Health care providers, must never deviate from respect for the dignity of the person

The XXV World Day of the Sick and Pastoral health care workers presented at the Vatican. Not everything that is technically possible is ethically acceptable.  This includes euthanasia and aggressive therapy, cloning, and the attempts of gestation of human embryos in animal or artificial wombs, abortion. Instead "deep palliative sedation" in the stages close to the time of death and the respect of the will of the person.

Vatican City (AsiaNews) - The Catholic Church reaffirms that in health care respect for the dignity of the person is an absolute value and that not everything that is technically possible is ethically acceptable. This includes euthanasia and aggressive therapy, cloning, and the attempts of gestation of human embryos in animal or artificial wombs, abortion. Instead "deep palliative sedation" in the stages close to the time of death and the respect of the will of the person, which must always be defended, even by promoting access to all medications and technologies for the population of developing countries. These are some of the suggestions offered by the New Charter of health care workers, presented today at the Vatican, along with the XXV World Day of the Sick, which will take place in Lourdes on 11 February.

The latter, recalled Card. Peter Turkson, Prefect of the Congregation for the Integral human development, "instituted by St. John Paul II in 1992 and organized for the first time precisely in Lourdes on 11 February of the following year", has arrived this year to celebrate its 'silver Jubilee'. "Although the last decade has been celebrated solemnly every three years like other World Days, this 25th edition, by the will of the Holy Father will be celebrated in the extraordinary form. The chosen theme is: Amazement at what God does, "he has done great things for me the Almighty ..." (Lk 1:49). "

With regards the first charter, published in 1995, it has been translated into 19 languages ​​and for almost twenty years has been the basic text for healthcare professionals”. The New Charter has therefore required several years of work involving a qualified group of experts."

From the doctrinal point of view, continued Msgr. Jean-Marie Mate Musivi Mupendawatu, secretary of the same dicastery, "the New Charter for Health Care Workers reaffirms the sanctity of life and its inviolability as a gift from God. Health workers are ministers of life because they are servants and called to love it and take it in the existential journey of generating life – living it - to death, the thematic triad of the New Charter. "

Gioacchino Antonio a Spagnolo, professor of bioethics and director of the Institute of Bioethics and Medical Humanities at the Catholic University of the Sacred Heart in Rome, explained that the charter takes into account the scientific achievements and subsequent magisterial pronouncements from 1994 on, keeping its original structure "as a tool for serious ethical preparation and continuing education for health Care Workers".

The patient appeals to the "science and conscience" of the doctor

Addressed to those working in the biomedical field - health personnel, but also biologists, pharmacists, lawmakers on health care, etc. - It states that "all these operators carry out their daily practice in an interpersonal relationship, spurred on by the confidence of a person marked by suffering and illness, which resorts to science and to the conscience of a healthcare provider that they meet to assist and cure them. The Charter seeks to support the health care worker fidelity to ethics in the choices and behaviors in which they embody service to life, and this fidelity is outlined in following the stages of human existence: to create, live, die, as moments of ethical and pastoral reflection".

The Charter seeks to support the ethical loyalty of the healthcare worker, in the choices and behaviour in which this service to life takes its form, and this loyalty is outlined following the stages of human existence – generating, living, dying – as moments of ethical and pastoral reflection.

Thus, continues Spagnolo in the section, “Generating”, “the criteria are specified further for the treatment of infertility and with reference to natural methods not only for the regulation of fertility but also as methods for obtaining a pregnancy. There is also an article on the freezing of ovarian tissue (Article 38) as an ethically sustainable option in the case of oncological therapies that may affect a woman’s fertility. The new attempts at human reproduction in the laboratory are also taken into consideration (Article 39): between human and animal gametes, the gestation of human embryos in animal or artificial wombs, the asexual reproduction of human beings by means of twin fission, cloning, or parthenogenesis other similar techniques. All these processes are contrary to the human dignity of the embryo and procreation, and are therefore considered morally unacceptable.  Among prenatal diagnoses, acceptable for certain conditions, attention is instead drawn to pre-implantation diagnosis (Article 36), considered unacceptable inasmuch as it is an expression of a eugenic mentality that legitimises selective abortion to prevent the birth of children suffering from various diseases”.

In the “Living” section, the existing position regarding abortion is confirmed, with the insertion of new articles regarding embryonic reduction, interception, contragestation, anencephalic foetuses, ectopic pregnancies, and the protection of the right to life (Articles 51-59). Attention is also turned to the issue of prevention and vaccines, the subject of recent public debate (Articles 69-70). Timely from a scientific point of view is the reference to gene therapy and regenerative medicine (80-82). At the social level, the document focuses on the issue of access to medicines and technologies by the people (Article 91), access that even today, above all in developing countries and especially those characterised by political instability or limited resources, is not guaranteed to broad sectors of the population, and especially in the case of so-called ‘rare’ and ‘neglected’ diseases, accompanied by the concept of ‘orphan drugs’ (Article 92). Healthcare providers and their professional associations are asked to take the lead in raising awareness of institutions, charities and the health industry, so that the right to health protection is extended to the entire population, leading to healthcare justice, safeguarding the sustainability of both research and healthcare systems. Also new are the references to the involvement in testing of minors or adults unable to decide, on vulnerable subjects, and on women of childbearing age in emergency situations”.

“Finally, this section highlights the role of clinical ethics consultation (Article 140), which may help to identify ethical conflicts and doubts, which individual healthcare workers, patients and relatives may experience in clinical practice, thus facilitating resolution with diagnostic and therapeutic choices shared at the patient’s bedside, in the framework of values proper to medicine and ethics”.

The section on “Dying” examines the attitude towards the patient in the terminal phase of illness, “which verifies the professionalism and ethical responsibilities of healthcare workers (Article 145). In this area, a very current aspect considered by the Charter – the subject of many discussions in the Italian Parliament in these days – is the reference to the expression in advance by a patient of his wishes (Article 150) regarding the treatments he would or would not like to undergo should he no longer be able to express his consent. The Charter affirms that the reasonable will and legitimate interests of the patient should always be respected, but the doctor is not a mere executor, and conserves the right and the duty to deny a request should his conscience not permit it”.

“An equally significant theme is that of nutrition and hydration, even artificially administered (Article 152), considered to be among the basic care due to the dying, other than when they prove too burdensome to the latter or are not of any benefit. Their unjustified suspension may have the sense of an act of euthanasia, but they remain obligatory inasmuch as and to the point that they can be shown to achieve their aim, which is the hydration and the nourishment of the patient. The ethical validity of palliative deep sedation in the phases close to the moment of death are confirmed, performed according to correct ethical protocols and submitted to constant monitoring”.

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