CHARTER FOR 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.
Nothing happens by chance in human affairs, and even chronological coincidence can have symbolic meanings. In fact, the awaited document is being published a few months after the institution (February 11, 1994), by the Holy Father, John Paul II, of the Pontifical Academy for Life, which ideally, operatively and in its statutary finality is closely associated with the tasks of the Office for Pastoral Assistance to Health Care Workers.
And this Office cannot but feel flattered that the Congregation for the Doctrine of the Faith approved and quickly confirmed in its entirety the text 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 expressly 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. Its publication fills a lacuna which was strongly felt not only in the Church but also by all those who empathize with the primary task it fulfills of promoting and defending life.
The extraordinary 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 explains why, especially from Pius XII onwards, the magisterium of the Church has intervened with increasing interest, with consistent firmness and ever more explicit directives concerning all the complex problems arising from the indissoluble bond between medicine and morality. None of these problems can be considered neutral at this time in relation to Hippocratic ethics and Christian morality. Hence the requirement, strictly respected in the Charter for Health Care Workers, for an organic and exhaustive 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—as often happens—doubtful interpretations may not prevail over the objective worth of the contents, in the redaction of the document the interventions of the Supreme Pontiffs and authoritative texts issued by the Offices of the Roman Curia have almost always been quoted 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 civilization.
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 evangelization" which, in service to life, especially for those who suffer, has, in imitation of Christ's ministry, its qualifying 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.
Card. Fiorenzo Angelini President of the Pontifical Council for Pastoral Assistance to Health Care Workers
1 The work of health care persons is a very valuable <service to life>. It expresses 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. It is "a form of Christian witness." "Their profession calls for them to be guardians and servants of human life" (<Evangelium Vitae> EV 89).
Life is a primary and fundamental good of the human person. Caring for life, then, expresses, first and foremost, a truly human activity in defense of physical life.
It 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 expression of "taking care" is their <vigilant and caring presence at the sickbed>. It is here that medical and nursing activity expresses its lofty human and Christian value.
1. John Paul II, during his visit to Mercy Maternity Hospital in Melbourne, Nov. 28, 1986, in <Insegnamenti> IX/2 (1986) 1734, n. 5. "Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them, taking into account the needs of others and the common good" (CEC 2288).
2 Health care activity is based on an interpersonal relationship of a special kind. It is "a meeting between trust and conscience." 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.
For him "the sick person is never merely a clinical case"—an anonymous individual on whom to apply the fruit of his knowledge—"but always a 'sick person,' towards whom" he shows a sincere attitude of "sympathy," in the ethymological sense of the term."
This requires love: availability, attention, understanding, sharing, benevolence, patience, dialogue. "Scientific and professional expertise" is not enough; what is required is "personal empathy with the concrete situations of each patient."
2. John Paul II, <To the participants at two congresses of medicine and surgery>, Oct. 27, 1980, in <Insegnamenti> III/2, p. 1010, n. 6.
3. "In exercising your profession, you are always dealing with the human person, who entrusts his body to you, confident of your competence as well as your solicitude and concern. It is the mysterious and wonderful reality of the life of a human being, with his suffering and his hope, that you are dealing with." John Paul II, <To the participants at a surgery congress>, Feb. 19, 1987, in <Insegnamenti X/1 (1987) 374, n. 2.
4. Cf. John Paul II, <To the participants at a medical congress on tumor therapy>, Feb. 25, 1982 in <Insegnamenti> V/1, 698. Cf. also John Paul II: "None of you can be merely a doctor of an organ or an apparatus, but you must look to the whole person," <To the World Congress of Catholic Doctors>, Oct. 3, 1982, in <Insegnamenti> V/3, pp. 673-674, n. 4.
5. Cf. John Paul II, <To the Congress of Italian Catholic Doctors, Oss. Rom.> Oct. 18,1988.
3 To safeguard, recover and better the state of health means serving life in its totality. In fact, "sickness and suffering are phenomena which, when examined in depth, ask questions which go beyond medicine to the essence of the human condition in this world. It 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."
In 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 required of him."
To speak of mission is to speak of <vocation>: 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, Jesus says: 'I came that they may have life, and have it abundantly' (Jn 10,10).... It is precisely in this 'life' that all the aspects and stages of human life achieve their full significance" (<Evangelium Vitae> 1).
The health care worker is the <good Samaritan> of the parable, who stops beside the wounded person, becoming his "neighbor in charity (cf. Lc 10,29-37).
6. John Paul II, Motu Proprio "<Dolentium hominum>," Feb. 11,1985, in <Insegnamenti> VIII/1, p. 474, n. 2. "<Care for the health of its citizens> requires that society help in the attainment of living conditions that allow them to grow and reach maturity: food and clothing, housing, health care, basic education, employment, and social assistance" (CEC 2288).
7. John Paul II, <To the participants at a medical congress on tumor therapy>, Feb. 25, 1982, in <Insegnamenti> V/1, p. 698, n. 4. Cf. <To the participants at a scientific congress>, May 21, 1982, in <Insegnamenti> V/2, p. 1792, n. 5.
8. "As I have said many times in my meetings with health care workers, your vocation is one which commits you to the noble mission of service to people in the vast, complex and mysterious field of suffering" John Paul II, <To representatives of the Italian Catholic Doctors>, March 4,1989, in <Insegnamenti> XII/1, p. 480, n. 2.)
9. John Paul II, <To the Association of Italian Catholic Doctors>, Dec. 28. 1978, in <Insegnamenti> I, p. 436. "You are aware of the close relationship, the analogy, the interaction between the mission of the priest on the one hand and that of the health care worker on the other: all are devoted, in different ways, to the salvation of the person, and care for his health, to free him from illness, suffering and death, to promote in him life well-being and happiness" (John Paul II, "<Discourse for the 120th anniversary of the foundation of the 'Bambin Gesu' hospital,>" March 18, 1989, in <Insegnamenti> XII/1, 605-608, n. 2).
10. Cf. John Paul II, Apost. Letter <Salvifici doloris>, in <Insegnamenti> VII/1, 353-358, nn. SD 28-30; <To an international group of scientists>, April 27, 1984, in <Insegnamenti> VII/1, 1133-1135, n. 2: <To the Catholic health organizations of the United States>, Sept. 14, 1987, in <Insegnamenti> X/3 (1987) 506.
4 This means that health-care is a ministerial instrument of God's outpouring love for the suffering person; and, at the same time, it is an act of love of God, shown in the loving care for the person. For the Christian, it is an actualized continuation of the healing love of Christ, who "went about doing good and healing everyone" (Ac 10,38). And at the same time it is love for Christ: he is the sick person—"I was sick"—who assumes the face of a suffering brother; since he considers as done to himself—"you did it to me"—the loving care of one's brother (cf. Mt 25,68).
Profession, vocation and mission meet and, in the Christian vision of life and health, they are mutually integrated. Seen in this light, health care assumes a new and more exalted meaning as "service to life" and "healing ministry." <Minister of life>, the health care worker is "the minister of that God, who in Scripture is presented as 'a lover of life"' (Sg 11,26). To serve life is to serve God in the person: it is to become "a collaborator with God in restoring health to the sick body" and to give praise and glory to God in the loving welcome to life, especially if it be weak and ill.
11. "The very personal relationship of dialogue and trust established between you and the patient requires of you a level of humanity which, for the believer, is found in the richness of Christian charity. This is the divine virtue which enriches all your actions and gives to your gestures, even the simplest of them, the power of an act performed by you in inner communion with Christ": John Paul II <To the Association of Dental Doctors>, Dec. 14, 1984, in <Insegnamenti> VII/2, 1592-1594, n. 4. "You bring to the sick-room and to the operating table something of God's charity, of the love and tenderness of Christ, the great Doctor of the soul and the body": John Paul II, <To the 'Fatebenefratelli' hospital>, April 5, 1981, in <Insegnamenti> IV/1, p. 895, n. 3.
12. Cf. John Paul II, <To the 'Armida Barelli' training school for professional nurses>, May 27, 1989, in <Insegnamenti> XII/1, p. 1364, n. 3. "What a stimulus for the desired 'personalization' of medicine could come from Christian charity, which makes it possible to see in the features of every sick person the adorable face of the great, mysterious Patient, who continues to suffer in those over whom your profession bends, wisely and providently!" (John Paul II, <To the participants at two congresses of medicine and surgery>, Oct. 27, 1980, in <Insegnamenti> III/2, p. 1010, n. 7).
13. Cf. John Paul II, <To the Association of Italian Catholic Doctors>, Dec. 28, 1978, in <Insegnamenti> 1, 437-438.
14. Cf. John Paul II, <To the staff of the 'Fatebenefratelli' hospital>, April 5, 1981, in <Insegnamenti> IV/1, p. 895. n. 3.
15. John Paul II, To the Association of Italian Catholic Doctors, Dec. 28, 1978, in <Insegnamenti> 1, p. 437.
16. John Paul II, To the Italian Federation of Orthopedic Technology Workers, Nov. 19, 1979, in <Insegnamenti> II/2, p. 1207, n. 4; cf. To the participants at a scientific congress, May 21, 1982, in <Insegnamenti> V/2, p. 1792, n. 5.
17. "Your work...can become a religious act" (John Paul II, To the participants at a surgery congress, Feb. 19, 1987, in <Insegnamenti> X/1 (1987) 375, n. 3; cf. Paul VI, <Insegnamenti> di Paolo VI, vol. 1, 1963, p. 141).
5 The Church, which considers "service to the sick as an integral part of its mission," assumes it as an expression of its ministry. "The Church...has always seen medicine as an important support for its own redeeming mission to humanity." In fact, "service to man's spirit cannot be fully effective except it be service to his psycho-physical unity. The Church knows well that physical evil imprisons the spirit, just as spiritual evil subjects the body."
It follows that the <therapeutic ministry> of health care workers is a sharing in the pastoral and evangelizing work of the Church. Service to life becomes a ministry of salvation, that is, a message that activates the redeeming love of Christ. "Doctors, 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:" witnesses of "the gospel of life."
18. John Paul II, Motu Proprio "<Dolentium hominum>," Feb. 11, 1985, in <Insegnamenti> VIII/1 (1985) p. 475.
19. "Every concern for illness and suffering is part of the life and the mission of the Church" (John Paul II, <To the Catholic health organizations of the United States of America>, Sept. 14, 1987, in <Insegnamenti> X/3  502-503, n. 3). "Allowing herself to be guided by the example of Jesus the 'Good Samaritan' (cf. Lc 10,29-37) and upheld by his strength, the Church has always been in the front line in providing charitable help: so many of her sons and daughters, especially men and women religious, in traditional and ever new forms, have consecrated and continue to consecrate their lives to God, freely giving of themselves out of love for their neighbor, especially for the weak and needy" (John Paul II, Encyclical <Evangelium vitae>, March 25, 1995, n. 27).
20. Cf. John Paul II, <To the world Congress of Catholic doctors>, Oct. 3 1982, in <Insegnamenti> V/3, p. 676, n. 3. "The Lord Jesus Christ physician of our souls and bodies, who forgave the sins of the paralytic and restored him to bodily health, has willed that his Church continue, in the power of the Holy Spirit, his work of healing and salvation even among her own members. This is the purpose of the two sacraments of healing: the sacrament of Penance and the sacrament of Anointing of the Sick (CEC 1421).
21. "Your presence at the sick-bed is bound up with that of those—priests, religious and laity—who are engaged in apostolate to the sick. Quite a number of the aspects of that apostolate coincide with the problems and tasks of the service to life rendered by medicine. There is a necessary interaction between the exercise of the medical profession and pastoral work, because the one object of both is the human person, seen in his dignity of a child of God, a brother or sister needing, just like ourselves, help and comforting" (John Paul II, <To the World Congress of Catholic Doctors>, Oct. 3 1982, in <Insegnamenti> V/3, p. 676, n. 6).
22. "You, while you alleviate sufferings and try to cure them, at the same time are witnesses of the Christian view of suffering and of the meaning of life and death, in the way it is taught by your Christian faith" (John Paul II, <To the Catholic Health Organizations of the United States of America>, Sept. 14, 1987, in <Insegnamenti> X/3  PP 502 and 505.)
23. John Paul II, Apost. Exhort. <Christifideles laici>, Dec. 30, 1988, in <Insegnamenti> XI/4, p. 2160, n. 53.
24. Cf. John Paul II, <To the participants at the International Congress for Assistance to the Dying>, in Oss. Rom. March 18, 1992, n. 6. "Every individual, precisely by reason of the mystery of the Word of God who was made flesh (cf. Jn 1,14), is entrusted to the maternal care of the Church" John Paul II, Encyclical <Evangelium vitae>, March 25, 1995, EV 3).
6 Service to life is such only if it is <faithful to the moral law>, which expresses exigently its value and its tasks. Besides 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 rights of the sick, should illuminate and govern both the research phase and the application of the findings." In 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 God, whose wisdom is expressed 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 questions 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—especially in the complexity of modern bio-technical possibilities—in his choices, always respecting life and its dignity.
25. John Paul II, <To the participants at a surgery congress>, Feb. 19,1987 in <Insegnamenti> X/1, p. 375, n. 3. "The advance of science and technology, this splendid witness of the human capacity for understanding and for perseverance, does not dispense humanity from the obligation to ask the ultimate religious questions. Rather it spurs us on to face the most painful and decisive of struggles, those of the heart and of the moral conscience" John Paul II, Encyclical <Veritatis splendor>, VS 1).
7 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 required competence and fitting professional expertise.
Side-by-side with this, they should be given a solid "ethico-religious formation," 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 faith and a true sense of morality, in a sincere search for a religious relationship with God, in whom all ideals of goodness and truth are based."
"All health care workers should be taught morality and bioethics." To achieve this. those responsible for their formation should endeavor to have chairs and courses in bioethics put in place.
26. Cf. John Paul II, Motu Proprio "<Dolentium hominum>," Feb. 11, 1985, in <Insegnamenti> VIII/1 (1985) p. 475. "Especially significant is the reawakening of an ethical reflection on issues affecting life. The emergence and ever more widespread development of bioethics is promoting more reflection and dialogue—between believers and non-believers, as well as between followers of different religions—on ethical problems, including fundamental issues pertaining to human life" (John Paul II, Encyclical <Evangelium vitae>, March 25, 1995, EV 27).
27. Cf. John Paul II, <To the Association of Catholic health care workers>, Oct. 24, 1986, in <Insegnamenti> IX/2, p. 1171, n. 3. "In today's cultural and social context, in which science and the practice of medicine risk losing sight of their inherent ethical dimension, health-care professionals can be strongly tempted at times to become manipulators of life, or even agents of death" John Paul II Encyclical <Evangelium vitae>, March 25, 1995, EV 89).
28. Synod of Bishops, special Assembly for Europe, <Concluding Statement>, in Oss. Rom. Dec. 20, 1991, n. 10. "It is illusory to claim that scientific research and its applications are morally neutral. On the other hand, guiding criteria cannot be deduced from merely technical efficacy, nor from the usefulness to some to the detriment of others, nor, worse still, from the dominant ideologies. Science and technology require, by their very inner significance, unconditional respect for the fundamental criteria of morality; they must be at the service of the human person, of his inalienable rights, of his true and integral good, in conformity with God's plan and will" Cong. Doct. Faith, Instruct. <Donum vitae>, Feb. 22, 1987, in AAS 80 (1988) Introduction, 2, p. 73 (cf. CEC 2294).
8 Health care workers, especially doctors, cannot be left to their own devices and burdened with unbearable responsibilities when faced with ever more complex and problematic clinical cases arising from biotechnical possibilities—many of which are at an experimental stage—open to modern medicine, and from the socio-medical import of certain questions.
To facilitate choices and to keep a check on them, the setting up of <ethical committees> in the principal medical centers should be encouraged. In 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.
29. Ethical committees, composed of specialists in the medical and moral nerds, are also established by governments, which give them consultative and supervisory roles. "The Church is aware that the issue of morality is one which deeply touches every person; it involves all people, even those who do not know Christ and his Gospel or God himself. She knows that it is precisely <on the path of the moral life that the way of salvation is open to all>" John Paul II, Encyclical <Veritatis splendor>, VS 3. "...No darkness of error or of sin can totally extinguish in the human person the light of God the Creator. In the depths of his heart there always remains a yearning for absolute truth and a thirst to attain full knowledge of it. This is eloquently proved by man's tireless research in all fields and in every sector. His search for the meaning of life proves it even more (ibid., VS 1). Cf. John Paul II, Encyclical <Evangelium vitae>, March 25, 1995. EV 4.
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 equilibrium 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.
The full concept of health reflects directly on that of medicine. In fact, "institutions are very important and indispensable; however, no institution can of itself substitute for the human heart, human compassion, human love, human initiative, when it is a question of helping another in his suffering."
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 <humanizing> medicine. This must be present both at the personal-professional level—the doctor-patient relationship—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 humanization as well as being a love-charity task is "an obligation of justice." "[This humanization strengthens] the bases of the 'civilization of life and love,' without which the life of individuals and of society itself loses its most genuinely human quality" (<Evangelium Vitae> EV 27).
30. Cf. John Paul II, <To the plenary assembly of the Pontifical Council for Pastoral Assistance to Health Care Workers>, Feb. 9,1990, in <Insegnamenti> XIII/2, p. 405, n. 4.
31. John Paul II, Apost. Letter <Salvifici doloris>, in <Insegnamenti> VII/1, 254-356, SD 29.
32. Cf. <To scientists and health care workers>, Nov. 12, 1987, in <Insegnamenti> X/3 (1987) 1088: "The humanization of medicine is a duty of justice, and its implementation cannot be entirely delegated to others, since it requires the commitment of all. Its operative field is very vast: it goes from health education to the creation of greater sensitivity in those in public authority; from direct involvement in one's own workplace to forms of cooperation—local, national and international— which are made possible by the existence of so many organizations and associations which have among their purposes the call, direct or indirect, for a need to make medicine ever more human."
10 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 existence: procreation, living, dying, as reference points for ethical-pastoral reflections.
11 "In 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 God, a deliberation to establish <a particular and specific bond with the Creator>: 'Let us make man in our image, after our likeness' (Gn 1,26). The life which God offers to man <is a gift by which God shares something of himself with his creature.>"
"'God himself who said, <it is not good for man to be alone> (Gn 2,18) and <who made man from the beginning male and female> (Mt 19,4), wished to share with man a certain participation in his own creative work. Thus he blessed male and female saying: <Increase and multiply>"'(Gn 1,28). 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' (Gn 2,24), and God who makes himself present."
Health care workers lend their service when" ever they help the parents to procreate responsibly, supporting the conditions, removing obstacles and protecting them from invasive techniques unworthy of human procreation.
33. John Paul II, Encyclical <Evangelium vitae>, March 25.1995. EV 34.
34. Ibid., EV 43.
12 The ever-widening knowledge of the human genetic patrimony (genome), 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.
In moral evaluation a distinction must be made between strictly <therapeutic> manipulation, which aims to cure illnesses caused by genetic or chromosome anomalies (genetic therapy), 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."
35. John Paul II, <To the World Medical Association>, Oct. 29, 1983, in <Insegnamenti> VI/2, 921. Cf. <Allocution to the participants at a congress of the Pontifical Academy of Sciences>, Oct. 23, 1982, in <Insegnamenti> V/3, 895-898.
13 On the other hand, interventions which are not directly curative, the purpose of which is "the production of human beings selected according to sex or other predetermined qualities," 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 justified on the pretext that they will produce some beneficial results for humanity in the future," "no social or scientific usefulness and no ideological purpose could ever justify an intervention on the human genome unless it be therapeutic, that is its finality must be the natural development of the human being."
36. Cong. Doct. Faith, Instruct. <Donum vitae>, Feb. 22, 1987, in AAS 80 (1988) 85. Cf. John Paul II, Apost. Exhort. <Christifdeles laici>, Dec. 30, 1988, in <Insegnamenti> XI/4, pp. 2133-2135, CL 38; cf. Holy See, <Charter of the Rights of the Family>, Oct. 22, 1983, art. 4.
37. John Paul II, <To the Union of Italian Jurists>, Dec. 5, 1987, in <Insegnamenti> X/3, (1987) 1295. "The Church remains deeply conscious of her 'duty in every age of examining the signs of the times and interpreting them in the light of the Gospel, so that she can offer in a manner appropriate to each generation replies to the continual human questionings on the meaning of this life and the life to come and on how they are related"' (John Paul II, Encyclical <Veritatis splendor>, VS 2).
14 In any case, this type of intervention "should not prejudice 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."
The negative ethical evaluations outlined here apply to all genetic manipulatory interventions concerned with embryos. On the other hand there are no moral objections to the manipulation of human body cells for curative purposes and the manipulation of animal or vegetable cells for pharmaceutical purposes.
38. John Paul II, <To the World Medical Association>, Oct. 29 1983, in <Insegnamenti> VI/2,921-923. Cf. Cong. Doct. Faith, Instruct. <Donum vitae>, Feb. 22, 1987, in AAS 80 (1988) 90-92.
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 Savior, who through them will increase and enrich his family from day to day." "When a new person is born of the conjugal union of the two, he brings with him into the world a particular image and likeness of God himself: <the genealogy of the person is inscribed in the very biology of generation>. In affirming that the spouses, as parents, cooperate with God the Creator in conceiving and giving birth to a new human being, we are not speaking merely with reference to the laws of biology.... Begetting is the continuation of Creation."
"Those are considered to exercise 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." In the latter case there is the problem of birth control.
39. Cf. Ecum. Coun. Vatican II, Past. Constit. <Gaudium et spes>, GS 50; Paul VI, Encyclical <Humanae vitae>, in AAS 60 (1968) p. 487.
40. John Paul II, Encyclical <Evangelium vitae>, March 25, 1995, EV 43.
41. Cf. Paul VI, Encyclical <Humanae vitae>, in AAS 60 (1968) p. 487, HV 10.
16 In evaluating behavior with regard to this control, the moral judgment "does not depend solely on good intentions and on the evaluation of motives; it is determined by objective criteria, criteria drawn from the dignity of the human person and human action." It is a question of the dignity of the man and the woman and of their most intimate relationship. Respect for this dignity shows the truth of their married love.
With regard to the marriage act, this expresses "the indissoluble bond between the two meanings of the act: the unitive meaning and the procreative meaning." In fact, the acts by which the partners fully express themselves and which intensify their union are the same ones that generate life and vice-versa.
Love which uses "body language" to express itself is at once unitive and procreative: "it clearly implies both spousal and parental significance."
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."
42. Ecum. Coun. Vatican II, Past. Constit. <Gaudium et spes>, GS 51.
43. Cf. Paul VI, Encyclical <Humanae vitae>, in AAS 60 (1968) p. 488, HV 12.
44. "The inner structure of the marriage act is such that, while it profoundly unites the partners, it fits them for the generation of new life, according to laws inscribed in the very being of the man and the woman" (Paul VI, Encyclical <Humanae vitae>, in AAS 60  PP 488-489, HV 12).
45. Cf. Cong. Doct. Faith, Instruct. <Donum vitae>, Feb. 22, 1987, in AAS 80 (1988) 91.
46. Cf. Paul VI, Encyclical <Humanae vitae>, HV 12; John Paul II, Apostol. Exhort. <Familiaris consortio>, in AAS 74 (1982) p. 118, n. 32. "Consequently, 'the one who wishes to understand himself thoroughly—and not just in accordance with immediate, partial, often superficial, and even illusory standards and measures of being—must with his unrest, uncertainty and even his weakness and sinfulness, with his life and death, draw near to Christ...."' (John Paul II, Encyclical <Veritatis splendor>, VS 8).
17 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.
Natural 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. "It is precisely this respect which makes legitimate, at the service of responsible procreation, the <use of natural methods of regulating fertility>. From 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."
Artificial means contradict "the nature of the man and the woman and of their most intimate relationship." Here sexual union is separated from procreation: the act is deprived of its natural openness to life. "Thus the original import of human sexuality is distorted and falsified, and the two meanings, unitive and procreative, inherent in the very nature of the conjugal act, are artificially separated: in this way the marriage union is betrayed and its fruitfulness is subjected to the caprice of the couple."
This occurs in "every action which, either in anticipation of the conjugal act, or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible."
47. Natural methods "are diagnostic means for the fertile periods of the woman, which make it possible to refrain from sexual relations when legitimate motives of responsibility dictate the avoidance of conception" (John Paul II, <To the participants at a course for teachers of natural methods>, Jan. 10, 1992, in Oss. Rom. Jan. 11, 1992, n. 3).
48. Cf. Paul VI, Encyclical <Humanae vitae>, in AAS 60 (1968) p. 488, HV 11 and p. 492, HV 16.
49. John Paul II, Encyclical <Evangelium vitae>, March 25, 1995, EV 97.
50. Cf. Paul VI, Encyclical <Humanae vitae>, in AAS 60 (1968) p. 489, HV 13; cf. also John Paul II, Apostol. Exhort. <Familiaris consortio>, in AAS 74 (1982) p. 118, FC 32.
51. John Paul II, Encyclical <Evangelium vitae>, March 25, 1995, EV 23.
52. Cf. Paul VI, Encyclical <Humanae vitae>, in AAS 60 (1968) p. 490, HV 14.
18 Here, then, is "the difference, both anthropological and moral, between contraception and recourse to the rhythm of the cycle."
"It is not a distinction simply of techniques or methods, where the decisive element would be the artificial or natural character of the procedure. " It is a difference involving "two irreconcilable concepts of the human person and of human sexuality."
The "difference," then, must be recognized and illustrated: "The ultimate reason for every natural method is not just its effectiveness or biological reliability, but its consistency with the Christian vision of sexuality as expressive of married love." "It is frequently asserted that <contraception>, if made safe and available to all, is the most effective remedy against abortion.... When looked at carefully, this objection is clearly unfounded.... Indeed, the pro-abortion culture is especially strong precisely where the Church's teaching on contraception is rejected."
53. Cf. John Paul II, Apostol. Exhort. <Familiaris consortio>, in AAS 74 (1982) p. 118, FC 32.
54. John Paul II, <To the participants at a course for teachers of natural methods>, Jan. 10, 1992, in Oss. Rom. Jan. 11, 1992, n. 3.
55. Cf. John Paul II, Apostol. Exhort. <Familiaris consortio,> in AAS 74 (1982) p. 118, FC 32.
56. John Paul II, <To the participants at two congresses on the problems of matrimony, the family and fertility>, June 8, 1984, in <Insegnamenti> VII/1, 1664-1665. "On the innate meaning which is that of mutual, total donation by the partners, contraception imposes an objectively contradictory meaning, namely that of not giving oneself completely to the other" (Apost. Exhort. <Familiaris consortio>, FC 32).
57. John Paul II, Encyclical <Evangelium vitae>, March 25, 1995, EV 13.
19 Rather than directions for use, natural methods are in keeping with the meaning of conjugal 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.... In this context...conjugal communion is enriched with those values of tenderness and affection which constitute the inner soul of human sexuality, in its physical dimension also."
58. John Paul II, Apost. Exhort. <Familiaris consortio>, in AAS 74 (1982) p. 120, FC 32.
20 Health care workers can contribute, when opportunities occur in their field, towards an acceptance of this human and Christian concept of sexuality by making available to married people, and even before that to young people, the required information for responsible behavior, respectful of the special dignity of human sexuality.
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 conjugal act which expresses that love."
59. Cf. ibid, p. 122, FC 33.
60. Ibid, p. 125, FC 35.
CHARTER FOR HEALTH CARE WORKERS