Archive for the ‘bioethics’ Category

British Parliament Launches Inquiry on Age Limit

By Father John Flynn, LC
ROME, OCT. 22, 2007 (Zenit.org).- A long-running debate over age limits for abortions was renewed last week in England. Current law allows abortions up to the 24th week of pregnancy, but improvements in survival rates for babies born prematurely have led to pressure for the limit to be lowered.

The Abortion Act of 1967 originally set at 28 weeks the legal limit for abortions. Then, in 1990, Parliament agreed to lower the time limit to 24 weeks.

An inquiry into the age limits commenced Oct. 15 by the House of Commons committee on science and technology. The committee Web page noted that the terms of reference for the inquiry do not include the ethical or moral questions related to the debate, but will concentrate on scientific and medical evidence about fetal viability.

One of those backing a reduction in the age limit is obstetrician Stuart Campbell, reported the Telegraph newspaper on Oct. 15. Campbell pioneered three-dimensional scans of fetuses sucking their thumbs and walking in the womb.

Campbell used to perform abortions at 20 weeks, the Telegraph reported. “I feel pretty appalled at the idea that we abort normal babies and most of them are born alive and most of them are allowed to die,” he said during a BBC radio program.

The committee’s Web site contains several hundred pages of evidence submitted to the inquiry.

A submission from the Department of Health to the committee provided information about abortions in England and Wales. In 2006, there were 193,700 abortions. Of these, 89% were carried out at under 13 weeks of pregnancy.

Out of the total number, 2,948 abortions were performed at 20 weeks and over. Of these, 1,262 were performed at 22 weeks and over, and 136 at 24 weeks and over.

Christian opposition

The Christian Medical Fellowship, an interdenominational Christian organization with more than 4,500 British doctor members, is in favor of a reduction. In its submission to the committee, it outlined a number of concerns related to abortion.

For a start, it argued that maternal mortality after abortion is higher than currently recognized. Moreover, the fellowship noted, strong evidence exists that induced abortion increases risk of premature birth in subsequent pregnancies. Such premature births not only cause neonatal mortality and ongoing disability, but also imply significant economic costs.

There is overwhelming recent evidence that abortion causes significant rates of serious mental health problems, the submission continued. Several studies have demonstrated higher levels of depression, suicidal tendencies, and problems with drug and alcohol use among women who have undergone abortion.

The fellowship also called for Parliament to reconsider the norms for abortions for reasons of fetal abnormality. The upper limit for abortion for disabled babies should not be higher than that for able-bodied babies.

Handicapped

The question of disabled babies being aborted was also raised by the London-based Lejeune Clinic for Children With Down Syndrome. In its submission to the parliamentary committee they said that in 2005 alone, 429 abortions were carried out on babies with Down syndrome. The law sets no time limits for abortions on babies that are held to be disabled.

The clinic also commented that after Down syndrome is detected, some women feel pressured to abort their babies. As well, very few women are offered information on help available to raise a child with the chromosomal disorder.

The submission argued that most children with Down syndrome are happy, sociable and enjoy friendships. Around 80% attend mainstream primary school, either full or part time, and nearly all integrate in a loving fashion into their families. Behavioral problems can occur, but this can be helped, the clinic pointed out.

In its conclusions, the clinic argued: “It is hard to see how the majority of children with Down syndrome fulfill the criteria for abortion on the ground of serious untreatable disability.” In fact, the majority suffer from only moderate learning difficulties and treatable physical health problems.

A written submission to the parliamentary committee was also made by the Pro-life Alliance (PLA). It started by noting its objection to any form of intentional abortion, at whatever age limit of the fetus.

Benefit of the doubt

Nevertheless, within the context of the current debate the PLA observed, “At the very least one would expect consensus in the country against the abortion of a viable baby, with the benefit of the doubt always on the side of the baby.”

Another pro-life group, also opposed to any form of abortion, which made a submission was the nonprofit organization Comment on Reproductive Ethics (CORE). Opinions over abortion vary widely, it observed, but there is common concern over the rising abortion rates in Britain.

The CORE submission also called for greater transparency about abortions. Currently 97% of all abortions are justified under Ground C of the Abortion Act, which groups together both the medical or psychological health of the mother as a justification. It would be much better, CORE argued, for the two to be separated as they are quite diverse conditions.

It also called for greater transparency for abortions performed on the grounds of fetal abnormality. The submission mentioned the 2001 case of a baby aborted at 7 months for cleft palate, which caused a major public reaction.

After the outcry over this case the government’s statistics became notably less specific in identifying details of the abnormalities for which abortions have been performed.

Defending life

A petition for changes in the abortion law also came from Scotland, in the form of an article published in the Scotsman newspaper July 6 by Cardinal Keith O’Brien, archbishop of Saint Andrews and Edinburgh. The Catholic leader called on Prime Minister Gordon Brown to review the law and thus ensure greater respect for human life.

The Scotsman reported that the latest data show that 13,081 abortions were carried out in Scotland in 2006, compared with 12,603 the year before — the fourth consecutive annual increase.

“Abortion is neither political nor medical, though clearly it has implications in these spheres,” the cardinal stated. “It is about morality and the destruction of human life.”

Cardinal O’Brien praised Brown for being “a man of principle and deeply held moral convictions,” and noted his efforts to reduce poverty in developing nations. He then called on the prime minister to support human life for those who are unborn.
“What exists in the womb is not ‘a potential human being,’ but rather ‘a human being with potential,'” the cardinal argued.

Not a right

Benedict XVI also had strong words to say recently on protecting unborn life. During his trip to Austria, he addressed the members of government and diplomatic corps Sept. 7.

During his speech, given in the reception hall of Vienna’s Hofburg Palace, the Pontiff recalled that Europe is the place where the notion of human rights was first formulated.

“The fundamental human right, the presupposition of every other right, is the right to life itself,” the Pope pointed out. “Abortion, consequently, cannot be a human right — it is the very opposite.”

Benedict XVI acknowledged the difficulties women experience in going ahead with difficult pregnancies, but at the same time, expressed his concern for the unborn children who have no voice.

He called upon political leaders to help bring about a society that welcomes children and encourages young married couples to start new families. Doing so, the Pope added, requires creating “a climate of joy and confidence in life, a climate in which children are not seen as a burden, but rather as a gift for all.” A gift unfortunately too often rejected by society today.



Debunking the Papal “Euthanasia”

Doctor Assails Claims Surrounding John Paul II’s Death

ROME, OCT. 11, 2007 (Zenit.org).- Here is a translation of a response written by Doctor Renzo Puccetti, specialist in internal medicine and secretary of the Association Science and Life of Pisa and Livorno, Italy, to claims that Pope John Paul II was euthanized.

He responds to the article of Doctor Lina Pavanelli, medical anesthesiologist and professor at the University of Ferrara, titled “La Dolce Morte di Karol Wojtyla” (The Sweet Death of Karol Wojtyla), which appeared in the May edition of the bimonthly Italian magazine Micromega.

Time Magazine reported on Pavanelli’s statements in the Sept. 21 story titled “Was John Paul II Euthanized?”

* * *

An article that recently appeared in the Italian political magazine Micromega has attracted some attention in the medical community, mostly because of the relevance of the person whom it discusses.

According to this article, Pope John Paul II is supposed to have died as the result of an omission in medical care that the Pontiff himself had desired as a patient.[1] The author of the article, Lina Pavanelli, an anesthesiologist and political activist, says that her findings are not the result of firsthand knowledge of the clinical situation of the events and the patient — she had never paid a direct visit to Karol Wojtyla — but stem from an Internet news search and the reading of a recent book by the Pope’s personal physician, Renato Buzzonetti.[2]

We can divide the article into two parts. In the first part the author furnishes a personal evaluation of the last weeks of John Paul II’s life based on the above-mentioned sources. This is a reconstruction that, at least in intention, should be technical and scientific. In the second part of the article this reconstruction becomes a point of departure for a kind of bioethical evaluation dealing with the issues surrounding end-of-life care and euthanasia.

We will attempt to show how, using the same research methods, it is possible to arrive at conclusions that are diametrically opposed to those of article under discussion. The thesis advanced by the libel can be summarized in the following way: Because the Pope’s Parkinson’s had caused him to have difficulty swallowing it would have been necessary to insert a nasal-gastric feeding tube and start artificial nutrition much earlier than had actually been done.

According to the author, who holds that any omissions on the part of the medical personnel who cared for the Pontiff were “improbable,” the delay in starting the artificial nutrition is to be imputed — as the only “plausible” hypothesis — to Pope Wojtyla himself, who, despite being “informed” and having “understood” “the gravity of the situation and the consequences of his decision,” is supposed to have “refused”;[3] such a procedure was allegedly understood by the patient himself as “aggressive medical care.”[4]

And yet this decision of the Pontiff to not be fed supposedly brought on the fatal crisis prematurely by weakening the defenses of the Pope’s immune system. The author has no doubts: “Karol Wojtyla would have been able to live for a long time, but he rejected this option.”[5]

It is claimed that the naturalness of the Pope’s death was only an appearance, “sweetly false.”[5] John Paul II was supposedly “sweetly accompanied along an easier route, toward a less dramatic end than he would have met.”[6]

From this assertion and from various Church documents that indicate that hydration and artificial nutrition are normal and obligatory, the author goes on to accuse Catholics and the same Pope of inconsistency — it is probably not by chance that Matthew 7:3 is cited at the beginning.

According to Catholic moral teaching, in fact “when a patient consciously refuses life-saving treatment, his action, along with the compliance or omission of the physicians, must be considered as constituting euthanasia, or, more precisely, assisted suicide.”[7] This is why, according to the author, there is no difference between the case of Piergiorgio Welby and the death of Karol Wojtyla: “The only difference is that [Welby] had breathing support removed at his request, whereas [Wojtyla] chose not to have support in the first place. Both patients died on account of their not having the necessary apparatus to keep them alive.”[6]

We have multiplied the citations so as not to incur misunderstandings. From here we would offer an alternative analysis of the facts. In regard to the presumed delay in starting artificial nutrition through nasal-gastric feeding tubes, the author speaks of the necessity of this measure in “the last two months of [the Pope’s] life”[6] — therefore, from the beginning of February, postulating a two-month delay in medical treatment, pointing to March 30 as the day in which the feeding apparatus was installed.[8] The Holy Father was allegedly malnourished for almost two months, from the beginning of February to the end of March. And yet there are a number of elements that contradict such an assumption, some are related by the author herself.

On the evening of Feb. 1 the Pope was at dinner,[9] thus, he was able to eat, but having difficulty breathing, he was hospitalized at Gemelli, where he remained until Feb. 10. On Feb. 3 the Vatican spokesman, Joaquín Navarro Valls, referring to the general condition of the Holy Father, adds that “he eats normally and alternative forms of nourishment have been excluded.”[10]

This claim does not convince Pavanelli, who suspects that already at this time, contrary to the official statements, malnourishment had manifested itself, making the nasal-gastric feeding tube necessary. Pavanelli’s hypothesis is difficult to reconcile with the fact that the difficulty in swallowing in question often regards not only solid food but liquids and is accompanied by the danger of aspiration pneumonia.[11] This would be a situation in which the positioning of a nasal-gastric feeding tube, even for preventative purposes, would have been necessarily urgent; the supposed refusal by the patient is incongruous with his later agreement to the more invasive tracheotomy procedure.

That the Pope’s nutritional problems need not have been grave can also be adduced from the fact that on Feb. 23, the eve of his last hospitalization, the Holy Father was at dinner,[12] and from the Feb. 24 statement by the director of the Parkinson’s Center at the Milan Istituti Clinici di Perfezionamento, Gianni Pezzoli: The Pope “recovered very well after his first stay in the hospital.”[5] Immediately following the tracheotomy, sources report him eating again — a caffe latte, 10 small cookies, a yogurt[13] — it is hard to imagine a sudden recovery of the capacity to swallow after having lacked it for nearly a month.

So knowing the skill of the medical personnel at Gemelli and the long-established relationship of confidence between them and John Paul II, along with his absolute and total abandonment to the Mother of God, it is hard to imagine a negligence in vigilance in regard to symptoms of solid-food swallowing problems over the whole period of the Pope’s last hospital stay until March 13. Doctor Buzzonetti subsequently clarified that the Pope was outfitted with the nasal-gastric feeding tube from Monday of Holy Week, that is, March 21,[14] and that during the Via Crucis [on Good Friday] the Pontiff was lying on his back precisely for this reason.

The presumed omission, then, would not regard a whole two months but, in the worst case, only eight days, an interval of time in which it is possible and likely that the doctors were waiting and watching in hopes of a possible improvement in the ability to swallow, an improvement which, when it did not present itself, it is possible that the medical personnel decided on the feeding tube. It is, moreover, difficult to understand how Pavanelli can infer the reduced efficaciousness of the tube from brief interruptions of a few minutes that occurred when the Pope appeared at the window of his Vatican apartments.[15] I cannot but admire Pavanelli’s ability in two different articles to define the same removal and re-application of the tube first as “not at all risky,”[3] “simple and not traumatic,”[16], and then as a torment.[15]

But Pavanelli’s consideration of the concept of natural death in this context is even more stupefying, if this is possible. It is stupefying that she interprets Pope Benedict’s XVI’s expression “natural passing away” as a death without any modification to the natural course of the illness[5] and not rather as a death that takes account of man, of his ontologically rational nature, respecting him, a death that takes place in the presence of reasonable care, or, more exactly, care that is proportionate to the situation.

On many points Pavanelli seems to want to advance the idea that trying from time to time to patch up the malfunctioning organs of a gravely sick organism, one can put off death almost indefinitely[5; 17], almost as if, with the nutritional problem being resolved, Pope Wojtyla would have certainly lived for a long time.

Unfortunately, the scientific literature teaches that after 10 years of sickness, despite all the modern medical helps available, patients suffering from Parkinson’s continue to have a mortality rate 350% greater than that of others the same age who do not have the disease.[18]

In the end, the author’s position seems to be strongly influenced by a retrospective reading of the events, forgetting — at least this appears to be the case — that often in medicine the nature of the actions and omissions is revealed only by the time decreed by the consequences. It is a consideration that renders the difference between the Welby case and Pope Wojtyla’s evident. In the Welby case the consequences of disconnecting the patient from the ventilator were well-known — it was a consequence that was desired, wanted by the patient, and accepted by the physician.

In the Pope’s case honesty forces us to recognize that the theoretically possible, although improbable and undemonstrated, delay of some days in the start of artificial nutrition was dictated by contingent situations unknown to us, perhaps with a view to the opportune moment for the placement of a PEG tube (percutaneous endoscopic gastrostomy)[19], or in the hope of the patient’s functional recovery.

This leads us to the, so to speak, bioethical interpretation that the author gives of the events, an interpretation that uses in an inappropriate way official texts of the Church and the magisterium together with the resolutions of authoritative bioethical consensuses and Catholic authors to argue that any omission of life-saving treatment must be considered as euthanasia and as such implicates the patient who voluntarily refuses such treatment along with the medical personnel who consent to his refusal.[7] Such a perspective completely distorts the content itself of the documents of the Church, which always, along with the clear indications of general norms, take care to underscore the necessity of specifying the subject and the circumstances in the moral judgment of the actions to which conscience is called.

Furthermore, Doctor Pavanelli completely fails to consider the content of the agent’s intention. In a 1980 document titled “Iura et Bona,” the Congregation for the Doctrine of the Faith defines euthanasia as death procured “with the purpose of eliminating all suffering.”[20]

As Pessina observes, there is a difference between a request for death and putting one’s life in the service of others through the category of “sacrifice.”[21] If one is not able to see the difference between euthanasia and the conduct of John Paul II, then one is unable to see the difference between taking and giving. What we have here is a choice that unites those who, while they consider life a primary good, do not consider it the absolute good, who remember that “No one has greater love than this: to lay down his life for his friends” (John 15:13), who have not refused Jesus’ example, but have followed it to the very end: “Totus tuus.”[22]

* * *

[1] Lina Pavanelli, “La dolce morte di Karol Wojtyla,” Micromega. May 2007: pp. 128-140.
[2] Ibid., p. 129.
[3] Ibid., p. 137.
[4] Ibid., p. 132.

[5] Ibid., p. 135.
[6] Ibid., p. 136.
[7] Ibid., p. 138.
[8] Ibid., p. 133.

[9] Archbishop Stanislaw Dziwisz, “Una vita con Karol,” Rizzoli. 2007: p. 219.
[10] Lina Pavanelli, op. cit., p. 131.
[11] E. Alfonsi, et al., “La disfagia oro-faringea nelle sindromi parkinsoniane. Aspetti clinico-elettrofisiologici e terapeutici,” Oral presentation at the XXXIII National LIMPE Congress, Stresa. Nov. 15-27, 2006.
[12] Ibid. 9, p. 220.

[13] “Pope Breathing Well After Tracheotomy,” ZENIT. Feb. 23, 2005.
[14] Luigi Accattoli, “Quel sondino che nutriva Wojtyla,” in Corriere della Sera. Sept. 15, 2007.
[15] Lina Pavanelli, op. cit.
[16] Ibid. 1, p. 132.

[17] Ibid. 1, p. 134.
[18] Chen H, et al., “Survival of Parkinson’s Disease Patients in a Large Prospective Cohort of Male Health Professionals,” Mov Disord. July 21, 2006: Vol. 7:1002-7.
[19] “Papa, niente udienza del mercoledì e si parla di un nuovo intervento,” La Repubblica. March 29, 2005.

[20] Congregation for the Doctrine of the Faith, “Iura et Bona,” (Declaration on Euthanasia). May 5, 1980.
[21] Adriano Pessina, “Eutanasia. Della morte e di altre cose,” Cantagalli. 2007: pp. 49-51.
[22] Ibid. 9, p. 221.



When Bioethics Turned Secular

Interview With Physician Father Joseph Tham

ROME, OCT. 8, 2007 (Zenit.org).- Recent news on the creation of hybrid embryos in England, and the U.S. debate on the use of embryos in research and cloning, all point to an increasingly secular agenda in life issues.

Legionary of Christ Father Joseph Tham, a physician and bioethicist who recently defended his doctoral dissertation on “The Secularization of Bioethics: A Critical History,” told ZENIT that this is yet another effect of the trend to push religion out of the social sphere.

The author of a book on natural family planning, “The Missing Cornerstone,” he teaches at the School of Bioethics of the Regina Apostolorum university.

Q: Can you tell us something about the religious roots of bioethics?

Father Tham: Since time immemorial, religion has been an integral part of medical ethics. Recent studies have demonstrated that even the Hippocratic oath is a product of a religious community founded by Pythagoras.

In the West, Christianity has clearly influenced the founding of hospitals and the care of the sick. There is a long tradition of medical ethics based on the sacraments and the virtues since the Middle Ages.

Many of the codes of ethics professed by physicians today were undoubtedly of Christian inspiration, and Catholics have produced very sophisticated manuals on medical ethics up until recently.

In fact, if you look at the names of the pioneers in the early days of bioethics, which began in the late 1960s in America, a majority of them were clerics or were very committed to religion.

Q: Why has bioethics turned secular?

Father Tham: In part, there has been a struggle since the Enlightenment to cast religion out of all spheres of society. We can certainly see this happening in the areas of culture, science, economics, law, philosophy and education.

Most people would agree that Europe and many countries in the West have become very secular today, and Benedict XVI has repeatedly spoken about this.

What happened in the ’60s and the ’70s was that many theologians and religious ethicists turned secular. Unwittingly, they have yielded to the secular culture that was exerting a great deal of pressure for them to conform.

Q: What are some of the reasons that caused them to turn away from their religious roots?

Father Tham: The causes are complex, and some of them are, as I said, the cultural ambience of the time. Remember, the ’60s were kind of crazy years. Among these, I will mention two crucial events: one is the secularization of the academy and the other is the theological debates in this period.

Many Ivy League universities such as Princeton, Yale and Harvard were originally founded by Protestant denominations. Religion was practiced and promoted in these schools originally, but at the turn of the last century, partly because of economic pressures and partly to become “inclusive” in the increasingly plural culture, many of these academies dropped their distinctive Christian features.

Catholic colleges and universities were also affected by this desire to shed themselves of their “sectarian” image. Thus, many institutions of higher studies became severed from their religious roots. This is still hotly debated today among Catholic educators, as witnessed by the question of implementing John Paul II’s apostolic constitution “Ex Corde Ecclesiae.”

Since most bioethicists were reared in this academic circle, many of them moved along with their institutions down the secular path.

The ’60s were also a period of theological experiments and controversies. At the turn of the last century, the Protestant denominations were embroiled in the questions of demythologization of the Scripture, Protestant liberalism, the Social Gospel movement, and the “death of God” theologies. Their Catholic counterparts, around the same time, were modernism and semirationalism. All these tendencies came to the fore in the ’60s in leading theological currents.

Vatican II sought to address many of these issues as the Church confronted the postmodern era. However, a major incident that greatly impacted the development of moral theology was the contraception controversy, especially with the issuance of the encyclical “Humanae Vitae” in 1968.

Q: How did this encyclical affect the beginning of bioethics?

Father Tham: As you may recall, “Humanae Vitae” was not well received by many Catholics. Some 600 theologians signed a letter of protest that originated from Father Charles Curran. This definitely undermined the Church’s authority in making pronouncements in the areas of morality.

As a result of this rejection of official Church teaching, many theologians began to criticize natural-law theory, especially its insistence on objective moral evil and absolute norms.

What came as a result of this discontent has been termed the “new morality,” or proportionalism, which has plagued many seminaries and theology departments since then. This was specifically addressed by Pope John Paul II in the 1994 encyclical “Veritatis Splendor.” But the problem persists in many parts of the Church.

Q: Has this affected bioethics directly?

Father Tham: Certainly; proportionalism tends to emphasize the consequences and circumstances of the moral act. When carried to the extreme, it could justify abortion or euthanasia because there are more good consequences than bad ones. It is the common rationale we hear today in many of these bioethical debates where the ends justify the means.

On a historical note, many of the founders of bioethics were disenchanted Catholics who defected from the Church structures to found alternative secular bioethical institutes, and in the process marginalized the input of theology.

Q: Can you give us a few examples of people who were affected by this?

Father Tham: André Hellegers was a gynecologist who sat on the papal birth-control commission established to inform the Pope on the morality of the pill. He was quite disappointed with “Humanae Vitae” and he eventually founded the Kennedy Institute of Ethics at Georgetown.

Daniel Callahan was editor of Commonweal magazine and was very upset with the encyclical. He co-founded the Hastings Center. Both the Kennedy Institute and the Hastings Center were influential in the early years of bioethics.

Albert Jonsen, Warren Reich and Daniel Maguire were all former priests turned bioethicists, all of them prominent in the field for their secular orientation.

Q: In your dissertation, you mentioned the secularizing effects of bioethics on theologians.

Father Tham: Yes, a glaring example of this would be Joseph Fletcher. He started writing in the 1950s when the word “bioethics” did not yet exist. In those days, he was an Episcopalian priest, but by the 1980s, Fletcher had left ministry and become an atheist, humanist, and member of the Euthanasia Society.

In the end, he advocated not only euthanasia but also non-voluntary sterilization, infanticide, eugenic programs, and reproductive cloning. He even went as far as proposing the creation of human-animal hybrids, and chimeras or cyborgs to produce soldiers and workers or to harvest organs. He eventually died an avowed atheist.

Q: Is there a future for religion in bioethics?

Father Tham: Secular bioethics has been deemed inadequate for a lot of right-thinking individuals, especially when certain academics are proposing such preposterous ideas as infanticide and eugenics.

In addition, many people are dissatisfied with the inability of contemporary bioethics to address the questions of human nature, of suffering and death, and of what constitutes a good life, health and the ends of medicine.

Religion has been addressing these issues for centuries. Hence, there seems to be a ray of hope for theology to play a more significant role in bioethics debates in the future. However, the challenge is great.

There is a need for theologically trained bioethicists, and this would also imply the need to recuperate sound theological investigations, especially in the religiously inspired academies.

I sense that the tide is changing with a new generation of laypeople and religious who are willing confront this secular and relativistic mind-set.



Cardinal Lozano Barragán on Future of Health Care

“Putting Technology at the Service of Man”

ROME, OCT. 6, 2007 (Zenit.org).- Here is the address delivered by Cardinal Javier Lozano Barragán, the president of the Pontifical Council for Health Care Ministry, during a conference co-sponsored by the Vatican dicastery and the Acton Institute, titled “Health, Technology and Common Good.” It was held at the Pontifical Gregorian University on Oct. 28.

* * *

My Dear Friends, Ladies and Gentlemen,

I have been honored to welcome all of you into this one-day conference which reflects themes based on Health, Technology, and Common Good. Well, I shall do this duty with pleasure, on behalf of the joint organizers of this Conference: The Acton Institute and the Pontifical Council for Health Pastoral Care.

First of all, it is my duty to welcome all the distinguished speakers of the day. We have a wide spectrum of topics as well as experts for each session. So let us give all of them a hearty welcome and wish that they will enlighten us throughout the day. Then, to all the participants so that the reflections of today will lead us to more fruitful action in the future.

I have been asked to present “The Future for Health Care: Putting Technology at the Service of Man.” Well, I am to do that presentation in two divided sessions, one in the beginning as I am doing now, and the other at the end of the day as closing remarks.

Part I: Introduction

Therefore, at this moment I shall try to introduce briefly the day’s theme: Health, Technology and the Common Good. First of all, there needs to be a clear understanding of what health is; because technology must be oriented to health, and to the future of care health. I am sure Monsignor Jean Laffite is an expert to explain it to us in detail. It has been my experience as the president of the Pontifical Council for Health Pastoral Care that there is a lot of confusion regarding health, even among political leaders as well as Church leaders. Many bishops from all over the world, when they come to visit the Pontifical council, had asked me to present for them what does it mean health today, especially when there are lot of technological developments. So I prepared especially for them a short volume called “Metabioethics and Biomedicine.”

My point is there are people who seriously want to understand clearly what health is, especially at this period of globalization, when they are bombarded with partial or unclear information, especially from various international organizations, NGOs and other associations who are involved in health care. There is clearly a paradigm shift in the ethical reflection on health. This so called “New Paradigm” is supposed to be the official thought of the United Nations and its various bodies like WHO and UNESCO.[1] It is supported by four NGOs in particular: “Women’s Environment and Development Organization,” “Earth Council,” “Green Peace” and “International Planned Parenthood Federation.”

According to its proponents the objective of the new global ethics is to achieve global well-being within the confines of sustainable development. This global well-being is what forms the target also known as World Health Organization Quality of Life (WHOQOL) and is defined as: “the perception by the individual of his position in life, within the context of the culture and system of values in which he finds himself, and in relation to his goals, expectations, models and interests.”

It covers six areas: 1. Physical health, 2. Psychological health, 3. Level of independence, 4. Social relations, 5. Context (economy, freedom, security, information, participation, environment, traffic, climate, transport…) 6. Spirituality. Aside from social duties, the basic factors are autonomy and self-determination.

One of the precepts of this new paradigm is “Health For All”. Health for all is defined as at Alma Ata: “the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

It requires ten aspects: health education, adequate nutrition, clean drinking water, basic health care, maternal infant care, immunization against the major contagious diseases, prevention and control of local endemic diseases, suitable treatment in the event of common disasters and illnesses, access to basic medicines and reproductive health.

Although apparently there are values in this new paradigm shift what is basically wrong is an ideology that is “closed to the transcendent.” First of all, there is an ethical subjectivism and relativism. Since there no objective validity in their argument those who hold to this thinking concentrate their activities above all in “lobbies,” to seek or buy consensus. Their thinking is based on a distinction made between the human being or individual and the person. In any case, there are only rights for the person, not for the human being or the individual.

One is a person only when he acts as such in the complex world of interrelationships of sensorial, mental, conscious, social activities, symbolic gestures, etc. If, at any given moment, someone is not capable of acting as such, he ceases to be a person and is simply a human being or an individual, deprived of any right that could be described as human right. This gives rise to questions related to health issues of the individual in relation to technological advancement, especially concerning the right to life of the fertilized egg, the human state of the “pre-embryo” or the embryo, the right to abortion, the ban on eugenics, euthanasia, etc.

As background of this way of thinking we find the confusion between well-being and happiness. And also the concept of liberty as something absolute and closed in itself.

In contrast with the position of the New Paradigm, we can approach to the authentic concept of health such as is described by the servant of God John Paul II: According him health is a tension towards harmony at the physical, psychological, spiritual and social level, and not mere absence of illness, and which enables man to fulfill his God-given mission in the stages of life he finds himself.[2]

Part II: The Future of Health-Care: Putting Technology at the Service of Man.

Following this pontifical description of health, what will be the future of the technology in the field of health, if it will be authentic progress?

Addressing the participants of the Plenary Assembly of the Pontifical Council for Health Pastoral Care, Pope Benedict XVI said: “The health of the human being, of the whole human being, was the sign chosen by Christ to manifest God’s closeness, his merciful love, which heals the mind, the soul and the body…. Going to the aid of the human being is a duty: both in response to a fundamental right of the person and because the care of individuals redounds to the benefit of the group. Medical science makes progress to the extent that it is willing to constantly discuss diagnosis and methods of treatment, in the knowledge that it will be possible to surpass the previous data acquired and the presumed limits. Moreover, esteem for and confidence in health-care personnel are proportionate to the certainty that these official guardians of life will never condemn a human life, however impaired it may be, and will always encourage endeavors to treat it. Consequently, treatment should be extended to every human being, meaning throughout his or her entire existence. The modern conception of health care is in fact human advancement: from the treatment of the sick person to preventive treatment, with the search for the greatest possible human development, encouraging an adequate family and social environment.”[3]

Therefore, when we speak about putting technology at the service of man we are considering humanity as such and for the common good in general. As the Second Vatican Council had observed, “Every day human interdependence grows more tightly drawn and spreads by degrees over the whole world. As a result the common good, that is, the sum of those conditions of social life which allow social groups and their individual members relatively thorough and ready access to their own fulfillment, today takes on an increasingly universal complexion and consequently involves rights and duties with respect to the whole human race. Every social group must take account of the needs and legitimate aspirations of other groups, and even of the general welfare of the entire human family.”[4]

In today’s globalized world we need to think in terms of human connectivity. Some of the modern technologies in health care themselves are connecting human race. An example is “eHealth” or health-care delivery supported by information technology, of digital data — transmitted, stored and retrieved electronically — in support of health care, both at the local level and at a distance.

Internet has helped connect so many medical personnel by providing information on the latest achievements in health technologies, thanks to servers installed by medical faculties and medical journals. Another example would be “Telemedicine.”

When the patient and doctor are in far away places, they could use modern communication technologies (two way interactive consultation and digital image/data transmission) to send radiology images, laboratory reports, medical records, etc.

Telemedicine has proven very efficient, especially in emergency situations like NASA (The National Aeronautics and Space Administration) intervening in the 1985 Mexico City earthquake, or the 1988 earthquake in Armenia. In 1994 they have improved it into ACTS or Advanced Communication Technology Satellite.

In 1996 TIP (Portable Telemedicine Instrumentation Pack) was made available for easy transportation by health care personnel. Today we can speak of telesugery, teleradiology, teledentistry, teledermitology, telepathology, teleoncology, telepsycology, telecardiology, teleneurology, telenursing, etc.

The European Health Telematics Observatory’s (EHTO) assertion is illustrative: health telematics activities are used by hospitals (34%), telephone utilities (14%), academic institutions (12%), clinicians (12%), governments (7%) and social services (4%).[5]

Some of the technologies enhance the past groundbreaking achievements in health care science: the concept about “public health”, Epidemiology and its branches like Neuron Epidemiology, Cardiovascular Epidemiology, Cancer Epidemiology, etc., Health Economics and Health Management and so on. This last one branch has helped form health policies where there is awareness that spending on health care “is not an expenditure but an investment.” This has also helped strategies of preventive and promotive measures in health care.

During my pastoral visits around the world, it is very heartening for me to see dozens of immaturely born children being cared in the incubators by well-trained, diligent and gentle health care personnel; or hundreds of children born to HIV infected mothers saved due to the timely administration of AZT. In the same way the news coming from a country in Africa that the death toll could be reduced to 1 from an average of 26 every month, thanks to the assistance they are getting from the Good Samaritan Foundation for the purchase of anti-retroviral medicine as well as basic nutrients.

Technology and Bioethics

What are the main principles that must lead the future of health technology? We try to answer regarding the biomedical field. As a general principle we can establish this; that which builds man is good, and that which destroys him is bad.

We know that Biomedical technology holds a great deal of promise in the areas of diagnosis and treatment of diseases. Strong health care systems invariably rely heavily on access to and use of health technologies. But we must also be aware of the fact that technology and medicine are only a part of the health care system and undue insistence on their capabilities may give more emphasis in meeting the demands of the providers than that of the human persons. The ultimate criterion in the use of all technologies must be the good of man. Everything technologically possible need not be ethically oriented. For this, ultimately we need a bioethics that is open to the transcendent.

In discussing the sciences of life and reflecting on the experimental sciences that manipulate life, one wonders about correct human behaviour in relation to human life, deficiency in human life, increase in human life, improvement in human life, procedures to be followed to obtain this improvement and deviations to be avoided. As a final condition, we find ourselves before the binomial necessity-satisfaction. This means that there is a living subject that aspires at improving himself, to do this he must journey along a path, and to do this he must plot the path, and to do this he must first know where he is heading for. Within the context of life, it is necessary to know what life is, what is the better life that one desires, the path to be followed and the path to be avoided in this journey, for instead of donating life, it could be taken away. In other words, biotechnology appears as a project for the building of man through the life and health sciences, that can build or destroy.

The horizon for Ethics in itself is finality. The horizon of Technology is only the possibility. The technology itself, is neuter, can build or destroy man. All depends from its direction, and the direction is given to Technology by Ethics. Therefore, in order to have a true code of bioethics, which provides us with rules of behaviour in the area of health and life, the first, question we must ask ourselves concerns the project for man, which involves the manipulation of life and health. Authentic Bioethics must appear as the project to improve human life and includes all the life and health sciences as its base, as that “intus legere” (inte-lecto, reading from inside) which in any analysis always concerns the final synthesis of what cannot be anything other than the construction of human life.

For a vital project to function (like any other project), it is necessary to understand the living reality that expects improvement as much as possible. This is a path that belongs to Bioethics. Here, we find rules which cannot simply be formulations or imperatives external to the person, instead they are real constructions of the same person and which little by little bring it nearer to the “better person”, thereby increasing its density.

This complexity brings him to a consciousness of his reality which means being relational, open and thus embarking on his journey, that is, freely opening himself up to the Other, which in this case is the fulfillment of the Power of Truth and Love, which is precisely God. To attain freedom, Man in his project for development, opens himself up to the force of genuine progress in Biotechnology in order to ascertain, each time ever more that his vital completeness is in constant harmony with God, with all of humanity and with the whole surrounding environment.

And now, if we try to pass over the natural way of thinking to Revelation of God, in Catholic thought, this Ethics that is open, “objective”, real, and with no constrictions, opens up to full communication with God the Almighty Father who brings about in us the Truth of His Son through His Incarnation, Passion, Death and Resurrection. He fulfils all our aspirations by bringing us along the Way that is Christ, in the fullness of the Love of His Spirit. Catholic Ethics and Bioethics are the Christ’s journey within us, to His Father through His death and resurrection, in the Love of the Holy Spirit. In this way, Bioethics will be the journeying within us of the Spirit along the paths of the life and health sciences. “Those led by the Spirit are the children of God” (Romans 8,14). The Spirit infuses in man the ability to journey towards the total construction of Christ — this ability are the virtues — and directs him into the comprehension of Christ Himself as a way, by means of the Commandments and the Sermon on the Mount.

We Christians know that the only possibility for the true vital construction of man is the resurrection. Stated in concrete historic terms, the only possibility for vital construction is union with Christ, who died and rose from the dead. This is the only Ethics that is objectively valid and to which all the authentic values found in non-Christian ethics come close to and as such are indicators of the sole reality which goes beyond illusions of vital permanence.

According to the Roman Catholic view, the construction of man is a theandric construction where divine and human actions intertwine. In translating these actions into principles of valid action for guiding Biomedicine, we can state the following:

1. The human being is a creation of God, it is from Him he comes and to whom he must tend as his exemplary and final Cause. The person is in the image of God, member of the Body of Christ, citizen of the people of God.

2. Human life is received from humanity, not as property but to be administered. Human life is inviolable from its very conception to its natural end. The dignity of the human person is inviolable. It is on this that all Anthropology and Bioethics is based.

3. The origin to human life must lie solely in marriage and solely as the fruit of the marital act.

4. Spouses are not the cause of human life but the instruments of God in
communicating life.

5. From Christ, the human person is capable of reflection, is an end in himself and can never be considered as a means.

6. The human person has his freedom and responsibility that he must put to practice in order to attain fulfillment. There is no freedom without responsibility that in turn implies respect for the freedom of others.

7. The totality is above the part and sometimes the part must be sacrificed in favor of the totality. The human person is in solidarity and must tend towards the common good.

8. The only explanation of life and its single source is Christ who died and was raised to life. If death and suffering are considered in unity with the death of Christ they are the only source of life.

9. In this context, the three principles of subjective Bioethics: autonomy, beneficence and justice, can be accepted and justified.

10. The human person is the synthesis of the universe and is the reason for everything that exists. Biomedical science and technology must be at the service of human life and not vice versa, namely, such knowledge should be used to develop man and never to destroy him.

Conclusion

If then we make an attempt to define Catholic Bioethics and so, try to synthesize principles that lead the authentic future of health Technology we can enounce the following as conclusion of this paper: The Bioethics is “The systematic and detailed study of the conduct that constructs man through the health and life sciences in order to walk in Christ towards the Father, the fullness of life, by the power of the Holy Spirit”.

This theological vision implies a profound structural dialogue with all sciences and technologies involved, with all the unifying ideas from the analyses, made by the different philosophical and theological schools, also in dialogue with other religions, bearing in mind that it is a behavioral study and therefore cannot be solely a line of reflection but must be concretized as a guiding light to resolve the difficult problems raised by science and technology.

Javier Cardinal Lozano Barragán
president
Pontifical Council for Health Pastoral Care
Vatican City

[1] See Kim Yersu, 1999. “A Common Framework for Ethics of the Twenty-First Century.” UNESCO, Division of Philosophy and Ethics. Cited Nov. 15, 1999, at http://www.unesco.or.kr/ethics/yersu_kim.htm.

[2] See John Paul II, “Message for the World Day of the Sick for the Year 2000,” “Dolentium Hominum,” 42 (3, 1999), No. 13.

[3] Benedict XVI, Address to the Plenary Assembly of the Pontifical Council for Health Pastoral Care, March 22, 2007.

[4] “Gaudium et spes,” No. 26.

[5] See Department of Essential Health Technologies (WHO), “Information Technology in Support of Health Care”, p. 2 at http://www.who.int/eht.



Interview With Cardinal Lozano Barragán

ROME, OCT. 5, 2007 (Zenit.org).- Technology without ethics is like a Ferrari without a steering wheel, according to Cardinal Javier Lozano Barragán.

The cardinal is the president of the Pontifical Council for Health Care Ministry, which recently co-sponsored a congress with the Acton Institute titled “Health, Technology and the Common Good.”

In this interview with ZENIT, the 74-year-old cardinal comments on the definition of health and the development of health care technologies.

Q: Today there is a lot of confusion about the concept of health. In your opinion, what is the right definition?

Cardinal Lozano Barragán: The “Declaration of Alma Ata” on primary health care says that health consists in a state of complete physical, mental and social well-being, and not simply care for sickness or infirmities. This state of perfect well-being is utopian, based on nonexistent foundations.

Pope John Paul II, in the “Jubilee Message for the World Day of the Sick” in 2000, says in Number 13 that health is a process toward harmony, not just physical, mental and social, but also psychological and spiritual. It is, therefore, that which enables a person to fulfill the mission that the Lord has entrusted to him, according to the stage in life they are in.

A person is truly healthy when he is harmonic. A society is healthy when it is harmonic. This is a very important aspect to develop and one in which eternal health can be found, because earthly health is not distinct from eternal health in that sense.

Q: What are the opportunities and challenges caused by the rapid development of technologies in the field of health care?

Cardinal Lozano Barragán: The challenges for the new technologies lie in the fact that their end is not the true promotion of health. This is the very destruction of health! And we can see this in all of the biogenetic technologies that are often directed toward the killing of the human person.

Life is being ended with euthanasia and with the murder of children in the womb, calling them fetuses, which is just a way to camouflage the killing of human persons.

These are the fruits of the Malthusian mentality that disguise killing under various names. John Paul II — and Benedict XVI as well — spoke of this when speaking about the “culture of death.”

Q: Today’s culture defines health as a perfect state of well-being, but paradoxically fights life itself through abortion and euthanasia. What conditions are needed to promote the person’s well-being and the common good?

Cardinal Lozano Barragán: Perfect well-being does not exist on this earth because the Lord promised us happiness, not well-being. Therefore, the basic error of this type of postmodern concept is the confusion between well-being and happiness.

The person cannot be well and still be happy, or be very well and yet be very unhappy, as the high suicide rate in highly developed countries shows.

Q: What are the consequences of the “culture of death” that humanity today refuses to see or recognize?

Cardinal Lozano Barragán: The “aging” of certain countries, of the world. For example, Italy’s population is the oldest in the world, and that’s because there are very few births.

Q: What link exists between the promotion of health, the development of technologies and the promotion of the common good?

Cardinal Lozano Barragán: There should exist a very close link, in the sense that technology should be based on ethics: Technology as such has, in fact, possibility as its law, while ethics has an aim, a goal.

If we leave technology as only possibility, it remains neutral. It can destroy or build up. Ethics gives it direction. Therefore, highly developed technology without ethics is like a Ferrari without a steering wheel.

Q: What are the priorities in your work at the Pontifical Council for Health Care Ministry in this regard?

Cardinal Lozano Barragán: To give the world, as spokesmen of the pontifical magisterium, the meaning of suffering, the meaning of pain and the meaning of the death and resurrection of the Lord.