The Roman Catholic Tradition

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Religious Beliefs and Healthcare Decisions

By Ronald P. Hamel Updated by Kevin O’Rourke

he Roman Catholic church is one of the largest Treligious bodies worldwide, numbering over 750 million members, and is the largest single church in the United States. It identifies its origins with Jesus of Nazareth. Although Jesus himself did not found a church, his followers in Jerusalem organized around the Twelve Apostles after his death (ca. 30 C.E.) and Contents carried on his mission of preaching and teaching the The Individual and the 7 reign of God and the “good news of salvation.” The Patient-Caregiver Relationship latter was the belief among Jesus’ followers that faith in Jesus, whom they believed to have been raised by Family, Sexuality, and Procreation 12 God from the dead, would lead to salvation. Genetics 17 Initially, the disciples of Jesus sought converts Organ and Tissue Transplantation 18 among fellow Jews throughout Palestine and did not view themselves as distinct from Judaism. The apostle Mental Health 19 Paul (d. ca. 67 C.E.) made the first significant attempt Death and Dying 20 to convert Gentiles to Christianity. After his own con- version from Judaism, Paul made several missionary Special Concerns 24 journeys throughout the Roman Empire. By about 60 C.E., he and others had preached the faith in most of the eastern Mediterranean and as far west as Rome. A century later, Christian communities existed in most if not all of the cities of the Roman Empire. The early Christian communities structured themselves in diverse ways and comprised a variety of

Ronald P. Hamel is Senior Associate in Ethics at the Catholic Health Association. Part of the “Religious Traditions and Healthcare Decisions” handbook series Kevin O’Rourke, O.P., is a professor at the Neiswanger Institute published by the Park Ridge Center of Ethics and Public Policy, Stritch School of Medicine, Loyola for the Study of Health, Faith, and Ethics University Chicago.

THE PARK RIDGE CENTER ministries and ministers, including deacons, eld- By the end of the fourth century, Christianity ers, presbyters, and bishops. Despite their diver- had made significant strides. Most of the urban sity, these communities did hold some elements population in Italy, Spain, Gaul, and Africa had in common: “faith in Jesus as Messiah and been converted. Much missionary work Lord; the practice of Baptism and the celebra- remained to be done, however, among the peas- tion of the Eucharist; the apostolic preaching ant populations and throughout the rest of and instruction; the high regard for communal Europe. love; and the expectation of the coming Both the spread of Christianity and papal Kingdom of God” (McBrien 1980, 2: 583). The power increased during the early Middle Ages apostle Peter, one of the original twelve, held a (500-1050), largely because of the 600-year position of prominence among the other apos- “invasion” of the Germanic tribes into western tles and within the local churches. Europe. Pope Gregory the Great (elected in 590) During the second and third centuries, took great interest in converting the “barbar- Christians were heavily persecuted by the ians” to Christianity for both religious and polit- Roman government. But this persecution ceased ical reasons. He saw, on the one hand, an oppor- in the fourth century, and Christianity spread. In tunity to spread the faith to larger regions of 313, the recently converted emperor Constantine Europe, and on the other, an occasion to gain not only legalized Christianity, thus ending the the support of the Germanic peoples in order to persecution, but also showed great favor to strengthen his own position, given the virtual Christians in the laws and policies he instituted. absence of support for him from the emperor of This trend was continued by all but one subse- the East. In fact, the collapse of the Roman quent emperor and culminated in 391 when the Empire and the leadership void it created emperor Theodosius declared Christianity the afforded the papacy even more temporal power. official religion of the Roman Empire. Thus The new converts to Christianity and the nations began an intimate relationship between church to which they belonged looked to Rome for and state that continued in Western Christianity leadership. And they in turn were for the pope a for the next thousand years. This relationship source of temporal power and wealth. These was founded on the belief that the emperor was trends were reinforced in the early ninth century divinely appointed and was charged with pro- when Charlemagne became ruler of the Holy tecting the church as well as ruling the empire. Roman Empire. He was a great supporter of the Constantine contributed in yet another way to papacy, and under his rule any lines that still the shaping of the Christian church. In 330, he separated the church and the Western empire transferred the capital of the empire from Rome quickly dissolved. to Byzantium in the East, renaming it By the time Gregory VII was elected pope in Constantinople. This action had profound conse- 1073, the Holy Roman Empire had shrunk in quences, among them, a gradual increase in size and had become fragmented into feudal papal power. The transfer of power to the East municipalities. Christianity was no longer coex- left a political vacuum in the ancient capital of tensive with the Western empire and, in fact, Rome, a vacuum increasingly filled by the pope. transcended its boundaries. Given all of this, it The papacy began to view itself as having seemed only fitting to Gregory that the pope absolute spiritual and temporal power within the should enjoy political as well as spiritual church and established Rome as the spiritual supremacy, and he acted accordingly. Popes dur- capital of Christianity. Some popes even saw ing the remainder of the High Middle Ages con- themselves as the Western counterpart to the tinued the tradition of a strong papal monarchy. emperor in the East and as having ultimate This changed during the late Middle Ages power within western Europe. (1300-1545) with the rise of nation-states of

2 THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS nationalistic populations headed by powerful With the founding of the colonies, Roman rulers. These forces ultimately led to the collapse Catholicism in the United States grew slowly. of papal supremacy and the power of Western Most of the colonists were Protestant, and in Christianity. The Great Schism (1378-1417), dur- 1652 legal restrictions were placed on Catholics ing which there were two, and at one point three, in Maryland, the colony they had founded in popes reigning simultaneously, further eroded 1634, as well as throughout the other colonies. the status and authority of the papacy. The Revolution, however, brought Catholics reli- The final blow to the unity, influence, and gious and political freedom. With the adoption power of Christianity and to the authority of the of the Constitution in 1787, religious equality pope came with the reform efforts of Luther, was legally guaranteed. Zwingli, and Calvin, the leaders of the Protestant Shortly after the Revolution, just over 18,000 Reformation. Initiatives by several popes and a Catholics lived in the U.S., concentrated mostly number of monastic orders to reform abuses had in Maryland, Pennsylvania, Virginia, and New limited success. The Protestant reformers took York. They had no clergy and were essentially more radical steps, challenging not only moral unorganized. After considerable conflict, John laxity and particular abuses within the church Carroll was named the “prefect apostolic” of the but also some of its theology. By the middle of 13 original states; the vicar apostolic of London the sixteenth century, the British Isles, refused to continue to exercise jurisdiction over Scandinavia, and much of France, Germany, and the “rebels.” By the early 1800s around 150,000 Austria had broken with Rome. The Catholics had organized about 80 churches. By Reformation “brought to an end the medieval 1890, the number had grown to 6,231,417, Catholic Church, a structure that had exercised largely because of the flood of immigrants from nearly exclusive authority in religion in western Catholic countries on the Continent. Today the Europe for a millennium” (Amundsen 1986: over 51 million Roman Catholics in the United 68). States belong to about 18,250 churches and The Counter Reformation was launched make up roughly 22 percent of the population. with the election of Pope Paul III in 1534 and the Council of Trent, which met from 1545 until 1563. The council corrected some abuses INSTITUTIONAL AUTHORITY AND and was extraordinarily influential in clarifying INDIVIDUAL CONSCIENCE matters of faith and in issuing disciplinary decrees, but it was not able to reunify Western The Roman Catholic church is probably the Christianity. most centralized of religious bodies. Authority Catholicism first came to North America with ultimately resides in the first among the bishops the early Spanish explorers, beginning with and the spiritual leader of the church, the bish- Columbus in 1492. By 1565, the first permanent op of Rome or the pope. His authority is parish in America was founded in St. Augustine, believed to derive from Jesus himself, who Florida. Subsequently, other missions were entrusted to St. Peter, chief among the Twelve founded in Florida, Alabama, California, and the Apostles, the authority to govern the church: “I Southwest by Spanish clergy, many of whom for my part declare to you, you are ‘Rock,’ and were Franciscans. The French explorers also on this rock I will build my church, and the jaws brought missionary clergy with them, and some of death shall not prevail against it. I will entrust of the explorers—Cartier, Joliet, Marquette, and to you the keys of the kingdom of heaven. Serra—were themselves clergy. These missionar- Whatever you declare bound on earth shall be ies spread the faith throughout the vast province bound in heaven; whatever you declare loosed of France that extended down the Mississippi on earth shall be loosed in heaven” (Matthew Valley to Louisiana. 16:18-19). As successor to St. Peter, the pope is

THE PARK RIDGE CENTER 3 entrusted with the same authority. Authority to mean several things. First, Catholics should resides at the next level in the individual bish- presume that church teaching is correct unless ops who also are successors of the Twelve and until there is clear and overwhelming evi- Apostles and have inherited the mission and dence to the contrary. The presumption is authority bestowed upon them by Jesus Christ. always in favor of church teaching. Second, if Most bishops are responsible for the Catholic they happen to disagree with the teaching, churches and institutions in specified geographi- Catholics must make every effort to reach intel- cal areas (dioceses) in countries where the lectual agreement with it. And, third, they must church is present. As leader of the church, it is strive to appropriate that teaching as their own the pope’s responsibility to ensure the integrity so that in performing or avoiding the behavior, of doctrine and morals. Decisions about these they do it out of personal conviction. The reason matters or about church organization and prac- behind this should be a religious one, namely, tice either are made by him or must receive his that Jesus commissioned the church to teach approval. Individual bishops have teaching and that the Holy Spirit guides the church in authority within their respective dioceses, and truth. national conferences of bishops have authority The Catholic tradition insists on the proper over the dioceses in their country, but that formation of personal conscience over time as authority is always subject to the pope. The well as prior to a particular judgment. The teaching authority of the church is often authoritative teaching of the church is a neces- referred to as the magisterium of the church. sary but not a sufficient component of this This structure has a direct bearing on moral process of conscience formation. Church teach- decision making and the role of conscience ing is not the sole basis for a moral judgment, within Catholicism. but it is an indispensable ingredient. In addition, Catholicism combines a profound respect for Catholics should attend to Scripture, to moral conscience and for the authoritative teaching of values, principles, and rules, to their own and the church. This teaching comes from the pope others’ experience, to the particularities of the himself, from particular offices in the papal situation, and to the insights of their hearts and administration in Rome, from bishops individu- minds. After carefully considering these, the ally or collectively, or from the pope together individual must discern the right action in with the bishops of the world. Authoritative response to the situation and consistent with his church teaching seeks to maintain the integrity or her faith (see Catechism of the Catholic of the faith and, in the area of morality, to guide Church [subsequently referred to as CCC] 1997: Catholics in discerning what behaviors are con- nos. 1776-1802 on conscience and nos. 2030-51 sistent with that faith. It is meant to communi- for a discussion of the teaching authority of the cate moral truth arrived at through the accumu- church). lated experience and wisdom of the community Catholics are expected by church authorities of faith and interpreted by its spiritual leaders. It to follow the church’s teachings on moral mat- seeks to overcome some of the limitations of ters. In reality, however, many Catholics find individual experience, perspective, and under- themselves at variance with some teachings, par- standing. ticularly those having to do with procreation and What then is the relationship of individual sexuality. Even a significant number of theolo- conscience to ordinary, authoritative church gians over the past 30 years have proposed posi- teaching on matters of faith and morals? The tions at variance with some church teaching and church requires a “religious assent of soul,” a have recommended revisions of that teaching. “religious submission of will and mind” to Hence, it is quite likely that in the healthcare authoritative teaching. This has been interpreted arena (as well as in others), not all Catholics will

4 THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS follow all of official church teaching. In the moral truth. A particular understanding of natu- search for moral truth, however, it should still ral law, however, has informed virtually all of be true that the guidance of church authority official Catholic teaching on sexual and medical will play a significant role. moral issues. It maintains that God has created The force and binding nature of church all of reality, including human beings and all teaching varies depending on its source (pope, their abilities, for particular purposes. In order Vatican offices, bishops, or pope and bishops for a human action to be moral, it must be con- together), on what form it takes (a papal encycli- sistent with or fulfill those purposes that are cal, declaration, instruction, apostolic letter, or written into the very structure and functioning of sermon; constitutions, decrees or declarations of human capabilities. The act of sexual inter- ecumenical councils, episcopal pastoral letters, course, for example, is considered to have been and so on), the frequency with which the teach- created by God to be procreative. Any interfer- ing has been repeated throughout the church’s ence with the procreative purpose of the sex act history, and the manner in which it is proposed (for example, contraception or sterilization) vio- (as infallible or as binding but not infallible). For lates its God-given nature and is therefore example, the pope, either alone or together with immoral. Actions that contradict God’s purposes the bishops of the world, is said to speak infalli- for a particular human faculty are often said to bly (that is, without error) when he speaks for- be intrinsically evil—that is, by their very nature, mally and officially (ex cathedra) to the entire they are evil. Such actions are always prohibited. church on matters of faith and morals. Such Over the past three decades, a less biological and pronouncements are to be considered as more person-centered approach to natural law revealed truth and as definitive. has shaped some ecclesiastical statements on This variable “authoritativeness” of church moral matters. This has not, however, altered teaching is reflected in the pages that follow. conclusions. Some present-day theologians (and Various sources have been employed in an many lay members of the church) do not espouse attempt to present a quasi-”official” Catholic a natural-law approach and sometimes arrive at perspective on issues in healthcare ethics. different conclusions on moral issues. These can- Although all the sources are ecclesiastical docu- not be considered as the official position of the ments—from popes, bishops, or Vatican commis- church, however. Catholics are expected to fol- sions—there is some variance among them low the teaching of the magisterium and not the regarding the weight they carry and the extent teaching of individual theologians. to which they represent an official Catholic posi- Several convictions guide Roman Catholic tion. A pope’s reflections in an address on teaching on moral issues in medicine: genetic research, for example, are not as authoritative as a Vatican declaration on euthanasia or • Because human beings are made in the image an instruction on the dignity of life that con- and likeness of God, every human being has an demns various reproductive technologies. inherent and inviolable dignity. It is this dignity that is the basis of every individual’s inalienable rights. This dignity is not conferred by human FUNDAMENTAL BELIEFS ABOUT ETHICS beings, cannot be measured in degrees, and cannot be taken away. Assessments of a person’s Roman Catholic thinking on moral issues is worth on the basis of social utility, the quality of a determined primarily by the Hebrew and person’s life, or any other characteristic (such as Christian Scriptures and by what is referred to as race, gender, social class) or denials of basic natural law. Most generally, natural law simply human rights are violations of human dignity. means the use of human reason to discover

THE PARK RIDGE CENTER 5 • Human beings are social by nature. Relationships son considered as a whole. This is the principle with others and with the community are essential normally employed to justify surgery. to their survival and flourishing; any exercise of autonomy must therefore consider the individual’s relationships and responsibilities to others and to • An action having both a good and a bad effect the larger community. In addition to having spe- may be justifiable under certain conditions. This is cific responsibilities to others, individuals have a known as the principle of double effect. Such an responsibility to contribute to the common good action is justifiable when (1) the action considered of society. by itself and independent of its effects is not morally evil; (2) the evil effect is not the means for producing the good effect; (3) the evil effect is not • Human life is considered to be sacred and invio- intended but only tolerated; (4) there is a propor- lable from the moment of conception, regardless of tionate reason for performing the action and its quality. It is a gift of God and the most basic of allowing the evil effect to occur. An example all human goods. For this reason, it is immoral to would be the removal of a cancerous uterus, end it directly or unjustly. Human life, however, is which has the good effect of saving the woman’s not considered to be an absolute. Therefore, not life but the bad effect of making her sterile. everything must be done to preserve or prolong it. Biological existence must always be subordinated to the total good of the person, particularly to the • The unitive and the procreative aspects of mar- person’s spiritual good. This might mean, in some riage are inseparable. This principle is based on instances, allowing someone to die. an understanding of the God-intended purposes of human sexuality, namely, lovemaking and procreation. It holds that God intended these purposes • Human beings are stewards of life. Human life is to be inseparable. Any lovemaking apart from an a gift of the Creator over which human beings are openness to procreation or procreation apart from stewards or caretakers. Hence, we have a funda- lovemaking is inherently immoral. mental responsibility to care for life and health. As created entities, we have only limited power or control over our lives; they are not ours to do with as we will. Only God has full dominion over life. FUNDAMENTAL BELIEFS CONCERNING Stewardship also applies to the goods of cre- HEALTH CARE ation. Because these are gifts of the Creator for our use, we are called to use them prudently, just- The Roman Catholic church has a very long tra- ly, and in a caring manner. dition in medical ethics. It could actually be said to date back to the early church and has evolved over the centuries as more and more behaviors • It is legitimate under certain conditions to sacri- were included and assessed, blossoming into a fice a part for the good of the whole. This is gener- separate discipline in the seventeenth century. It ally known as the “principle of totality.” continued to flourish in the nineteenth and Traditionally, it has meant that a part of the body twentieth centuries. can be sacrificed for the good of the whole body During much of this time, and particularly in (for example, a cancerous uterus can justifiably be the modern period, several fundamental theologi- removed for the overall good of the woman’s cal convictions have served to guide ethical body). More recent theology has broadened this reflection about specific medical procedures and principle somewhat by focusing not only on the interventions. good of the body but also on the good of the per-

6 THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS • Every person has dignity. The Catholic/Christian not considered to be goods in their own right, they view of the person is grounded in the biblical can have meaning. They are opportunities for spir- teaching that all human beings are made in the itual growth. For some believers they can have a image and likeness of God, particularly in possess- purifying effect, while for others they can be ing intelligence and free will (Genesis 1:26-31). viewed as enabling one to share in the redemptive Every person is unique and irreplaceable and is suffering of Christ and in his resurrection. The called both to human fulfillment and to eternal church recognizes that people’s capacity for suffer- life. All human beings are equal (Romans 2:11; ing varies and that this difference must always be Galatians 4:38; Ephesians 6:9); and all human taken into account. Furthermore, it recognizes the life, because it originates in God, is sacred. legitimacy of trying to eliminate or reduce pain and suffering. The patient is not required to endure pain and suffering at any price (Pontifical • Health is to be understood holistically. The Council Cor Unum [hereafter cited as Pontifical Catholic/ Christian tradition understands health Council] 1981; Pius XII, 1944; Congregation for holistically; it encompasses physiological, psycho- the Doctrine of the Faith [hereafter cited as CDF] logical, social, and spiritual dimensions of the per- 1980). son. Human health can never be reduced only to physiological or psychological functioning. These aspects of the person should always be subordi- • Death is natural and is a transitional stage to life nated to the social and spiritual well-being of the with God. Death is to be approached with awe and individual. respect and accepted with responsibility and dignity. It marks the end of earthly existence and thus is a decisive summing up of a person’s moral and • Suffering can possess meaning. While the religious life, but it opens up to a new mode of Catholic tradition affirms the pursuit of health, it existence—personal life with God. Catholics, with also recognizes that all human beings are wound- most Christians, believe that Jesus Christ, in being ed in various ways and to various degrees. raised up by God, has given a new meaning to suf- Woundedness and the suffering it produces are fering and death. Through faith in Jesus Christ, part of the human condition. They are elements of believers overcome the negativities associated with human finitude and are, in part, the result of human suffering and death; they have hope in the human sinfulness. Although suffering and pain are reality of resurrection and eternal life.

THE INDIVIDUAL AND THE PATIENT-CAREGIVER RELATIONSHIP

he Catholic church does not hold an official in medical ethics on autonomy, understood indi- Tposition on the patient-caregiver relation- vidualistically and almost as an absolute, is not ship, but it does communicate a certain perspec- compatible with a Catholic understanding of the tive in its many documents related to health person and of professional relationships general- care. As one might expect, that perspective is ly. Nor is paternalism compatible because it vio- shaped by Catholicism’s staunch belief in the lates aspects of human dignity. In the patient- dignity of the human person and in the individ- caregiver relationship, the Catholic tradition ual’s inherent relatedness to others, especially to tries to maintain a balance between respect for the family and to society. The current emphasis the individual and awareness of the individual’s

THE PARK RIDGE CENTER 7 relationships and responsibilities toward others. informed consent is required prior to the per- Overall, the church does support the primacy of formance of any medical procedure or treat- the patient in decision making, though not to ment. It involves communicating to the patient the exclusion of the patient’s family and others or surrogate reasonable information about the who might be important to the decision. nature of the proposed treatment, its risks, ben- Pope Pius XII speaks of the patient’s role in efits, costs, and legitimate alternatives, including decision making in two addresses. The patient, no treatment at all (D. 26, 27). Finally, the he maintains, is clearly the primary decision Directives state that “the free and informed maker: “The doctor . . . cannot take any meas- health care decision of the person or the per- ure or try an intervention without the consent of son’s surrogate is to be followed so long as it the patient. The doctor has only that power over does not contradict Catholic principles” (D. 28). the patient which the latter gives him, be it explicitly, or implicitly and tacitly” (Pius XII, 1952). In the other document he writes: “The CLINICAL ISSUES rights and duties of the doctor are correlative to those of the patient. The doctor, in fact, has no Self-determination and informed consent separate or independent right where the patient The Catholic church is very supportive of devel- is concerned. In general he can take action only opments in science and technology. Advances in if the patient explicitly or implicitly, directly or human knowledge, the search for truth, and the indirectly, gives him permission” (Pius XII, use of human creative abilities for the good of 1957). human beings are an expression of human A more comprehensive statement can be dominion over the created world. God created found in the Ethical and Religious Directives for human beings in his own image and likeness Catholic Health Care Services published by the (Genesis 1:27), entrusting them with the respon- United States Conference of Catholic Bishops in sibility of “dominion over the earth” (Genesis 2001. In the introduction to the section on the 1:28). “Basic scientific research and applied professional-patient relationship, the bishops research constitute a significant expression of state: this dominion of man over creation. Science and technology are valuable resources for man when A person in need of health care and the profession- placed at his service and when they promote his al health care provider who accepts that person as a integral development for the benefit of all” patient enter into a relationship that requires, (CDF 1987: introduction, no. 2; Pius XII, 1952). among other things, mutual respect, trust, honesty, Not everything in scientific research and in and appropriate confidentiality. The resulting free the development of various technologies is per- exchange of information must avoid manipulation, mitted, however. Science and technology cannot intimidation, or condescension. Such a relationship themselves be the source of moral norms, of the enables the patient to disclose personal information meaning of human progress, or of human exis- needed for effective care and permits the health tence. Usefulness, efficacy, and efficiency are not care provider to use his or her professional compe- moral criteria. Rather science and technology tence most effectively to maintain or restore the are subject to and limited by moral values patient’s health. Neither the health care profession- derived from the human person. In the words of al nor the patient acts independently of the other; the Congregation for the Doctrine of the Faith, both participate in the healing process. (United the Vatican office responsible for maintaining States Conference of Catholic Bishops 2001 [here- orthodoxy in matters of faith and morals: “They after cited as ERD]: 13) [science and technology] draw from the person and his moral values the indication of their pur- More specifically, the Directives state that pose and the awareness of their limits. . . .

8 THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS Science and technology require for their own on the basis of this anthropological vision that one intrinsic meaning an unconditional respect for is to find the fundamental criteria for decision the fundamental criteria of the moral law: That making in the case of procedures which are not is to say, they must be at the service of the strictly therapeutic, as, for example, those aimed at human person, of his inalienable rights and his the improvement of the human biological condi- true and integral good according to the design tion. (CDF 1987: introduction, no. 3) and will of God” (CDF 1987: introduction, no. 2; Pius XII, 1952; CCC 1997: nos. 2292-95). The church recognizes that in the process of The Congregation for the Doctrine of the acquiring new knowledge and developing new Faith goes on to elaborate an ethical perspective technologies, experimentation on human beings and a basic principle to guide scientific research may at some point be essential. Furthermore, it and technological developments. Adequate crite- recognizes that all risk cannot be eliminated. If ria in this area can be derived only from a holis- only risk-free research were permitted, both sci- tic understanding of the human person, that is, entific research and the well-being of individuals one that takes into account that human beings would suffer. Hence, the church accepts experi- are a “unified totality,” a unity of the corporal mentation on human beings, even experimenta- and the spiritual. The corporal dimension of the tion that involves some risk. However, there are person is a constitutive element; it is the manner limits and conditions. by which the individual expresses himself or The greatest moral threat of experimentation herself. Furthermore, because the body is united on human beings is turning them into mere with a spiritual soul, it cannot be considered a objects or violating the “integral well-being” of mere assemblage of tissues and organs or noth- the person. To some degree, these dangers can ing more than the bodies of animals. The be avoided by the free and informed consent of human body is something more and needs to be the individual. But there are limits even to treated as such. informed consent. In the words of Pope Pius XII: This bodily and spiritual nature of the person gives rise to moral norms. The norm that should The patient has not the right to involve his physical guide science and technology is articulated this and psychic integrity in medical experiments or way: researches, when these interventions entail, either immediately or subsequently, acts of destruction, or An intervention on the human body affects not of mutilation and wounds, or grave dangers. only the tissues, the organs, and their functions, Furthermore, in exercising his right to dispose but also involves the person himself on different of himself, of his faculties and organs, the individ- levels. It involves, therefore, perhaps in an implicit ual must observe the hierarchy of the scale of val- but nonetheless real way, a moral significance and ues, and within an identical order of values, the responsibility. Pope John Paul II forcefully reaf- hierarchy of individual goods, to the extent firmed this to the World Medical Association when demanded by the laws of morality. So, for example, he said: man cannot perform upon himself or allow med- Each human person, in his absolutely unique ical operations, either physical or somatic, which singularity, is constituted not only by his spirit, but beyond doubt do remove serious defects or physi- by his body as well. Thus, in the body and through cal or psychic weaknesses, but which entail at the the body, one touches the person himself in his same time permanent destruction of, or a consid- concrete reality. To respect the dignity of man con- erable and lasting lessening of freedom, that is to sequently amounts to safeguarding this identity of say, of the human personality in its particular and the man corpore et anima unus, as the Second characteristic function. (Pius XII, 1952) Vatican Council says (Gaudium et Spes, 14.1). It is

THE PARK RIDGE CENTER 9 Hence, the individual cannot give consent to In formulating its position, the church distin- any experiment that is likely to harm the core of guishes between living and dead embryos and the person. between therapeutic and nontherapeutic experi- Like secular medical ethics, the church dis- mentation on living embryos. Therapeutic experi- tinguishes between therapeutic and nonthera- mentation is permitted, provided appropriate peutic experimentation. Pope John Paul II, for informed consent has been obtained, the propor- example, observes that for the most part the rea- tion of risks to benefits has been weighed, and son justifying cooperation in an experiment is no other alternatives exist, whereas nontherapeu- the improvement of one’s own health. However, tic experimentation on living embryos is strictly it can also be the case that an individual may prohibited (pt. 1, no. 4). In the words of the CDF, undertake some degree of risk as a “personal contribution to the progress of medicine and No objective, even though noble in itself such as a thus to the common good.” Pope John Paul sees foreseeable advantage to science, to other human this as a gift of self which “within the limits set beings, or to society, can in any way justify [non- by the moral law can . . . be a highly meritorious therapeutic] experimentation on living human proof of love and an occasion of spiritual growth embryos or fetuses, whether viable or not, either of such magnitude as to offset the dangers of a inside or outside the mother’s womb. . . . To use possible physical diminution that is not substan- human embryos or fetuses as the object or instru- tial in kind” (John Paul II, 1980). In both cases, ment of experimentation constitutes a crime experimentation can be moral only if it does not against their dignity as human beings having a pose the probability of grave harm to the sub- right to the same respect that is due to the child stantial integrity of the person. already born and to every human person. (CDF 1987: pt. 1, no. 4; see also John Paul II, 1982) Experimentation on human embryos The church’s position regarding experimentation Dead embryos or fetuses, according to the on human embryos rests on its convictions CDF, must be shown the same respect as the about the status of embryos. Perhaps the clear- corpses of any other human beings. They should est and most recent articulation of this connec- not be mutilated until verification that death has tion is to be found in the CDF’s 1987 Instruction: occurred and the consent of the parents, especially the mother, has been obtained. In addi- Thus the fruit of human generation from the first tion, there must be no complicity in direct abor- moment of its existence, that is to say, from the tion in order to obtain dead embryos and fetuses moment the zygote has formed, demands the for experimentation, and commercial trafficking unconditional respect that is morally due to the in such embryos and fetuses is to be considered human being in his bodily and spiritual totality. illicit and should be prohibited (CDF 1987: pt. The human being is to be respected and treated as 1, no. 4). The Directives strongly discourage a person from the moment of conception and Catholic hospitals from using tissue obtained by therefore from that same moment his rights as a direct abortion for research or even therapeutic person must be recognized, among which in the purposes (D. 66). It is also immoral, according first place is the inviolable right of every innocent to the CDF, to produce human embryos in vitro human being to life. . . . Since the embryo must solely for the sake of experimentation, “destined be treated as a person, it must also be defended in to be exploited as disposable ‘biological materi- its integrity, tended and cared for, to the extent al’” (no. 5), or to engage in experiments “which possible, in the same way as any other human damage or impose grave and disproportionate being as far as medical assistance is concerned. risks” upon embryos (CDF 1987: pt.1, no. 5; see (CDF 1987: pt. 1, no. 3) also John Paul II, 1995: no. 63).

10 THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS Truth-telling and confidentiality Regarding confidentiality, Pope Pius XII The Catholic church bases its position in regard affirms the obligation of the physician to pre- to truth-telling and confidentiality on respect for serve professional secrets, but he cautions that persons and on its more general teaching about this obligation is not absolute. It should not be the moral obligation to communicate truthfully. placed “at the service of crime or injustice” It supports the current beliefs and practices in because this would harm the common good, medical ethics regarding these issues. Pope Pius precisely what it is meant to foster (Pius XII, XII did address the matter of truth-telling: 1944). The Directives state quite simply that “health care providers are to respect each per- The eighth commandment likewise has its place in son’s privacy and confidentiality regarding infor- the morality of medicine. According to the moral mation related to the person’s diagnosis, treat- law, no one may tell a lie. And yet there are cases ment, and care” (D. 34). when a doctor, even when asked, though he cannot give an answer which is positively untrue, at Proxy decision making and advance the same time cannot crudely tell the whole truth, directives especially when he knows that the patient has not In two separate statements, Pope Pius XII recog- the strength to stand such a revelation. But there nizes the legitimacy of proxy decision making. are other cases when the doctor has most certainly In one statement he notes that “the rights and the duty of speaking out clearly, a duty before duties of the family depend in general upon the which every other medical or humanitarian con- presumed will of the unconscious patient if he is sideration must give way. It is not lawful to lull the of age and ‘sui juris’”(Pius XII, 1957). This sick person or his relations into a false sense of would seem to suggest that family members can security when there is the risk of compromising speak on behalf of the patient and also that the the eternal salvation of the former, or the fulfill- basis of their decision should be what the ment of his duties in justice and charity. It would patient would choose if the patient were able. be wrong to try to justify or excuse such conduct This is often referred to as “substituted judg- under the pretext that the physician always says ment.” In the other statement, the pope observes what, in his opinion, will best contribute to the that the rights of proxies in their decision-mak- patient’s well-being. . . . (Pius XII, 1944) ing capacity are coextensive with those of the patient; that is, proxies have the same rights that Much of the attention given to the matter of the patient has, and to the same extent (Pius truth-telling has been in the context of inform- XII, 1952). ing the terminally ill that they are dying. “The The Directives also affirm the legitimacy of dying, and, more generally, anyone with an proxy decision making as well as advance direc- incurable disease, have a right to be told the tives, provided neither violates Catholic moral truth” (Pontifical Council 1981). This enables principles: “Each person may identify in the individual to engage in a personal prepara- advance a representative to make health care tion for death and also to fulfill responsibilities decisions as his or her surrogate in the event to family and to have an opportunity to put his that the person loses the capacity to make or her financial matters in order. The responsi- health care decisions” (D. 25). If a patient has bility to inform the patient rests with those clos- not executed an advance directive and has lost est to him or her and should probably be shared decision-making capacity, those who know the among family, the chaplain, and the medical person best—usually family members and loved team (Pontifical Council 1981). A similar posi- ones—should participate in making the treat- tion is echoed in the 2001 Directives (D. 55). ment decision.

THE PARK RIDGE CENTER 11 FAMILY, SEXUALITY, AND PROCREATION

he Catholic tradition has the highest regard one another until death. The total physical self- Tfor marriage and family. Both are viewed as giving would be a lie if it were not the sign and created and ordered by God: “Creating the fruit of a total personal self-giving, in which the human race in his own image and continually whole person . . . is present” (John Paul II, keeping it in being, God inscribed in the 1981: no. 11). humanity of man and woman the vocation, and Because it is a sign and an expression of total thus the capacity and responsibility, of love and self-giving, sexual intercourse, as ordered by communion” (John Paul II, 1981: no. 11). One God, is appropriate only in the context of mar- of the two primary ways in which this love is riage. This has been the constant teaching of the realized is through marriage. Because God cre- Catholic church. Furthermore, God has ordered ated man and woman to unite as husband and sexual intercourse within marriage not only as wife, to be a community of persons, marriage is an expression and cause of mutual self-giving seen to be fundamentally good (Second Vatican but also as a means for the procreation of chil- Council 1965: no. 48; see also CCC 1997: nos. dren. “By its very nature the institution of mar- 2201-6). riage and married love is ordered to the procre- The same can be said of human sexuality. It ation and education of offspring and it is in too is a creation of God and is therefore good. It them that it finds its crowning glory” (Second is viewed within the Catholic tradition as an Vatican Council 1965: no. 48). Children are essential aspect of human identity and as funda- considered to be the “supreme gift” of marriage mental to human relations. It is considered one and to contribute greatly to the good of the of the principal formative influences in the life of spouses. The procreation of children is, indeed, human beings, the “source of the biological, psy- considered to be cooperation in the creative chological, and spiritual characteristics which work of God and God’s building up of the make a person male or female and which thus human family. considerably influence each individual’s progress Until the Second Vatican Council, the towards maturity and membership of society.” Catholic church considered the procreative pur- Sexuality is intimately related to human beings’ pose of conjugal love to be its primary purpose. need to love and be loved, to enter into relation- Since then the unitive dimension has been con- ships; it is vital to the creation of families and of sidered equally important. At no time, however, the human community (CDF 1975a: no. 1; see were these two purposes thought to be separable also Vatican Congregation for Catholic Education one from the other. The church has always held 1983: no. 4; CCC 1997: nos. 2360-79). them to be inseparable because they were Sexual intercourse, as an expression of ordained by God as such. The very nature of human sexuality, is considered to be the most human acts of sexual intercourse is to be both profound expression and commitment of one expressive of love and procreative. To separate person to another. In the words of John Paul II: these two purposes intentionally is to violate “Sexuality, by means of which man and woman God’s purposes. give themselves to one another through the acts Although married couples should regard it as which are proper and exclusive to spouses, is by their proper mission to transmit human life and no means something purely biological, but con- to educate their children, they should exercise cerns the innermost being of the human person this mission responsibly. Spouses are called to as such. It is realized in a truly human way only responsible stewardship in the exercise of their if it is an integral part of the love by which a procreative capacities. The decision to have chil- man and a woman commit themselves totally to dren must be made conscientiously, taking into

12 THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS account factors that will have an impact on the An act of mutual love which impairs the capac- future child, the family, and society. Exercising ity to transmit life which God the Creator, through this stewardship involves “consideration of their specific laws, has built into it, frustrates his design own good and the good of their children already which constitutes the norms of marriage, and con- born or yet to come, an ability to read the signs tradicts the will of the Author of life. Hence, to of the times and of their own situation on the use this divine gift while depriving it, even if only material and spiritual level, and, finally, an esti- partially, of its meaning and purpose, is equally mation of the good of the family, of society, and repugnant to the nature of man and woman, of the Church. It is the married couple them- strikes at the heart of their relationship, and is selves who must in the last analysis arrive at consequently in opposition to the plan of God and these judgments before God” (Second Vatican his holy will. (Paul VI, 1968: nos. 12, 13; see also Council 1965: no. 50; see also Paul VI, 1968: Second Vatican Council 1965: no. 50; John Paul no. 10). II, 1981: no. 32; CCC 1997: no. 2370)

A further reason noted by Paul VI for con- CLINICAL ISSUES demning artificial contraception is that human beings, just as they do not have full dominion Contraception over their bodies, likewise do not have full The Catholic church does not permit the use of dominion over their sexual faculties. These any medication, instrument, or procedure capacities by their very nature have to do with before, during, or after sexual intercourse that is the generation of life, of which God is the intended to prevent conception. Any such meas- source (Paul VI, 1968: no. 13). Pope John Paul ures would separate the unitive and procreative II adds another reason: the separation of the aspects of sexual intercourse and thus would unitive and procreative aspects of marriage violate the divine will. Such measures are con- degrades human sexuality by altering its value sidered intrinsically evil. In the words of Pope of total self-giving. “The innate language that Pius XI: “Since, therefore, the conjugal act is expresses the total reciprocal self-giving of hus- destined primarily by nature for the begetting of band and wife is overlaid, through contracep- children, those who in exercising it deliberately tion, by an objectively contradictory language, frustrate its natural power and purpose sin namely, that of not giving oneself totally to the against nature and commit a deed which is other” (John Paul II, 1981: no. 32). shameful and intrinsically vicious” (Pius XI, A chemical agent or procedure that happens 1930: no. 4). Pope Paul VI puts it equally force- to have a contraceptive effect may, however, be fully in his famous 1968 encyclical: used to treat a pathological condition. The contraceptive effect, though it is foreseen, must not This particular doctrine, often expounded by the be intended and must be unavoidable. The prin- Magisterium of the Church, is based on the insep- ciple of double effect discussed above is opera- arable connection, established by God, which man tive here (Paul VI, 1968: no. 15). on his own initiative may not break, between the unitive significance and the procreative signifi- Sterilization cance which are both inherent to the marriage act. Sterilization—whether female or male, perma- The reason is that the marriage act, because of nent or temporary—is also condemned by the its fundamental structure, while it unites husband church for the same reason: it frustrates the pro- and wife in the closest intimacy, also brings into creative aspect of sexual intercourse and of mar- operation laws written into the actual nature of man riage. If, however, the sterilization occurs as the and of woman for the generation of new life. . . . result of a medical procedure intended to cure,

THE PARK RIDGE CENTER 13 alleviate, or prevent a serious pathological con- condemned without right of appeal. dition when no other reasonable alternatives Only the husband and wife have the reciprocal exist, it is morally permissible on the basis of right on the body of the other for the purpose of the principle of double effect. Such sterilizations generating new life: an exclusive, inalienable, are called “indirect” because the sterilizing incommunicable right. And that is as it should be, effect is an unintended result of a therapeutic also for the sake of the child. To whoever gives life measure. Sterilization is considered to be to the tiny creature, nature imposes, in virtue of “direct” and immoral when it intends to prevent that very bond, the duty of protecting and educat- procreation (Paul VI, 1968: no. 15; see also ing the child. But when the child is the fruit of the ERD, D. 53; Pius XII, 1951; CDF 1975b; NCCB active elements of a third person—even granting 1980; CCC 1997: nos. 2370, 2399). the husband’s consent—between the legitimate husband and the child there is no such bond of origin, nor the moral and juridical bond of conju- NEW REPRODUCTIVE TECHNOLOGIES gal procreation. (Pius XII, 1949: no. 3)

Artificial insemination The 1987 CDF document offers a similar In its 1987 “Instruction on Respect for Human condemnation: “Heterologous artificial fertiliza- Life,” the Congregation for the Doctrine of the tion is contrary to the unity of marriage, to the Faith addresses several reproductive technolo- dignity of the spouses, to the vocation proper to gies, including artificial insemination. Reflecting parents, and to the child’s right to be conceived its traditional view on procreation, the Vatican and brought into the world in marriage and condemns artificial insemination between hus- from marriage” (CDF 1987: pt. 2.A, no. 2). band and wife (homologous) if it replaces the Artificial insemination using the gametes of a act of sexual intercourse. As previously noted, third party shows disrespect for the unity of the procreation of new life must result from an marriage and for conjugal fidelity. It violates the act of conjugal love; artificial insemination sepa- “bond existing between husband and wife rates the procreation of new life from an act of [which] accords the spouses . . . the exclusive sexual love. Furthermore, it likely involves mas- right to become father and mother solely turbation for obtaining sperm, which is also pro- through each other”; it violates the reciprocal hibited (CDF 1987: pt. 2.B, no. 6; see also ERD, commitment of the spouses. It furthermore vio- D. 41; Pius XII, 1949: no. 4; Pius XII, 1951; lates the rights of the child to a filial relation- CCC 1997: no. 2376). If, however, artificial ship with his or her parental origins and could insemination simply assists the act of sexual conceivably hinder the development of the intercourse or helps it to reach its natural end, child’s personal identity. And, finally, it namely, fertilization, then it can be considered “deprives conjugal fruitfulness of its unity and morally acceptable. integrity” by rupturing genetic parenthood, ges- Heterologous artificial insemination, that is, tational parenthood, and responsibility for the the use of donor sperm or egg, is never morally child’s upbringing. The desire to have a child permissible. Not only does it involve a separation cannot justify heterologous artificial insemina- of procreation from sexual intercourse, it also tion (see also ERD, D. 40). separates procreation from the exclusive union of husband and wife. In the words of Pius XII: Gamete intrauterine fallopian transfer (GIFT) Artificial insemination in matrimony, but pro- In gamete intrauterine fallopian transfer, the duced by means of the active element of a third ovaries are hyperstimulated and ova are person, is equally immoral, and as such is to be retrieved. Ova and sperm are placed in a

14 THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS catheter close to each other and are reinserted human beings or their utilization for different into the fallopian tube so that fertilization can purposes to the detriment of their integrity and occur in the woman’s body. The church has not life is contrary to the doctrine on procured abor- spoken definitively on this matter, but since the tion” (CDF 1987: pt. 2, Introduction). procedure assists natural fertilization, there is reason to believe that it would be morally Surrogate motherhood acceptable. In the same document, the Vatican also condemns surrogate motherhood. It “represents an In vitro fertilization (IVF) objective failure to meet the obligations of In vitro fertilization involves procuring sperm maternal love, of conjugal fidelity, and of and egg(s) so that fertilization can occur in a responsible motherhood; it offends the dignity laboratory dish, hence outside the body of the and the right of the child to be conceived, car- woman. Sperm and eggs may be either from the ried in the womb, brought into the world, and spouses (homologous) or from donors (heterolo- brought up by his own parents; it sets up, to the gous). Both types are considered by the church detriment of families, a division between the to be immoral because they “involve the separa- physical, psychological, and moral elements tion of procreation from an act of conjugal love, which constitute those families” (CDF 1987: pt. thereby violating the very nature of marriage 2.A, no. 3). The Directives add to the reasons for and the conjugal act” (CDF 1987: pt. 2.B, nos. this condemnation a denigration of the dignity 4-5). In vitro fertilization also violates the digni- of women, especially the poor (D. 42). ty of the child.

In reality, the origin of a human person is the ABORTION AND THE STATUS OF THE result of an act of giving. The one conceived must FETUS be the fruit of his parents’ love. He cannot be desired or conceived as the product of an inter- The Catholic church has maintained consistent vention or medical or biological techniques; that opposition to all abortion that has as its primary would be equivalent to reducing him to an object aim the direct termination of fetal life for any of scientific technology. No one may subject the reason, whether it be to preserve the life or coming of a child into the world to conditions of health of the mother, to avoid serious genetic technical efficiency which are to be evaluated abnormality, to prevent a birth resulting from according to standards of control and dominion. . . . rape or incest, or to forgo the burdens of an Such fertilization entrusts the life and identity of additional child. Abortions which aim at the ter- the embryo into the power of doctors and biolo- mination of fetal life are called direct abortions. gists and establishes the domination of technology Under no circumstances are they permissible over the origin and destiny of the human person. (CDF 1974; see also ERD, D. 45; John Paul II, Such a relationship of domination is in itself con- 1995: nos. 57-62; CCC 1997: nos. 2270-72). trary to the dignity and equality that must be com- The primary reason for this condemnation is mon to parents and children. (CDF, 1987: pt. 2.B, that the church considers the fertilized ovum to nos. 4, 5) be human life and even a human person. “Thus the fruit of human generation, from the first A further concern is that this procedure usu- moment of its existence, that is to say from the ally, though not necessarily, involves a deliberate moment the zygote has formed, demands the destruction of fertilized eggs, constituting abor- unconditional respect that is morally due to the tions in the eyes of the church. The CDF docu- human being in his bodily and spiritual totality. ment states: “Such deliberate destruction of The human being is to be respected and treated

THE PARK RIDGE CENTER 15 as a person from the moment of conception; and The mother who would seek prenatal diagnosis therefore from that same moment his rights as a for this purpose, anyone suggesting or imposing person must be recognized, among which in the it, and any specialist who in communicating the first place is the inviolable right of every inno- results suggests a link between prenatal diagno- cent human being to life” (CDF 1987: pt. 1, sis and abortion would be acting immorally. Introduction; see also CDF 1974: no. 12). The Furthermore, “any directive or program of the fertilized egg is neither the life of the mother civil and health authorities or of scientific organ- nor the life of the father. It is rather the life of a izations which in any way were to favor a link new human being with its own growth. between prenatal diagnosis and abortion, or The church does, however, permit indirect which were to go as far as directly to induce abortion. This occurs when a treatment, opera- expectant mothers to submit to prenatal diagno- tion, or medication is aimed at curing or allevi- sis planned for the purpose of eliminating fetus- ating a serious pathological condition in the es which are affected by malformations or which pregnant woman even if it has an abortive effect, are carriers of hereditary illness, is to be con- if there are no other reasonable alternatives demned as a violation of the unborn child’s right (CDF 1974; ERD, D. 47). The death of the fetus to life and as an abuse of the prior rights and is unintended (though foreseen) and is the duties of the spouses” (CDF 1987: pt. 1, no. 2). unavoidable by-product of the procedure. A classic example is the removal of a cancerous uterus in early pregnancy. The aim is to save the CARE OF SEVERELY HANDICAPPED life of the mother. The removal of the pathology NEWBORNS simultaneously saves the mother’s life and results in the death of the fetus. The principle of Because of its view of the human person, the double effect is operative here. Catholic church affirms the dignity and worth of severely handicapped newborns. They cannot be discriminated against on the basis of their limi- PRENATAL DIAGNOSIS AND TREATMENT tations. They have the same right to life and to medical care as any “normal” newborn. At the The official teaching of the church supports the same time, however, parents of handicapped use of prenatal diagnosis if it “respects the life newborns and their caregivers must ask whether and integrity of the embryo and the human fetus medical treatment is appropriate and, if so, and is directed toward its safeguarding or heal- which treatments are appropriate. The same ing as an individual” (CDF 1987: pt. 1, no. 2; steps are taken here as with adult patients, see also ERD, D. 50; CCC 1997: no. 2274; John namely, an assessment of the benefits and bur- Paul II, 1995, no. 63). In other words, insofar as dens of treatment to the infant. The handicap prenatal testing makes it possible to anticipate itself and burdens upon the family are not in earlier and more effectively certain therapeutic, themselves legitimate reasons for withholding or medical, or surgical procedures without subject- withdrawing treatment from these babies. The ing the fetus or the mother to disproportionate early delivery of anencephalic infants, an issue risk, it is morally acceptable, if the parents’ debated by several theologians in the past ten informed consent has been obtained. years, was declared unethical by the National If prenatal diagnosis is to be done, however, Conference of Catholic Bishops in l996 (NCCB with the deliberate intention of aborting a fetus 1996). that is found to be malformed or abnormal, it is considered gravely immoral and is prohibited.

16 THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS GENETICS

he Catholic tradition views genetics positive- or mentally disabled. Because of this, the church Tly though cautiously. It is positive in that it sees its role as defending the rights of disabled affirms genetic medicine’s actual and future persons, particularly their right to life as well as capability of helping human beings overcome other rights which enable the handicapped indi- limitations on the normal functioning of their vidual to “achieve the fullest measure of person- psychophysical selves and its intention to con- al development of which he or she is capable” tribute to the good of individuals and of the (United States Catholic Conference [hereafter community. In the words of Pope Pius XII cited as USCC] 1978). It is also incumbent upon (1953), “The fundamental tendency of genetics the church to work for the realization of the and eugenics is to influence the transmission of rights of the handicapped in society. It must hereditary factors in order to promote what is work to sensitize society to the needs of the good and eliminate what is injurious. This fun- handicapped and to support their rightful damental tendency is irreproachable from the demand for justice. This involves being moral viewpoint.” He believes that the “practical “informed by a sincere and understanding love aims being pursued by genetics are noble and that penetrates the wall of strangeness and worthy of recognition and encouragement.” affirms the common humanity underlying all At the same time, however, Catholicism is distinction” (USCC 1978). cautious. Certain values must not be violated. The biological nature of every human is inviolable insofar as it constitutes an essential com- CLINICAL ISSUES ponent of the personal identity of the individual. The person is a unity of body and soul. Genetic screening and counseling Respecting the dignity of the person means There is no official church teaching in this area. respecting this unity. Pope John Paul II also Given the church’s moral stance concerning raises cautions against racially motivated genetic issues in genetics, the church would approve of manipulations or manipulations that arise out of genetic screening and counseling if it con- a materialist mentality which promotes a reduc- tributed to more responsible parenthood and to tive view of human happiness. More specifically, better preparation for the treatment and care of he writes: “Genetic manipulation becomes arbi- children likely to be born with genetic abnor- trary and unjust when it reduces life to an malities. Screening that is discriminatory, invol- object, when it forgets that it has to do with a untary, or provided without sufficient informed human subject, capable of intelligence and lib- consent from the couple or that violates the erty, and worthy of respect, whatever its limita- couple’s right to procreate may be considered tions; or when genetic manipulation treats the morally unacceptable (ERD, D. 54). human subject in terms of criteria not founded on the integral reality of the human person, at Sex selection the risk of doing damage to his dignity. In this In the 1987 “Instruction on Respect for Human case it exposes man to the caprice of others, by Life,” the church condemns the use of sex selec- depriving him of his autonomy” (John Paul II, tion of embryos. These nontherapeutic manipu- 1983). lations “are contrary to the personal dignity of It would be appropriate to mention here the the human being and his or her integrity and Catholic view of disability. The Catholic tradi- identity” (CDF 1987). tion recognizes the fundamental dignity of all persons, including those who may be physically

THE PARK RIDGE CENTER 17 Selective abortion human beings can be cured during their The abortion of malformed or abnormal fetuses intrauterine life or in the period immediately is condemned (CDF 1974; CDF 1987). after birth” (John Paul II, 1982; see also John Paul II, 1983). Gene therapy Nontherapeutic interventions must also aim In principle, therapeutic interventions that seek at improving the human biological condition; to correct various abnormalities are considered they must not do violence to the dignity of the moral and even desirable as long as they gen- person and to the common biological nature uinely promote human well-being and do not that all share. They threaten to do this if they harm the integrity of the person or worsen the treat persons as objects or diminish their auton- person’s life conditions. “The research of mod- omy, if they are undertaken with racist motives ern biology gives hope that the transfer and or aim at a materialist view of happiness, or if mutation of genes can ameliorate the condition they create people who are likely to be socially of those who are affected by chromosomal dis- marginalized (John Paul II, 1983). eases; in this way the smallest and weakest of

ORGAN AND TISSUE TRANSPLANTATION

he Catholic church considers the donation health and well-being of another person. In this Tof an organ to those who have need of it a sense, the medical act of transplantation makes “noble and meritorious act,” particularly if it is possible the donor’s act of self-giving, that sincere motivated by human and Christian solidarity— gift of self which expresses our constitutive calling “the love of neighbor, which forms the inspiring to love and communion. motive of the Gospel message, and which has Love, communion, solidarity, and absolute been defined, indeed, as the new command- respect for the dignity of the human person con- ment” (John Paul II, 1984a). stitute the only legitimate context of organ trans- John Paul II has been very supportive of plantation. It is essential not to ignore the moral organ and tissue transplantation. In a 1991 dis- and spiritual values which come into play when cussion focused on transplantation, he writes: individuals, while observing the ethical norms “We should rejoice that medicine, in its service which guarantee the dignity of the human person to life, has found in organ transplantation a new and bring it to perfection, freely and consciously way of serving the human family, precisely by decide to give a part of themselves, a part of their safeguarding that fundamental good of the per- own body, in order to save the life of another son” (John Paul II, 1991). He frames transplan- human being . . . tation in the context of gift: For Christians, Jesus’ offering of himself is the essential point of reference and inspiration of the This form of treatment is inseparable from a love underlying the willingness to donate an human act of donation. In effect, transplantation organ, which is a manifestation of generous soli- presupposes a prior, explicit, free and conscious darity, all the more eloquent in a society which decision on the part of the donor or of someone has become excessively utilitarian and less sensi- who legitimately represents the donor, generally tive to unselfish giving. (John Paul II, 1991; ERD, the closest relatives. It is a decision to offer, with- D. 63) out reward, a part of one’s own body for the

18 THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS CLINICAL ISSUES church statement regarding the procurement of tissue or organs from anencephalic newborns Issues concerning recipients has been made. However, one can infer a posi- Recipients of organs should not forget that they tion from church teaching on the dignity of the are receiving a gift of self offered by the donor. human person and on organ transplantation This is a profound act of human solidarity (John generally. Procurement of organs from anen- Paul II, 1991). cephalic newborns who have died would be treated like procurement from any other corpse. Issues concerning donors But the removal of organs while the infant is Organ and tissue donation from live donors is still living (breathing spontaneously) which considered to be morally acceptable if it is done results in the death of the infant would be a with the free and informed consent of the donor, form of homicide. The church does not permit if it does not deprive the donor of life or the the removal of organs if removal would cause integrity of an organ system, and if there is an the individual’s death. Nor would it permit the acceptable proportion between the good to be use of anencephalics merely as a source of experienced by the recipient and the harm done organs. to the donor (John Paul II, 1984a; CCC 1997: Much the same would be true of human no. 2296). fetuses. (See also “Experimentation on human Procurement of organs from corpses is also embryos,” above.) morally acceptable if respect is shown for the The sale of organs is condemned. “Such a body and the rights of the next of kin. It should reductive materialist conception would lead to a not normally occur without the consent of the merely instrumental use of the body, and there- next of kin or over the previous objections of fore of the person. In such a perspective, organ the potential donor (Pius XII, 1956). transplantation and the grafting of tissue would While a statement has been made by the no longer correspond to an act of donation but NCCB concerning the early delivery of anen- would amount to the dispossession or plunder- cephalic infants (NCCB 1996), no official ing of a body” (John Paul II, 1991).

MENTAL HEALTH

ot much attention has been given to the cation is undertaken for the well-being of the Ntopic of mental health in official church patient, achieves a suitable proportion between teaching. One of the few to address it was Pope benefits and risks or harms, and is attempted Pius XII, who was concerned primarily about with the informed consent of the patient or the compatibility of psychotherapy and clinical guardian, it would be considered ethical. psychology with a Christian understanding of Behavior control that is nontherapeutic and that the person (Pius XII, 1952). It would be safe to is undertaken for the benefit of others is consid- say, in view of the principles enunciated earlier, erably more difficult to justify, especially if it that no form of psychotherapy or chemical or results in harm to the patient. Respect for surgical manipulation of human behavior would human dignity and the integrity of the person be justifiable if it eliminated or severely limited are essential. human freedom or severely damaged the human Several moral principles provide further guid- personality. Short of this, if the behavior modifi- ance in this area:

THE PARK RIDGE CENTER 19 1. The functional integrity of the person may be Psychotherapy, behavior modification, and sacrificed to maintain the health or life of the per- psychopharmacology son when no other morally permissible means is Psychotherapy, behavior modification, and psy- available (ERD, D. 29). chopharmacology can be morally justified when 2. Therapeutic procedures that are likely to cause they are employed for the well-being of the harm or undesirable side effects can be justified patient and have the effect of enhancing the only by a proportionate benefit to the patient patient’s freedom. The principles noted above (ERD, D. 33). would guide these decisions. 3. The greater the person’s incompetency and vul- nerability, the more compelling the reasons must Electroshock be to perform any medical experimentation, espe- There is no official Catholic teaching on elec- cially nontherapeutic procedures (ERD, D. 31). troshock. The treatment would seem, however, to be justifiable on the basis of the principle of totality. It involves manipulating (and possibly damag- CLINICAL ISSUES ing) a part of the body for the good of the whole person. As with other interventions, the church Involuntary commitment insists on the free and informed consent of the There is no official Catholic teaching on this individual (to the degree possible) or the proxy. issue. But since involuntary commitment is a The full exploration of any less radical alterna- deprivation of human freedom, it could be justi- tives, and an acceptable proportion between fied only for a serious reason. harms and benefits, must also be reckoned.

DEATH AND DYING

atholicism views death as a natural event, also be a time of personal transformation and Cpart of the human condition. It is a fact of growth before the final summing up of one’s life life, inextricably bound up with human finitude. in death. The process of dying can provide Insofar as it ends an individual’s existence, rup- extraordinary opportunities for good to occur. tures relationships, disrupts lives, and creates Catholicism’s beliefs about the sacredness of profound losses, it is viewed as tragic and nega- human life should also be kept in mind when tive. But Catholics also believe that Christ, one is considering ethical issues in the care of through his death and resurrection, has over- the dying. Life is a sacred gift of the Creator and come the “sting of death.” Death is not the final a fundamental good. It is a good over which we word. Catholic Christians live in the hope of do not have complete power. As stewards, we their own resurrection. They face death with the have a duty to preserve life and use it for the confidence of faith. Death, then, makes possible purposes for which it was intended. But this a new and better existence, one that constitutes duty to prolong life is not absolute. Not every- the ultimate fulfillment of the human person thing must be done to preserve life, though and of human existence: union with God. nothing can be done intentionally and directly The dying process can also be a most impor- to end innocent human life (CDF, 1980). tant time, a time of preparation for the moment Finally, Catholicism’s approach to the care of of death. This preparation can include a deepen- the dying is shaped by a profound respect for ing of relationships and even a healing of rela- the dignity and total well-being of the person. tionships with God, family, and friends. It can These convictions have enabled Catholicism to

20 THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS avoid two extremes: maintaining life at all costs peace; of sharing, perhaps, a last intense rela- and directly hastening death. tionship between a person reduced to that last of human poverties and another person who will have been privileged by knowing him. And, if CLINICAL ISSUES the dying person is a Christian, he is being deprived of experiencing his death in commun- Determining death ion with Christ” (Pontifical Council 1981). So The Catholic church recognizes total brain death while it is permissible to attempt to reduce or as a criterion for determining that a person has even eliminate pain, it is not optimal to plunge died. The Pontifical Academy of Sciences has the patient into unconsciousness to do so, unless stated: “A person is dead when he has irre- that is absolutely necessary. There must be a versibly lost all capacity to integrate and coordi- compelling reason to deprive someone of con- nate the physical and mental functions of the sciousness in the attempt to relieve pain (ERD, body. Death has occurred when: A. The sponta- D. 61). neous cardiac and respiratory functions have The other danger or concern is the belief that definitively ceased; or B. An irreversible cessa- analgesics are sufficient to address pain and suf- tion of every brain function is verified” fering. The same Pontifical Council document (Pontifical Academy of Sciences 1985). The insists on the importance of human presence to ERD state that physicians should determine help alleviate pain. In particular they call for death on the basis of “commonly accepted sci- health professionals to be trained in how to lis- entific criteria” (D. 62). In cases of total brain ten to the dying, how to provide support for one death, the church also supports the use of another, and how to help families provide loving mechanical ventilation to prolong respiratory care throughout the dying process. and cardiac function so that organs may be The final issue in the use of pain medications removed for transplantation (Pontifical Academy is the problem of possibly hastening death of Sciences 1985; see also United States through the use of analgesics intended to relieve Catholic Conference Advisory Committee on pain. This issue was addressed by Pope Pius Ethical and Religious Directives for Catholic XII, and his position has been reiterated in sev- Health Facilities 1975). eral subsequent Vatican statements. The 1980 Vatican “Declaration on Euthanasia,” for exam- Pain control and palliative care ple, states: As previously noted, Catholicism upholds the belief that pain and suffering can be beneficial, At this point it is fitting to recall a declaration by but it does not see them as good in themselves Pius XII, which retains its full force; in answer to or as conditions to be endured without relief. a group of doctors who had put the questions: “Is The church not only supports but recommends the suppression of pain and consciousness by the the relief of pain and suffering—with some quali- use of narcotics . . . permitted by religion and fications, however. A major concern that sur- morality to the doctor and the patient (even at the faces in various ecclesiastical documents is the approach of death and if one foresees that the use fear that analgesics will be used to such an of narcotics will shorten life)?” the Pope said: “If extent that they will prevent the dying person no other means exist, and if, in the given circum- from experiencing his or her dying and doing stances, this does not prevent the carrying out of the work of dying. In the words of the Pontifical other religious and moral duties: Yes.” In this case, Council Cor Unum, the excessive use of anal- of course, death is in no way intended or sought, gesics “deprives him of arriving at a serene even if the risk of it is reasonably taken; the inten- acceptance of [death], of achieving a state of tion is simply to relieve pain effectively, using for

THE PARK RIDGE CENTER 21 this purpose painkillers available to medicine. “ordinary” and “extraordinary” means. Whether (CDF 1980; ERD, D. 61) a treatment was ordinary or extraordinary was determined by assessing its benefits and burdens Hence, the position of the church is that to the patient, not the nature of the treatment analgesics may be used in sufficient amounts to itself. For a particular patient, then, an IV, as relieve pain even if they may also shorten life, simple and common as it is, could be considered provided the latter effect is not intended. The “extraordinary means” if it would not benefit principle of double effect is operative here. the patient considered holistically or if it would impose excessive burdens on the patient. Forgoing life-sustaining treatment Likewise, a ventilator could, in appropriate cir- Catholic thinking and teaching regarding the cumstances, be considered “ordinary means” for matter of forgoing life-sustaining treatment dates a given patient. In other words, what makes a back to the sixteenth century. The first explicit treatment ordinary or extraordinary is not the discussion is to be found in the work of a simplicity or complexity of the treatment, its Spanish Dominican theologian, Francisco di common use, or its availability but rather its Vittoria. His fundamental principles are still impact upon the total well-being of the patient. valid: “God does not want us to worry about a Because of the ambiguity about the terminology long life, but a good life,” and, “It is one thing of ordinary and extraordinary means, the lan- to end one’s life, and another thing to not pro- guage of benefit and burden is preferable, long it.” He also addressed the moral obligation though it must be kept in mind that what is a to employ food to prolong life. Subsequent the- benefit and what a burden will vary from patient ologians refined di Vittoria’s position. This to patient and should be determined from the development probably culminated in the well- perspective of the patient (ERD, D. 57, 58). known 1958 statement of Pope Pius XII. The A particular form of forgoing life-sustaining most recent official statement on the matter is treatment that is still a subject of discussion is the 1980 “Declaration on Euthanasia” by the the withholding or withdrawal of artificially Congregation for the Doctrine of the Faith. administered nutrition and hydration. While The Catholic tradition has long supported for- there is no definitive Catholic position on this going life-sustaining treatment in certain cir- issue, a number of statements have been made cumstances based on the principle of benefit by various bishops and ecclesiastical bodies. and burden. In brief, there is a moral obligation Some believe that artificial nutrition and hydra- to accept treatments that prolong life if they are tion are to be considered medical treatments, of benefit to the patient and can be employed and decisions about them should be made on without excessive burden. The degree of burden the basis of the principle of burden and benefit. is to be judged by the patient or the patient’s Others believe that since nutrition and hydration surrogate and includes emotional, psychological, are so essential to life and such a basic form of spiritual, and economic burdens as well as phys- care, they must always be provided. The ical ones. There is, however, no moral obligation Directives take the following position: “There to utilize treatments that are of little or no bene- should be a presumption in favor of providing fit to the patient or that impose burdens dispro- nutrition and hydration to all patients, including portionate to the benefits hoped for or obtained patients who require medically assisted nutrition (CDF 1980). and hydration, as long as this is of sufficient Prior to the Vatican’s 1980 statement, forgo- benefit to outweigh the burdens involved to the ing treatment was usually discussed in terms of patient” (D. 58).

22 THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS Suicide, assisted suicide, and active the basic moral norm in Catholicism against euthanasia taking innocent human life for the reasons dis- Suicide, assisted suicide, and active euthanasia cussed above. In the words of the Vatican decla- are forbidden in the Catholic tradition. On the ration (CDF, 1980): matter of suicide, the CDF wrote in its “Declaration on Euthanasia” (1980): It is necessary to state firmly once more that nothing and no one can in any way permit the killing of Intentionally causing one’s own death, or suicide, an innocent human being, whether a fetus or an is . . . equally as wrong as murder; such an action embryo, an infant or an adult, an old person, or on the part of a person is to be considered as a one suffering from an incurable disease, or a per- rejection of God’s sovereignty and loving plan. son who is dying. Furthermore, no one is permitted Furthermore, suicide is also often a refusal of love to ask for this act of killing, either for himself or for self, the denial of the natural instinct to live, a herself or for another person entrusted to his or flight from the duties of justice and charity owed her care, nor can he or she consent to it, either to one’s neighbor, to various communities, or to explicitly or implicitly. Nor can any authority legiti- the whole of society—although, as is generally rec- mately recommend or permit such an action. For it ognized, at times there are psychological factors is a question of the violation of the divine law, an present that can diminish responsibility or even offense against the dignity of the human person, a completely remove it. crime against life, and an attack on humanity.

The church recognizes that most suicides occur This opposition to euthanasia is reiterated in at as the result of psychiatric factors and, conse- least three recent statements by the current quently, that the individual is usually not held to pope (John Paul II, 1984b; 1985; 1995: n. 64- be fully responsible for the act. 66; see also ERD, D. 60; CCC 1997: nos. 2276- The Vatican “Declaration on Euthanasia” 83). defines euthanasia as “an action or an omission which of itself or by intention causes death, in Autopsy and postmortem care order that all suffering may in this way be elimi- Autopsy is morally permitted in Catholicism, nated” (CDF 1980). Hence, the key elements in provided that the body is not treated merely as a determining whether an action is euthanasia are thing and that consent has been obtained from the intention implicit in the act and the means. the next of kin (Pius XII, 1954). These two elements are what distinguish “allowing to die” or “forgoing life-sustaining treat- Last rites, burial, and mourning customs ment” from euthanasia. In allowing to die, the The celebration of the Eucharist is central to intention of the external act is not directly to Catholic belief and life and is likewise central to bring about death but rather to cease employing religious rites for the deceased. There is a spe- treatments that are ineffective or burdensome, cial funeral liturgy for Catholics who have died: even though it may be known that the patient the Mass of Christian Burial. This usually takes will die sooner as a consequence. The principle place in the deceased individual’s parish church, of double effect is operative here. When a per- with the body present, two or three days after son is allowed to die, the cause of death is the the individual has died. In some locations, the underlying pathology, whereas in euthanasia, it visitation, wake, or vigil takes place in the is the means itself (which is entirely extrinsic to church prior to the funeral liturgy. the pathology) that brings about death. Because Prior to the Second Vatican Council, the death is directly intended and brought about in Catholic funeral ritual was somber. This tone euthanasia, it is morally forbidden. It violates was reflected in the prayers, hymns, and vest-

THE PARK RIDGE CENTER 23 ments of the priest (black). Since Vatican II, the vided that it has not been chosen “for reasons general theme of the Catholic funeral service which are contrary to Christian teaching” (C. has been resurrection. Now one finds the use of 1176.3). white vestments, hymns and prayers referring to Christ’s resurrection from the dead, and use of Stillbirths the Easter candle which symbolizes the risen Two issues arise in the case of stillbirths: bap- Christ (CCC 1997: nos. 1680-90). tism and burial. The practice of the church, Burial is normally in the earth, though use of reflected in an earlier Code of Canon Law (C. mausoleums and even of cremation is permitted. 747), is that if a fetus is delivered clearly dead, it Until 1969, cremation was banned because it should not be baptized. If, however, there is any was used by some as a denial of the resurrec- doubt that it is dead, it should be baptized con- tion. Today, however, it has become a practical ditionally. Stillborn fetuses should be buried, for way of dealing with the corpse and does not according to the church’s teaching, they are usually carry with it a denial of resurrection. considered human beings with all the rights of The Code of Canon Law permits cremation, pro- persons.

SPECIAL CONCERNS

ATTITUDES TOWARD DIET AND THE USE RELIGIOUS OBSERVANCES OF DRUGS Anointing of the sick Catholics are required to fast on Ash Wednesday The sacrament of the sick or the “anointing of and Good Friday. On those days they cannot the sick” is among the seven sacraments that take solid foods between meals, and the smaller the church celebrates. The ritual part of the meals taken during the day cannot equal the church’s pastoral care of the sick and the dying, main meal of the day. This applies to people the practice goes back to the early days of the between 18 and 59 years of age. Catholics must church. Until 1972, when the rite was reformed also abstain from eating meat on Ash in accordance with the Second Vatican Council, Wednesday, the Fridays of Lent, and Good it was referred to as “extreme unction” or the Friday. Both fasting and abstinence are occa- “last anointing” and was usually reserved for the sions for reflecting on one’s life, expressing sor- imminently dying. Today it is offered to any row for sin, and resolving to reform one’s life. Catholic who is experiencing illness or debilita- The local pastor can grant dispensations from tion in order to provide spiritual strength as well these requirements. Illness would normally be a as to express the support of the community. The sufficient reason for such a dispensation. ritual consists primarily in praying and in In addition, Catholics must refrain from food anointing with oil (CCC 1997: nos. 1499-1525). and drink, with the exception of water and medicine, for at least one hour prior to receiving Sacrament of reconciliation communion. This does not apply, according to The sacrament of reconciliation, also one of the the Code of Canon Law (C. 919.3), to those of seven sacraments, involves the confession of advanced age or to those “who suffer from any one’s sins to a priest, the representative of infirmity” and those who care for them. There Christ, in order to obtain forgiveness. It is the are no other dietary observances or require- ritual whereby sinners are reconciled with God, ments in Catholicism. the church, and fellow human beings. It is an

24 THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS important part of the spiritual care of the ill, and and the feast of All Saints on November 1). On of the terminally ill in particular (CCC 1997: holy days of obligation Catholics are required to nos. 1422-70). participate in the celebration of the Eucharist, though their pastor can give them dispensation Eucharist for a “just and reasonable cause.” Illness and Eucharist can refer either to the liturgical cele- disability would normally be sufficient reasons bration of the Eucharist, the commemoration of for being granted dispensation from participat- Christ’s last supper with his disciples and ing in the Eucharist. Catholicism’s most important ritual, or to recep- tion of the wafer (holy communion), consecrated Prayer during the celebration of the Eucharist and Prayer is an important part of Catholic life. In believed to be the body of Christ. This is a par- addition to praying to God, Catholics pray to ticularly important spiritual observance for Mary, as the mother of Christ, and to the saints. Catholics because it symbolizes and effects Many Catholics make use of representations of union with Christ and with members of the Mary or the saints in the form of pictures or Christian community. Eucharist is especially statues. Two common forms of prayer among important during a time of illness (CCC 1997: more traditional Catholics are the rosary and the nos. 1322-1419). novena. The former consists in the use of beads which have five sets of ten beads each. The Holy days prayer “Hail Mary” is said on each bead, and Sunday is the primary day of worship for each “decade” is introduced by the Lord’s Catholics. On this day, Catholics are bound to Prayer and concluded with a prayer (the participate in a celebration of the Eucharist (the Doxology) that praises the three persons in Mass) and to refrain from labors that might dis- God—Father, Son, and Spirit. A novena consists tract them from the worship of God or impede in repeating a particular prayer nine consecutive physical and mental relaxation. “Holy days of times (for example, nine days, nine Saturdays, obligation” are days that celebrate events in the nine first Fridays of each month). Usually nove- life of Christ or that honor his mother or the nas are prayed with a special intention. saints (Christmas, the Ascension of Christ, Mary the Mother of God on January 1, the Fasting Assumption of Mary on August 15, the See “Attitudes toward diet and the use of drugs,” Immaculate Conception of Mary on December 8, above.

THE PARK RIDGE CENTER 25 NOTES

1. The following sources inform this historical section: 4. Ethical and Religious Directives for Catholic Health McBrien 1980: vol. 2, 569-655 (pt. 4, “The Church”); Care Services (ERD), revised and published by the Melton 1993: vol. 1, 5-29 (chap. 1, “The Liturgical United States Conference of Catholic Bishops in 2001, Family” [Western tradition]); and Numbers and provides authoritative ethical guidance to all Catholic Amundsen 1986: 40-145 (chaps. 2-4). healthcare facilities. It can also serve as a helpful resource for understanding a Catholic approach to 2. For further discussion of the development of Catholic ethical issues in health care. The 1997 Catechism of medical ethics, see Kelly 1979. the Catholic Church (CCC) is another helpful resource for gaining a better understanding of the beliefs and 3. Unless otherwise noted, all quotations of ecclesiastical practices of Catholicism. documents have been taken from Kevin O’Rourke and Philip Boyle’s Medical Ethics: Sources of Catholic Teaching (1993). This volume contains excerpts from ecclesiastical documents on a wide variety of topics in medical ethics. The topics are arranged alphabetically. Additional bibliographical information on the ecclesiastical documents can be found there.

BIBLIOGRAPHY

Amundsen, Darrel W. 1986. “The Medieval Catholic ______. 1985. “The Mystery of Life and Death.” Tradition.” In Numbers and Amundsen, eds.: 65-107. ______. 1991. “Many Ethical, Legal, and Social Questions Catechism of the Catholic Church. 1997. Second edition. Must Be Examined in Greater Depth.” Washington, D.C.: United States Catholic Conference. ______. 1995. “The Gospel of Life” (Evangelium vitae). Congregation for the Doctrine of the Faith (CDF). 1974. New York: Random House. “Declaration on Procured Abortion.” Kelly, David. 1979. The Emergence of Medical Ethics in ______. 1975a. “Declaration on Certain Problems of Roman Catholicism. New York: Edwin Mellon Press. Sexual Ethics.” McBrien, Richard P. 1980. Catholicism. Vol. 2. ______. 1975b. “Sterilization in Catholic Hospitals.” Minneapolis: Winston Press.

______. 1980. “Declaration on Euthanasia.” Melton, J. Gordon. 1993. The Encyclopedia of American Religions. Detroit: Gale Research. ______. 1987. “Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation.” National Conference of Catholic Bishops. 1980. “Statement on Tubal Ligations.” Washington, D.C.: United States John Paul II. 1980. “A Patient Is a Person.” Catholic Conference.

______. 1981. “The Christian Family in the Modern ______. 1986. “The Rights of the Terminally Ill.” Origins World.” 16, no. 12 (4 September): 222-24.

______. 1982. “Biological Experimentation.” ______. 1996. “Moral Principles Concerning Infants with Anencephaly.” Origins 26, no. 17 (10 October): 276. ______. 1983. “The Ethics of Genetic Manipulation.” Numbers, Ronald L., and Darrel W. Amundsen, eds. 1986. ______. 1984a. “Blood and Organ Donors.” Caring and Curing: Health and Medicine in the Western Religious Traditions. New York: Macmillan. ______. 1984b. “Opposing Euthanasia.”

26 THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS O’Rourke, Kevin, and Philip Boyle. 1993. Medical Ethics: Pontifical Council Cor Unum. 1981. Questions of Ethics Sources of Catholic Teaching. Second edition. Regarding the Fatally Ill and Dying. Washington, D.C.: Georgetown University Press. Second Vatican Council. 1965. “The Church in the Modern Paul VI. 1968. “Encyclical Letter on Human Life.” World” (Gaudium et Spes).

Pius XI. 1930. “Encyclical Letter on Christian Marriage.” United States Catholic Conference. 1978. “Pastoral Statement of the United States Catholic Bishops on Pius XII. 1944. “Christian Principles and the Medical Handicapped People.” Washington, D.C.: United States Profession.” Catholic Conference.

______. 1949. “Christian Norms of Morality.” United States Catholic Conference Advisory Committee on Ethical and Religious Directives for Catholic Health ______. 1951. “Fundamental Laws Governing Conjugal Facilities. 1975. “Guidelines for the Determination of Relations.” Brain Death.” Hospital Progress 56 (December): 26.

______. 1952. “The Intangibility of the Human Person.” United States Conference of Catholic Bishops. 2001. Ethical and Religious Directives for Catholic Health ______. 1953. “Moral Aspects of Genetics.” Care Services. Washington, D.C.: United States Conference of Catholic Bishops. ______. 1954. “Moral Problems in Medicine.” Vatican Congregation for Catholic Education. 1983. ______. 1956. “Tissue Transplantation.” “Educational Guidance in Human Love.” Origins 13, no. 27 (15 December): 451-53. ______. 1957. “The Prolongation of Life.”

Pontifical Academy of Sciences. 1985. “Report on Prolonging Life and Determining Death.”

THE PARK RIDGE CENTER 27 Introduction to the series

eligious beliefs provide meaning for people gious views on clinical issues. Rather, they Rconfronting illness and seeking health, partic- should be used to supplement information com- ularly during times of crisis. Increasingly, ing directly from patients and families, and used healthcare workers face the challenge of providing as a primary source only when such firsthand appropriate care and services to people of different information is not available. religious backgrounds. Unfortunately, many We hope that these booklets will help practi- healthcare workers are unfamiliar with the reli- tioners see that religious backgrounds and beliefs gious beliefs and moral positions of traditions play a part in the way patients deal with pain, ill- other than their own. This booklet is one of a ness, and the decisions that arise in the course of series that aims to provide accessible and practical treatment. Greater understanding of religious tra- information about the values and beliefs of differ- ditions on the part of care providers, we believe, ent religious traditions. It should assist nurses, will increase the quality of care received by the physicians, chaplains, social workers, and adminis- patient. trators in their decision making and care giving. It can also serve as a reference for believers who desire to learn more about their own traditions. Each booklet gives an introduction to the history of the tradition, including its perspectives on health and illness. Each also covers the tradition’s positions on a variety of clinical issues, with attention to the points at which moral dilemmas often arise in the clinical setting. Final- ly, each booklet offers information on special concerns relevant to the particular tradition. The editors have tried to be succinct, objective, and informative. Wherever possible, we have included the tradition’s positions as reflected in official statements by a governing or other formal body, or by reference to positions formulated by authorities within the tradition. Bear in mind that within any religious tradition, there may be more than one denomination or sect that holds views in opposition to mainstream positions, or THE PARK RIDGE CENTER groups that maintain different emphases. FOR THE STUDY OF HEALTH, FAITH, AND ETHICS The editors also recognize that the beliefs and 205 West Touhy Avenue ● Suite 203 ● Park Ridge, Illinois 60068-4202 values of individuals within a tradition may vary from the so-called official positions of their tradition. In fact, some traditions leave moral deci- The Park Ridge Center explores and sions about clinical issues to individual enhances the interaction of health, faith, conscience. We would therefore caution the read- and ethics through research, education, and consultation to improve the lives of er against generalizing too readily. individuals and communities. The guidelines in these booklets should not substitute for discussion of patients’ own reli- © 2002 The Park Ridge Center. All rights reserved.

28 THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS