CHARTER FOR HEALTH CARE WORKERS 50
50 Safeguarding health commits the health care worker particularly in the area of prevention.
Prevention is better than cure, both because it spares the person the discomfort and suffering from the illness, and because it spares society the costs, and not only economic costs, of treatment.
51 <Medical prevention>, properly so called, which consists in administering particular medicines, vaccination, <screening> tests to ascertain predispositions, in prescribing behavior and habits to prevent the occurrence, the spread and the worsening of the illness, essentially belongs to health care workers. This might be for all the members of a society, for groups of people or for individuals.
52 There is also <medical prevention in the wider sense of the term>, in which the work of the health care worker is but a part of the preventive commitment set in motion by society. This is the type of prevention used in cases of so-called social illnesses, such as drug-dependency, alcoholism, tobacco addiction, AIDS; of the problems of social sectors of individuals such as adolescents, the handicapped, the aged; of risks to health tied up with the conditions and ways of living nowadays, such as in food, the environment, the work-place, sports, urban traffic, the use of transportation means, of machines and domestic electrical appliances.
In these cases preventive intervention is the primary and most effective remedy, if not, indeed, the only possible one. But it needs a concerted effort from all sectors of a society. Prevention in this case is more than a medical-health action. It involves a sensitizing of the culture, through a recovery of forgotten values and education in them, to a more sober and integral concept of life, information about risky habits, the formation of a political consensus for supporting laws.
The effective and efficacious possibility of prevention is linked not only, nor primarily, to the techniques adopted, but to the reasons behind it and to their being made concrete and made known in that culture.
53 Although it shares in the transcendent value of the person, corporeal life, of its nature, reflects the precariousness of the human condition. This is shown especially in sickness and suffering, which affect the whole person adversely. "Sickness and suffering are not experiences which affect only the physical substance of the human being, but they affect him in his entirety and in his somatic-spiritual unity."[127]
Sickness is more than a clinical fact, medically controlled. It is always the condition of a human being, the sick person. It is with this <holistic human view> of sickness that health care workers should relate to the patient. It means that they have, together with the requisite technical-professional competence, an awareness of values and meanings that make sense of sickness and of their own work, and makes every individual clinical case a human encounter.
127. John Paul II, Motu Proprio "<Dolentium hominum>," Feb. 11, 1985, in <Insegnamenti> VIII/1 (1985) pp. 473-474. "Illness and suffering have always been among the gravest problems confronted in human life. In illness man experiences his powerlessness, his limitations, and his finitude. Every illness can make us glimpse death" (CEC 1500). "The mission of Jesus, with the many healings he performed, shows <God's great concern even for man's bodily life>" (John Paul II, Encyclical <Evangelium vitae>, March 25,1995, EV 47).
54 The Christian knows by faith that sickness and suffering share in the salvific efficacy of the Redeemer's cross. "Christ's redemption and its salvific grace touches the whole person in his human condition and hence also in sickness, suffering and death."[128] "On the Cross, the miracle of the serpent lifted up by Moses in the desert (Jn 3,14-15 cf. Num. Nb 21,8-9) is renewed and brought to full and definitive perfection. Today, too, by looking upon the one who was pierced, every person whose life is threatened encounters the sure hope of finding freedom and redemption."[129]
Borne "in close union with the sufferings of Jesus," sickness and suffering assume "an extraordinary spiritual fruitfulness." So that the sick person can say with the Apostle: "I fill up in my body what is wanting to the sufferings of Christ, for the sake of his body which is the Church" (Col 1,24).[130]
From this new Christian meaning, the sick person can be helped to develop a triple salutary attitude to the illness: an "<awareness>" of its reality "without minimizing it or exaggerating it"; "<acceptance>," "not with a more or less blind resignation" but in the serene knowledge that "the Lord can and wishes to draw good from evil"; "<the oblation>," "made out of love for the Lord and one's brothers and sisters."[131]
128. John Paul II, Motu Proprio "<Dolentium hominum>," Feb. 11, 1985, in <Insegnamenti> VIII/1 (1985) pp. 473-474.
129. John Paul II, Encyclical <Evangelium vitae>, March 25, 1995, EV 50.
130. Cf. John Paul II, during a visit to Mercy Maternity Hospital in Melbourne, Nov. 28, 1986, in <Insegnamenti> IX/2 (1986) 1733, n. 2. "The sick too are sent as laborers into the Lord's vineyard. The burden that tires the members of the body and shatters the serenity of the spins, far from deterring them from work in the vineyard, calls them to live out their human and Christian vocation and to share in the growth of the Kingdom of God in new ways, which are also more valuable" (John Paul II, Apost. Exhort. <Christifideles laici>, in <Insegnamenti> XI/4, p. 2160, CL 53).
131. John Paul II, <Discourse in Lourdes>, August 15, 1983, n. 4 "On the cross, Christ made his own all the weight of evil and took away the sin of the world (Jn 1,29), of which sickness is but a consequence, By his passion and death on the cross, Christ has given new meaning to suffering: now it can configure us to him and unite us with his redemptive passion."
55 In the person of the patient, in any case, the <family> is always affected. Helping the relatives, and their cooperation with health care workers are a valuable component of health care.
The health care worker is called to give the family of the patient—either individually or through membership in appropriate organizations—together with the treatment also enlightenment, counsel, direction and support.[132]
132. John Paul II, Apost. Exhort. <Familiaris consortio>, FC 75.
56 Guided by this integrally human and properly Christian view of sickness, the health care worker should seek, first and foremost, to find the illness and analyze it in the patient: this is the <diagnosis> and related <prognosis>.
A condition for any treatment is the previous and exact individuation of the symptoms and causes of the illness.
57 In this, the health care worker will make his own the questions and anxieties of the patient and he must guard himself from the twofold, opposing pitfalls of "hopeless" and "tenacious" diagnosis.
In the first case the patient is forced to go from one specialist or health care service to another, without finding the doctor or diagnostic center capable and willing to treat his illness. Over-specialization and fragmentation of clinical competencies and divisions, while ensuring professional expertise, is damaging to the patient when health services in the place prevent a caring and global approach to his illness.
In the second case, instead, one persists until some illness is found at any cost. It may be through ignorance, laziness, for gain, or for rivalry that an illness is diagnosed or problems are treated as medical when, in fact, they are not medical-health in nature. In this case the person is not helped to perceive the exact nature of their problem, thus misleading them about themselves and their responsibilities.
58 The diagnosis does not pose, in general, problems of an ethical order when these excesses are excluded and it is conducted in full respect for the dignity and integrity of the person, particularly with regard to the use of instrumentally invasive techniques. Of itself, its purpose is therapeutic: it is an action to promote health.
However, particular problems are posed by predictive diagnosis, because of the possible repercussions at a psychological level and the discriminations it could lead to and to prenatal diagnosis. In the latter case we are dealing with a substantially new possibility which is rapidly developing, and as such merits separate treatment.
59 The ever-expanding knowledge of intrauterine life and the development of instruments giving access to it make it possible nowadays to diagnose prenatal life, thus opening the way for ever more timely and effective therapeutic interventions.
Prenatal diagnosis reflects the moral goodness of every diagnostic intervention. At the same time, however, it presents its own ethical problems, connected with the diagnostic risk and the purpose for its request and practice.
60 The <risk> factor concerns the life and physical integrity of the embryo, and only in part that of the mother, relative to the various diagnostic techniques and the perceptual risk which each presents.
Hence, there is need "to evaluate carefully the possible negative consequences which the necessary use of a particular investigative technique can have" and "avoid recourse to diagnostic procedures about which the honest purpose and substantial harmlessness cannot be sufficiently guaranteed." And if a certain amount of risk must be taken, recourse to diagnosis should have reasonable indications, to be ascertained in a diagnostic center.[133]
Consequently, "such diagnosis is licit if the methods used, with the consent of the parents who have been adequately instructed, safeguard the life and integrity of the embryo and its mother and does not subject them to disproportionate risks."[134]
133. Cf. John Paul II, <To the participants at a congress of "Movement for Life>," Dec. 4, 1982, in <Insegnamenti>, V/3, p. 1512, n. 4.
134. Cong. Doct. Faith, Instruct. <Donum vitae>, Feb. 22, 1987, in AAS 80 (1988) 79-80. With regard to the diagnostic techniques mostly used, which are echography (and amniocentesis, it can be said that the former appears to be risk-free whereas the latter contains elements of risk considered acceptable and therefore proportionate. The same cannot be said for other techniques, such as placento centesis, fetoscopy and the collecting of villi samples which have more or less high levels of risk.
61 The <objectives> of prenatal diagnoses warranting their request and practice should always be of benefit to the child and the mother; their purpose is to make possible therapeutic interventions, to bring assurance and peace to pregnant women who are anxious lest the fetus be deformed and are tempted to have an abortion, to prepare, if the prognosis is an unhappy one, for the welcome of a handicapped child.
Prenatal diagnosis "is gravely contrary to the moral law when it contemplates the possibility, depending on the result, of provoking an abortion. A diagnosis revealing the existence of a deformity or an hereditary disease should not be equivalent to a death sentence."[135]
Equally unlawful is any directive or program of civil and health authorities or of scientific organizations which support a direct connection between prenatal diagnosis and abortion. The specialist who, in carrying out the diagnosis and communicating the result, would voluntarily contribute to the establishing and support of a connection between prenatal diagnosis and abortion would be guilty of illicit collaboration.[136]
135. Ibid. "Prenatal diagnosis, which presents no moral objections if carried out in order to identify the medical treatment which may be needed by the children the womb, all too often becomes an opportunity for proposing and procuring an abortion. This is eugenic abortion, justified in public opinion on the basis of a mentality...which accepts life only under certain conditions and rejects it when it is affected by any limitation, handicap or illness" (John Paul II, Encyclical <Evangelium vitae>, March 25, 1995, EV 14).
136. Cf. Cong. Doct. Faith, Instruct. <Donum vitae>, Feb. 22, 1987, in AAS 80 (1988) 79-80. "Since it must be treated from conception as a person, the embryo must be defended in its integrity, cared for, and healed, as far as possible. like any other human being" (CEC 2274).
62 After diagnosis comes therapy and rehabilitation: the putting into effect of those curative and medical interventions which lead to the cure and personal and social reintegration of the patient.
Therapy is a medical action properly so-called, aimed at combating the causes, manifestations and complications of the illness. Rehabilitation, on the other hand, is an amalgam of medical, physiotherapeutic, psychological measures and functional exercises, aimed at reviving or improving the psychophysical efficiency of people in some way handicapped in their ability to integrate, to relate and to work productively.
Therapy and rehabilitation "are aimed not only at the well-being and health of the body, but of the person as such who is stricken by bodily illness."[137] All therapy aimed at the integral well-being of the person is not content with clinical success, but views the rehabilitative action as a restoring of the individual to his full self, through the reactivation or re-appropriation of physical functions weakened by the illness.
137. Cf. John Paul II, Motu Proprio "<Dolentium hominum>," Feb. 11, 1985, in <Insegnamenti> VIII/1 (1985) pp. 473-474. "Those whose lives are diminished or weakened deserve special respect. Sick or handicapped persons should be helped to lead lives as normal as possible" (CEC 2276).
63 The patient has a right to any treatment from which he can draw salutary benefit.[138]
Responsibility for health care imposes on everyone "the duty of caring for himself and of seeking treatment." Consequently, "those who care for the sick should be very diligent in their work and administer the remedies which they think are necessary or useful."[139] Not only those aimed at a possible cure, but also those which alleviate pain and bring relief in incurable cases.
138. "Every person has a primary right to what is necessary for the care of his or her health and therefore to suitable medical assistance" (John Paul II, <To the World Congress of Catholic Doctors>, Oct. 3, 1992, in <Insegnamenti> V/3, p. 673, n. 3).
139. Cong. Doct. Faith, <Declaration on Euthanasia>, May 5, 1980, in AAS 72 (1980) p. 549.
64 The health care worker who cannot effect a cure must never cease to treat.[140] He is bound to apply all "proportionate" remedies. But there is no obligation to apply "disproportionate" ones.
In relation to the conditions of a patient, those remedies must be considered ordinary where there is <due proportion> between the means used and the end intended. Where this proportion does not exist, the remedies are to be considered extraordinary.
To verify and establish whether there is due proportion in a particular case, "the means should be well evaluated by comparing the type of therapy, the degree of difficulty and risk involved, the necessary expenses and the possibility of application, with the result that can be expected, taking into account the conditions of the patient and his physical and moral powers."[141]
140. "Even when it cannot cure, science can and should treat and assist the sick person" (John Paul II, <To the participants at a study course on "human pre-leukemias>," Nov. 15, 1985, in <Insegnamenti> VIII/2, p. 1265, n. 5. Cf. John Paul II, <To two work groups set up by the Pontifical Academy of Sciences>, Oct. 21, 1985, in <Insegnamenti> VII/2, p. 1082, n. 4.
141. Cong. Doct. Faith, <Declaration on Euthanasia>, May 5, 1980 in AAS 72 (1980) pp. 549-550.
65 The principle here proposed of <appropriate medical treatment in the remedies> can be thus specified and applied:
—"In the absence of other remedies, it is lawful to have recourse, with the consent of the patient, to the means made available by the most advanced medicine, even if they are still at an experimental stage and not without some element of risk."
—"It is lawful to interrupt the application of such means when the results disappoint the hopes placed in them," because there is no longer due proportion between "the investment of instruments and personnel" and "the foreseeable results" or because "the techniques used subject the patient to suffering and discomfort greater than the benefits to be had."
—"It is always lawful to be satisfied with the normal means offered by medicine. No one can be obliged, therefore, to have recourse to a type of remedy which, although already in use, is still not without dangers or is too onerous." This refusal "is not the equivalent of suicide." Rather it might signify "either simple acceptance of the human condition, or the wish to avoid the putting into effect of a remedy disproportionate to the results that can be hoped for, or the desire not to place too great a burden on the family or on society."[142]
142. Cf. ibid.
66 For the restoration of the person to health, interventions may be required, in the absence of other remedies, which involve the modification, mutilation or removal of organs.
Therapeutic manipulation of the organism is legitimized here by the <principle of totality>,[143] and for this very reason also called the principle of therapeuticity, by virtue of which "each particular organ is subordinated to the whole of the body and should be subjected to it in case of conflict. Consequently, the one who has received the use of the whole organism has the right to sacrifice a particular organ if by keeping it, it or its activity might cause appreciable harm to the whole organism, which cannot be avoided otherwise."[144]
143. "The principle of totality states that the part exists for the whole, and consequently that the good Of the part is subordinated to that of the whole: that the whole is determining for the part and it can dispose of it in its own interests (Pius XII, <To the members of the First International Congress on Histopathology of the Nervous System>, Sept. 14, 1952, in AAS 44 [1952] p. 787).
144. Pius XII, <To the members of the XXVI Italian Congress of Urology>, Oct. 8, 1953, in AAS 45 (1953) p. 674; cf. Pius XII, <To the members of the First International Congress on Histopathology of the Nervous System>, Sept. 14, 1952, in AAS 44 (1952) 782-783. The principle of totality is applied at the outbreak of the illness: there alone is verified "correctly" the relation of the part to the whole. Cf. ibid, p. 787. "Where the relationship of the part to the whole is verified, and to the extent that it is verified, the part is subordinated to the whole, which can in its own interests dispose of the part (ibid). The physical integrity of a person cannot be impaired to cure an illness of psychic or spiritual origin. Here it is not a question Of diseased or malfunctioning organs. And so their medico-surgical manipulation is an arbitrary alteration of the physical integrity of the person. It is not lawful to sacrifice to the whole, by mutilating it, modifying it or removing it, a part which is not pathologically related to the whole. And this is why the principle of totality cannot be correctly taken as a criterion for legitimatizing anti-procreative sterilization therapeutic abortion and transsexual medicine and surgery. It is different with psychic sufferings and spiritual disorders with an organic basis, that is, which arise from a defect or physical disease: on these it is legitimate to intervene therapeutically.
67 Physical life, although on the one hand manifesting the person and sharing his worth, so that it cannot be disposed of as an object, on the other hand it does not exhaust the value of the person nor does it represent the greatest good.[145]
This is why part of it can be disposed of legitimately for the well-being of the person. Just as it can be sacrificed or put at risk for a higher good "such as the glory of God, the salvation of souls and service to one's neighbor."[146] "Corporeal life is a fundamental good, a condition here below of all the others; but there are higher values for which it could be legitimate or even necessary to expose oneself to the danger of losing it."[147]
145. Cong. Doct. Faith, Instruct. <Donum vitae>, Feb. 22, 1987, in AAS 80 (1988) 75.
146. Cong. Doct. Faith, <Declaration on Euthanasia>, May 5, 1980, in AAS 72 (1980) p. 545.
147. Cong. Doct. Faith, <Declaration on Procured Abortion>, June 18, 1974, in AAS 66 (1974) 736-737.
68 Pain, on the one hand, has of itself a therapeutic function, because "it eases the confluence of the physical and psychic reaction of the person to a bout of illness,"[148] and on the other hand it appeals to medicine for an alleviating and healing therapy.
148. Cf. John Paul II, <To the participants at a congress of the Italian Association of Anesthesiology>, Oct. 4, 1984, in <Insegnamenti> VII/2, p. 749 n. 2.
69 For the Christian, pain has a lofty penitential and salvific meaning. "It is, in fact, a sharing in Christ's Passion and a union with the redeeming sacrifice which he offered in obedience to the Father's will. Therefore, one must not be surprised if some Christians prefer to moderate their use of painkillers, in order to accept voluntarily at least part of their sufferings and thus associate themselves in a conscious way with the sufferings of Christ."[149]
Acceptance of pain, motivated and supported by Christian ideals, must not lead to the conclusion that all suffering and all pain must be accepted, and that there should be no effort to alleviate them.[150] On the contrary this is a way of humanizing pain. Christian charity itself requires of health care workers the alleviation of physical suffering.
149. Cong. Doct. Faith, <Declaration on Euthanasia>, May 5, 1980, in AAS 72 (1980) 542-552, III.
150. "The Christian is bound to mortify the flesh and apply himself to interior purification.... Insofar as self-control and control of disordered tendencies cannot be acquired without the help of physical pain, this becomes a need and it must be accepted, but insofar as it is not required for this purpose, it cannot be said that there is a strict obligation for it. Hence the Christian is never obliged to desire it; he sees it as a more or less suitable means, according to the circumstances, to the end he is pursuing" (Pius XII, <To an international assembly of doctors and surgeons>, Feb. 24, 1957, in AAS 49 [1957] p. 135).
70 "In the long run pain is an obstacle to the attainment of higher goods and interests."[151] It can produce harmful effects for the psycho-physical integrity of the person. When suffering is too intense, it can diminish or impede the control of the spirit. Therefore it is legitimate, and beyond certain limits of endurance it is also a duty for the health care worker to prevent, alleviate and eliminate pain. It is morally correct and right that the researcher should try "to bring pain under human control."[152]
Anesthetics like painkillers, "by directly acting on the more aggressive and disturbing effects of pain, gives the person more control, so that suffering becomes a more human experience."[153]
151. Ibid, p. 136.
152. Cf. Pont. Coun. "Cor Unum," <Some Ethical Questions Relating to the Gravely Ill and the Dying>, July 27, 1981, in <Enchiridion Vaticanum>, 7, <Documenti ufficiali della Santa Sede> 1980-1981. EDB, Bologna 1985, p. 1141, n. 2.3.1; John Paul II, <To two work groups set up by the Pontifical Academy of Sciences>, Oct. 21, 1985, in <Insegnamenti> VIII/2, p. 1082, n. 4.
153. John Paul II, <To the participants at a congress of the Italian Association of Anesthesiology>, Oct. 4, 1984, in <Insegnamenti> VII/2, p. 750, n. 3.
71 Sometimes the use of analgesic and anaesthesic techniques and medicines involves the suppression or diminution of consciousness and the use of the higher faculties. In so far as the procedures do not aim directly at the loss of consciousness and freedom but at dulling sensitivity to pain, and are limited to the clinical need alone, they are to be considered ethically legitimate.[154]
154. Cf. Pius XII, <To an international assembly of doctors and surgeons>, Feb. 24, 1957, in AAS 49 (1957) pp. 138-143.
72 To intervene medically, the health care worker should have the express or tacit consent of the patient.
In fact, he "does not have a separate and independent right in relation to the patient. In general, he can act only if the patient explicitly or implicitly (directly or indirectly) authorizes him."[155] Without such authorization he gives himself an arbitrary power.[156]
Besides the medical relationship there is a human one: dialogic, non-objective. The patient "is not an anonymous individual" on whom medical expertise is practiced, but "a responsible person, who should be called upon to share in the improvement of his health and in becoming cured. He should be given the opportunity of personally choosing, and not be made to submit to the decisions and choices of others."[157]
So that the choice may be made with full awareness and freedom, the patient should be given a precise idea of his illness and the therapeutic possibilities, with the risks, the problems and the consequences that they entail.[158] This means that the patient should be asked for an <informed consent>.
155. Pius XII, <To the doctors of the G. Mendel Institute>, Nov. 24, 1957, in AAS 49 (1957) p. 1031.
156. "The patient cannot be the object of decisions which he will not make, or, if he is not able to do so, which he could not approve. The "person," principally responsible for his own life, should be the center of any assisting intervention: others are there to help him, not to replace him" (Pont. Coun. "Cor Unum," <Some Ethical Questions Relating to the Gravely Ill and the Dying>, July 27, 1981, in <Enchiridion Vaticanum> 7, <Documenti ufficiali della Santa Sede> 1980-1981. EDB, Bologna 1985, p. 1137, n. 2.1.2).
157. John Paul II, To the World Congress of Catholic Doctors, Oct. 3, 1982, in <Insegnamenti> V/3, p. 673, n. 4.
158. Cf. John Paul II, <To the participants at two congresses on medicine and surgery>, Oct. 27,1980, in <Insegnamenti> III/2, 1008-1009, n. 5.
73 With regard to <presumed consent>, a distinction must be made between the patient who is in a condition to know and will and one who is not.
In the former, consent cannot be presumed: it must be clear and explicit.
In the latter case, however, the health care worker can, and in extreme situations must, presume the consent to therapeutic interventions, which from his knowledge and in conscience he thinks should be made. If there is a temporary loss of knowing and willing, the health care worker can act in virtue of <the principle of therapeutic trust>, that is the original confidence with which the patient entrusted himself to the health care worker. Should there be a permanent loss of knowing and willing, the health care worker can act in virtue of <the principle of responsibility for health care>, which obliges the health care worker to assume responsibility for the patient's health.
74 With regard to the relatives, they should be informed about ordinary interventions, and involved in the decision making when there is question of extraordinary and optional interventions.
75 A therapeutic action which is apt to be increasingly beneficial to health is for that very reason open to new investigative possibilities. These are the result of a progressive and ongoing activity of research and experimentation, which thus succeeds in arriving at new medical advances.
To proceed by way of research and experimentation is a law of every applied science: scientific progress is structurally connected with it. Biomedical sciences and their development are subject to this law also. But they operate in a particular field of application and observation which is the life of the human person.
The latter, because of his unique dignity, can be the subject of research and clinical experimentation with the safeguards due to a being with the value of a subject and not an object. For this reason, biomedical sciences do not have the same freedom of investigation as those sciences which deal with things. "The ethical norm, founded on respect for the dignity of the person, should illuminate and discipline both the research stage and the application of the results obtained from it."[159]
159. John Paul II, <To the representatives of the Italian Society of Medicine and the Italian Society of General Surgery>, Oct. 27, 1980, n. 3.
76 In the <research> stage, the ethical norm requires that its aim be to "promote human well-being."[160] Any research contrary to the true good of the person is immoral. To invest energies and resources in it contradicts the human finality of science and its progress.[161]
In the <experimental> stage, that is, testing the findings of research on a person, the good of the person, protected by the ethical norm, demands respect for previous conditions which are essentially linked with consent and risk.
160. John Paul II, <To the participants at a congress on cancer>, April 26, 1986, in <Insegnamenti> IX/1, 1152-1153.
161. Cf. John Paul II, <To scientists and health care workers>, Nov. 12, 1987, in <Insegnamenti> X/3, (1987) 1086-1087, n. 4. "Some abusive interpretations of scientific research in the field of anthropology must also be mentioned. Arguing from the great variety of customs, behavior patterns and institutions present in humanity these theories conclude, if not always with the denial of universal human values, at least with a relativist conception of morality" (John Paul II, Encyclical <Veritatis splendor>, VS 33).
77 First of all, <the consent of the patient>. He "should be informed about the experimentation, its purpose and possible risks, so that he can give or refuse his consent with full knowledge and freedom. In fact, the doctor has only that power and those rights which the patient himself gives him."[162]
This consent can be presumed when it is of benefit to the patient himself, that is, when there is a question of therapeutic experimentation.
162. John Paul II, <To the participants at two congresses on medicine and surgery>, Oct. 27, 1980, in <Insegnamenti> III/2,1009, n. 5.
78 Secondly, there is <the risk factor>. Of its nature, every experimentation has risks. Hence, "it cannot be demanded that all danger and all risk be excluded. This is beyond human possibility; it would paralyze all serious scientific research and would quite often be detrimental to the patient.... But there is a level of danger that the moral law cannot allow."[163]
A human subject cannot be exposed to the same risk as beings which are not human. There is a threshold beyond which the risk becomes humanly unacceptable. This threshold is indicated by the inviolable good of the person, which forbids him "to endanger his life, his equilibrium. his health, or to aggravate his illness."[164]
163. Pius XII, <To the members of the First International Congress on Histopathology of the Nervous System>, Sept. 14, 1952, in AAS 44 (1952) p. 788.
164. John Paul II, <To a conference on pharmacy in the synod hall>, Oct. 24, 1986, in <Insegnamenti> IX/2, p. 1183; cf. <To the participants at a surgery congress>, Feb. 19, 1987, in <Insegnamenti> X/1 (1987) 376, n. 4. "Research or experimentation on the human being cannot legitimate acts that are in themselves contrary to the dignity of persons and to the moral law. The subjects' potential consent does not justify such acts. Experimentation on human beings is not morally legitimate if it exposes the subject's life or physical and psychological integrity to disproportionate or avoidable risks" (CEC 2295).
79 Experimentation cannot be begun and generalized until every safeguard has been put in place to guarantee the harmlessness of the intervention and to lessen the risk. "The pre-clinical basic phase, carried out carefully, should give the widest documentation and the most secure pharmacological-toxicological guarantees and ensure operational safety."[165]
To acquire these assurances, if it be useful and necessary, the <testing> of new pharmaceutical products or of new techniques should first be done <on animals> before they are tried on humans. "It is certain that the animal is for the service of man and can therefore be the object of experimentation. However, it should be treated as one of God's creatures, meant to cooperate in man's good but not to be abused."[166] It follows that all experimentation "should be carried out with consideration for the animal, without causing it useless suffering."[167]
When these guarantees are in place, in the clinical phase experimentation on the human person must be in accord with the principle of <proportionate risk>, that is, of due proportion between the advantages and foreseeable risks. Here a distinction must be made between experimentation on a sick person, for therapeutic reasons, and on a healthy person, for scientific and humanitarian reasons.
165. Cf. John Paul II, <To the participants at two congresses on medicine and surgery>, Oct. 27, 1980, in <Insegnamenti> III/2, 1008-1009, n. 5; <To the participants at a study course on "human pre-leukemias,>" Nov. 15, 1985, in <Insegnamenti> VIII/2, p. 1265, n. 5.
166. John Paul II, <To the participants at a meeting of the Pontifical Academy of Sciences>, Oct. 23, 1982, in <Insegnamenti> V/3, p. 897, n. 4: "Therefore, the reduction in experiments on animals, which are progressively becoming less necessary, is in accordance with the good of all creation" (ibid ).
167. Cf. John Paul II, <To a conference on pharmacy in the synod hall,> Oct. 24, 1986, in <Insegnamenti> IX/2, p. 1183.
80 In <experimentation on a sick person>, due proportion is attained from a comparison of the condition of the sick person and the foreseeable effects of the drugs or the experimental methods. Hence the risk rate which might be proportionate and legitimate for one patient may not be so for another.
It is a valid principle—as already said—that "in the absence of other remedies, it is licit to have recourse, with the consent of the patient, to means made available by the most advanced medicine, even if they are still at an experimental stage and are not without some risk. By accepting them the patient might also give an example of generosity for the benefit of humanity."[168] But there must always be "great respect for the patient in the application of new therapy still at the experimental stage...when these are still high-risk procedures."[169]
"In desperate cases, when the patient will die if there is no intervention, if there is a medication available, or a method or an operation which, though not excluding all danger, still has some possibility of success, any right-thinking person would concede that the doctor could certainly, with the explicit or tacit consent of the patient, proceed with the application of the treatment."[170]
168. Cong. Doct. Faith, <Declaration on Euthanasia>, May 5,1980, in AAS 72 (1980) p. 550. "It may happen, in doubtful cases, when known means have failed, that a new method, as yet insufficiently tested, offers, together with rather dangerous elements, a good probability of success. If the patient consents, the application of the procedure in question is lawful" (Pius XII, <To the participants at the First International Congress on Histopathology of the Nervous System>, Sept. 14, 1952, in AAS 44 (1952) p. 788).
169. John Paul II, <To the participants at a study course on "human pre-leukemias,>" Nov. 15, 1985, in <Insegnamenti> VIII/2, p. 1265, n. 5.
170. Pius XII, <To the participants at the VII Assembly of the World Medical Association>, Sept. 30, 1954, in Pius XII, <Discourses to Doctors>, Rome, 1960, p. 358.
81 Clinical <experimentation> can also be practiced <on a healthy person>, who voluntarily offers himself "to contribute by his initiative to the progress of medicine and, in that way, to the good of the community." In this case, "once his own substantial integrity is safeguarded, the patient can legitimately accept a certain degree of risk."[171]
This is legitimized by the human and Christian solidarity which motivates the gesture: "To give of oneself, within the limits marked out by the moral law, can be a witness of highly meritorious charity and a means of such significant spiritual growth that it can compensate for the risk of any insubstantial physical impairment."[172]
In any case, it is a duty to always interrupt the experimentation when the results disappoint the expectations.
171. Cf John Paul II, <To the participants at two congresses on medicine and surgery>, Oct. 27, 1980, in <Insegnamenti> III/2, p. 1009, n. 5.
172. Ibid
82 Since the human individual, in the prenatal stage, must be given the dignity of a human person, <research and experimentation on human embryos and fetuses> is subject to the ethical norms valid for the child already born and for every human subject.
<Research> in particular, that is the observation of a given phenomenon during pregnancy, can be allowed only when "there is moral certainty that there will be no harm either to the life or the integrity of the expected child and the mother, and on condition that the parents have given their consent."[173]
<Experimentation>, on the other hand, is possible only for clearly therapeutic purposes, when no other possible remedy is available. "No finality, even if in itself noble, such as the foreseeing of a usefulness for science, for other human beings or for society, can in any way justify experimentation on live human embryos and fetuses, whether viable or not, in the maternal womb or outside of it. The informed consent, normally required for clinical experimentation on an adult, cannot be given by the parents, who may not dispose either of the physical integrity or the life of the expected child. On the other hand, experimentation on embryos or fetuses has the risk, indeed in most cases the certain foreknowledge, of damaging their physical integrity or even causing their death. To use a human embryo or the fetus as an object or instrument of experimentation is a crime against their dignity as human beings." "The practice of keeping human embryos alive, actually or in vitro, for experimental or commercial reasons," is especially and "altogether contrary to human dignity."[174]
173. Cong. Doct. Faith, Instruct. <Donum vitae>, in AAS 80 (1988) 81-83. "This evaluation of the morality of abortion is to be applied also to the recent forms of <intervention on human embryos> which, although carried out for purposes legitimate in themselves, inevitably involve the killing of those embryos.... The use of human embryos or fetuses as an object of experimentation constitutes a crime against their dignity as human beings who have a right to the same respect owed to a child once born, just as to every person" (John Paul II, Encyclical <Evangelium vitae>, March 25, 1995, EV 63).
174. Cf. Cong. Doct. Faith, Instruct. <Donum vitae>, in AAS 80 (1988) 81-83. "I condemn in a most explicit and formal way experimental manipulation of the human embryo, because it is a human being; from the moment of its conception until death it can never be instrumentalized for any reason whatsoever" (John Paul II, <To the participants at a meeting of the Pontifical Academy of Sciences>, Oct. 25, 1982, in AAS 75 (1983) 37). "Respect for the human being excludes all kinds of experimental manipulation or exploitation of the embryo" (Holy See, <Charter on the Rights of the Family>, 4/b, in Oss. Rom., Oct. 25, 1983).
CHARTER FOR HEALTH CARE WORKERS 50