pchpc charter health care workers 9405

8/12/2019 Pchpc Charter Health Care Workers 9405

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Charter for Health Care Workers

May 1994

Pontifical Council for Pastoral Assistance

Document Type: Other Ecclesial Pronouncements

PRE ACE

After lon!" careful an# multi$#iscipline preparation" the Charter for %ealth Care &or'ersis no( )ein! pu)lishe# at the initiati*e of the Pontifical Council for Pastoral Assistance to%ealth Care &or'ers+

,othin! happens )y chance in human affairs" an# e*en chronolo!ical coinci#ence canha*e sym)olic meanin!s+ -n fact" the a(aite# #ocument is )ein! pu)lishe# a fe( monthsafter the institution . e)ruary 11" 1994/" )y the %oly ather" 0ohn Paul --" of the Pontifical

Aca#emy for ife" (hich i#eally" operati*ely an# in its statutary finality is closelyassociate# (ith the tas's of the Office for Pastoral Assistance to %ealth Care &or'ers+

An# this Office cannot )ut feel flattere# that the Con!re!ation for the Doctrine of theaith appro*e# an# 2uic'ly confirme# in its entirety the te3t of the Charter su)mitte# to it:

another reason for its full *ali#ity an# secure authority" )ut also a concrete proof of theinter#icastery cooperation e3pressly #esire# in the motu proprio (hich set up thePontifical Council for Pastoral Assistance to %ealth Care &or'ers+

There are many reasons for recommen#in! a 'no(le#!e" the #i*ul!ation an# theapplication of the #irecti*es containe# in this #eontolo!ical co#e for those en!a!e# in

health care+ -ts pu)lication fills a lacuna (hich (as stron!ly felt not only in the Church)ut also )y all those (ho empathi e (ith the primary tas' it fulfills of promotin! an##efen#in! life+

The e3traor#inary a#*ances of science an# technolo!y in the *ery *ast fiel# of healthan# me#icine ha*e pro#uce# an in#epen#ent #iscipline calle# )ioethics" or ethics of life+This e3plains (hy" especially from Pius 5-- on(ar#s" the ma!isterium of the Church hasinter*ene# (ith increasin! interest" (ith consistent firmness an# e*er more e3plicit#irecti*es concernin! all the comple3 pro)lems arisin! from the in#issolu)le )on#)et(een me#icine an# morality+ ,one of these pro)lems can )e consi#ere# neutral atthis time in relation to %ippocratic ethics an# Christian morality+ %ence the re2uirement"strictly respecte# in the Charter for %ealth Care &or'ers" for an or!anic an# e3hausti*e

synthesis of the Church6s position on all that pertains to the affirmation" in the fiel# ofhealth care" of the primary an# a)solute *alue of life: of all life an# the life of e*eryhuman )ein!+

Therefore" after an intro#uction on the fi!ure an# essential tas's of health care (or'ers"or )etter" of the 7ministers of life"7 the Charter !athers its #irecti*es aroun# the tripletheme of procreation" life an# #eath+ An# so thatas often happens#ou)tfulinterpretations may not pre*ail o*er the o)8ecti*e (orth of the contents" in the re#actionof the #ocument the inter*entions of the upreme Pontiffs an# authoritati*e te3ts issue#


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)y the Offices of the Roman Curia ha*e almost al(ays )een 2uote# #irectly+ Theseinter*entions sho( conclusi*ely that the position of the Church on the fun#amentalpro)lems of )ioethics" (hile safe!uar#in! the sacre# limits impose# )y the promotionan# #efense of life" is hi!hly constructi*e an# open to true pro!ress in science an#technolo!y" (hen this pro!ress is (el#e# to that of ci*ili ation+

At the )e!innin! of the Charter the acti*ity of the health care (or'er is sai# to )e 7a formof Christian (itness+7

%um)ly" )ut also prou#ly" (e can say that this Charter for %ealth Care &or'ers is part ofthe 7ne( e*an!eli ation7 (hich" in ser*ice to life" especially for those (ho suffer" has" inimitation of Christ6s ministry" its 2ualifyin! moment+

The hope then is that this (or'$tool may )ecome an inte!ral part of the initial an#on!oin! formation of health care (or'ers" so that their (itness may )e proof that theChurch" in its #efense of life" opens its heart an# its arms to all people since Christ6smessa!e is a##resse# to all people+

Car#+ ioren o An!elini Presi#ent of the Pontifical Council for Pastoral Assistance to%ealth Care &or'ers

INTRODUCTION

M-,- TER O - E

1+ The (or' of health care persons is a *ery *alua)le ser*ice to life + -t e3presses aprofoun#ly human an# Christian commitment" un#erta'en an# carrie# out not only as atechnical acti*ity )ut also as one of #e#ication to an# lo*e of nei!h)or+ -t is 7a form ofChristian (itness+7.1/ 7Their profession calls for them to )e !uar#ians an# ser*ants ofhuman life7 . E*an!elium itae ;9/+

ife is a primary an# fun#amental !oo# of the human person+ Carin! for life" then"e3presses" first an# foremost" a truly human acti*ity in #efense of physical life+

-t is to this that professional or *oluntary health care (or'ers #e*ote their acti*ity+ Theseare #octors" nurses" hospital chaplains" men an# (omen reli!ious" a#ministrators"*oluntary care !i*ers for those (ho suffer" those in*ol*e# in the #ia!nosis" treatment an#reco*ery of human health+ The principal an# sym)olic e3pression of 7ta'in! care7 is their*i!ilant an# carin! presence at the sic')e# + -t is here that me#ical an# nursin! acti*itye3presses its lofty human an# Christian *alue+


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-t follo(s that the therapeutic ministry of health care (or'ers is a sharin! in thepastoral.


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The term an# concept of health em)races all that pertains to pre*ention" #ia!nosis"treatment an# reha)ilitation for !reater e2uili)rium an# the physical" psychic an# spiritual(ell$)ein! of the person+ The term an# concept of me#icine" on the other han#" refers toall that concerns health policy" le!islation" pro!rammin! an# structures+.=B/

The full concept of health reflects #irectly on that of me#icine+ -n fact" 7institutions are*ery important an# in#ispensa)le> ho(e*er" no institution can of itself su)stitute for thehuman heart" human compassion" human lo*e" human initiati*e" (hen it is a 2uestion ofhelpin! another in his sufferin!+7.=1/

The meetin! an# the practical synthesis of the #eman#s an# #uties arisin! from theconcepts of health an# me#icine are the )asis an# (ay for humani in! me#icine+ Thismust )e present )oth at the personal$professional le*elthe #octor$patient relationshipan# at the socio$policy le*el so as to safe!uar# in institutional an# technolo!icalstructures the human$Christian interests in society an# the institutional an# technolo!icalinfrastructures+ The first )ut not (ithout the secon#" since such humani ation as (ell as)ein! a lo*e$charity tas' is 7an o)li!ation of 8ustice+7.=


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1 it is #etermine# )y


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o)8ecti*e criteria" criteria #ra(n from the #i!nity of the human person an# humanaction+7.4


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19+ Rather than #irections for use" natural metho#s are in 'eepin! (ith the meanin! ofcon8u!al lo*e" (hich !i*es #irection to the life of the couple: 7The choice of the naturalrhythms in*ol*es acceptin! the cycle of the person" that is the (oman" an# there)yacceptin! #ialo!ue" reciprocal respect" share# responsi)ility an# self$control++++ -n thisconte3t+++con8u!al communion is enriche# (ith those *alues of ten#erness an# affection(hich constitute the inner soul of human se3uality" in its physical #imension also+7.?;/


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function an# thus is contrary to the #i!nity an# inaliena)le ri!hts of the spouses an# ofthe e3pecte# chil#+7.@ /


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to )e concei*e# an# )orn in an# from a marria!e+ 7 Procreation then+++e3presses a#esire" or in#ee# the intention" to ha*e a chil# 6at all costs"6 an# not )ecause it si!nifiesthe complete acceptance of the other an# therefore an openness to the richness of life(hich the chil# represents+7. ;/

These techni2ues" in fact" i!nore the common an# unitary *ocation of the partners topaternity an# maternityto 7)ecome father an# mother only throu!h one another7an#they cause 7a rupture )et(een !enetic parenthoo#" !estational parenthoo# an#e#ucational responsi)ility"7 (hich" from the family" has repercussions in society+. 9/

A further reason for unla(fulness is the commerciali ation an# eu!enic selection of the!ametes+


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=4+ This responsi)ility commits the health care (or'er to a ser*ice to life e3ten#in! 7fromits *ery )e!innin! to its natural en#"7 that is" 7from the moment of conception to#eath+7.;@/

II. LIFE

e!innin! of life an# )irth

=?+ 7 rom the time that the o*um is fertili e#" a life is )e!un (hich is neither that of thefather nor of the mother> it is rather the life of a ne( human )ein! (ith its o(n !ro(th+ -t(oul# ne*er )e ma#e human if it (ere not human alrea#y++++ Ri!ht from the fertili ationthe a#*enture of a ne( life )e!ins" an# each of its capacities re2uires timea ratherlen!thy timeto fin# its place an# to )e in a position to act+7.; /

Recent a#*ances in human )iolo!y ha*e come to pro*e that 7in the y!ote arisin! fromfertili ation" the )iolo!ical i#entity of a ne( human in#i*i#ual is alrea#y present+7.;;/ -t isthe in#i*i#uality proper to an autonomous )ein!" intrinsically #etermine#" #e*elopin! in!ra#ual continuity+

iolo!ical in#i*i#uality" an# therefore the personal nature of the y!ote is such fromconception+ 7%o( can anyone thin' that e*en a sin!le moment of this mar*elous processof the unfol#in! of life coul# )e separate# from the (ise an# lo*in! (or' of the Creator"an# left prey to human capriceF7.;9/ As a result" it is erroneous an# mista'en to spea'of a preem)ryo" if )y this is meant a sta!e or con#ition of prehuman life of the concei*e#human )ein!+.9B/

=@+ Prenatal life is fully human in e*ery phase of its #e*elopment+ %ence health care(or'ers o(e it the same respect" the same protection an# the same care as that !i*ento a human person+

ynecolo!ists an# o)stetricians especially 7must 'eep a careful (atch o*er the(on#erful an# mysterious process of !eneration ta'in! place in the maternal (om)" toensure its normal #e*elopment an# successful outcome (ith the )irth of the ne(chil#+7.91/

= + The )irth of a chil# is an important an# si!nificant sta!e in the #e*elopment )e!un atconception+ -t is not a 7leap7 in 2uality or a ne( )e!innin!" )ut a sta!e" (ith no )rea' incontinuity" of the same process+ Chil#)irth is the passa!e from maternal !estation tophysiolo!ical autonomy of life+

Once )orn" the chil# can li*e in physiolo!ical in#epen#ence of the mother an# can entera ne( relationship (ith the e3ternal (orl#+

-t may happen" in the case of premature )irth" that this in#epen#ence is not fullyreache#+ -n this case health care (or'ers are o)li!e# to assist the ne()orn chil#"ma'in! a*aila)le to it all the con#itions necessary for attainin! this in#epen#ence+

-f" #espite e*ery effort" the life of the chil# is at serious ris'" health care (or'ers shoul#see to the chil#6s )aptism accor#in! to the con#itions pro*i#e# )y the Church+ -f anor#inary minister of the sacrament is una*aila)lea priest or a #eaconthe health care(or'er has the faculty to confer it+.9


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The *alue of life: unity of )o#y an# soul

=;+ The respect" protection an# care proper to human life #eri*es from its sin!ular#i!nity+ 7-n the (hole of *isi)le creation it .human life/ has a uni2ue *alue+7 7The human)ein!" in fact" is the 6only creature that o# has (ante# for its o(n sa'e+ E*erythin! iscreate# for humans+ The human )ein!6.9=/ alone" create# in the ima!e an# li'eness of

o# .cf+ en 1:


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7The 2uestion: 6&hat ha*e you #oneF6 . en 4:1B/" (hich o# a##resses to Cain after hehas 'ille# his )rother A)el" interprets the e3perience of e*ery person: in the #epths of hisconscience" man is al(ays remin#e# of the in*iola)ility of lifehis o(n life an# that ofothersas somethin! (hich #oes not )elon! to him" )ecause it is the property an# !iftof o# the Creator an# ather+7.1B=/

The )o#y" in#i*isi)ly (ith the spirit" shares in the #i!nity an# human (orth of the person:)o#y$su)8ect not )o#y$o)8ect" an# as such is in#isposa)le an# in*iola)le+.1B4/ The )o#ycannot )e treate# as a )elon!in!+ -t cannot )e #ealt (ith as a thin! or an o)8ect of (hichone is the o(ner an# ar)iter+

E*ery a)usi*e inter*ention on the )o#y is an insult to the #i!nity of the person an# thusto o# (ho is its only an# a)solute or#: 7The human )ein! is not master of his o(n life:he recei*es it in or#er to use it" he is not the proprietor )ut the a#ministrator" )ecause

o# alone is or# of life+7.1B?/

4=+ The fact that life )elon!s to o# an# not to the human )ein!.1B@/ !i*es it that sacre#character.1B / (hich pro#uces an attitu#e of profoun# respect: 7a #irect conse2uence ofthe #i*ine ori!in of life is its in#isposa)ility" its untoucha)ility" that is" itssacre#ness+7.1B;/ -n#isposa)le an# untoucha)le )ecause sacre#: it is 7a naturalsacre#ness" (hich e*ery ri!ht reason can reco!ni e" e*en apart from reli!iousfaith+7.1B9/

Me#ical health acti*ity is a)o*e all a *i!ilant an# protecti*e ser*ice to this sacre#ness: aprofession (hich #efen#s the non$instrumental *alue of this !oo# 7in itself7that is" notrelati*e to another or others )ut to o# alone(hich human life is+.11B/ 7Man6s lifecomes from o#> it is his !ift" his ima!e an# imprint" a sharin! in his )reath of life+ o#therefore is the sole or# of this life : man cannot #o (ith it as he (ills+7.111/

44+ This must )e affirme# (ith particular ri!or an# recei*e# (ith *i!ilant a(areness at a

time of in*asi*e #e*elopment in )iome#ical technolo!y" (here the ris' of a)usi*emanipulation of human life is increasin!+ The techni2ues in themsel*es are not thepro)lem" )ut rather their presume# ethical neutrality+ ,ot e*erythin! (hich is technicallypossi)le can )e consi#ere# morally a#missi)le+

Technical possi)ilities must )e measure# a!ainst ethical la(fulness" (hich esta)lishestheir human compati)ility" that is" their effecti*e employment in the protection of an#respect for the #i!nity of the human person+.11


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4@+ The #i*ine lor#ship of life is the foun#ation an# !uarantee of the ri!ht to life" (hich isnot" ho(e*er" a po(er o*er life+.11?/ Rather" it is the ri!ht to li*e (ith human #i!nity".11@/ as (ell as )ein! !uarantee# an# protecte# in this fun#amental" primal an#unsuppressi)le !oo# (hich is the root an# con#ition of e*ery other !oo#$ri!ht of theperson+.11 /

7The su)8ect of this ri!ht is the human )ein! in e*ery phase of his #e*elopment" fromconception to natural #eath> an# in e*ery con#ition" either health or sic'ness" perfectionor han#icap" (ealth or paupery 7.11;/

4 + The ri!ht to life poses a t(o$fol# 2uestion for the health care (or'er+ irst of all" hemust not thin' that he has a ri!ht$po(er o*er the life he is carin! for" somethin! (hichneither he nor the patient himself has+ an# therefore cannot )e !i*en )y the latter+.119/

The ri!ht of the patient is not one of o(nership nor a)solute" )ut it is )oun# up (ith an#limite# )y the finality esta)lishe# )y nature+.1 the a)solute master of such a #ecision is the Creator alone" in(hom 6(e li*e an# mo*e an# ha*e our )ein!76 .Acts 1 :


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?1+ Me#ical pre*ention" properly so calle#" (hich consists in a#ministerin! particularme#icines" *accination" screenin! tests to ascertain pre#ispositions" in prescri)in!)eha*ior an# ha)its to pre*ent the occurrence" the sprea# an# the (orsenin! of theillness" essentially )elon!s to health care (or'ers+ This mi!ht )e for all the mem)ers of asociety" for !roups of people or for in#i*i#uals+

?


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up in my )o#y (hat is (antin! to the sufferin!s of Christ" for the sa'e of his )o#y (hichis the Church7 .Col 1:


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amal!am of me#ical" physiotherapeutic" psycholo!ical measures an# functionale3ercises" aime# at re*i*in! or impro*in! the psychophysical efficiency of people insome (ay han#icappe# in their a)ility to inte!rate" to relate an# to (or' pro#ucti*ely+

Therapy an# reha)ilitation 7are aime# not only at the (ell$)ein! an# health of the )o#y")ut of the person as such (ho is stric'en )y )o#ily illness+7.1= / All therapy aime# at theinte!ral (ell$)ein! of the person is not content (ith clinical success" )ut *ie(s thereha)ilitati*e action as a restorin! of the in#i*i#ual to his full self" throu!h the reacti*ationor reappropriation of physical functions (ea'ene# )y the illness+

@=+ The patient has a ri!ht to any treatment from (hich he can #ra( salutary )enefit+.1=;/

Responsi)ility for health care imposes on e*eryone 7the #uty of carin! for himself an# ofsee'in! treatment+7 Conse2uently" 7those (ho care for the sic' shoul# )e *ery #ili!ent intheir (or' an# a#minister the reme#ies (hich they thin' are necessary or useful+7.1=9/,ot only those aime# at a possi)le cure" )ut also those (hich alle*iate pain an# )rin!relief in incura)le cases+

@4+ The health care (or'er (ho cannot effect a cure must ne*er cease to treat+.14B/ %eis )oun# to apply all 7proportionate7 reme#ies+ ut there is no o)li!ation to apply7#isproportionate7 ones+

-n relation to the con#itions of a patient" those reme#ies must )e consi#ere# or#inary(here there is #ue proportion )et(een the means use# an# the en# inten#e#+ &herethis proportion #oes not e3ist" the reme#ies are to )e consi#ere# e3traor#inary+

To *erify an# esta)lish (hether there is #ue proportion in a particular case" 7the meansshoul# )e (ell e*aluate# )y comparin! the type of therapy" the #e!ree of #ifficulty an#ris' in*ol*e#" the necessary e3penses an# the possi)ility of application" (ith the result

that can )e e3pecte#" ta'in! into account the con#itions of the patient an# his physicalan# moral po(ers+7.141/

@?+ The principle here propose# of appropriate me#ical treatment in the reme#ies can )ethus specifie# an# applie#:

7-n the a)sence of other reme#ies" it is la(ful to ha*e recourse" (ith the consent of thepatient" to the means ma#e a*aila)le )y the most a#*ance# me#icine" e*en if they arestill at an e3perimental sta!e an# not (ithout some element of ris'+7

7-t is la(ful to interrupt the application of such means (hen the results #isappoint thehopes place# in them"7 )ecause there is no lon!er #ue proportion )et(een 7the

in*estment of instruments an# personnel7 an# 7the foreseea)le results7 or )ecause 7thetechni2ues use# su)8ect the patient to sufferin! an# #iscomfort !reater than the )enefitsto )e ha#+7

7-t is al(ays la(ful to )e satisfie# (ith the normal means offere# )y me#icine+ ,o onecan )e o)li!e#" therefore" to ha*e recourse to a type of reme#y (hich" althou!h alrea#yin use" is still not (ithout #an!ers or is too onerous+7 This refusal 7is not the e2ui*alent ofsuici#e+7 Rather it mi!ht si!nify 7either simple acceptance of the human con#ition" or the(ish to a*oi# the puttin! into effect of a reme#y #isproportionate to the results that can


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)e hope# for" or the #esire not to place too !reat a )ur#en on the family or onsociety+7.14


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Anesthetics li'e pain'illers" 7)y #irectly actin! on the more a!!ressi*e an# #istur)in!effects of pain" !i*es the person more control" so that sufferin! )ecomes a more humane3perience+7.1?=/

1+ ometimes the use of anal!esic an# anaesthesic techni2ues an# me#icines in*ol*esthe suppression or #iminution of consciousness an# the use of the hi!her faculties+ -n sofar as the proce#ures #o not aim #irectly at the loss of consciousness an# free#om )utat #ullin! sensiti*ity to pain" an# are limite# to the clinical nee# alone" they are to )econsi#ere# ethically le!itimate+.1?4/

The informe# consent of the patient


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?+ A therapeutic action (hich is apt to )e increasin!ly )eneficial to health is for that *eryreason open to ne( in*esti!ati*e possi)ilities+ These are the result of a pro!ressi*e an#on!oin! acti*ity of research an# e3perimentation" (hich thus succee#s in arri*in! at ne(me#ical a#*ances+

To procee# )y (ay of research an# e3perimentation is a la( of e*ery applie# science:scientific pro!ress is structurally connecte# (ith it+ iome#ical sciences an# their#e*elopment are su)8ect to this la( also+ ut they operate in a particular fiel# ofapplication an# o)ser*ation (hich is the life of the human person+

The latter" )ecause of his uni2ue #i!nity" can )e the su)8ect of research an# clinicale3perimentation (ith the safe!uar#s #ue to a )ein! (ith the *alue of a su)8ect an# notan o)8ect+ or this reason" )iome#ical sciences #o not ha*e the same free#om ofin*esti!ation as those sciences (hich #eal (ith thin!s+ 7The ethical norm" foun#e# onrespect for the #i!nity of the person" shoul# illuminate an# #iscipline )oth the researchsta!e an# the application of the results o)taine# from it+7.1?9/

@+ -n the research sta!e" the ethical norm re2uires that its aim )e to 7promote human(ell$)ein!+7.1@B/ Any research contrary to the true !oo# of the person is immoral+ Toin*est ener!ies an# resources in it contra#icts the human finality of science an# itspro!ress+.1@1/

-n the e3perimental sta!e" that is" testin! the fin#in!s of research on a person" the !oo#of the person" protecte# )y the ethical norm" #eman#s respect for pre*ious con#itions(hich are essentially lin'e# (ith consent an# ris'+

+ irst of all" the consent of the patient + %e 7shoul# )e informe# a)out thee3perimentation" its purpose an# possi)le ris's" so that he can !i*e or refuse hisconsent (ith full 'no(le#!e an# free#om+ -n fact" the #octor has only that po(er an#those ri!hts (hich the patient himself !i*es him+7.1@ it (oul# paraly e all serious scientific research an# (oul# 2uite often)e #etrimental to the patient++++ ut there is a le*el of #an!er that the moral la( cannotallo(+7.1@=/

A human su)8ect cannot )e e3pose# to the same ris' as )ein!s (hich are not human+There is a threshol# )eyon# (hich the ris' )ecomes humanly unaccepta)le+ This

threshol# is in#icate# )y the in*iola)le !oo# of the person" (hich for)i#s him 7toen#an!er his life" his e2uili)rium+ his health" or to a!!ra*ate his illness+7.1@4/

9+ E3perimentation cannot )e )e!un an# !enerali e# until e*ery safe!uar# has )eenput in place to !uarantee the harmlessness of the inter*ention an# to lessen the ris'+7The pre$clinical )asic phase" carrie# out carefully" shoul# !i*e the (i#est #ocumentationan# the most secure pharmacal$to3icolo!ical !uarantees an# ensure operationalsafety+7.1@?/


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To ac2uire these assurances" if it )e useful an# necessary" the testin! of ne(pharmaceutical pro#ucts or of ne( techni2ues shoul# first )e #one on animals )eforethey are trie# on humans+ 7-t is certain that the animal is for the ser*ice of man an# cantherefore )e the o)8ect of e3perimentation+ %o(e*er" it shoul# )e treate# as one of

o#6s creatures" meant to cooperate in man6s !oo# )ut not to )e a)use#+7.1@@/ -t follo(sthat all e3perimentation 7shoul# )e carrie# out (ith consi#eration for the animal" (ithoutcausin! it useless sufferin!+7.1@ /

&hen these !uarantees are in place" in the clinical phase e3perimentation on the humanperson must )e in accor# (ith the principle of proportionate ris'" that is" of #ueproportion )et(een the a#*anta!es an# foreseea)le ris's+ %ere a #istinction must )ema#e )et(een e3perimentation on a sic' person" for therapeutic reasons" an# on ahealthy person" for scientific an# humanitarian reasons+

;B+ -n e3perimentation on a sic' person" #ue proportion is attaine# from a comparison ofthe con#ition of the sic' person an# the foreseea)le effects of the #ru!s or thee3perimental metho#s+ %ence the ris' rate (hich mi!ht )e proportionate an# le!itimatefor one patient may not )e so for another+

-t is a *ali# principleas alrea#y sai#that 7in the a)sence of other reme#ies" it is licit toha*e recourse" (ith the consent of the patient" to means ma#e a*aila)le )y the mosta#*ance# me#icine" e*en if they are still at an e3perimental sta!e an# are not (ithoutsome ris'+ y acceptin! them the patient mi!ht also !i*e an e3ample of !enerosity forthe )enefit of humanity+7.1@;/ ut there must al(ays )e 7!reat respect for the patient inthe application of ne( therapy still at the e3perimental sta!e+++(hen these are still hi!h$ris' proce#ures+7.1@9/

7-n #esperate cases" (hen the patient (ill #ie if there is no inter*ention" if there is ame#ication a*aila)le" or a metho# or an operation (hich" thou!h not e3clu#in! all#an!er" still has some possi)ility of success" any ri!ht$thin'in! person (oul# conce#e

that the #octor coul# certainly" (ith the e3plicit or tacit consent of the patient" procee#(ith the application of the treatment+7.1 B/

;1+ Clinical e3perimentation can also )e practice# on a healthy person" (ho *oluntarilyoffers himself 7to contri)ute )y his initiati*e to the pro!ress of me#icine an#" in that (ay"to the !oo# of the community+7 -n this case" 7once his o(n su)stantial inte!rity issafe!uar#e#" the patient can le!itimately accept a certain #e!ree of ris'+7.1 1/

This is le!itimi e# )y the human an# Christian soli#arity (hich moti*ates the !esture:7To !i*e of oneself" (ithin the limits mar'e# out )y the moral la(" can )e a (itness ofhi!hly meritorious charity an# a means of such si!nificant spiritual !ro(th that it cancompensate for the ris' of any insu)stantial physical impairment+7.1


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Research in particular" that is the o)ser*ation of a !i*en phenomenon #urin! pre!nancy"can )e allo(e# only (hen 7there is moral certainty that there (ill )e no harm either to thelife or the inte!rity of the e3pecte# chil# an# the mother" an# on con#ition that theparents ha*e !i*en their consent+7.1 =/

E3perimentation" on the other han#" is possi)le only for clearly therapeutic purposes"(hen no other possi)le reme#y is a*aila)le+ 7,o finality" e*en if in itself no)le" such asthe foreseein! of a usefulness for science" for other human )ein!s or for society" can inany (ay 8ustify e3perimentation on li*e human em)ryos an# fetuses" (hether *ia)le ornot" in the maternal (om) or outsi#e of it+ The informe# consent" normally re2uire# forclinical e3perimentation on an a#ult" cannot )e !i*en )y the parents" (ho may not#ispose either of the physical inte!rity or the life of the e3pecte# chil#+ On the otherhan#" e3perimentation on em)ryos or fetuses has the ris'" in#ee# in most cases thecertain fore'no(le#!e" of #ama!in! their physical inte!rity or e*en causin! their #eath+To use a human em)ryo or the fetus as an o)8ect or instrument of e3perimentation is acrime a!ainst their #i!nity as human )ein!s+7 7The practice of 'eepin! human em)ryosali*e" actually or in *itro" for e3perimental or commercial reasons"7 is especially an#7alto!ether contrary to human #i!nity+7.1 4/

Donation an# transplantin! of or!ans

;=+ The pro!ress an# sprea# of transplant me#icine an# sur!ery no(a#ays ma'espossi)le treatment an# cure for many illnesses (hich" up to a short time a!o" coul# onlylea# to #eath or" at )est" a painful an# limite# e3istence+.1 ?/ This 7ser*ice to life"7.1 @/(hich the #onation an# transplant of or!ans represents" sho(s its moral *alue an#le!itimi es me#ical practice+ There are" ho(e*er" some con#itions (hich must )eo)ser*e#" particularly those re!ar#in! #onors an# the or!ans #onate# an# implante#+E*ery or!an or human tissue transplant re2uires an e3plant (hich in some (ay impairsthe corporeal inte!rity of the #onor+

;4+ Autoplastic transplants" in (hich there is the e3plant an# implant on the sameperson" are le!itimate in *irtue of the principle of totality )y (hich it is possi)le to #isposeof a part for the inte!ral !oo# of the or!anism+

;?+ %omoplastic transplants" in (hich the transplant is ta'en from a person of the samespecies as the recipient" are le!itimi e# )y the principle of soli#arity (hich 8oins human)ein!s" an# )y charity (hich prompts one to !i*e to sufferin! )rothers an# sisters+.1 /7&ith the a#*ent of or!an transplants" )e!un (ith )loo# transfusions" human personsha*e foun# a (ay to !i*e part of themsel*es" of their )loo# an# of their )o#ies" so thatothers may continue to li*e+ Than's to science an# to professional trainin! an# the#e#ication of #octors an# health care (or'ers+++ne( an# (on#erful challen!es areemer!in!+ &e are challen!e# to lo*e our nei!h)or in ne( (ays> in e*an!elical termsto

lo*e 6e*en unto the en#6 .0n 1=:1/" e*en if (ithin certain limits (hich cannot )etrans!resse#" limits place# )y human nature itself+7.1 ;/

-n homoplastic transplants" or!ans may )e ta'en either from a li*in! #onor or from acorpse+

;@+ -n the first case the remo*al is le!itimate pro*i#e# it is a 2uestion of or!ans of (hichthe e3plant (oul# not constitute a serious an# irrepara)le impairment for the #onor+


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7One can #onate only (hat he can #epri*e himself of (ithout serious #an!er to his life orpersonal i#entity" an# for a 8ust an# proportionate reason+7.1 9/

; + -n the secon# case (e are no lon!er concerne# (ith a li*in! person )ut a corpse+This must al(ays )e respecte# as a human corpse" )ut it no lon!er has the #i!nity of asu)8ect an# the en# *alue of a li*in! person+ 7A corpse is no lon!er" in the proper senseof the term" a su)8ect of ri!hts" )ecause it is #epri*e# of personality" (hich alone can )ethe su)8ect of ri!hts+7 %ence" 7to put it to useful purposes" morally )lameless an# e*enno)le7 is a #ecision 7not )e con#emne# )ut to )e positi*ely 8ustifie#+7.1;B/

There must )e certainty" ho(e*er" that it is a corpse" to ensure that the remo*al ofor!ans #oes not cause or e*en hasten #eath+ The remo*al of or!ans from a corpse isle!itimate (hen the certain #eath of the #onor has )een ascertaine#+ %ence the #uty of7ta'in! steps to ensure that a corpse is not consi#ere# an# treate# as such )efore #eathhas )een #uly *erifie#+7.1;1/

-n or#er that a person )e consi#ere# a corpse" it is enou!h that cere)ral #eath of the#onor )e ascertaine#" (hich consists in the 7irre*ersi)le cessation of all cere)ralacti*ity+7 &hen total cere)ral #eath is *erifie# (ith certainty" that is" after the re2uire#tests" it is licit to remo*e or!ans an# also to surro!ate or!anic functions artificially inor#er to 'eep the or!ans ali*e (ith a *ie( to a transplant+.1; )ut the transplant of the cornea of a non$humanor!anism to a human or!anism (oul# not create any pro)lem if it (ere )iolo!icallypossi)le an# a#*isa)le+7.1;=/

Amon! hetero!eneous transplants are also inclu#e# the implantin! of artificial or!ans"the la(fulness of (hich is con#itione# )y the )eneficial effect for the person an# respectfor his #i!nity+

9B+ The me#ical inter*ention in transplants 7is insepara)le from a human act of

#onation+7.1;4/ -n life or in #eath the person from (hom the remo*al is ma#e shoul# )ea(are that he is a #onor" that is" one (ho freely consents to the remo*al+

Transplants presuppose a free an# conscious pre*ious #ecision on the part of the #onoror of someone (ho le!itimately represents him" normally the closest relati*es+ 7-t is a#ecision to offer" (ithout recompense" part of someone6s )o#y for the health an# (ell$)ein! of another person+ -n this sense" the me#ical act of transplantin! ma'es possi)lethe act of #onation of the #onor" that sincere !ift of himself (hich e3presses ouressential call to lo*e an# communion+7.1;?/


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The possi)ility" than's to )iome#ical pro!ress" of 7pro8ectin! )eyon# #eath their *ocationto lo*e7 shoul# persua#e persons 7to offer #urin! life a part of their )o#y" an offer (hich(ill )ecome effecti*e only after #eath+7 This is 7a !reat act of lo*e" that lo*e (hich !i*eslife to others+7.1;@/

91+ As part of this o)lati*e 7economy7 of lo*e" the me#ical act itself of transplantin!" ofe*en 8ust )loo# transfusion" 7is not 8ust another inter*ention+7 -t 7cannot )e separate#from the #onor6s act of !i*in!" from life$!i*in! lo*e+7.1; /

%ere the health care (or'er 7)ecomes a me#iator of somethin! (hich is particularlymeanin!ful" the !ift of self )y a persone*en after #eathso that another mi!htli*e+7.1;;/

Depen#ency

9


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9?+ The #eto3ification of the person a##icte# to #ru!s is more than me#ical treatment+Moreo*er" me#icines are of little or no use+ Deto3ification is an inte!rally human processmeant to 7!i*e a complete an# #efiniti*e meanin! to life"7.19


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-t is the tas' of health authorities" #octors an# those responsi)le for research centers toapply themsel*es in or#er to re#uce these ris's to a minimum throu!h apt measures ofpre*ention an# information+7.


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The same respect prohi)its the influencin! or forcin! of the patient6s (ill+ 7Thepsycholo!ist (hose only #esire is the !oo# of the patient" (ill )e all the more careful torespect the limits to his action set #o(n )y the moral co#e in thatin a manner ofspea'in!he hol#s in his han#s the psycholo!ical faculties of a person" his a)ility to actfreely" to achie*e the no)lest i#eals (hich his personal #estiny an# his social callin!imply+7. ' 9:


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This means that pastoral care of the sic' has a special place in catechesis" in the litur!yan# in charity+ Respecti*ely" it is a matter of e*an!eli in! illness" helpin! a person tounco*er the re#empti*e meanin! of sufferin! )orne in communion (ith Christ> ofcele)ratin! the sacraments as efficacious si!ns of the recreati*e an# *itali in! !race of

o#> of (itnessin! )y means of the 7#ia'onia7 .ser*ice/ an# the 7'oinonia7 .communion/to the therapeutic po(er of charity+

111+ -n pastoral care of the sic'" the lo*efull of truth an# of !race of o# comes nearto them in a special sacrament meant for them: the Anointin! of the ic' +. he feels stren!thene# in his trust in o# an# he recei*es reinforcementa!ainst the temptations of the #e*il an# the fear of #eath+7.


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7The sacrament cannot )e conferre# on a patient (ho is alrea#y #ea#+7.


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11@+ Dyin! is part of life as its ultimate phase+ -t shoul# )e care# for" then" as )elon!in!to it+ %ence it calls for the therapeutic responsi)ility of the health care (or'er 8ust asmuch an# no less than e*ery other moment in human life+

The #yin! person shoul# not )e #ismisse# as incura)le an# a)an#one# to his o(nresources an# those of the family" )ut shoul# )e reentruste# to the care of #octors an#nurses+ These" interactin! an# inte!ratin! (ith the assistance !i*en )y chaplains" social(or'ers" relati*es an# frien#s" allo( the #yin! person to accept an# li*e out his #eath+.


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This cannot )e interprete# as the po(er to 'ill oneself or to !i*e this po(er to others" )utto e3perience #yin! in a human an# Christian (ay an# not flee from it 7at any cost+7 Thisri!ht is )ein! e3plicitly e3presse# )y people to#ay in or#er to safe!uar# themsel*es atthe point of #eath a!ainst 7the use of techni2ues that run the ris' of )ecomin!a)usi*e+7.


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of supportin! them+ The suppression of pain" instea#" )rin!s or!anic an# psychic reliefma'in! prayer easier an# ena)lin! one to !i*e oneself more !enerously+7.


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The person has a ri!ht to )e informe# of their con#ition + This ri!ht is not lessene#(here there is a #ia!nosis an# pro!nosis of a terminal illness" rather" it is hei!htene#+

This information" in fact" is lin'e# to important responsi)ilities (hich cannot )e #ele!ate#to another+ There are responsi)ilities )earin! on the treatment to )e applie# (ith theinforme# consent of the patient+

&ith the approach of #eath comes the responsi)ility to fulfill certain #uties in one6srelationship (ith the family" settlin! possi)le le!al matters" resol*in! o)li!ations to a thir#party+ or a )elie*er the approach of #eath re2uires that he )e fully a(are (hen heperforms certain actions" especially the reconcilin! encounter (ith o# in the sacramentof Penance+

The person cannot )e a)an#one# to unconsciousness in the #ecisi*e 7hour7 of his life"ta'in! him a(ay from himself an# from his final an# most important #ecisions+ 7Death istoo essential a moment for its prospect to )e a*oi#e#+7.


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1


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the Christian from the )e!innin! to the en# of life+ The last (or# of the ospel is the(or# of life that con2uers #eath an# opens up the !reatest hope to the #yin! person+

1=1+ Death" then" must )e e*an!eli e# : the ospel must )e announce# to the #yin!person+ -t is a pastoral #uty of the ecclesial community in each one of its mem)ers"accor#in! to the responsi)ilities of each+ The hospital chaplain has a special o)li!ationhere" since he is calle# to minister to the #yin! (ithin the )roa#er limits of the pastoralcare of the sic'+

or him this #uty implies not only the role he personally carries out at the si#e of the#yin! entruste# to his care" )ut also the promotion of this pastoral acti*ity" throu!hor!ani in! reli!ious ser*ices" formin! an# sensiti in! health care (or'ers an# in*ol*in!relati*es an# frien#s+

The announcement of the ospel to the #yin! fin#s especially e3pressi*e an# effecti*eforms in charity" prayer an# the sacraments+

1=


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1=?+ -n this faith$fille# (ith charity the po(erlessness e3perience# (hen face# (ith themystery of #eath is not a!oni in! an# paraly in!+ The Christian fin#s hope an# in it thepossi)ility" #espite e*erythin!" to li*e an# not suffer #eath+

The suppression of life

1=@+ The in*iola)ility of human life means an# implies in the last analysis theunla(fulness of e*ery act (hich #irectly suppresses human life+ 7The in*iola)ility of theri!ht to life of the innocent human )ein! from conception to #eath is a si!n an# are2uirement of the *ery in*iola)ility of the person" to (hom the Creator has !i*en the !iftof life+7.


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1=9+ The in*iola)ility of the human person from conception prohi)its a)ortion as thesuppression of prenatal life+ This is 7a #irect *iolation of the fun#amental ri!ht to life ofthe human )ein!7.


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le!itimate+ The a)ortion in this case is the in#irect result of an act (hich is not in itselfa)orti*e+.< =/

14=+ -f the health care (or'er is face# (ith le!islation fa*ora)le to a)ortion he 7mustrefuse politely )ut firmly+7.< 4/ 7One can ne*er o)ey a la( that is intrinsically immoral"an# this is so in the case of a la( (hich a#mits" in principle" the la(fulness ofa)ortion+7.< ?/

As a result" #octors an# nurses are o)li!e# to )e conscientious o)8ectors + The !reat"fun#amental *alue of life ma'es this o)li!ation a !ra*e moral #uty for me#ical personnel(ho are encoura!e# )y the la( to carry out a)ortions or to cooperate pro3imately in#irect a)ortion+

A(areness of the in*iola)le *alue of life an# of o#6s la( protectin! it" is antece#ent toall positi*e human la(+ &hen the latter is contrary to o#6s la(" conscience affirms itsprimary ri!ht an# the primacy of o#6s la(: 7One must o)ey o# rather than men7 .Acts?:


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i'e(ise" the fetus cannot )e use# for e3perimentation or transplant if the a)ortion (ascause# *oluntarily+ To #o so (oul# )e an un(orthy instrumentali ation of a human life+

Euthanasia

14 + A mentality e*er less rea#y to reco!ni e life as a *alue in itself" relati*e to o#alone" in#epen#ent of ho( it came into )ein!> a concept of the 2uality of life in terms ofefficiency an# psychophysical satisfaction" incapa)le of seein! any meanin! in sufferin!an# han#icap" an# hence to )e a*oi#e# at any cost an# )y e*ery means> a *ision of#eath as an a)sur# en# to a life still to )e en8oye#" or as a li)eration from an e3istencealrea#y consi#ere# meanin!less> all of this(ithin a culture (hich" lea*in! o# asi#e"ma'es man responsi)le to himself alone an# to freely esta)lishe# la(s of societyis thesoil of the euthanasia culture+ &here these con*ictions are #isseminate# 7it coul# seemlo!ical an# 6human6 to en# one6s o(n life or that of another 6peacefully6" (hen all that isleft to it is sufferin! an# serious impairment+7.< 9/

7 ut this is really a)sur# an# inhuman+7.


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interaction )et(een the mission of the priest on the one han# an# that of the health care(or'er on the other: all are #e*ote#" in #ifferent (ays" to the sal*ation of the person" an#care for his health" to free him from illness" sufferin! an# #eath" to promote in him life(ell$)ein! an# happiness7 .0ohn Paul --" 7 Discourse for the 1


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)o#ies" (ho for!a*e the sins of the paralytic an# restore# him to )o#ily health" has (ille#that his Church continue" in the po(er of the %oly pirit" his (or' of healin! an#sal*ation e*en amon! her o(n mem)ers+ This is the purpose of the t(o sacraments ofhealin!: the sacrament of Penance an# the sacrament of Anointin! of the ic' .CCC14


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true an# inte!ral !oo#" in conformity (ith o#6s plan an# (ill7 Con!+ Doct+ aith" -nstruct+Donum *itae" e)+


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4?+ Cf+ Con!+ Doct+ aith" -nstruct+ Donum *itae" e)+


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an# )iolo!ists an# !i*es technolo!y #ominion o*er the ori!in an# #estiny of the humanperson7 .i)i#+" p+ 9=/+ 1+ Cf+ i)i#+" AA ;B .19;;/ pp+ ;?$;@" 91$9


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91+ 0ohn Paul --" To the participants at a con!ress for o)stetricians" 0an+


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Association of Anesthesiolo!y" Oct+ 4" 19;4" in -nse!namenti --G To theCatholic health or!ani ations of the nite# tates of America" ept+ 14" 19; " in-nse!namenti 5G= .19; / ?B4+ 1B;+ 0ohn Paul --" To the participants at a con!ress of the 7Mo*ement for ife"7 Oct+1


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14B+ 7E*en (hen it cannot cure" science can an# shoul# treat an# assist the sic'person7 .0ohn Paul --" To the participants at a stu#y course on 7human preleu'emias"7,o*+ 1?" 19;?" in -nse!namenti ---G


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!roups set up )y the Pontifical Aca#emy of ciences" Oct+


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!oo# pro)a)ility of success+ -f the patient consents" the application of the proce#ure in2uestion is la(ful7 .Pius 5--" To the participants at the irst -nternational Con!ress on%istopatholo!y of the ,er*ous ystem" ept+ 14" 19?


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Discourses to Doctors p+ 4@ : 7-n a#*ertisin! .for cornea #onors/ an intelli!ent reser*eshoul# )e maintaine# to a*oi# serious interior an# e3terior conflicts+ Also" is it necessary"as often happens" to refuse any compensation as a matter of principleF The 2uestionhas arisen+ &ithout #ou)t there can )e !ra*e a)uses if recompense is #eman#e#> )ut it(oul# )e an e3a!!eration to say that any acceptance or re2uirement of recompense isimmoral+ The case is analo!ous to that of )loo# transfusion> it is to the #onor6s cre#it ifhe refuses recompense" )ut it is not necessarily a fault to accept it+7 1;@+ Cf+ 0ohn Paul --" To the participants at the irst international Con!ress on theTransplant of Or!ans" 0une


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is still intact in an ol# person" e*en if he or she is *ery #e)ilitate#> an incura)ly ill person#oes not lose it+ -t is no less le!itimate in the ne()orn chil# than in the mature person7Con!+ Doct+ aith" Declaration on Procure# A)ortion" 0une 1;" 19 4" in AA @@ .19 4/

= $ =;+


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pchpc charter health care workers 9405

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