Morality: medical topics

A 2008 Roman Catholic document:
Dignitatis Personae, "The dignity of a person"

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About Dignitatis Personae:

The Roman Catholic Congregation for the Doctrine of the Faith at the Vatican released "Dignitas Personae" on 2008-DEC-12. _1,2 It is a new Instruction "on certain bioethical questions" approved by the Pope Benedict XVI. It updates an earlier Instruction "Donum Vitae" issued by Pope Benedict XVI on 1987-FEB-22 when he was Cardinal Joseph Ratzinger and Prefect of the Vatican's Congregation for the Doctrine of the Faith.

It is unrelated to an earlier declaration on religious freedom with a similar name, titled Dignitatis Humanae, issued in 1965.

Bioethical developments:

The new Instruction was felt to be necessary because of the rapid growth over the past two decades of both research and procedures in the field of bioethics. There has been major growth in the areas of assisted reproduction technologies, pre-implantation genetic diagnosis (PGD), genetic research, stem cell research, etc.

Perhaps the most recent bioethical concern involves organ transplants. Doctors typically wait several minutes after death of the donor before starting to harvest her/his organs. Some suggest that organs be harvested prior to the actual death of the donor, assuming that the donor is: unconscious, have no chance of regaining consciousness, have started the process of death; and will certainly be dead within minutes. Studies have shown that organs harvested a few minutes before actual death have a significantly greater likelihood of being successfully transplanted. This would result in more lives saved and/or much suffering reduced. However, the procedure raises significant moral questions.

Catholic beliefs that form the foundation for the Instructions:

Both Instructions are based on a number of fundamental beliefs of the Roman Catholic church that have a major impact on bioethics. These beliefs are collectively often referred to as the "Gospel of Life." Some of them are:

A new human person starts at conception when a unique DNA is formed within the pre-embryo. Her or his right to life begins at that time. The instruction states:

"The human being is to be respected and treated as a person from the moment of conception; and therefore from that same moment his rights as a person must be recognized, among which in the first place is the inviolable right of every innocent human being to life."

Other religions and secular systems of ethics promote alternate beliefs concerning the beginning of personhood.

Abortion at any time is a profound moral evil even if it is needed to avoid the death of the pregnant woman. For example, in those rare circumstances where a physician's choice is between:

	An abortion which would probably result in life for the woman and would certainly and intentionally cause the death for the fetus, or
	No abortion which would result in death for the fetus and almost certainly would also result in the woman's death,

only the latter is morally permissible. The physician is expected to administer comfort care, and perhaps prayer for a miracle, but otherwise must only stand by as the woman and fetus die. This belief is based on the Church's fundamental principle that it is never moral to perform an evil deed (e.g. an abortion that would intentionally kill the fetus) in order to achieve a positive end (e.g. preserve the life of the woman). Again, most or all other religions and ethical systems disagree with these concepts. They tend to weigh the positive and negative results for each option and select the most positive, or least negative.

Human personhood only ends at "natural death." Suicide and physician assisted suicide are profound moral evils, even if the individual is dying in intense, continuous, and untreatable pain. That is, a person may not morally commit suicide, nor may anyone help a person commit suicide.

Conception must occur within the the woman's body as the result of sexual intercourse, which is only moral if performed between a woman and man who are married to each other. The instruction states:

"The origin of human life has its authentic context in marriage and in the family, where it is generated through an act which expresses the reciprocal love between a man and a woman. Procreation which is truly responsible vis-� -vis the child to be born must be the fruit of marriage."

Every act of sexual intercourse must be open to the possibility of conception. The use of condoms is immoral even if needed to prevent the transmission of a inevitably fatal STD like HIV -- the virus which causes AIDS. Again, if one party is HIV positive, the other party must accept the possibility of death with every sex act. The only other option is abstinence.

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Some teachings of "Dignitatis Personae:"

Some procedures are considered acceptable:

	Medical "... techniques which act as an aid to the conjugal act and its fertility are permitted."
	Certain techniques "... aimed at removing obstacles to natural fertilization" are permitted.
	Research into the prevention of sterility should be encouraged.
	Adoption should be "... encouraged, promoted and facilitated."
	The use of adult stem cells taken -- with due regard for safety -- from a human adult, umbilical cord blood, or fetuses who have died of natural causes is licit.

Others are considered illicit:

In vitro fertilization: In this procedure, the husband's sperm is mixed in a fertility lab with perhaps two dozen ova removed from the wife. Typically, about four of the healthiest fertilized ova are selected and implanted in the woman's womb in the hopes that one or more will cause a pregnancy. The Instruction rejects this procedure because the unused fertilized embryos, who the church consider to be full human persons, are discarded or frozen for potential future use. All or essentially all will eventually die. The church cannot find a "morally licit solution regarding the human destiny" of the hundreds of thousands of "frozen" embryos currently in American fertility clinics.

Intracytoplasmic sperm injection (ICSI): This is a form of in vitro fertilization in which a single spermatozoon or immature germ cells taken from the man are physically injected into a ovum to produce conception. This is also considered illicit because fertilization takes place in a lab "... outside the bodies of the couple through actions of third parties whose competence and technical activity determine the success of the procedure. Such fertilization entrusts the life and identity of the embryo into the power of doctors and biologists and establishes the domination of technology over the origin and destiny of the human person."

Embryo reduction: Sometimes multiple pregnancies result from in vitro procedures. Physicians have sometimes recommended that one or more embryos or fetuses in the womb be selectively aborted in order to assure that the remaining embryos or fetus will not die and are born healthy. This is a form of abortion and is thus considered illicit.

Pre-implantation genetic diagnosis (PGD): This procedure involves an in vitro procedure. A single cell is taken from each of the healtheist embryos and analyzed for genetic defects. The genes that cause hemophilia A and B, Huntington disease, muscular dystrophy, cystic fibrosis, sickle cell anemia, and dozens of other diseases can be detected. Only those embryos that are free of the disease are implanted in the woman's womb.

This procedure avoids many abortions, because many women who are aware that they or their partner is a carrier of one of these serious diseases would otherwise decide to automatically abort any pregnancy. The PGD procedure is also considered illicit by the church.

Interception and contragestation methods and medications: The Vatican uses the term:

"Interception" to refers to methods that interfere "with the embryo before implantation" and result in the death of the embryo. Emergency contraception (a.k.a. EC, Morning After Pill, MAP) usually prevent the release of an ovum from a ovary, or prevent conception. However, years ago, doctors believed that there was a slim chance that EC might prevent implantation, thus ending the life of an embryo. Subsequent research has indicated that this is extremely unlikely or impossible. However, the Church continues to reject this research.

The Intrauterine Device (IUD) is an example of a real interception device.

"Contragestation" refer to methods that terminate pregnancy after implantation of the embryo in the womb. The RU-286 abortion pill and surgical abortions are two such methods.

All of these are considered: "... within the sin of abortion and are gravely immoral."

Gene therapy: These offer potential dangers to the recipient which must be considered.

Human reproductive cloning is "... intrinsically illicit in that�€�it seeks to give rise to a new human being without a connection to the act of reciprocal self-giving between the spouses and, more radically, without any link to sexuality. This leads to manipulation and abuses gravely injurious to human dignity."

Human therapeutic cloning is also illicit because to "... create embryos with the intention of destroying them, even with the intention of helping the sick, is completely incompatible with human dignity, because it makes the existence of a human being at the embryonic stage nothing more than a means to be used and destroyed. It is gravely immoral to sacrifice a human life for therapeutic ends."

By "human life" we assume they are referring to a pre-embryo or embryo or fetus, all of which the church considers human persons. The hundreds of millions of spermatazoon that a man releases during ejaculation and human ova are forms of human life in that they are alive and contain human DNA. But presumably the church does not consider their sacrifice a "gravely immoral" act.

Stem cells: Extracting cells from embryos cause the death of the embryo, and is thus illicit. The use of such stem cells already extracted by other researchers "... presents serious problems from the standpoint of cooperation in evil and scandal."

Attempts at hybridization: This refers to embryonic research in which the nucleus of a human ovum is removed and replaced with the nucleus of a non-human species. This creates a pre-embryo from which stem cells may be extracted. "From the ethical standpoint, such procedures represent an offense against the dignity of human beings on account of the admixture of human and animal genetic elements capable of disrupting the specific identity of man."

Use of human "biological material" of illicit origin: This typically involves the use of body parts from aborted fetuses in order to create vaccines or other products. This may be considered licit under strictly controlled conditions, if the need is sufficiently great.

Church influence:

The Instruction states that the Church does not directly enforce its beliefs concerning bioethics:

"The Church, by expressing an ethical judgment on some developments of recent medical research concerning man and his beginnings, does not intervene in the area proper to medical science itself, but rather calls everyone to ethical and social responsibility for their actions."

However, this statement does not appear to necessarily extend from the church to agencies controlled by the Church. For example, many Catholic hospitals have a policy of refusing to dispense emergency contraception (EC; a.k.a. the morning after pill) and/or of refusing to refer women to an agency where they can obtain EC.

References:

The following information sources were used to prepare and update the above essay. The hyperlinks are not necessarily still active today.

"Dignitatis Personae" The Vatican, 2008-DEC-08, at: http://www.vatican.va/
"Regarding the instruction 'Dignitas Personae'," 2008-DEC-12, at: http://www.vatican.va/

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