 4he *soHcalled Cspare e!bryosC are...used ,or research 5hich, under the prete8t o, scienti,ic or !edical progress, in ,act reduces hu!an 9. li,e to the level o, si!ple Cbiological !aterialC to be ,reely disposed o,* $John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. 1(%. 12ac/3 && 0,. 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988%, p. 9(. *0ertainly ho!ologous 9I:I4 is not burdened 5ith all the ethical negativity 5hich is to be ,ound in e8traH!atri!onial procreationE the ,a!ily and the !arriage are still the a!bient o, the birth and education o, the child.* Ho5ever, it is at variance 5ith the dignity o, hu!an procreation, depriving it o, the dignity 5hich is proper and connatural to it. 12ac/3 &8 John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. 2'. 12ac/3 &9 0,. 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988%, pp. 8&H89. 12ac/3 87 0,. ibid, p. 88E see also John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. 2'. 12ac/3 81 0,. ibid, p. 89. 12ac/3 82 0,. ibid, pp. 92H9(. 12ac/3 8' 0,. ibid, p. 9). 12ac/3 8( 0,. ibid, pp. 9)H9. 12ac/3 8) 0,. John Paul II, 4o the sta,, o, the ne5 C=egina MarghentaC hospital, <ec. 27, 1981, in Insegna!enti I:#2, p. 11&9, n. '. 12ac/3 8 0,. John Paul II, 4o the participants at the ')th -eneral @sse!bly o, the .orld Medical @ssociation, 6ct. 29, 198', in Insegna!enti :I#2, 91&H92', @@D & $198(% '973E 4o the 0atholic health organi>ations o, the Fnited Dtates o, @!erica, Dept. 1(, 198&, in Insegna!enti "#' $198&% )77H)7&E 4o the participants at the :II Dy!posiu! o, Iuropean 2ishops, 6ct. 1&, 1989, in Insegna!enti "II#2, p. 9(&, n. &. 12ac/3 8& 0ong. <oct. 9aith. <eclaration on Procured @bortion, June 18, 19&(, in @@D $19&(% &'8. 12ac/3 88 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% &8H &9. 12ac/3 89 Iven the theory o, the ,ourteenth day J the day 5hen the pri!itive strea/ appears, in 5hich the cells lose their totiHpotentiality and t5in divisions are no longer possible J cannot ignore and deny the ,unda!ental and decisive biogenetic ,act o, the hu!an and individual nature o, the ,ruit o, the conception. 12ac/3 97 John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. ((. 12ac/3 91 John Paul II, 4o the participants at a congress ,or obstetricians, Jan. 2, 1987, in Insegna!enti III#1, p. 192, n. 1. 12ac/3 99 92 0,. 0ode o, 0anon +a5, can. 82#2. 12ac/3 9' John Paul II, 4o the participants at a congress ,or 6bstetricians, Jan. 2, 1987, in Insegna!enti III#1, p. 192, n. 2. 0,. John Paul II, Incyclical :eratatis splendor, n. 1'. 12ac/3 9( Icu!. 0oun. :at. II, Past. 0onstit. -audiu! et spes, n. 2(. 12ac/3 9) 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% &(. 12ac/3 9 John Paul II, 4o the participants at the ')th -eneral @sse!bly o, the .orld Medical @ssociation, 6ct. 29, 198', in Insegna!enti :I#2, 91&H92', @@D & $198(% '9'3. *4he hu!an person, created in the i!age o, -od, is a being at once corporeal and spiritual. 4he biblical account e8presses this reality in sy!bolic language 5hen it a,,ir!s that Cthen the +ord -od ,or!ed !an o, dust ,ro! the ground, and breathed into his nostrils the breath o, li,eE and !an beca!e a living beingC $-en 2;&%. Man, 5hole and entire, is there,ore 5illed by -od* $000 '2%. 12ac/3 9& 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% &(H &). *4he unity o, soul and body is so pro,ound that one has to consider the soul to be the C,or!C o, the body; i.e., it is because o, its spiritual soul that the body !ade o, !atter beco!es a hu!an, living bodyE spirit and !atter, in !an, are not t5o natures united, but rather their union ,or!s a single nature* $000 ')%. 12ac/3 98 0,. John Paul II, 4o the participants at the ')th -eneral @sse!bly o, the .orld Medical @ssociation, 6ct. 29, 198', in Insegna!enti :I#2, 927, n. ). 12ac/3 99 *4he body reveals the hu!an being, e8presses the person and is the ,irst !essage o, -od to the hu!an being hi!sel,* $John Paul II, allocutions o, Jan. 9 and 9eb. 27,1987, in Insegna!enti III#1, 889) and (28H('(%. 12ac/3 177 4he !oral la5, in 5hich biological !eanings ta/e shape, *cannot be seen as a !erely biological nor!* but as integrally hu!an; in it is e8pressed *the rational order according to 5hich the hu!an person is called by the 0reator to direct and regulate his li,e and his actions and, in particular, souse and dispose o, his o5n body*; 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% p. &(E Paul :I, Incyclical Hu!anae vitae, in @@D 7 $198% p. (8&, n. 17. 12ac/3 171 0,. John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. 2'. 12ac/3 172 John Paul II, @post. I8hort. 0hristi,ideles laici, <ec. '7, 1988, in Insegna!enti "I#(, p. 21'', n. '8. 12ac/3 17' John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. (7. 12ac/3 17( 0,. Pius "II, 4o the participants at the 0ongress o, Italian 0atholic 6bstetricians, 6ct. 29, 19)1, in @@D (' $19)1% 8'8; John Paul II, 4o the participants at the )(th updating 0ourse o, the 0atholic Fniversity, Dept. , 198(, 91 in Insegna!enti :II#2, p. '''. *4he hu!an body shares in the dignity o, the Ci!age o, -odC; it is a hu!an body precisely because it is ani!ated by a spiritual soul, and it is the 5hole hu!an person that is intended to beco!e, in the 2ody o, 0hrist, a te!ple o, the Dpirit* $000 '(%. 12ac/3 17) John Paul II, 4o the participants at a congress o, the *Move!ent ,or +i,e,* 6ct. 12, 198), in Insegna!enti :I#2, 9''H9', n. 2. 0, 4o scientists and health care 5or/ers, Nov. 12, 198&,in Insegna!enti "#' $198&% 178(H178), n. 2. 0,. Pius "II, 4o the !e!bers o, the 9irst International 0ongress o, Histopathology o, the Nervous Dyste!, Dept. 1(, 19)2, in @@D (( $19)2% p. &82. 12ac/3 17 0,. Pius "II, <iscourses and 2roadcasts, ", :atican Polyglot Press, 19(9, pp. 98,,E 4o the *Dan +uca* Italian Fnion o, Medical 2iology, Nov. 12, 19((, in <iscourses and 2roadcasts, :I cit., 191,,E John Paul II, 4o the Ponti,ical @cade!y o, Dciences, 6ct. 21, 198), in Insegna!enti :III#2, p. 1781 n. '. 12ac/3 17& John Paul II, 4o the participants at a congress ,or obstetricians, Jan. 2, 1987, in Insegna!enti III#1, p. 192, n. 2E 4o the participants at the congress o, the Italian @ssociation o, @nesthesiology, 6ct. (, 198(, in Insegna!enti :II#2, p. &)7, n. (E 4o the 0atholic health organi>ations o, the Fnited Dtates o, @!erica, Dept. 1(, 198&, in Insegna!enti "#' $198&% )7(. 12ac/3 178 John Paul II, 4o the participants at a congress o, the *Move!ent ,or +i,e,* 6ct. 12, 198), in Insegna!enti :III#2, pp. 9''H9', n. 2. 12ac/3 179 John Paul II, 4o the participants at the III 0ongress o, the @ssociation o, 0atholic Health 0are .or/ers, 6ct. 2(, 198, in Insegna!enti I"#2, p. 11&2. 12ac/3 117 *Dcientists and doctors !ust not thin/ that they are lords o, li,e, but rather its e8pert and generous servants* $John Paul II, 4o the Ponti,ical @cade!y o, Dciences, 6ct. 21, 198), in Insegna!enti :III#2, p. 1781, n. '. 12ac/3 111 John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. '9. 12ac/3 112 John Paul II, 4o the participants at a congress o, the *Move!ent ,or +i,e,* <ec. (, 1982, in Insegna!enti :#', p. 1)1', n. ), 4o the Ponti,ical @cade!y o, Dciences, 6ct. 2', 1982, in Insegna!enti :#', p. 89, n. 2E 4o the participants at the 0ollo?uiu! o, the *Nova Dpes* international 9oundation, Nov. 9, 198&, in Insegna!enti "#' $198&% 17)7H17)1, n. 2. 12ac/3 11' 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% &'. 12ac/3 11( Icu!. 0ou!. :at. II, Past. 0onstit. -audiu! et spes, n. 1); *6ur age, !ore than any o, the past, needs such 5isdo! i, all that !an discovers is to be ennobled through hu!an e,,ort.* 12ac/3 98 11) 0,. Pont. 0oun. *0orFnu!*, Do!e ethical ?uestions relating to the gravely in and the dying, July 2&, 1981, in Inchiridion :aticanu!, &. <ocu!enti u,,iciali della Danta Dede 1987H1981. I<2, 2ologna 198), p. 11'&, n. 2.1. 12ac/3 11 0,. John Paul II, 4o the @ssociation o, Italian 0atholic <octors, <ec. 28, 1987, in Insegna!enti III#2, p. 177&, n. 'E 4o a delegation o, the *9ood and <isar!a!ent International* @ssociation, 9eb. 1', 198, n. '. 12ac/3 11& 0,. 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% )((H)()E John Paul II, 4o the .orld Medical @ssociation, 6ct. 29, 198', in Insegna!enti :I#2, 918, n. 2E @post. I8hort. 0hristi,ideles laici, <ec. '7, 1988, in Insegna!enti "I#(, p. 21''H21'), n. '8. 12ac/3 118 John Paul II, @post. I8hort. 0hristi,ideles laici, <ec. '7, 1988, in Insegna!enti "I#(, p. 21'', n. '8. *Man is not the !aster o, li,e, nor is he the !aster o, death. In li,e and in death, he has to entrust hi!sel, co!pletely to the Cgood pleasure o, the Most High,C to his loving plan* $John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. (%. 12ac/3 119 *4he doctor has only the po5er and rights over the patient 5hich the latter gives hi!, either e8plicitly or tacitly. 9or his part, the patient cannot give !ore rights than he has* $Pius "II, 4o the !e!bers o, the 9irst International 0ongress on Histopathology o, the Nervous Dyste!, Dept.1(, 19)2, in @@D (( 119)23 p. &82.% 12ac/3 127 *4he patient is bound by the i!!anent teleology established by nature. He has the right to use J li!ited by the natural ,inality J the ,aculties and po5ers o, his hu!an nature.* $Ibid.% 12ac/3 121 John Paul II, Incyclical Ivangeliu! vitae, March 2),199), n. (&. 12ac/3 122 0,. Pius "II, 4o the !e!bers o, the 9irst International 0ongress on Histopathology o, the Nervous Dyste!, Dept. 1(, 19)2 in @@D (( $19)2% p. &82. 12ac/3 12' John Paul II, 4o the participants at a surgery congress, 9eb. 19, 198&, in Insegna!enti "I#1 $198&% '&(, n. 2. 12ac/3 12( John Paul II, 4o the sta,, o, the C=egina Margherita hospital, <ec. 27, 1981, in Insegna!enti I:#2, p. 11&9, n. '. 12ac/3 12) Pont. 0oun. *0or Fnu!,* 0o!!unity health, in Inchiridion :aticanu!, . <ocu!enti u,,iciali della Danta Dede 19&&H19&9. I<2, 2ologna 198', p. '2), n. 1.2. 12ac/3 12 John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. &9. 12ac/3 12& John Paul II, Motu Proprio *<olentiu! ho!inu!,* 9eb. 11, 198), in Insegna!enti :III#1 $198)% pp. (&'H(&(. *Illness and su,,ering have al5ays been a!ong the gravest proble!s con,ronted in hu!an li,e. In illness !an e8periences 9: his po5erlessness, his li!itations, and his ,initude. Ivery illness can !a/e us gli!pse death* $000 1)77%. *4he !ission o, Jesus, 5ith the !any healings he per,or!ed, sho5s -odCs great concern even ,or !anCs bodily li,e* $John Paul II, Incyclical Ivangeliu! vitae, March 2),199), n. (&%. 12ac/3 128 John Paul II, Motu Proprio *<olentiu! ho!inu!,* 9eb. 11, 198), in Insegna!enti :III#1 $198)% pp. (&'H(&(. 12ac/3 129 John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. )7. 12ac/3 1'7 0,. John Paul II, during a visit to Mercy Maternity Hospital in Melbourne, Nov. 28, 198, in Insegna!enti I"#2 $198% 1&'', n. 2. *4he sic/ too are sent as laborers into the +ordCs vineyard. 4he burden that tires the !e!bers o, the body and shatters the serenity o, the spins, ,ar ,ro! deterring the! ,ro! 5or/ in the vineyard, calls the! to live out their hu!an and 0hristian vocation and to share in the gro5th o, the Ningdo! o, -od in ne5 5ays, 5hich are also !ore valuable* $John Paul II, @post. I8hort. 0hristi,ideles laici, in Insegna!enti "I#(, p. 217, )'%. 12ac/3 1'1 John Paul II, <iscourse in +ourdes, @ugust 1), 198', n. ( *6n the cross, 0hrist !ade his o5n all the 5eight o, evil and too/ a5ay the sin o, the 5orld $Jn 1, 29%, o, 5hich sic/ness is but a conse?uence, 2y his passion and death on the cross, 0hrist has given ne5 !eaning to su,,ering; no5 it can con,igure us to hi! and unite us 5ith his rede!ptive passion.* 12ac/3 1'2 John Paul II, @post. I8hort. 9a!iliaris consortio, n. &). 12ac/3 1'' 0,. John Paul II, 4o the participants at a congress o, *Move!ent ,or +i,e,* <ec. (, 1982, in Insegna!enti, :#', p. 1)12, n. (. 12ac/3 1'( 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% &9H87. .ith regard to the diagnostic techni?ues !ostly used, 5hich are echography $and a!niocentesis, it can be said that the ,or!er appears to be ris/H ,ree 5hereas the latter contains ele!ents o, ris/ considered acceptable and there,ore proportionate. 4he sa!e cannot be said ,or other techni?ues, such as placento centesis, ,etoscopy and the collecting o, villi sa!ples 5hich have !ore or less high levels o, ris/. 12ac/3 1') Ibid. *Prenatal diagnosis, 5hich presents no !oral obLections i, carried out in order to identi,y the !edical treat!ent 5hich !ay be needed by the children the 5o!b, all too o,ten beco!es an opportunity ,or proposing and procuring an abortion. 4his is eugenic abortion, Lusti,ied in public opinion on the basis o, a !entality...5hich accepts li,e only under certain conditions and reLects it 5hen it is a,,ected by any li!itation, handicap or illness* $John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. 1(%. 12ac/3 15 1' 0,. 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% &9H87. *Dince it !ust be treated ,ro! conception as a person, the e!bryo !ust be de,ended in its integrity, cared ,or, and healed, as ,ar as possible. li/e any other hu!an being* $000 22&(%. 12ac/3 1'& 0,. John Paul II, Motu Proprio *<olentiu! ho!inu!,* 9eb. 11, 198), in Insegna!enti :III#1 $198)% pp. (&'H(&(. *4hose 5hose lives are di!inished or 5ea/ened deserve special respect. Dic/ or handicapped persons should be helped to lead lives as nor!al as possible* $000 22&%. 12ac/3 1'8 *Ivery person has a pri!ary right to 5hat is necessary ,or the care o, his or her health and there,ore to suitable !edical assistance* $John Paul II, 4o the .orld 0ongress o, 0atholic <octors, 6ct. ', 1992, in Insegna!enti :#', p. &', n. '%. 12ac/3 1'9 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% p. )(9. 12ac/3 1(7 *Iven 5hen it cannot cure, science can and should treat and assist the sic/ person* $John Paul II, 4o the participants at a study course on *hu!an preH leu/e!ias,* Nov. 1), 198), in Insegna!enti :III#2, p. 12), n. ). 0,. John Paul II, 4o t5o 5or/ groups set up by the Ponti,ical @cade!y o, Dciences, 6ct. 21, 198), in Insegna!enti :II#2, p. 1782, n. (. 12ac/3 1(1 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987 in @@D &2 $1987% pp. )(9H))7. 12ac/3 1(2 0,. ibid. 12ac/3 1(' *4he principle o, totality states that the part e8ists ,or the 5hole, and conse?uently that the good 6, the part is subordinated to that o, the 5hole; that the 5hole is deter!ining ,or the part and it can dispose o, it in its o5n interests $Pius "II, 4o the !e!bers o, the 9irst International 0ongress on Histopathology o, the Nervous Dyste!, Dept. 1(, 19)2, in @@D (( 119)23 p. &8&%. 12ac/3 1(( Pius "II, 4o the !e!bers o, the "":I Italian 0ongress o, Frology, 6ct. 8, 19)', in @@D () $19)'% p. &(E c,. Pius "II, 4o the !e!bers o, the 9irst International 0ongress on Histopathology o, the Nervous Dyste!, Dept. 1(, 19)2, in @@D (( $19)2% &82H&8'. 4he principle o, totality is applied at the outbrea/ o, the illness; there alone is veri,ied *correctly* the relation o, the part to the 5hole. 0,. ibid, p. &8&. *.here the relationship o, the part to the 5hole is veri,ied, and to the e8tent that it is veri,ied, the part is subordinated to the 5hole, 5hich can in its o5n interests dispose o, the part $ibid%. 4he physical integrity o, a person cannot be i!paired to cure an illness o, psychic or spiritual origin. Here it is not a ?uestion 6, diseased or !al,unctioning organs. @nd so their !edicoHsurgical !anipulation is an arbitrary alteration o, the physical integrity o, the person. It is not la5,ul to sacri,ice to the 5hole, by !utilating it, !odi,ying it or re!oving it, a 1- part 5hich is not pathologically related to the 5hole. @nd this is 5hy the principle o, totality cannot be correctly ta/en as a criterion ,or legiti!ati>ing antiH procreative sterili>ation therapeutic abortion and transse8ual !edicine and surgery. It is di,,erent 5ith psychic su,,erings and spiritual disorders 5ith an organic basis, that is, 5hich arise ,ro! a de,ect or physical disease; on these it is legiti!ate to intervene therapeutically. 12ac/3 1() 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% &). 12ac/3 1( 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% p. )(). 12ac/3 1(& 0ong. <oct. 9aith, <eclaration on Procured @bortion, June 18, 19&(, in @@D $19&(% &'H&'&. 12ac/3 1(8 0,. John Paul II, 4o the participants at a congress o, the Italian @ssociation o, @nesthesiology, 6ct. (, 198(, in Insegna!enti :II#2, p. &(9 n. 2. 12ac/3 1(9 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% )(2H))2, III. 12ac/3 1)7 *4he 0hristian is bound to !orti,y the ,lesh and apply hi!sel, to interior puri,ication.... Inso,ar as sel,Hcontrol and control o, disordered tendencies cannot be ac?uired 5ithout the help o, physical pain, this beco!es a need and it !ust be accepted, but inso,ar as it is not re?uired ,or this purpose, it cannot be said that there is a strict obligation ,or it. Hence the 0hristian is never obliged to desire itE he sees it as a !ore or less suitable !eans, according to the circu!stances, to the end he is pursuing* $Pius "II, 4o an international asse!bly o, doctors and surgeons, 9eb. 2(, 19)&, in @@D (9 119)&3 p. 1')%. 12ac/3 1)1 Ibid, p. 1'. 12ac/3 1)2 0,. Pont. 0oun. *0or Fnu!,* Do!e Ithical Kuestions =elating to the -ravely Ill and the <ying, July 2&, 1981, in Inchiridion :aticanu!, &, <ocu!enti u,,iciali della Danta Dede 1987H1981. I<2, 2ologna 198), p. 11(1, n. 2.'.1E John Paul II, 4o t5o 5or/ groups set up by the Ponti,ical @cade!y o, Dciences, 6ct. 21, 198), in Insegna!enti :III#2, p. 1782, n. (. 12ac/3 1)' John Paul II, 4o the participants at a congress o, the Italian @ssociation o, @nesthesiology, 6ct. (, 198(, in Insegna!enti :II#2, p. &)7, n. '. 12ac/3 1)( 0,. Pius "II, 4o an international asse!bly o, doctors and surgeons, 9eb. 2(, 19)&, in @@D (9 $19)&% pp. 1'8H1('. 12ac/3 1)) Pius "II, 4o the doctors o, the -. Mendel Institute, Nov. 2(, 19)&, in @@D (9 $19)&% p. 17'1. 12ac/3 1) *4he patient cannot be the obLect o, decisions 5hich he 5ill not !a/e, or, i, he is not able to do so, 5hich he could not approve. 4he *person,* principally 13 responsible ,or his o5n li,e, should be the center o, any assisting intervention; others are there to help hi!, not to replace hi!* $Pont. 0oun. *0or Fnu!,* Do!e Ithical Kuestions =elating to the -ravely Ill and the <ying, July 2&, 1981, in Inchiridion :aticanu! &, <ocu!enti u,,iciali della Danta Dede 1987H1981. I<2, 2ologna 198), p. 11'&, n. 2.1.2%. 12ac/3 1)& John Paul II, 4o the .orld 0ongress o, 0atholic <octors, 6ct. ', 1982, in Insegna!enti :#', p. &', n. (. 12ac/3 1)8 0,. John Paul II, 4o the participants at t5o congresses on !edicine and surgery, 6ct. 2&,1987, in Insegna!enti III#2, 1778H1779, n. ). 12ac/3 1)9 John Paul II, 4o the representatives o, the Italian Dociety o, Medicine and the Italian Dociety o, -eneral Durgery, 6ct. 2&, 1987, n. '. 12ac/3 17 John Paul II, 4o the participants at a congress on cancer, @pril 2, 198, in Insegna!enti I"#1, 11)2H11)'. 12ac/3 11 0,. John Paul II, 4o scientists and health care 5or/ers, Nov. 12, 198&, in Insegna!enti "#', $198&% 178H178&, n. (. *Do!e abusive interpretations o, scienti,ic research in the ,ield o, anthropology !ust also be !entioned. @rguing ,ro! the great variety o, custo!s, behavior patterns and institutions present in hu!anity these theories conclude, i, not al5ays 5ith the denial o, universal hu!an values, at least 5ith a relativist conception o, !orality* $John Paul II, Incyclical :eritatis splendor, n. ''%. 12ac/3 12 John Paul II, 4o the participants at t5o congresses on !edicine and surgery, 6ct. 2&, 1987, in Insegna!enti III#2,1779, n. ). 12ac/3 1' Pius "II, 4o the !e!bers o, the 9irst International 0ongress on Histopathology o, the Nervous Dyste!, Dept. 1(, 19)2, in @@D (( $19)2% p. &88. 12ac/3 1( John Paul II, 4o a con,erence on phar!acy in the synod hall, 6ct. 2(, 198, in Insegna!enti I"#2, p. 118'E c,. 4o the participants at a surgery congress, 9eb. 19, 198&, in Insegna!enti "#1 $198&% '&, n. (. *=esearch or e8peri!entation on the hu!an being cannot legiti!ate acts that are in the!selves contrary to the dignity o, persons and to the !oral la5. 4he subLectsC potential consent does not Lusti,y such acts. I8peri!entation on hu!an beings is not !orally legiti!ate i, it e8poses the subLectCs li,e or physical and psychological integrity to disproportionate or avoidable ris/s* $000 229)%. 12ac/3 1) 0,. John Paul II, 4o the participants at t5o congresses on !edicine and surgery, 6ct. 2&, 1987, in Insegna!enti III#2, 1778H1779, n. )E 4o the participants at a study course on *hu!an preHleu/e!ias,* Nov. 1), 198), in Insegna!enti :III#2, p. 12), n. ). 12ac/3 14 1 John Paul II, 4o the participants at a !eeting o, the Ponti,ical @cade!y o, Dciences, 6ct. 2', 1982, in Insegna!enti :#', p. 89&, n. (; *4here,ore, the reduction in e8peri!ents on ani!als, 5hich are progressively beco!ing less necessary, is in accordance 5ith the good o, all creation* $ibid %. 12ac/3 1& 0,. John Paul II, 4o a con,erence on phar!acy in the synod hall, 6ct. 2(, 198, in Insegna!enti I"#2, p. 118'. 12ac/3 18 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ),1987, in @@D &2 $1987% p. ))7. *It !ay happen, in doubt,ul cases, 5hen /no5n !eans have ,ailed, that a ne5 !ethod, as yet insu,,iciently tested, o,,ers, together 5ith rather dangerous ele!ents, a good probability o, success. I, the patient consents, the application o, the procedure in ?uestion is la5,ul* $Pius "II, 4o the participants at the 9irst International 0ongress on Histopathology o, the Nervous Dyste!, Dept. 1(, 19)2, in @@D (( $19)2% p. &88%. 12ac/3 19 John Paul II, 4o the participants at a study course on *hu!an preHleu/e!ias,* Nov. 1), 198), in Insegna!enti :III#2, p. 12), n. ). 12ac/3 1&7 Pius "II, 4o the participants at the :II @sse!bly o, the .orld Medical @ssociation, Dept. '7, 19)(, in Pius "II, <iscourses to <octors, =o!e, 197, p. ')8. 12ac/3 1&1 0, John Paul II, 4o the participants at t5o congresses on !edicine and surgery, 6ct. 2&, 1987, in Insegna!enti III#2, p. 1779, n. ). 12ac/3 1&2 Ibid 12ac/3 1&' 0ong. <oct. 9aith, Instruct. <onu! vitae, in @@D 87 $1988% 81H8'. *4his evaluation o, the !orality o, abortion is to be applied also to the recent ,or!s o, intervention on hu!an e!bryos 5hich, although carried out ,or purposes legiti!ate in the!selves, inevitably involve the/illing o, those e!bryos.... 4he use o, hu!an e!bryos or ,etuses as an obLect o, e8peri!entation constitutes a cri!e against their dignity as hu!an beings 5ho have a right to the sa!e respect o5ed to a child once born, Lust as to every person* $John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. '%. 12ac/3 1&( 0,. 0ong. <oct. 9aith, Instruct. <onu! vitae, in @@D 87 $1988% 81H8'. *I conde!n in a !ost e8plicit and ,or!al 5ay e8peri!ental !anipulation o, the hu!an e!bryo, because it is a hu!an beingE ,ro! the !o!ent o, its conception until death it can never be instru!entali>ed ,or any reason 5hatsoever* $John Paul II, 4o the participants at a !eeting o, the Ponti,ical @cade!y o, Dciences, 6ct. 2), 1982, in @@D &) $198'% '&%. *=espect ,or the hu!an being e8cludes all /inds o, e8peri!ental !anipulation or e8ploitation o, the e!bryo* $Holy Dee, 0harter on the =ights o, the 9a!ily, (#b, in 6ss. =o!., 6ct. 2), 198'%. 12ac/3 17 1&) 0,. John Paul II, 4o the participants at the 9irst International 0ongress on the 4ransplant o, 6rgans, June 27, 1991, in Insegna!enti "I:#1 $1991% 1&17. 12ac/3 1& Ibid, *6rgan transplants are not !orally acceptable i, the donor or those 5ho legiti!ately spea/ ,or hi! have not given their in,or!ed consent. 6rgan transplants con,or! 5ith the !oral la5 and can be !eritorious i, the physical and psychological dangers and ris/s incurred by the donor are proportionate to the good sought ,or the recipient. It is !orally inad!issible directly to bring about the disabling !utilation or death o, a hu!an being, even in order to delay the death o, other persons* $000 229%. 12ac/3 1&& 0,. Pius "II, 4o the delegates o, the Italian @ssociation o, 0ornea <onors and the Italian Fnion ,or the 2lind, May 1(, 19), in @@D (8 $19)% ((H()E John Paul II, 4o the participants at the 9irst International 0ongress on the 4ransplant o, 6rgans, June 27 1991, in Insegna!enti "I:#1 $1991% 1&11. 12ac/3 1&8 John Paul II, 4o the participants at the 9irst International 0ongress on the 4ransplant o, 6rgans, June 27, 1991, in Insegna!enti "I:#1 $1991% 1&11. 12ac/3 1&9 Ibid., n. (. 12ac/3 187 0,. Pius "II, 4o the delegates o, the Italian @ssociation o, 0ornea <onors and the Italian Fnion ,or the 2lind. May 1(, 19) in @@D (8 $19)% pp. (2H((. 12ac/3 181 Ibid, pp. (H(&. 12ac/3 182 0,. Ponti,ical @cade!y o, Dciences, <eclaration on the @rti,icial Prolongation o, +i,e and <eter!ining the Precise Mo!ent o, <eath, 6ct. 21, 198), n. 1, '. 12ac/3 18' Pius "II, 4o the delegates o, the Italian @ssociation o, 0ornea <onors and the Italian Fnion ,or the 2lind, May 1(, 19), in @@D (8 $19)% pp. (2H((. 12ac/3 18( John Paul II, 4o the participants at the 9irst International 0ongress on the 4ransplant o, 6rgans, June 27, 1991, in Insegna!enti "I:#I $1991% 1&11, n. '. 12ac/3 18) IbidE c,. Pius "II, 4o the delegates o, the Italian @ssociation ,or 0ornea <onors and the Italian Fnion ,or the 2lind, May 1( 19), in @@D (8 $19)% p. (). 0,. Pius "II, <iscourses to <octors p. (&; *In advertising $,or cornea donors% an intelligent reserve should be !aintained to avoid serious interior and e8terior con,licts. @lso, is it necessary, as o,ten happens, to re,use any co!pensation as a !atter o, principleO 4he ?uestion has arisen. .ithout doubt there can be grave abuses i, reco!pense is de!andedE but it 5ould be an e8aggeration to say that any acceptance or re?uire!ent o, reco!pense is i!!oral. 4he case is analogous to that o, blood trans,usionE it is to the donorCs credit i, he re,uses reco!pense, but it is not necessarily a ,ault to accept it.* 12ac/3 1. 18 0,. John Paul II, 4o the participants at the 9irst international 0ongress on the 4ransplant o, 6rgans, June 27, 1991, in Insegna!enti "I:#1 $1991% 1&12. 12ac/3 18& 0,. ibid, &, p. 1&1', n. ). 12ac/3 188 Ibid., p. 1&1', n. ); *4he di,,iculty o, the intervention, the need to act pro!ptly, and the need ,or !a8i!u! concentration on the tas/, should not lead to the doctorCs losing sight o, the !ystery o, love contained in 5hat he is doing.* *4he di,,erent co!!and!ents o, the <ecalogue are really so !any re,lections o, the one co!!and!ent about the good o, the person, at the level o, the !any di,,erent goods 5hich characteri>e his identity as a spiritual and bodily being in relationship 5ith -od, 5ith his neighbor and 5ith the !aterial 5orld* $John Paul II, Incyclical :eritatis splendor, n. 1'%. 12ac/3 189 *@t the root o, alcohol and drug abuse J ta/ing into account the pain,ul co!ple8ity o, causes and situations J there is usually an e8istential vacuu!, due to an absence o, values and a lac/ o, sel,Hestee!, o, trust in others and in li,e in general* $John Paul II, 4o the participants at the International 0on,erence on <rugs and @lcohol, Nov. 2', 1991, in Insegna!enti "I:#2 $1991% 12(9, n. 2. 12ac/3 197 Ibid., n. (. 12ac/3 191 0,. John Paul II, 4o the participants at the :II .orld 0ongress o, 4herapeutic 0o!!unities, Dept. &, 198(, in Insegna!enti :II#2, p. '(&, n. '. 12ac/3 192 Ibid, p. ')7, n. &. 12ac/3 19' 0,. John Paul II, Message to the International 0ongress in :ienna, June (, 198&, in Insegna!enti :II#2, p. '(&, n. '. 12ac/3 19( John Paul II, 4o the participants at the :II .orld 0ongress o, 4herapeutic 0o!!unities, Dept. &, 198(, in Insegna!enti :II#2, p. '(&, n. '. 12ac/3 19) John Paul II, 4o the participants at the International 0on,erence on <rugs and @lcohol, Nov. 2', 1991, n. (. *4he use o, drugs in,licts very grave da!age on hu!an li,e and health. 4heir use, e8cept on strictly therapeutic grounds, is a grave o,,ense. 0landestine production o, and tra,,ic/ing in drugs are scandalous practices. 4hey constitute direct cooperation in evil, since they encourage people to practices gravely contrary to the !oral la5* $000 2291%. 12ac/3 19 John Paul II, 4o the participants at the International 0on,erence on <rugs and @lcohol, Nov. 2', 1991, n. (. 12ac/3 19& Ibid, n. (. 12ac/3 198 *4he present econo!ic conditions in society, as 5ell as the high level o, poverty and une!ploy!ent, can be contributary ,actors that increase in your people a sense o, unrest, insecurity, ,rustration and social alienation, leading the! on to the illusory 5orld o, alcohol as an escape ,ro! the proble!s o, li,e*; John 19 Paul II, 4o the participants at a congress on alcoholis!, in Insegna!enti :III#1, p. 1&(1. 12ac/3 199 4here are three categories o, psychoHphar!aceuticals. 4he ,irst is that o, neuroleptics, the antiHpsychotics 5hich have !ade possible the closing o, psychiatric hospitals, since they overco!e agitation, deliria and hallucinations, and so !a/e it useless to con,ine and isolate patientsE in any case, these !easures 5ere nonHcurative. 4he second category is co!prised o, sedatives or tran?uili>ers and the third antidepressives. 12ac/3 277 John Paul II, 4o the participants at the International 0on,erence on <rugs and @lcohol, Nov. 2', 1991, n. (. 12ac/3 271 Ibid. 12ac/3 272 0,. Pius "II, 4o the International 0ongress o, NeuroHpsychophar!acology, Dept. 9, 19)8, in <iscourses and 2roadcasts :ol. "", pp. '2&H'''. 12ac/3 27' 4his is con,ir!ed by the ,re?uency and the conviction 5ith 5hich patients tell the doctor; *No5 that I have spo/en to you I ,eel better.* @nd in ,act Lust as *there is therapeutic input 5hich physical healing can bring to the spirit o, the patientE inversely, there is a therapeutic input 5hich can be brought to physical su,,ering through psychologicoHspiritual co!,orting.* Paul :I, 4o the III .orld 0ongress o, the International 0ollege o, Psychoso!atic Medicine, Dept. 18 19&), in @@D & $19&)% )((. 12ac/3 27( 0,. John Paul II, Motu Proprio <olentiu! ho!inu!, 9eb. 11, 1988, in Insegna!enti :III#1, p. (&(. 12ac/3 27) *0onsidered in its totality, !odern psychology deserves approval ,ro! the !oral and religious vie5point.* $Pius "II, 4o the !e!bers o, the "III International 0ongress on @pplied Psychology, @pril 17, 19)8, in @@D )7 $19)8% p. 2&(. 12ac/3 27 Ibid, p. 2&. 12ac/3 27& Ibid, p. 281. 12ac/3 278 *I8perience teaches that !an, needing either preventative or therapeutic assistance, reveals needs that go beyond actual organic pathology. It is not only suitable treat!ent that he 5ants ,ro! the doctor JE treat!ent 5hich, in any case, sooner or later 5ill ,atally sho5 itsel, to be insu,,icient J but the hu!an support o, a brother, 5ho can share 5ith hi! a li,e vie5, in 5hich also the !ystery o, su,,ering and death 5ill !a/e sense. @nd 5hence can be had, i, not in ,aith, this tran?uili>ing response to the supre!e ?uestions o, e8istenceO* $John Paul II, 4o the .orld 0ongress o, 0atholic <octors, 6ct. ', 1982, in Insegna!enti :#', p. &), n. %. 12ac/3 279 John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. '7. 12ac/3 11 217 *@ uni?ue light shines ,ro! the paschal !ystery on the speci,ic tas/ 5hich pastoral health care is called to ,ul,ill in the great co!!it!ent o, evangeli>ation* $John Paul II, 4o the plenary asse!bly o, the Ponti,ical 0ouncil ,or Pastoral @ssistance to Health 0are .or/ers, 9eb. 11, 1992, in 6ss. =o!. 9eb. 12, 1992, n. &%. 0,. 000 1)7'. 12ac/3 211 In the an8ious and pain,ul state in 5hich he ,inds hi!sel,, the seriously ill person needs a special grace ,ro! -od to /eep hi! ,ro! losing heart. 4here is the danger that te!ptation !ight !a/e his ,aith 5aver. 9or this very reason, 0hrist 5ished to give his sic/ ,aith,ul the strength and the very real support o, the *sacra!ent o, @nointing* $0ong. <iv. .orship, Dacra!ent o, @nointing and Pastoral 0are o, the Dic/, Nov. 1&, 19&2. Id. 4ypica, :at. Polyglot Press, 19&2, p. 81, n. )%. 0,. 000 1)11. 12ac/3 212 Ibid, n. . 12ac/3 21' 0,. Icu!. 0oun. :atican II, 0onstit. on the Dacred +iturgy Dacrosanctu! conciliu!, n. &'. 0,. 000 1)1(. 12ac/3 21( *2y the grace o, this sacra!ent the sic/ person receives the strength and the gi,t o, uniting hi!sel, !ore closely to 0hristCs PassionE in a certain 5ay he is consecrated to bear ,ruit by con,iguration to the DaviorCs rede!ptive Passion* $000 1)21%. 4he sic/ 5ho receive this sacra!ent, *by ,reely uniting the!selves to the passion and death o, 0hrist,* *contribute to the good o, the people o, -od* $+- 11%. *2y celebrating this sacra!ent, the 0hurch, in the co!!union o, saints, intercedes ,or the bene,it o, the sic/ person, and he, ,or his part, through thegrace o, this sacra!ent, contributes to the sancti,ication o, the 0hurch and to the good o, all people ,or 5ho! the 0hurch su,,ers and o,,ers hersel, through 0hrist to -od the 9ather* $000 1)22%. 12ac/3 21) 0,. 0ong. <iv. .orship, 4he Dacra!ent o, @nointing and Pastoral 0are o, the Dic/, nn. 8H19. 12ac/3 21 0ode o, 0anon +a5, can. 177)E c,. can. 177(H177&. 12ac/3 21& 0ong. <iv. .orship, 4he Dacra!ent o, @nointing and Pastoral 0are o, the Dic/, n. 2. 0,. 000 1)2(. 12ac/3 218 Ibid., n. 2. 12ac/3 219 *@ll the bapti>ed 5ho can receive Holy 0o!!union are obliged to receive :iaticu!. In ,act all the ,aith,ul, 5ho ,or any reason are in danger o, death, are bound by precept to receive Holy 0o!!union, and pastors should ta/e care that the ad!inistration o, this sacra!ent be not de,erred, so that the ,aith,ul can bene,it ,ro! it 5hile they are still in ,ull possession o, their ,aculties* $Ibid, n. 2&%. 12ac/3 227 0,. ibid, n. 29. 12ac/3 18 221 John Paul II, 4o the participants at the International 0ongress o, the *6!nia Ho!inis* @ssociation, @ug. 2), 1997, in Insegna!enti "III#2, p. '28. *Duch a situation can threaten the already ,ragile e?uilibriu! o, an individualCs personal and ,a!ily li,e, 5ith the result that, on the one hand, the sic/ person, despite the help o, increasingly e,,ective !edical and social assistance ris/s ,eeling over5hel!ed by his or her o5n ,railtyE and on the other hand, those close to the sic/ person can be !oved by an understandable even i, !isplaced co!passion* $John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. 1)%. 12ac/3 222 0,. 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ) 1987. in @@D &2 $1987% p. ))1. 12ac/3 22' 0,. John Paul II, 4o the participants at the International 0ongress on @ssistance to the <ying, in 6ss. =o!. March 18, 1992 n. ). 12ac/3 22( *It is only a hu!an presence, discreet and caring, 5hich allo5s the patient to e8press hi!sel, and to ,ind a hu!an and spiritual co!,ort, that 5ill have a tran?uili>ing e,,ect* $Pont. 0oun. *0or Fnu!,* Do!e Ithical Kuestions =elating to the -ravely Ill and the <ying, July 2&, 1981, in Inchiridion :aticanu! &, <ocu!enti u,,iciali della Danta Dede 1987H1981. I<2, 2ologna 198), p. 11)1, n. (.'%. 12ac/3 22) 0,. John Paul II, 4o the participants at the International 0ongress on @ssistance to the <ying, in 6ss. =o!. March 18, 1992, n. ). 12ac/3 22 Ibid, n. 1. *CIt is in regard to death that !anCs condition is !ost shrouded in doubtC $-D, 18%. In a sense bodily death is natural, but ,or ,aith it is in ,act Cthe 5ages o, sinC $=!. ;2'%. 9or those 5ho die in 0hristCs grace it is a participation in the death o, the +ord, so that they can also share his =esurrection* $000 177E c,. also 000 1779%. 12ac/3 22& John Paul II, 4o t5o 5or/ groups set up by the Ponti,ical @cade!y o, Dciences, 6ct. 21, 198), in Insegna!enti, :III#2, p. 178', n. E c,. 4o the participants at the International 0ongress on @ssistance to the <ying, in 6ss. =o!. March 18, 1992, n. ). 12ac/3 228 John Paul II, 4o t5o 5or/ groups set up by the Ponti,ical @cade!y o, Dciences, 6ct. 21, 198), in Insegna!enti :III#2, p. 178', n. . 0,. 000 1717. *<eath itsel, is anything but an event 5ithout hope. It is the door 5hich opens 5ide on eternity and, ,or those 5ho live in 0hrist, an e8perience o, participation in the !ystery o, his death and resurrection* $John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. 9&%. 12ac/3 229 0, 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% p. )(9. 12ac/3 2'7 Ibid. 12ac/3 1: 2'1 0,. John Paul II, 4o the participants at the International 0ongress on @ssistance to the <ying, in 6ss. =o! March 18, 1992, n. (. 0,. John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. ). 12ac/3 2'2 John Paul II, 4o t5o 5or/ groups set up by the Ponti,ical @cade!y o, Dciences, 6ct. 21, 198), in Insegna!enti :III#2, p. 1782, n. ). 12ac/3 2'' *9ro! this point o, vie5, the use o, therapeutic !eans can so!eti!es raise proble!s*; 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% p. )(9. 12ac/3 2'( 0,. John Paul II, 4o t5o 5or/ groups set up by the Ponti,ical @cade!y o, Dciences, 6ct. 21, 198), in Insegna!enti :III#2, p. 1782. n. 12ac/3 2') 0ong. <oc. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% p. ))1. 0,. John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. ). 12ac/3 2' 0,. Pont. 0oun. *0or Fnu!,* Do!e Ithical Kuestions =elating to the -ravely Ill and the <ying, July 2&, 1981, in Inchiridion :aticanu!, &, <ocu!enti u,,iciali della Danta Dede 1987H1981. I<2, 2ologna 198), p. 11), n. &.2E ibid., p. 11(', n. 2.(.1; *Iarthly li,e is a ,unda!ental but not absolute good. Hence the li!its o, the obligation to /eep a person alive !ust be speci,ied. 4he distinction J already outlined J bet5een CproportionateC !eans, 5hich !ust never be renounced so as not to anticipate or cause death, and CdisproportionateC !eans, 5hich can be and, so as not to ,all into therapeutic tyranny, !ust be renounced, is a decisive ethical criterion ,or speci,ying these li!its. Here the health care 5or/er ,inds a !eaning,ul and reassuring guideline ,or the solution o, the co!ple8 cases entrusted to his responsibility. .e are thin/ing in particular o, states o, per!anent and irreversible co!a, o, tu!orous pathologies 5ith unhappy prognosis, o, the aged in grave and ter!inal states o, li,e.* 12ac/3 2'& 0,. John Paul II, 4o the participants at the congress o, the Italian @ssociation o, @nesthesiology, 6ct. (, 198(, in Insegna!enti :II#2, p. &(9, n. 2E 4o t5o 5or/ groups set up by the Ponti,ical @cade!y o, Dciences, 6ct. 21, 198), in Insegna!enti :III#2, p. 1782, n. (. 12ac/3 2'8 9or the believer *pain, especially that o, the ,inal !o!ents o, li,e, assu!es a special !eaning in -odCs salvi,ic plan,* as *a participation in the passion* and *union 5ith the rede!ptive sacri,ice* o, 0hrist. 9or this reason the 0hristian can be ,reely induced to accept pain 5ithout alleviation or to !oderate the use o, pain/illers; c,. 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ) 1987, in @@D &2 $1987% p. )(&. 12ac/3 2'9 0,. Pius "II, 4o an international asse!bly o, doctors and surgeons, 9eb. 2(, 19)&, in @() (9 $19)&% p. 1(&E 4o the participants at a congress on neuroH 85 psychophar!acology, Dept. 9, 19)8, in @@D )7 $19)8% p. 9(E 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% p. )(&. 12ac/3 2(7 0,. John Paul II, 4o t5o 5or/ groups set up by the Ponti,ical @cade!y o, Dciences, 6ct. 21, 198), in Insegna!enti :III#2, p. 1782, n. (. 12ac/3 2(1 0,. Pius "II, 4o an international asse!bly o, doctors and surgeons, 9eb. 2(, 19)&, in @@D (9 $19)&% p. 1((. 12ac/3 2(2 0,. 0ong. <oct 9aith, <eclaration on Iuthanasia, May ), 1987. in @@D &2 $1987% pp. )(&H)(8. 12ac/3 2(' 0,. Pius "II, 4o the participants at a congress on neuroHpsychophar!acology, Dept. 9, 19)8, in @@D )7 $19)8% p. 9(. 12ac/3 2(( 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% p. )(8. 0,. Pius "II, 4o an international asse!bly o, doctors and surgeons, 9eb. 2(, 19)&, in @@D (9 $19)&% p. 1(E 4o the participants at a congress on neuroHpsychophar!acology, Dept. 9, 19)8, *2MI '29.* 0,. John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. ). 12ac/3 2() 0,. 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% p. )(8. 12ac/3 2( Pius "II, 4o an international asse!bly o, doctors and surgeons, 9eb. 2(, 19)&, in @@D (9 $19)&% pp. 1((H1(). 12ac/3 2(& 0, Pont. 0oun. *0or Fnu!,* Do!e Ithical Kuestions =elating to the -ravely Ill and to the <ying, July 2&, 1981, in Inchiridion :aticanu! &, <ocu!enti u,,iciali della Danta Dede 1987H1981. I<2, 2ologna 198), p. 11)', n. (.(. 12ac/3 2(8 0,. Pius "II, 4o an international asse!bly o, doctors and surgeons, 9eb. 2(, 19)&, in @@D (9 $19)&% 1(). 12ac/3 2(9 0,. Pius "II, 4o an international asse!bly o, doctors and surgeons, 9eb. 2(, 19)&, in @@D (9 $19)&% p. 1('H1(E 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% p. )(8. *I, the patient obstinately re,uses and persists in as/ing ,or the narcosis, the doctor !ay agree to it 5ithout thereby beco!ing guilty o, ,or!al cooperation in the ,ault co!!itted. 4his, in ,act, does not depend on the narcosis, but on the i!!oral 5ill o, the patientE 5hether the analgesic it given to hi! or not, his behavior 5ill be identical; he 5ill not do his duty.* $Pius "II, 4o an international asse!bly o, doctors and surgeons, 9eb. 2(, 19)&, in @@D (9 119)&3 p. 1(%. 12ac/3 2)7 0, Pont. 0oun. *0or Fnu!,* Do!e Ithical Kuestions =elating to the -ravely Ill and the <ying, in Inchiridion :aticanu! &, <ocu!enti u,,iciali della Danta Dede 1987H1981. I<2, 2ologna 198), p. 11)9, n. .1.1. *<eath is the end o, !anCs earthly pilgri!age, o, the ti!e o, grace and !ercy 5hich -od o,,ers hi! so as to 8- 5or/ out his earthly li,e in /eeping 5ith the divine plan, and to decide his ulti!ate destiny* $000 171'%. 12ac/3 2)1 Pont. 0oun. *0or Fnu!,* Do!e Ithical Kuestions =elating to the -ravely Ill and the <ying, in Inchiridion :aticanu! & <ocu!enti u,,iciali della Danta Dede 1987H1981. I<2, 2ologna 198), p. 11)9, n. .1.2. 12ac/3 2)2 0,. Icu!. 0oun. :atican II, Past. 0onstit. -audiu! et spes, n. 18E John Paul II, @post. +etter Dalvi,ici doloris, in Insegna!enti :II 11, '''H''), n. 1)E 4o the participants at the Meeting o, the Ponti,ical @cade!y o, Dciences on *<eter!ining the Mo!ent o, <eath,* <ec. 1(, 1989, in Insegna!enti "II#2, p. 1)2&, n. (. 12ac/3 2)' 0,. John Paul II, 4o the participants at the Meeting o, the Ponti,ical @cade!y o, Dciences on *<eter!ining the Mo!ent o, <eath,* <ec. 1(, 1989, in Insegna!enti "II#2, 1)2'H1)29, n. (. 12ac/3 2)( 0,. ibid. 12ac/3 2)) Pius "II, 4o a group o, doctors, Nov. 2(, 19)&, *2MI ('2, ('(.* 12ac/3 2) John Paul II, 4o the participants at the !eeting o, the Ponti,ical @cade!y o, Dciences on *<eter!ining the Mo!ent o, <eath,* <ec. 1(, 1989, in Insegna!enti "II#2. 1)2'H1)29. n. . 12ac/3 2)& 0,. Ponti,ical @cade!y o, Dciences, <eclaration on the @rti,icial Prolongation o, +i,e and <eter!ining I8actly the Mo!ent o, <eath, n. 1. 12ac/3 2)8 0ong. <oct. 9aith, Instruct. <onu! vitae, 9eb. 22, 198&, in @@D 87 $1988% &)H&E c,. John Paul II, 4o the participants at the 4hird -eneral @sse!bly o, the .orld Medical @ssociation, 6ct. 29, 198', n. 2. 12ac/3 2)9 0,. John Paul II, 4o the participants at a !eeting o, the *Move!ent ,or +i,e,* 6ct. 12, 198), in Insegna!enti :III#2, 9''H9' n. 2. 12ac/3 27 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% p. )((. 0,. John Paul II, Incyclical :eritatis splendor, n. 1'. 12ac/3 21 0, Pius "II, 4o the congress o, the Italian 0atholic Fnion o, 6bstetricians, 6ct. 29, 19)1, in @@D (' $19)1% p. 8'8. *Dcripture speci,ies the prohibition contained in the ,i,th co!!and!ent; *<o not slay the innocent and the righteous* $I8. 2';&%. 4he deliberate !urder o, an innocent person is gravely contrary to the dignity o, the hu!an being, to the golden rule, and to the holiness o, the 0reator. 4he la5 ,orbidding it is universally valid; it obliges each and everyone, al5ays and every5here* $000 221%. 12ac/3 22 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% )((H)(). *It is unLusti,ied to discri!inate bet5een the di,,erent li,e stages. 4he right to li,e is still intact in an old person, even i, he or she is very debilitatedE an incurably ill person does not lose it. It is no less legiti!ate in the ne5born child 83 than in the !ature person* 0ong. <oct. 9aith, <eclaration on Procured @bortion, June 18, 19&(, in @@D $19&(% &'&H&'8. 12ac/3 2' John Paul II, 4o the @ssociation o, Italian 0atholic <octors, <ec. 28, 19&8, in Insegna!enti 1, p. ('8. 12ac/3 2( John Paul II, 4o the .orld 0ongress o, 0atholic <octors, 6ct. ',1982, in Insegna!enti :#' &1. 12ac/3 2) 0, 0ong. <oct 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% p. )(); *Iveryone has the obligation o, living in con,or!ity 5ith -odCs plan. :oluntary death, that is suicide...is a re,usal on !anCs part to accept -odCs 5ill and his loving purpose. 2esides, suicide is o,ten a denial o, love ,or onesel,, a reLection o, the natural aspiration ,or li,e, a renounce!ent o, oneCs duties o, Lustice and charity to oneCs neighbor, to the various co!!unities and to society at large, although at ti!es there !ay be J as 5e /no5 J psychological ,actors 5hich attenuate or, indeed, ta/e a5ay responsibility. @ clear distinction should be !ade, ho5ever, bet5een suicide andsacri,ice !ade ,or a higher !otive J such as -odCs glory, the salvation o, souls, service to oneCs neighbor J by 5hich one gives oneCs li,e or puts it in danger* $ibid.%. 12ac/3 2 Holy Dee, 0harter on the =ights o, the 9a!ily, art. ( la. 12ac/3 2& Icu!. 0oun. :atican II, Past. 0onstit., -audiu! et spes, n. )1. 0,. Paul :I, 4o the participants at the ""III National 0ongress o, the Fnion o, Italian 0atholic Jurists, in @@D ( $19&2% pp. &&H&&9. 12ac/3 28 0,. John Paul II, 4o the representatives o, the *Move!ent ,or li,e,* Jan. 2), 198, in Insegna!enti I"#1, 197H192, n. '. 12ac/3 29 0,. John Paul II, 4o t5o international groups o, scholars, Nov. ', 19&9, in Insegna!enti II#2, pp. 17'(H17''). 12ac/3 2&7 John Paul II, Incyclical Ivangeliu! vitae, March 2), 199), n. (. 12ac/3 2&1 0,. John Paul II, 4o the @ssociation o, Italian 0atholic <octors, <ec. 28, 19&8, in Insegna!enti I p. ('8 0ong. <oct. 9aith <eclaration on Procured @bortion, June 18,19&1, in @@D $19&(% &((, n. 2(. *Dince the ,irst century the 0hurch has a,,ir!ed the !oral evil o, every procured abortion. 4his teaching has not changed and re!ains unchangeable. <irect abortion, that is to say, abortion 5illed either as an end or a !eans, is gravely contrary to the !oral la5. CAou shall not /ill the e!bryo by abortion and shall not cause the ne5born to perishC $<idache 2, 2%* 1000 22&13. 12ac/3 2&2 0,. 0ong. <oct. 9aith, <eclaration on Procured @bortion, June 18, 19&(, in @@D $19&(% &'9. 12ac/3 2&' 09 Pius "II 4o *9ace o, the 9a!ily* and the *@ssociations o, +arge 9a!ilies,* Nov. 2&, 19)1, in @@D (' $19)1% p. 8)9. 12ac/3 84 2&( 0,. John Paul II, 4o the participants at a !eeting ,or obstetricians, Jan. 2, 1987, in Insegna!enti III#1, p. 19(, n. '. 12ac/3 2&) 0ong. <oct. 9aith, <eclaration on Procured @bortion, June 18, 19&(. in @@D $19&(% &((. n. 22. 12ac/3 2& Ibid, n. 2(. 12ac/3 2&& 0ode o, 0anon +a5, can. 1'98. +atae sententiae !eans that the e8co!!unication need not be pronounced by authority in every single case. It is incurred by anyone 5ho procures an abortion by the si!ple ,act o, having voluntarily procured it 5hile a5are o, the e8co!!unication. 12ac/3 2&8 0,. 0ode o, 0anon +a5, can. 8&1. 12ac/3 2&9 John Paul II, 4o the participants at the )(th Fpdating 0ourse o, the 0atholic Fniversity, Dept. , 198(, in Insegna!enti :II#2, '''H''(. 12ac/3 287 Ibid., p. ''(, n. '. *.hatever its !otives and !eans, direct euthanasia consists in putting an end to the lives o, handicapped, sic/ or dying persons. It is !orally unacceptable* $000 22&&%. 12ac/3 281 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% pp. )()H)(. 12ac/3 282 0,. John Paul II, 4o the participants at the III .orld 0ongress o, the *International 0ollege o, Psychoso!atic Medicine,* Dept. 18, 19&). in @@D & $19&)% )(). 12ac/3 28' 0ong. <oct. 9aith, <eclaration on Iuthanasia, May ), 1987, in @@D &2 $1987% p. )(. 0,. John Paul II, 4o the participants at the International 0ongress on @ssistance to the <ying, in 6ss. =o!. March 18, 1992, nn. ', ). 12ac/3 28( 0,. John Paul II, 4o t5o 5or/ groups set up by the Ponti,ical @cade!y o, Dciences, 6ct. 21, 198), n. '. 12ac/3 28) 0,. John Paul II, 4o the participants at a study course on *hu!an preleu/oe!ias,* Nov. 1), 198), in Insegna!enti :III#2, p. 12), n. ). 12ac/3 28 0,. John Paul II, 4o the participants at the )(th Fpdating 0ourse o, the 0atholic Fniversity, Dept. , 198(, in Insegna!enti :II#2, p. ''(, n. (. 12ac/3 87