The Roman Catholic Tradition - Advocate Health Carewhen Charlemagne became ruler of the Holy Roman...

THE PARK RIDGE CENTER

The Roman Catholic church is one of the largestreligious bodies worldwide, numbering over 750

million members, and is the largest single church inthe United States. It identifies its origins with Jesus ofNazareth. Although Jesus himself did not found achurch, his followers in Jerusalem organized aroundthe Twelve Apostles after his death (ca. 30 C.E.) andcarried on his mission of preaching and teaching thereign of God and the “good news of salvation.” Thelatter was the belief among Jesus’ followers that faithin Jesus, whom they believed to have been raised byGod from the dead, would lead to salvation.

Initially, the disciples of Jesus sought convertsamong fellow Jews throughout Palestine and did notview themselves as distinct from Judaism. The apostlePaul (d. ca. 67 C.E.) made the first significant attemptto convert Gentiles to Christianity. After his own con-version from Judaism, Paul made several missionaryjourneys throughout the Roman Empire. By about 60C.E., he and others had preached the faith in most ofthe eastern Mediterranean and as far west as Rome. Acentury later, Christian communities existed in mostif not all of the cities of the Roman Empire.

The early Christian communities structured them-selves in diverse ways and comprised a variety of

The Roman Catholic Tradition

Religious Beliefs andHealthcare Decisions

By Ronald P. Hamel Updated by Kevin O’Rourke

Contents

The Individual and the 7Patient-Caregiver Relationship

Family, Sexuality, and Procreation 12

Genetics 17

Organ and Tissue Transplantation 18

Mental Health 19

Death and Dying 20

Special Concerns 24

Part of the “Religious Traditions andHealthcare Decisions” handbook series

published by the Park Ridge Center for the Study of Health, Faith, and Ethics

Ronald P. Hamel is Senior Associate in Ethics at the CatholicHealth Association.

Kevin O’Rourke, O.P., is a professor at the Neiswanger Institute of Ethics and Public Policy, Stritch School of Medicine, LoyolaUniversity Chicago.

THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS

ministries and ministers, including deacons, eld-ers, presbyters, and bishops. Despite their diver-sity, these communities did hold some elementsin common: “faith in Jesus as Messiah andLord; the practice of Baptism and the celebra-tion of the Eucharist; the apostolic preachingand instruction; the high regard for communallove; and the expectation of the comingKingdom of God” (McBrien 1980, 2: 583). Theapostle Peter, one of the original twelve, held aposition of prominence among the other apos-tles and within the local churches.

During the second and third centuries,Christians were heavily persecuted by theRoman government. But this persecution ceasedin the fourth century, and Christianity spread. In313, the recently converted emperor Constantinenot only legalized Christianity, thus ending thepersecution, but also showed great favor toChristians in the laws and policies he instituted.This trend was continued by all but one subse-quent emperor and culminated in 391 when theemperor Theodosius declared Christianity theofficial religion of the Roman Empire. Thusbegan an intimate relationship between churchand state that continued in Western Christianityfor the next thousand years. This relationshipwas founded on the belief that the emperor wasdivinely appointed and was charged with pro-tecting the church as well as ruling the empire.

Constantine contributed in yet another way tothe shaping of the Christian church. In 330, hetransferred the capital of the empire from Rometo Byzantium in the East, renaming itConstantinople. This action had profound conse-quences, among them, a gradual increase inpapal power. The transfer of power to the Eastleft a political vacuum in the ancient capital ofRome, a vacuum increasingly filled by the pope.The papacy began to view itself as havingabsolute spiritual and temporal power within thechurch and established Rome as the spiritualcapital of Christianity. Some popes even sawthemselves as the Western counterpart to theemperor in the East and as having ultimatepower within western Europe.

By the end of the fourth century, Christianityhad made significant strides. Most of the urbanpopulation in Italy, Spain, Gaul, and Africa hadbeen converted. Much missionary workremained to be done, however, among the peas-ant populations and throughout the rest ofEurope.

Both the spread of Christianity and papalpower increased during the early Middle Ages(500-1050), largely because of the 600-year“invasion” of the Germanic tribes into westernEurope. Pope Gregory the Great (elected in 590)took great interest in converting the “barbar-ians” to Christianity for both religious and polit-ical reasons. He saw, on the one hand, an oppor-tunity to spread the faith to larger regions ofEurope, and on the other, an occasion to gainthe support of the Germanic peoples in order tostrengthen his own position, given the virtualabsence of support for him from the emperor ofthe East. In fact, the collapse of the RomanEmpire and the leadership void it createdafforded the papacy even more temporal power.The new converts to Christianity and the nationsto which they belonged looked to Rome forleadership. And they in turn were for the pope asource of temporal power and wealth. Thesetrends were reinforced in the early ninth centurywhen Charlemagne became ruler of the HolyRoman Empire. He was a great supporter of thepapacy, and under his rule any lines that stillseparated the church and the Western empirequickly dissolved.

By the time Gregory VII was elected pope in1073, the Holy Roman Empire had shrunk insize and had become fragmented into feudalmunicipalities. Christianity was no longer coex-tensive with the Western empire and, in fact,transcended its boundaries. Given all of this, itseemed only fitting to Gregory that the popeshould enjoy political as well as spiritualsupremacy, and he acted accordingly. Popes dur-ing the remainder of the High Middle Ages con-tinued the tradition of a strong papal monarchy.

This changed during the late Middle Ages(1300-1545) with the rise of nation-states of

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nationalistic populations headed by powerfulrulers. These forces ultimately led to the collapseof papal supremacy and the power of WesternChristianity. The Great Schism (1378-1417), dur-ing which there were two, and at one point three,popes reigning simultaneously, further erodedthe status and authority of the papacy.

The final blow to the unity, influence, andpower of Christianity and to the authority of thepope came with the reform efforts of Luther,Zwingli, and Calvin, the leaders of the ProtestantReformation. Initiatives by several popes and anumber of monastic orders to reform abuses hadlimited success. The Protestant reformers tookmore radical steps, challenging not only morallaxity and particular abuses within the churchbut also some of its theology. By the middle ofthe sixteenth century, the British Isles,Scandinavia, and much of France, Germany, andAustria had broken with Rome. TheReformation “brought to an end the medievalCatholic Church, a structure that had exercisednearly exclusive authority in religion in westernEurope for a millennium” (Amundsen 1986:68).

The Counter Reformation was launched with the election of Pope Paul III in 1534 andthe Council of Trent, which met from 1545 until 1563. The council corrected some abusesand was extraordinarily influential in clarifyingmatters of faith and in issuing disciplinarydecrees, but it was not able to reunify WesternChristianity.

Catholicism first came to North America withthe early Spanish explorers, beginning withColumbus in 1492. By 1565, the first permanentparish in America was founded in St. Augustine,Florida. Subsequently, other missions werefounded in Florida, Alabama, California, and theSouthwest by Spanish clergy, many of whomwere Franciscans. The French explorers alsobrought missionary clergy with them, and someof the explorers—Cartier, Joliet, Marquette, andSerra—were themselves clergy. These missionar-ies spread the faith throughout the vast provinceof France that extended down the MississippiValley to Louisiana.

With the founding of the colonies, RomanCatholicism in the United States grew slowly.Most of the colonists were Protestant, and in1652 legal restrictions were placed on Catholicsin Maryland, the colony they had founded in1634, as well as throughout the other colonies.The Revolution, however, brought Catholics reli-gious and political freedom. With the adoptionof the Constitution in 1787, religious equalitywas legally guaranteed.

Shortly after the Revolution, just over 18,000Catholics lived in the U.S., concentrated mostlyin Maryland, Pennsylvania, Virginia, and NewYork. They had no clergy and were essentiallyunorganized. After considerable conflict, JohnCarroll was named the “prefect apostolic” of the13 original states; the vicar apostolic of Londonrefused to continue to exercise jurisdiction overthe “rebels.” By the early 1800s around 150,000Catholics had organized about 80 churches. By1890, the number had grown to 6,231,417,largely because of the flood of immigrants fromCatholic countries on the Continent. Today theover 51 million Roman Catholics in the UnitedStates belong to about 18,250 churches andmake up roughly 22 percent of the population.

INSTITUTIONAL AUTHORITY ANDINDIVIDUAL CONSCIENCE

The Roman Catholic church is probably themost centralized of religious bodies. Authorityultimately resides in the first among the bishopsand the spiritual leader of the church, the bish-op of Rome or the pope. His authority isbelieved to derive from Jesus himself, whoentrusted to St. Peter, chief among the TwelveApostles, the authority to govern the church: “Ifor my part declare to you, you are ‘Rock,’ andon this rock I will build my church, and the jawsof death shall not prevail against it. I will entrustto you the keys of the kingdom of heaven.Whatever you declare bound on earth shall bebound in heaven; whatever you declare loosedon earth shall be loosed in heaven” (Matthew16:18-19). As successor to St. Peter, the pope is

3THE PARK RIDGE CENTER

entrusted with the same authority. Authorityresides at the next level in the individual bish-ops who also are successors of the TwelveApostles and have inherited the mission andauthority bestowed upon them by Jesus Christ.Most bishops are responsible for the Catholicchurches and institutions in specified geographi-cal areas (dioceses) in countries where thechurch is present. As leader of the church, it isthe pope’s responsibility to ensure the integrityof doctrine and morals. Decisions about thesematters or about church organization and prac-tice either are made by him or must receive hisapproval. Individual bishops have teachingauthority within their respective dioceses, andnational conferences of bishops have authorityover the dioceses in their country, but thatauthority is always subject to the pope. Theteaching authority of the church is oftenreferred to as the magisterium of the church.This structure has a direct bearing on moraldecision making and the role of consciencewithin Catholicism.

Catholicism combines a profound respect forconscience and for the authoritative teaching ofthe church. This teaching comes from the popehimself, from particular offices in the papaladministration in Rome, from bishops individu-ally or collectively, or from the pope togetherwith the bishops of the world. Authoritativechurch teaching seeks to maintain the integrityof the faith and, in the area of morality, to guideCatholics in discerning what behaviors are con-sistent with that faith. It is meant to communi-cate moral truth arrived at through the accumu-lated experience and wisdom of the communityof faith and interpreted by its spiritual leaders. Itseeks to overcome some of the limitations ofindividual experience, perspective, and under-standing.

What then is the relationship of individualconscience to ordinary, authoritative churchteaching on matters of faith and morals? Thechurch requires a “religious assent of soul,” a“religious submission of will and mind” toauthoritative teaching. This has been interpreted

to mean several things. First, Catholics shouldpresume that church teaching is correct unlessand until there is clear and overwhelming evi-dence to the contrary. The presumption isalways in favor of church teaching. Second, ifthey happen to disagree with the teaching,Catholics must make every effort to reach intel-lectual agreement with it. And, third, they muststrive to appropriate that teaching as their ownso that in performing or avoiding the behavior,they do it out of personal conviction. The reasonbehind this should be a religious one, namely,that Jesus commissioned the church to teachand that the Holy Spirit guides the church intruth.

The Catholic tradition insists on the properformation of personal conscience over time aswell as prior to a particular judgment. Theauthoritative teaching of the church is a neces-sary but not a sufficient component of thisprocess of conscience formation. Church teach-ing is not the sole basis for a moral judgment,but it is an indispensable ingredient. In addition,Catholics should attend to Scripture, to moralvalues, principles, and rules, to their own andothers’ experience, to the particularities of thesituation, and to the insights of their hearts andminds. After carefully considering these, theindividual must discern the right action inresponse to the situation and consistent with hisor her faith (see Catechism of the CatholicChurch [subsequently referred to as CCC] 1997:nos. 1776-1802 on conscience and nos. 2030-51for a discussion of the teaching authority of thechurch).

Catholics are expected by church authoritiesto follow the church’s teachings on moral mat-ters. In reality, however, many Catholics findthemselves at variance with some teachings, par-ticularly those having to do with procreation andsexuality. Even a significant number of theolo-gians over the past 30 years have proposed posi-tions at variance with some church teaching andhave recommended revisions of that teaching.Hence, it is quite likely that in the healthcarearena (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 thesearch for moral truth, however, it should stillbe true that the guidance of church authoritywill play a significant role.

The force and binding nature of churchteaching varies depending on its source (pope,Vatican offices, bishops, or pope and bishopstogether), on what form it takes (a papal encycli-cal, declaration, instruction, apostolic letter, orsermon; constitutions, decrees or declarations ofecumenical councils, episcopal pastoral letters,and so on), the frequency with which the teach-ing has been repeated throughout the church’shistory, and the manner in which it is proposed(as infallible or as binding but not infallible). Forexample, the pope, either alone or together withthe bishops of the world, is said to speak infalli-bly (that is, without error) when he speaks for-mally and officially (ex cathedra) to the entirechurch on matters of faith and morals. Suchpronouncements are to be considered asrevealed truth and as definitive.

This variable “authoritativeness” of churchteaching is reflected in the pages that follow.Various sources have been employed in anattempt to present a quasi-”official” Catholicperspective on issues in healthcare ethics.Although all the sources are ecclesiastical docu-ments—from popes, bishops, or Vatican commis-sions—there is some variance among themregarding the weight they carry and the extentto which they represent an official Catholic posi-tion. A pope’s reflections in an address ongenetic research, for example, are not as author-itative as a Vatican declaration on euthanasia oran instruction on the dignity of life that con-demns various reproductive technologies.

FUNDAMENTAL BELIEFS ABOUT ETHICS

Roman Catholic thinking on moral issues isdetermined primarily by the Hebrew andChristian Scriptures and by what is referred to asnatural law. Most generally, natural law simplymeans the use of human reason to discover

moral truth. A particular understanding of natu-ral law, however, has informed virtually all ofofficial Catholic teaching on sexual and medicalmoral issues. It maintains that God has createdall of reality, including human beings and alltheir abilities, for particular purposes. In orderfor a human action to be moral, it must be con-sistent with or fulfill those purposes that arewritten into the very structure and functioning ofhuman capabilities. The act of sexual inter-course, for example, is considered to have beencreated by God to be procreative. Any interfer-ence with the procreative purpose of the sex act(for example, contraception or sterilization) vio-lates its God-given nature and is thereforeimmoral. Actions that contradict God’s purposesfor a particular human faculty are often said tobe intrinsically evil—that is, by their very nature,they are evil. Such actions are always prohibited.Over the past three decades, a less biological andmore person-centered approach to natural lawhas shaped some ecclesiastical statements onmoral matters. This has not, however, alteredconclusions. Some present-day theologians (andmany lay members of the church) do not espousea natural-law approach and sometimes arrive atdifferent conclusions on moral issues. These can-not be considered as the official position of thechurch, however. Catholics are expected to fol-low the teaching of the magisterium and not theteaching of individual theologians.

Several convictions guide Roman Catholicteaching on moral issues in medicine:

• Because human beings are made in the imageand likeness of God, every human being has aninherent and inviolable dignity. It is this dignitythat is the basis of every individual’s inalienablerights. This dignity is not conferred by humanbeings, cannot be measured in degrees, and can-not be taken away. Assessments of a person’sworth on the basis of social utility, the quality of aperson’s life, or any other characteristic (such asrace, gender, social class) or denials of basichuman rights are violations of human dignity.

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• Human beings are social by nature. Relationshipswith others and with the community are essentialto their survival and flourishing; any exercise ofautonomy must therefore consider the individual’srelationships and responsibilities to others and tothe larger community. In addition to having spe-cific responsibilities to others, individuals have aresponsibility to contribute to the common goodof society.

• Human life is considered to be sacred and invio-lable from the moment of conception, regardless ofits quality. It is a gift of God and the most basic ofall human goods. For this reason, it is immoral toend it directly or unjustly. Human life, however, isnot considered to be an absolute. Therefore, noteverything must be done to preserve or prolong it.Biological existence must always be subordinatedto the total good of the person, particularly to theperson’s spiritual good. This might mean, in someinstances, allowing someone to die.

• Human beings are stewards of life. Human life isa gift of the Creator over which human beings arestewards or caretakers. Hence, we have a funda-mental responsibility to care for life and health. Ascreated entities, we have only limited power orcontrol over our lives; they are not ours to do withas we will. Only God has full dominion over life.

Stewardship also applies to the goods of cre-ation. Because these are gifts of the Creator forour use, we are called to use them prudently, just-ly, and in a caring manner.

• It is legitimate under certain conditions to sacri-fice a part for the good of the whole. This is gener-ally known as the “principle of totality.”Traditionally, it has meant that a part of the bodycan be sacrificed for the good of the whole body(for example, a cancerous uterus can justifiably beremoved for the overall good of the woman’sbody). More recent theology has broadened thisprinciple somewhat by focusing not only on thegood of the body but also on the good of the per-

son considered as a whole. This is the principlenormally employed to justify surgery.

• An action having both a good and a bad effectmay be justifiable under certain conditions. This isknown as the principle of double effect. Such anaction is justifiable when (1) the action consideredby itself and independent of its effects is notmorally evil; (2) the evil effect is not the means forproducing the good effect; (3) the evil effect is notintended but only tolerated; (4) there is a propor-tionate reason for performing the action andallowing the evil effect to occur. An examplewould be the removal of a cancerous uterus,which has the good effect of saving the woman’slife but the bad effect of making her sterile.

• The unitive and the procreative aspects of mar-riage are inseparable. This principle is based onan understanding of the God-intended purposes ofhuman sexuality, namely, lovemaking and procre-ation. It holds that God intended these purposesto be inseparable. Any lovemaking apart from anopenness to procreation or procreation apart fromlovemaking is inherently immoral.

FUNDAMENTAL BELIEFS CONCERNINGHEALTH CARE

The Roman Catholic church has a very long tra-dition in medical ethics. It could actually be saidto date back to the early church and has evolvedover the centuries as more and more behaviorswere included and assessed, blossoming into aseparate discipline in the seventeenth century. Itcontinued to flourish in the nineteenth andtwentieth centuries.

During much of this time, and particularly inthe modern period, several fundamental theologi-cal convictions have served to guide ethicalreflection about specific medical procedures andinterventions.

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• Every person has dignity. The Catholic/Christianview of the person is grounded in the biblicalteaching that all human beings are made in theimage and likeness of God, particularly in possess-ing intelligence and free will (Genesis 1:26-31).Every person is unique and irreplaceable and iscalled both to human fulfillment and to eternallife. All human beings are equal (Romans 2:11;Galatians 4:38; Ephesians 6:9); and all humanlife, because it originates in God, is sacred.

• Health is to be understood holistically. TheCatholic/ Christian tradition understands healthholistically; it encompasses physiological, psycho-logical, social, and spiritual dimensions of the per-son. Human health can never be reduced only tophysiological or psychological functioning. Theseaspects of the person should always be subordi-nated to the social and spiritual well-being of theindividual.

• Suffering can possess meaning. While theCatholic tradition affirms the pursuit of health, italso recognizes that all human beings are wound-ed in various ways and to various degrees.Woundedness and the suffering it produces arepart of the human condition. They are elements ofhuman finitude and are, in part, the result ofhuman sinfulness. Although suffering and pain are

not considered to be goods in their own right, theycan have meaning. They are opportunities for spir-itual growth. For some believers they can have apurifying effect, while for others they can beviewed as enabling one to share in the redemptivesuffering of Christ and in his resurrection. Thechurch recognizes that people’s capacity for suffer-ing varies and that this difference must always betaken into account. Furthermore, it recognizes thelegitimacy of trying to eliminate or reduce painand suffering. The patient is not required toendure pain and suffering at any price (PontificalCouncil Cor Unum [hereafter cited as PontificalCouncil] 1981; Pius XII, 1944; Congregation forthe Doctrine of the Faith [hereafter cited as CDF]1980).

• Death is natural and is a transitional stage to lifewith God. Death is to be approached with awe andrespect and accepted with responsibility and digni-ty. It marks the end of earthly existence and thusis a decisive summing up of a person’s moral andreligious life, but it opens up to a new mode ofexistence—personal life with God. Catholics, withmost Christians, believe that Jesus Christ, in beingraised up by God, has given a new meaning to suf-fering and death. Through faith in Jesus Christ,believers overcome the negativities associated withhuman suffering and death; they have hope in thereality of resurrection and eternal life.

THE INDIVIDUAL AND THE PATIENT-CAREGIVER RELATIONSHIP

The Catholic church does not hold an officialposition on the patient-caregiver relation-

ship, but it does communicate a certain perspec-tive in its many documents related to healthcare. As one might expect, that perspective isshaped by Catholicism’s staunch belief in thedignity of the human person and in the individ-ual’s inherent relatedness to others, especially tothe family and to society. The current emphasis

in medical ethics on autonomy, understood indi-vidualistically and almost as an absolute, is notcompatible with a Catholic understanding of theperson and of professional relationships general-ly. Nor is paternalism compatible because it vio-lates aspects of human dignity. In the patient-caregiver relationship, the Catholic traditiontries to maintain a balance between respect forthe individual and awareness of the individual’s


relationships and responsibilities toward others.Overall, the church does support the primacy ofthe patient in decision making, though not tothe exclusion of the patient’s family and otherswho might be important to the decision.

Pope Pius XII speaks of the patient’s role indecision making in two addresses. The patient,he maintains, is clearly the primary decisionmaker: “The doctor . . . cannot take any meas-ure or try an intervention without the consent ofthe patient. The doctor has only that power overthe patient which the latter gives him, be itexplicitly, or implicitly and tacitly” (Pius XII,1952). In the other document he writes: “Therights and duties of the doctor are correlative tothose of the patient. The doctor, in fact, has noseparate or independent right where the patientis concerned. In general he can take action onlyif the patient explicitly or implicitly, directly orindirectly, gives him permission” (Pius XII,1957).

A more comprehensive statement can befound in the Ethical and Religious Directives forCatholic Health Care Services published by theUnited States Conference of Catholic Bishops in2001. In the introduction to the section on theprofessional-patient relationship, the bishopsstate:

A person in need of health care and the profession-al health care provider who accepts that person as apatient enter into a relationship that requires,among other things, mutual respect, trust, honesty,and appropriate confidentiality. The resulting freeexchange of information must avoid manipulation,intimidation, or condescension. Such a relationshipenables the patient to disclose personal informationneeded for effective care and permits the healthcare provider to use his or her professional compe-tence most effectively to maintain or restore thepatient’s health. Neither the health care profession-al nor the patient acts independently of the other;both participate in the healing process. (UnitedStates Conference of Catholic Bishops 2001 [here-after cited as ERD]: 13)

More specifically, the Directives state that

informed consent is required prior to the per-formance of any medical procedure or treat-ment. It involves communicating to the patientor surrogate reasonable information about thenature of the proposed treatment, its risks, ben-efits, costs, and legitimate alternatives, includingno treatment at all (D. 26, 27). Finally, theDirectives state that “the free and informedhealth care decision of the person or the per-son’s surrogate is to be followed so long as itdoes not contradict Catholic principles” (D. 28).

CLINICAL ISSUES

Self-determination and informed consentThe Catholic church is very supportive of devel-opments in science and technology. Advances inhuman knowledge, the search for truth, and theuse of human creative abilities for the good ofhuman beings are an expression of humandominion over the created world. God createdhuman beings in his own image and likeness(Genesis 1:27), entrusting them with the respon-sibility of “dominion over the earth” (Genesis1:28). “Basic scientific research and appliedresearch constitute a significant expression ofthis dominion of man over creation. Science andtechnology are valuable resources for man whenplaced at his service and when they promote hisintegral development for the benefit of all”(CDF 1987: introduction, no. 2; Pius XII, 1952).

Not everything in scientific research and inthe development of various technologies is per-mitted, however. Science and technology cannotthemselves be the source of moral norms, of themeaning of human progress, or of human exis-tence. Usefulness, efficacy, and efficiency are notmoral criteria. Rather science and technologyare subject to and limited by moral valuesderived from the human person. In the words ofthe Congregation for the Doctrine of the Faith,the Vatican office responsible for maintainingorthodoxy in matters of faith and morals: “They[science and technology] draw from the personand his moral values the indication of their pur-pose and the awareness of their limits. . . .

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Science and technology require for their ownintrinsic meaning an unconditional respect forthe fundamental criteria of the moral law: Thatis to say, they must be at the service of thehuman person, of his inalienable rights and histrue and integral good according to the designand will of God” (CDF 1987: introduction, no.2; Pius XII, 1952; CCC 1997: nos. 2292-95).

The Congregation for the Doctrine of theFaith goes on to elaborate an ethical perspectiveand a basic principle to guide scientific researchand technological developments. Adequate crite-ria in this area can be derived only from a holis-tic understanding of the human person, that is,one that takes into account that human beingsare a “unified totality,” a unity of the corporaland the spiritual. The corporal dimension of theperson is a constitutive element; it is the mannerby which the individual expresses himself orherself. Furthermore, because the body is unitedwith a spiritual soul, it cannot be considered amere assemblage of tissues and organs or noth-ing more than the bodies of animals. Thehuman body is something more and needs to betreated as such.

This bodily and spiritual nature of the persongives rise to moral norms. The norm that shouldguide science and technology is articulated thisway:

An intervention on the human body affects notonly the tissues, the organs, and their functions,but also involves the person himself on differentlevels. It involves, therefore, perhaps in an implicitbut nonetheless real way, a moral significance andresponsibility. Pope John Paul II forcefully reaf-firmed this to the World Medical Association whenhe said:

Each human person, in his absolutely uniquesingularity, is constituted not only by his spirit, butby his body as well. Thus, in the body and throughthe body, one touches the person himself in hisconcrete reality. To respect the dignity of man con-sequently amounts to safeguarding this identity ofthe man corpore et anima unus, as the SecondVatican Council says (Gaudium et Spes, 14.1). It is

on the basis of this anthropological vision that oneis to find the fundamental criteria for decisionmaking in the case of procedures which are notstrictly therapeutic, as, for example, those aimed atthe improvement of the human biological condi-tion. (CDF 1987: introduction, no. 3)

The church recognizes that in the process ofacquiring new knowledge and developing newtechnologies, experimentation on human beingsmay at some point be essential. Furthermore, itrecognizes that all risk cannot be eliminated. Ifonly risk-free research were permitted, both sci-entific research and the well-being of individualswould suffer. Hence, the church accepts experi-mentation on human beings, even experimenta-tion that involves some risk. However, there arelimits and conditions.

The greatest moral threat of experimentationon human beings is turning them into mereobjects or violating the “integral well-being” ofthe person. To some degree, these dangers canbe avoided by the free and informed consent ofthe individual. But there are limits even toinformed consent. In the words of Pope Pius XII:

The patient has not the right to involve his physicaland psychic integrity in medical experiments orresearches, when these interventions entail, eitherimmediately or subsequently, acts of destruction, orof mutilation and wounds, or grave dangers.

Furthermore, in exercising his right to disposeof himself, of his faculties and organs, the individ-ual must observe the hierarchy of the scale of val-ues, and within an identical order of values, thehierarchy of individual goods, to the extentdemanded by the laws of morality. So, for example,man cannot perform upon himself or allow med-ical operations, either physical or somatic, whichbeyond doubt do remove serious defects or physi-cal or psychic weaknesses, but which entail at thesame time permanent destruction of, or a consid-erable and lasting lessening of freedom, that is tosay, of the human personality in its particular andcharacteristic function. (Pius XII, 1952)

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Hence, the individual cannot give consent toany experiment that is likely to harm the core ofthe person.

Like secular medical ethics, the church dis-tinguishes between therapeutic and nonthera-peutic experimentation. Pope John Paul II, forexample, observes that for the most part the rea-son justifying cooperation in an experiment isthe improvement of one’s own health. However,it can also be the case that an individual mayundertake some degree of risk as a “personalcontribution to the progress of medicine andthus to the common good.” Pope John Paul seesthis as a gift of self which “within the limits setby the moral law can . . . be a highly meritoriousproof of love and an occasion of spiritual growthof such magnitude as to offset the dangers of apossible physical diminution that is not substan-tial in kind” (John Paul II, 1980). In both cases,experimentation can be moral only if it does notpose the probability of grave harm to the sub-stantial integrity of the person.

Experimentation on human embryosThe church’s position regarding experimentationon human embryos rests on its convictionsabout the status of embryos. Perhaps the clear-est and most recent articulation of this connec-tion is to be found in the CDF’s 1987 Instruction:

Thus the fruit of human generation from the firstmoment of its existence, that is to say, from themoment the zygote has formed, demands theunconditional respect that is morally due to thehuman being in his bodily and spiritual totality.The human being is to be respected and treated asa person from the moment of conception andtherefore from that same moment his rights as aperson must be recognized, among which in thefirst place is the inviolable right of every innocenthuman being to life. . . . Since the embryo mustbe treated as a person, it must also be defended inits integrity, tended and cared for, to the extentpossible, in the same way as any other humanbeing as far as medical assistance is concerned.(CDF 1987: pt. 1, no. 3)

In formulating its position, the church distin-guishes between living and dead embryos andbetween therapeutic and nontherapeutic experi-mentation on living embryos. Therapeutic experi-mentation is permitted, provided appropriateinformed consent has been obtained, the propor-tion of risks to benefits has been weighed, andno other alternatives exist, whereas nontherapeu-tic experimentation on living embryos is strictlyprohibited (pt. 1, no. 4). In the words of the CDF,

No objective, even though noble in itself such as aforeseeable advantage to science, to other humanbeings, or to society, can in any way justify [non-therapeutic] experimentation on living humanembryos or fetuses, whether viable or not, eitherinside or outside the mother’s womb. . . . To usehuman embryos or fetuses as the object or instru-ment of experimentation constitutes a crimeagainst their dignity as human beings having aright to the same respect that is due to the childalready born and to every human person. (CDF1987: pt. 1, no. 4; see also John Paul II, 1982)

Dead embryos or fetuses, according to theCDF, must be shown the same respect as thecorpses of any other human beings. They shouldnot be mutilated until verification that death hasoccurred and the consent of the parents, espe-cially the mother, has been obtained. In addi-tion, there must be no complicity in direct abor-tion in order to obtain dead embryos and fetusesfor experimentation, and commercial traffickingin such embryos and fetuses is to be consideredillicit and should be prohibited (CDF 1987: pt.1, no. 4). The Directives strongly discourageCatholic hospitals from using tissue obtained bydirect abortion for research or even therapeuticpurposes (D. 66). It is also immoral, accordingto the CDF, to produce human embryos in vitrosolely for the sake of experimentation, “destinedto be exploited as disposable ‘biological materi-al’” (no. 5), or to engage in experiments “whichdamage or impose grave and disproportionaterisks” upon embryos (CDF 1987: pt.1, no. 5; seealso John Paul II, 1995: no. 63).

THE ROMAN CATHOLIC TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS10

Truth-telling and confidentialityThe Catholic church bases its position in regardto truth-telling and confidentiality on respect forpersons and on its more general teaching aboutthe moral obligation to communicate truthfully.It supports the current beliefs and practices inmedical ethics regarding these issues. Pope PiusXII did address the matter of truth-telling:

The eighth commandment likewise has its place inthe morality of medicine. According to the morallaw, no one may tell a lie. And yet there are caseswhen a doctor, even when asked, though he can-not give an answer which is positively untrue, atthe same time cannot crudely tell the whole truth,especially when he knows that the patient has notthe strength to stand such a revelation. But thereare other cases when the doctor has most certainlythe duty of speaking out clearly, a duty beforewhich every other medical or humanitarian con-sideration must give way. It is not lawful to lull thesick person or his relations into a false sense ofsecurity when there is the risk of compromisingthe eternal salvation of the former, or the fulfill-ment of his duties in justice and charity. It wouldbe wrong to try to justify or excuse such conductunder the pretext that the physician always sayswhat, in his opinion, will best contribute to thepatient’s well-being. . . . (Pius XII, 1944)

Much of the attention given to the matter oftruth-telling has been in the context of inform-ing the terminally ill that they are dying. “Thedying, and, more generally, anyone with anincurable disease, have a right to be told thetruth” (Pontifical Council 1981). This enablesthe individual to engage in a personal prepara-tion for death and also to fulfill responsibilitiesto family and to have an opportunity to put hisor her financial matters in order. The responsi-bility to inform the patient rests with those clos-est to him or her and should probably be sharedamong family, the chaplain, and the medicalteam (Pontifical Council 1981). A similar posi-tion is echoed in the 2001 Directives (D. 55).

Regarding confidentiality, Pope Pius XIIaffirms the obligation of the physician to pre-serve professional secrets, but he cautions thatthis obligation is not absolute. It should not beplaced “at the service of crime or injustice”because this would harm the common good,precisely what it is meant to foster (Pius XII,1944). The Directives state quite simply that“health care providers are to respect each per-son’s privacy and confidentiality regarding infor-mation related to the person’s diagnosis, treat-ment, and care” (D. 34).

Proxy decision making and advance directivesIn two separate statements, Pope Pius XII recog-nizes the legitimacy of proxy decision making.In one statement he notes that “the rights andduties of the family depend in general upon thepresumed will of the unconscious patient if he isof age and ‘sui juris’”(Pius XII, 1957). Thiswould seem to suggest that family members canspeak on behalf of the patient and also that thebasis of their decision should be what thepatient would choose if the patient were able.This is often referred to as “substituted judg-ment.” In the other statement, the pope observesthat the rights of proxies in their decision-mak-ing capacity are coextensive with those of thepatient; that is, proxies have the same rights thatthe patient has, and to the same extent (PiusXII, 1952).

The Directives also affirm the legitimacy ofproxy decision making as well as advance direc-tives, provided neither violates Catholic moralprinciples: “Each person may identify inadvance a representative to make health caredecisions as his or her surrogate in the eventthat the person loses the capacity to makehealth care decisions” (D. 25). If a patient hasnot executed an advance directive and has lostdecision-making capacity, those who know theperson best—usually family members and lovedones—should participate in making the treat-ment decision.


The Catholic tradition has the highest regardfor marriage and family. Both are viewed as

created and ordered by God: “Creating thehuman race in his own image and continuallykeeping it in being, God inscribed in thehumanity of man and woman the vocation, andthus the capacity and responsibility, of love andcommunion” (John Paul II, 1981: no. 11). Oneof the two primary ways in which this love isrealized is through marriage. Because God cre-ated man and woman to unite as husband andwife, to be a community of persons, marriage isseen to be fundamentally good (Second VaticanCouncil 1965: no. 48; see also CCC 1997: nos.2201-6).

The same can be said of human sexuality. Ittoo is a creation of God and is therefore good. Itis viewed within the Catholic tradition as anessential aspect of human identity and as funda-mental to human relations. It is considered oneof the principal formative influences in the life ofhuman beings, the “source of the biological, psy-chological, and spiritual characteristics whichmake a person male or female and which thusconsiderably influence each individual’s progresstowards maturity and membership of society.”Sexuality is intimately related to human beings’need to love and be loved, to enter into relation-ships; it is vital to the creation of families and ofthe human community (CDF 1975a: no. 1; seealso Vatican Congregation for Catholic Education1983: no. 4; CCC 1997: nos. 2360-79).

Sexual intercourse, as an expression ofhuman sexuality, is considered to be the mostprofound expression and commitment of oneperson to another. In the words of John Paul II:“Sexuality, by means of which man and womangive themselves to one another through the actswhich are proper and exclusive to spouses, is byno means something purely biological, but con-cerns the innermost being of the human personas such. It is realized in a truly human way onlyif it is an integral part of the love by which aman and a woman commit themselves totally to

one another until death. The total physical self-giving would be a lie if it were not the sign andfruit of a total personal self-giving, in which thewhole person . . . is present” (John Paul II,1981: no. 11).

Because it is a sign and an expression of totalself-giving, sexual intercourse, as ordered byGod, is appropriate only in the context of mar-riage. This has been the constant teaching of theCatholic church. Furthermore, God has orderedsexual intercourse within marriage not only asan expression and cause of mutual self-givingbut also as a means for the procreation of chil-dren. “By its very nature the institution of mar-riage and married love is ordered to the procre-ation and education of offspring and it is inthem that it finds its crowning glory” (SecondVatican Council 1965: no. 48). Children areconsidered to be the “supreme gift” of marriageand to contribute greatly to the good of thespouses. The procreation of children is, indeed,considered to be cooperation in the creativework of God and God’s building up of thehuman family.

Until the Second Vatican Council, theCatholic church considered the procreative pur-pose of conjugal love to be its primary purpose.Since then the unitive dimension has been con-sidered equally important. At no time, however,were these two purposes thought to be separableone from the other. The church has always heldthem to be inseparable because they wereordained by God as such. The very nature ofhuman acts of sexual intercourse is to be bothexpressive of love and procreative. To separatethese two purposes intentionally is to violateGod’s purposes.

Although married couples should regard it astheir proper mission to transmit human life andto educate their children, they should exercisethis mission responsibly. Spouses are called toresponsible stewardship in the exercise of theirprocreative capacities. The decision to have chil-dren must be made conscientiously, taking into


FAMILY, SEXUALITY, AND PROCREATION

account factors that will have an impact on thefuture child, the family, and society. Exercisingthis stewardship involves “consideration of theirown good and the good of their children alreadyborn or yet to come, an ability to read the signsof the times and of their own situation on thematerial and spiritual level, and, finally, an esti-mation of the good of the family, of society, andof the Church. It is the married couple them-selves who must in the last analysis arrive atthese judgments before God” (Second VaticanCouncil 1965: no. 50; see also Paul VI, 1968:no. 10).

CLINICAL ISSUES

ContraceptionThe Catholic church does not permit the use ofany medication, instrument, or procedurebefore, during, or after sexual intercourse that isintended to prevent conception. Any such meas-ures would separate the unitive and procreativeaspects of sexual intercourse and thus wouldviolate the divine will. Such measures are con-sidered intrinsically evil. In the words of PopePius XI: “Since, therefore, the conjugal act isdestined primarily by nature for the begetting ofchildren, those who in exercising it deliberatelyfrustrate its natural power and purpose sinagainst nature and commit a deed which isshameful and intrinsically vicious” (Pius XI,1930: no. 4). Pope Paul VI puts it equally force-fully in his famous 1968 encyclical:

This particular doctrine, often expounded by theMagisterium of the Church, is based on the insep-arable connection, established by God, which manon his own initiative may not break, between theunitive significance and the procreative signifi-cance which are both inherent to the marriage act.

The reason is that the marriage act, because ofits fundamental structure, while it unites husbandand wife in the closest intimacy, also brings intooperation laws written into the actual nature of manand of woman for the generation of new life. . . .

An act of mutual love which impairs the capac-ity to transmit life which God the Creator, throughspecific laws, has built into it, frustrates his designwhich constitutes the norms of marriage, and con-tradicts the will of the Author of life. Hence, touse this divine gift while depriving it, even if onlypartially, of its meaning and purpose, is equallyrepugnant to the nature of man and woman,strikes at the heart of their relationship, and isconsequently in opposition to the plan of God andhis holy will. (Paul VI, 1968: nos. 12, 13; see alsoSecond Vatican Council 1965: no. 50; John PaulII, 1981: no. 32; CCC 1997: no. 2370)

A further reason noted by Paul VI for con-demning artificial contraception is that humanbeings, just as they do not have full dominionover their bodies, likewise do not have fulldominion over their sexual faculties. Thesecapacities by their very nature have to do withthe generation of life, of which God is thesource (Paul VI, 1968: no. 13). Pope John PaulII adds another reason: the separation of theunitive and procreative aspects of marriagedegrades human sexuality by altering its valueof total self-giving. “The innate language thatexpresses the total reciprocal self-giving of hus-band and wife is overlaid, through contracep-tion, by an objectively contradictory language,namely, that of not giving oneself totally to theother” (John Paul II, 1981: no. 32).

A chemical agent or procedure that happensto have a contraceptive effect may, however, beused to treat a pathological condition. The con-traceptive effect, though it is foreseen, must notbe intended and must be unavoidable. The prin-ciple of double effect discussed above is opera-tive here (Paul VI, 1968: no. 15).

SterilizationSterilization—whether female or male, perma-nent or temporary—is also condemned by thechurch for the same reason: it frustrates the pro-creative aspect of sexual intercourse and of mar-riage. If, however, the sterilization occurs as theresult of a medical procedure intended to cure,


alleviate, or prevent a serious pathological con-dition when no other reasonable alternativesexist, it is morally permissible on the basis ofthe principle of double effect. Such sterilizationsare called “indirect” because the sterilizingeffect is an unintended result of a therapeuticmeasure. Sterilization is considered to be“direct” and immoral when it intends to preventprocreation (Paul VI, 1968: no. 15; see alsoERD, D. 53; Pius XII, 1951; CDF 1975b; NCCB1980; CCC 1997: nos. 2370, 2399).

NEW REPRODUCTIVE TECHNOLOGIES

Artificial inseminationIn its 1987 “Instruction on Respect for HumanLife,” the Congregation for the Doctrine of theFaith addresses several reproductive technolo-gies, including artificial insemination. Reflectingits traditional view on procreation, the Vaticancondemns artificial insemination between hus-band and wife (homologous) if it replaces theact of sexual intercourse. As previously noted,the procreation of new life must result from anact of conjugal love; artificial insemination sepa-rates the procreation of new life from an act ofsexual love. Furthermore, it likely involves mas-turbation for obtaining sperm, which is also pro-hibited (CDF 1987: pt. 2.B, no. 6; see also ERD,D. 41; Pius XII, 1949: no. 4; Pius XII, 1951;CCC 1997: no. 2376). If, however, artificialinsemination simply assists the act of sexualintercourse or helps it to reach its natural end,namely, fertilization, then it can be consideredmorally acceptable.

Heterologous artificial insemination, that is,the use of donor sperm or egg, is never morallypermissible. Not only does it involve a separationof procreation from sexual intercourse, it alsoseparates procreation from the exclusive union ofhusband and wife. In the words of Pius XII:

Artificial insemination in matrimony, but pro-duced by means of the active element of a thirdperson, is equally immoral, and as such is to be

condemned without right of appeal.Only the husband and wife have the reciprocal

right on the body of the other for the purpose ofgenerating new life: an exclusive, inalienable,incommunicable right. And that is as it should be,also for the sake of the child. To whoever gives lifeto the tiny creature, nature imposes, in virtue ofthat very bond, the duty of protecting and educat-ing the child. But when the child is the fruit of theactive elements of a third person—even grantingthe husband’s consent—between the legitimatehusband and the child there is no such bond oforigin, nor the moral and juridical bond of conju-gal procreation. (Pius XII, 1949: no. 3)

The 1987 CDF document offers a similarcondemnation: “Heterologous artificial fertiliza-tion is contrary to the unity of marriage, to thedignity of the spouses, to the vocation proper toparents, and to the child’s right to be conceivedand brought into the world in marriage andfrom marriage” (CDF 1987: pt. 2.A, no. 2).Artificial insemination using the gametes of athird party shows disrespect for the unity ofmarriage and for conjugal fidelity. It violates the“bond existing between husband and wife[which] accords the spouses . . . the exclusiveright to become father and mother solelythrough each other”; it violates the reciprocalcommitment of the spouses. It furthermore vio-lates the rights of the child to a filial relation-ship with his or her parental origins and couldconceivably hinder the development of thechild’s personal identity. And, finally, it“deprives conjugal fruitfulness of its unity andintegrity” by rupturing genetic parenthood, ges-tational parenthood, and responsibility for thechild’s upbringing. The desire to have a childcannot justify heterologous artificial insemina-tion (see also ERD, D. 40).

Gamete intrauterine fallopian transfer(GIFT)In gamete intrauterine fallopian transfer, theovaries are hyperstimulated and ova areretrieved. Ova and sperm are placed in a


catheter close to each other and are reinsertedinto the fallopian tube so that fertilization canoccur in the woman’s body. The church has notspoken definitively on this matter, but since theprocedure assists natural fertilization, there isreason to believe that it would be morallyacceptable.

In vitro fertilization (IVF)In vitro fertilization involves procuring spermand egg(s) so that fertilization can occur in alaboratory dish, hence outside the body of thewoman. Sperm and eggs may be either from thespouses (homologous) or from donors (heterolo-gous). Both types are considered by the churchto be immoral because they “involve the separa-tion of procreation from an act of conjugal love,thereby violating the very nature of marriageand the conjugal act” (CDF 1987: pt. 2.B, nos.4-5). In vitro fertilization also violates the digni-ty of the child.

In reality, the origin of a human person is theresult of an act of giving. The one conceived mustbe the fruit of his parents’ love. He cannot bedesired or conceived as the product of an inter-vention or medical or biological techniques; thatwould be equivalent to reducing him to an objectof scientific technology. No one may subject thecoming of a child into the world to conditions oftechnical efficiency which are to be evaluatedaccording to standards of control and dominion. . . .Such fertilization entrusts the life and identity ofthe embryo into the power of doctors and biolo-gists and establishes the domination of technologyover the origin and destiny of the human person.Such a relationship of domination is in itself con-trary to the dignity and equality that must be com-mon to parents and children. (CDF, 1987: pt. 2.B,nos. 4, 5)

A further concern is that this procedure usu-ally, though not necessarily, involves a deliberatedestruction of fertilized eggs, constituting abor-tions in the eyes of the church. The CDF docu-ment states: “Such deliberate destruction of

human beings or their utilization for differentpurposes to the detriment of their integrity andlife is contrary to the doctrine on procured abor-tion” (CDF 1987: pt. 2, Introduction).

Surrogate motherhoodIn the same document, the Vatican also con-demns surrogate motherhood. It “represents anobjective failure to meet the obligations ofmaternal love, of conjugal fidelity, and ofresponsible motherhood; it offends the dignityand the right of the child to be conceived, car-ried in the womb, brought into the world, andbrought up by his own parents; it sets up, to thedetriment of families, a division between thephysical, psychological, and moral elementswhich constitute those families” (CDF 1987: pt.2.A, no. 3). The Directives add to the reasons forthis condemnation a denigration of the dignityof women, especially the poor (D. 42).

ABORTION AND THE STATUS OF THEFETUS

The Catholic church has maintained consistentopposition to all abortion that has as its primaryaim the direct termination of fetal life for anyreason, whether it be to preserve the life orhealth of the mother, to avoid serious geneticabnormality, to prevent a birth resulting fromrape or incest, or to forgo the burdens of anadditional child. Abortions which aim at the ter-mination of fetal life are called direct abortions.Under no circumstances are they permissible(CDF 1974; see also ERD, D. 45; John Paul II,1995: nos. 57-62; CCC 1997: nos. 2270-72).The primary reason for this condemnation isthat the church considers the fertilized ovum tobe human life and even a human person. “Thusthe fruit of human generation, from the firstmoment of its existence, that is to say from themoment the zygote has formed, demands theunconditional respect that is morally due to thehuman being in his bodily and spiritual totality.The human being is to be respected and treated


as a person from the moment of conception; andtherefore from that same moment his rights as aperson must be recognized, among which in thefirst place is the inviolable right of every inno-cent human being to life” (CDF 1987: pt. 1,Introduction; see also CDF 1974: no. 12). Thefertilized egg is neither the life of the mothernor the life of the father. It is rather the life of anew human being with its own growth.

The church does, however, permit indirectabortion. This occurs when a treatment, opera-tion, or medication is aimed at curing or allevi-ating a serious pathological condition in thepregnant woman even if it has an abortive effect,if there are no other reasonable alternatives(CDF 1974; ERD, D. 47). The death of the fetusis unintended (though foreseen) and is theunavoidable by-product of the procedure. Aclassic example is the removal of a cancerousuterus in early pregnancy. The aim is to save thelife of the mother. The removal of the pathologysimultaneously saves the mother’s life andresults in the death of the fetus. The principle ofdouble effect is operative here.

PRENATAL DIAGNOSIS AND TREATMENT

The official teaching of the church supports theuse of prenatal diagnosis if it “respects the lifeand integrity of the embryo and the human fetusand is directed toward its safeguarding or heal-ing as an individual” (CDF 1987: pt. 1, no. 2;see also ERD, D. 50; CCC 1997: no. 2274; JohnPaul II, 1995, no. 63). In other words, insofar asprenatal testing makes it possible to anticipateearlier and more effectively certain therapeutic,medical, or surgical procedures without subject-ing the fetus or the mother to disproportionaterisk, it is morally acceptable, if the parents’informed consent has been obtained.

If prenatal diagnosis is to be done, however,with the deliberate intention of aborting a fetusthat is found to be malformed or abnormal, it isconsidered gravely immoral and is prohibited.

The mother who would seek prenatal diagnosisfor this purpose, anyone suggesting or imposingit, and any specialist who in communicating theresults suggests a link between prenatal diagno-sis and abortion would be acting immorally.

Furthermore, “any directive or program of thecivil and health authorities or of scientific organ-izations which in any way were to favor a linkbetween prenatal diagnosis and abortion, orwhich were to go as far as directly to induceexpectant mothers to submit to prenatal diagno-sis planned for the purpose of eliminating fetus-es which are affected by malformations or whichare carriers of hereditary illness, is to be con-demned as a violation of the unborn child’s rightto life and as an abuse of the prior rights andduties of the spouses” (CDF 1987: pt. 1, no. 2).

CARE OF SEVERELY HANDICAPPEDNEWBORNS

Because of its view of the human person, theCatholic church affirms the dignity and worth ofseverely handicapped newborns. They cannot bediscriminated against on the basis of their limi-tations. They have the same right to life and tomedical care as any “normal” newborn. At thesame time, however, parents of handicappednewborns and their caregivers must ask whethermedical treatment is appropriate and, if so,which treatments are appropriate. The samesteps are taken here as with adult patients,namely, an assessment of the benefits and bur-dens of treatment to the infant. The handicapitself and burdens upon the family are not inthemselves legitimate reasons for withholding orwithdrawing treatment from these babies. Theearly delivery of anencephalic infants, an issuedebated by several theologians in the past tenyears, was declared unethical by the NationalConference of Catholic Bishops in l996 (NCCB1996).


The Catholic tradition views genetics positive-ly though cautiously. It is positive in that it

affirms genetic medicine’s actual and futurecapability of helping human beings overcomelimitations on the normal functioning of theirpsychophysical selves and its intention to con-tribute to the good of individuals and of thecommunity. In the words of Pope Pius XII(1953), “The fundamental tendency of geneticsand eugenics is to influence the transmission ofhereditary factors in order to promote what isgood and eliminate what is injurious. This fun-damental tendency is irreproachable from themoral viewpoint.” He believes that the “practicalaims being pursued by genetics are noble andworthy of recognition and encouragement.”

At the same time, however, Catholicism iscautious. Certain values must not be violated.The biological nature of every human is invio-lable insofar as it constitutes an essential com-ponent of the personal identity of the individual.The person is a unity of body and soul.Respecting the dignity of the person meansrespecting this unity. Pope John Paul II alsoraises cautions against racially motivated geneticmanipulations or manipulations that arise out ofa materialist mentality which promotes a reduc-tive view of human happiness. More specifically,he writes: “Genetic manipulation becomes arbi-trary and unjust when it reduces life to anobject, when it forgets that it has to do with ahuman subject, capable of intelligence and lib-erty, and worthy of respect, whatever its limita-tions; or when genetic manipulation treats thehuman subject in terms of criteria not foundedon the integral reality of the human person, atthe risk of doing damage to his dignity. In thiscase it exposes man to the caprice of others, bydepriving him of his autonomy” (John Paul II,1983).

It would be appropriate to mention here theCatholic view of disability. The Catholic tradi-tion recognizes the fundamental dignity of allpersons, including those who may be physically

or mentally disabled. Because of this, the churchsees its role as defending the rights of disabledpersons, particularly their right to life as well asother rights which enable the handicapped indi-vidual to “achieve the fullest measure of person-al development of which he or she is capable”(United States Catholic Conference [hereaftercited as USCC] 1978). It is also incumbent uponthe church to work for the realization of therights of the handicapped in society. It mustwork to sensitize society to the needs of thehandicapped and to support their rightfuldemand for justice. This involves being“informed by a sincere and understanding lovethat penetrates the wall of strangeness andaffirms the common humanity underlying alldistinction” (USCC 1978).

CLINICAL ISSUES

Genetic screening and counselingThere is no official church teaching in this area.Given the church’s moral stance concerningissues in genetics, the church would approve ofgenetic screening and counseling if it con-tributed to more responsible parenthood and tobetter preparation for the treatment and care ofchildren likely to be born with genetic abnor-malities. Screening that is discriminatory, invol-untary, or provided without sufficient informedconsent from the couple or that violates thecouple’s right to procreate may be consideredmorally unacceptable (ERD, D. 54).

Sex selectionIn the 1987 “Instruction on Respect for HumanLife,” the church condemns the use of sex selec-tion of embryos. These nontherapeutic manipu-lations “are contrary to the personal dignity ofthe human being and his or her integrity andidentity” (CDF 1987).


GENETICS

Selective abortionThe abortion of malformed or abnormal fetusesis condemned (CDF 1974; CDF 1987).

Gene therapyIn principle, therapeutic interventions that seekto correct various abnormalities are consideredmoral and even desirable as long as they gen-uinely promote human well-being and do notharm the integrity of the person or worsen theperson’s life conditions. “The research of mod-ern biology gives hope that the transfer andmutation of genes can ameliorate the conditionof those who are affected by chromosomal dis-eases; in this way the smallest and weakest of

human beings can be cured during theirintrauterine life or in the period immediatelyafter birth” (John Paul II, 1982; see also JohnPaul II, 1983).

Nontherapeutic interventions must also aimat improving the human biological condition;they must not do violence to the dignity of theperson and to the common biological naturethat all share. They threaten to do this if theytreat persons as objects or diminish their auton-omy, if they are undertaken with racist motivesor aim at a materialist view of happiness, or ifthey create people who are likely to be sociallymarginalized (John Paul II, 1983).


The Catholic church considers the donationof an organ to those who have need of it a

“noble and meritorious act,” particularly if it ismotivated by human and Christian solidarity—“the love of neighbor, which forms the inspiringmotive of the Gospel message, and which hasbeen defined, indeed, as the new command-ment” (John Paul II, 1984a).

John Paul II has been very supportive oforgan and tissue transplantation. In a 1991 dis-cussion focused on transplantation, he writes:“We should rejoice that medicine, in its serviceto life, has found in organ transplantation a newway of serving the human family, precisely bysafeguarding that fundamental good of the per-son” (John Paul II, 1991). He frames transplan-tation in the context of gift:

This form of treatment is inseparable from ahuman act of donation. In effect, transplantationpresupposes a prior, explicit, free and consciousdecision on the part of the donor or of someonewho legitimately represents the donor, generallythe closest relatives. It is a decision to offer, with-out reward, a part of one’s own body for the

health and well-being of another person. In thissense, the medical act of transplantation makespossible the donor’s act of self-giving, that sinceregift of self which expresses our constitutive callingto love and communion.

Love, communion, solidarity, and absoluterespect for the dignity of the human person con-stitute the only legitimate context of organ trans-plantation. It is essential not to ignore the moraland spiritual values which come into play whenindividuals, while observing the ethical normswhich guarantee the dignity of the human personand bring it to perfection, freely and consciouslydecide to give a part of themselves, a part of theirown body, in order to save the life of anotherhuman being . . .

For Christians, Jesus’ offering of himself is theessential point of reference and inspiration of thelove underlying the willingness to donate anorgan, which is a manifestation of generous soli-darity, all the more eloquent in a society whichhas become excessively utilitarian and less sensi-tive to unselfish giving. (John Paul II, 1991; ERD,D. 63)

ORGAN AND TISSUE TRANSPLANTATION

CLINICAL ISSUES

Issues concerning recipientsRecipients of organs should not forget that theyare receiving a gift of self offered by the donor.This is a profound act of human solidarity (JohnPaul II, 1991).

Issues concerning donorsOrgan and tissue donation from live donors isconsidered to be morally acceptable if it is donewith the free and informed consent of the donor,if it does not deprive the donor of life or theintegrity of an organ system, and if there is anacceptable proportion between the good to beexperienced by the recipient and the harm doneto the donor (John Paul II, 1984a; CCC 1997:no. 2296).

Procurement of organs from corpses is alsomorally acceptable if respect is shown for thebody and the rights of the next of kin. It shouldnot normally occur without the consent of thenext of kin or over the previous objections ofthe potential donor (Pius XII, 1956).

While a statement has been made by theNCCB concerning the early delivery of anen-cephalic infants (NCCB 1996), no official

church statement regarding the procurement oftissue or organs from anencephalic newbornshas been made. However, one can infer a posi-tion from church teaching on the dignity of thehuman person and on organ transplantationgenerally. Procurement of organs from anen-cephalic newborns who have died would betreated like procurement from any other corpse.But the removal of organs while the infant isstill living (breathing spontaneously) whichresults in the death of the infant would be aform of homicide. The church does not permitthe removal of organs if removal would causethe individual’s death. Nor would it permit theuse of anencephalics merely as a source oforgans.

Much the same would be true of humanfetuses. (See also “Experimentation on humanembryos,” above.)

The sale of organs is condemned. “Such areductive materialist conception would lead to amerely instrumental use of the body, and there-fore of the person. In such a perspective, organtransplantation and the grafting of tissue wouldno longer correspond to an act of donation butwould amount to the dispossession or plunder-ing of a body” (John Paul II, 1991).


Not much attention has been given to thetopic of mental health in official church

teaching. One of the few to address it was PopePius XII, who was concerned primarily aboutthe compatibility of psychotherapy and clinicalpsychology with a Christian understanding ofthe person (Pius XII, 1952). It would be safe tosay, in view of the principles enunciated earlier,that no form of psychotherapy or chemical orsurgical manipulation of human behavior wouldbe justifiable if it eliminated or severely limitedhuman freedom or severely damaged the humanpersonality. Short of this, if the behavior modifi-

cation is undertaken for the well-being of thepatient, achieves a suitable proportion betweenbenefits and risks or harms, and is attemptedwith the informed consent of the patient orguardian, it would be considered ethical.Behavior control that is nontherapeutic and thatis undertaken for the benefit of others is consid-erably more difficult to justify, especially if itresults in harm to the patient. Respect forhuman dignity and the integrity of the personare essential.

Several moral principles provide further guid-ance in this area:

MENTAL HEALTH

1. The functional integrity of the person may besacrificed to maintain the health or life of the per-son when no other morally permissible means isavailable (ERD, D. 29).2. Therapeutic procedures that are likely to causeharm or undesirable side effects can be justifiedonly by a proportionate benefit to the patient(ERD, D. 33).3. The greater the person’s incompetency and vul-nerability, the more compelling the reasons mustbe to perform any medical experimentation, espe-cially nontherapeutic procedures (ERD, D. 31).

CLINICAL ISSUES

Involuntary commitmentThere is no official Catholic teaching on thisissue. But since involuntary commitment is adeprivation of human freedom, it could be justi-fied only for a serious reason.

Psychotherapy, behavior modification, andpsychopharmacologyPsychotherapy, behavior modification, and psy-chopharmacology can be morally justified whenthey are employed for the well-being of thepatient and have the effect of enhancing thepatient’s freedom. The principles noted abovewould guide these decisions.

Electroshock There is no official Catholic teaching on elec-troshock. The treatment would seem, however, tobe justifiable on the basis of the principle of total-ity. It involves manipulating (and possibly damag-ing) a part of the body for the good of the wholeperson. As with other interventions, the churchinsists on the free and informed consent of theindividual (to the degree possible) or the proxy.The full exploration of any less radical alterna-tives, and an acceptable proportion betweenharms and benefits, must also be reckoned.

Catholicism views death as a natural event,part of the human condition. It is a fact of

life, inextricably bound up with human finitude.Insofar as it ends an individual’s existence, rup-tures relationships, disrupts lives, and createsprofound losses, it is viewed as tragic and nega-tive. But Catholics also believe that Christ,through his death and resurrection, has over-come the “sting of death.” Death is not the finalword. Catholic Christians live in the hope oftheir own resurrection. They face death with theconfidence of faith. Death, then, makes possiblea new and better existence, one that constitutesthe ultimate fulfillment of the human personand of human existence: union with God.

The dying process can also be a most impor-tant time, a time of preparation for the momentof death. This preparation can include a deepen-ing of relationships and even a healing of rela-tionships with God, family, and friends. It can

also be a time of personal transformation andgrowth before the final summing up of one’s lifein death. The process of dying can provideextraordinary opportunities for good to occur.

Catholicism’s beliefs about the sacredness ofhuman life should also be kept in mind whenone is considering ethical issues in the care ofthe dying. Life is a sacred gift of the Creator anda fundamental good. It is a good over which wedo not have complete power. As stewards, wehave a duty to preserve life and use it for thepurposes for which it was intended. But thisduty to prolong life is not absolute. Not every-thing must be done to preserve life, thoughnothing can be done intentionally and directlyto end innocent human life (CDF, 1980).

Finally, Catholicism’s approach to the care ofthe dying is shaped by a profound respect forthe dignity and total well-being of the person.These convictions have enabled Catholicism to


DEATH AND DYING

avoid two extremes: maintaining life at all costsand directly hastening death.

CLINICAL ISSUES

Determining deathThe Catholic church recognizes total brain deathas a criterion for determining that a person hasdied. The Pontifical Academy of Sciences hasstated: “A person is dead when he has irre-versibly lost all capacity to integrate and coordi-nate the physical and mental functions of thebody. Death has occurred when: A. The sponta-neous cardiac and respiratory functions havedefinitively ceased; or B. An irreversible cessa-tion of every brain function is verified”(Pontifical Academy of Sciences 1985). TheERD state that physicians should determinedeath on the basis of “commonly accepted sci-entific criteria” (D. 62). In cases of total braindeath, the church also supports the use ofmechanical ventilation to prolong respiratoryand cardiac function so that organs may beremoved for transplantation (Pontifical Academyof Sciences 1985; see also United StatesCatholic Conference Advisory Committee onEthical and Religious Directives for CatholicHealth Facilities 1975).

Pain control and palliative careAs previously noted, Catholicism upholds thebelief that pain and suffering can be beneficial,but it does not see them as good in themselvesor as conditions to be endured without relief.The church not only supports but recommendsthe relief of pain and suffering—with some quali-fications, however. A major concern that sur-faces in various ecclesiastical documents is thefear that analgesics will be used to such anextent that they will prevent the dying personfrom experiencing his or her dying and doingthe work of dying. In the words of the PontificalCouncil Cor Unum, the excessive use of anal-gesics “deprives him of arriving at a sereneacceptance of [death], of achieving a state of

peace; of sharing, perhaps, a last intense rela-tionship between a person reduced to that lastof human poverties and another person who willhave been privileged by knowing him. And, ifthe dying person is a Christian, he is beingdeprived of experiencing his death in commun-ion with Christ” (Pontifical Council 1981). Sowhile it is permissible to attempt to reduce oreven eliminate pain, it is not optimal to plungethe patient into unconsciousness to do so, unlessthat is absolutely necessary. There must be acompelling reason to deprive someone of con-sciousness in the attempt to relieve pain (ERD,D. 61).

The other danger or concern is the belief thatanalgesics are sufficient to address pain and suf-fering. The same Pontifical Council documentinsists on the importance of human presence tohelp alleviate pain. In particular they call forhealth professionals to be trained in how to lis-ten to the dying, how to provide support for oneanother, and how to help families provide lovingcare throughout the dying process.

The final issue in the use of pain medicationsis the problem of possibly hastening deaththrough the use of analgesics intended to relievepain. This issue was addressed by Pope PiusXII, and his position has been reiterated in sev-eral subsequent Vatican statements. The 1980Vatican “Declaration on Euthanasia,” for exam-ple, states:

At this point it is fitting to recall a declaration byPius XII, which retains its full force; in answer toa group of doctors who had put the questions: “Isthe suppression of pain and consciousness by theuse of narcotics . . . permitted by religion andmorality to the doctor and the patient (even at theapproach of death and if one foresees that the useof narcotics will shorten life)?” the Pope said: “Ifno other means exist, and if, in the given circum-stances, this does not prevent the carrying out ofother religious and moral duties: Yes.” In this case,of course, death is in no way intended or sought,even if the risk of it is reasonably taken; the inten-tion is simply to relieve pain effectively, using for


this purpose painkillers available to medicine.(CDF 1980; ERD, D. 61)

Hence, the position of the church is thatanalgesics may be used in sufficient amounts torelieve pain even if they may also shorten life,provided the latter effect is not intended. Theprinciple of double effect is operative here.

Forgoing life-sustaining treatmentCatholic thinking and teaching regarding thematter of forgoing life-sustaining treatment datesback to the sixteenth century. The first explicitdiscussion is to be found in the work of aSpanish Dominican theologian, Francisco diVittoria. His fundamental principles are stillvalid: “God does not want us to worry about along life, but a good life,” and, “It is one thingto end one’s life, and another thing to not pro-long it.” He also addressed the moral obligationto employ food to prolong life. Subsequent the-ologians refined di Vittoria’s position. Thisdevelopment probably culminated in the well-known 1958 statement of Pope Pius XII. Themost recent official statement on the matter isthe 1980 “Declaration on Euthanasia” by theCongregation for the Doctrine of the Faith.

The Catholic tradition has long supported for-going life-sustaining treatment in certain cir-cumstances based on the principle of benefitand burden. In brief, there is a moral obligationto accept treatments that prolong life if they areof benefit to the patient and can be employedwithout excessive burden. The degree of burdenis to be judged by the patient or the patient’ssurrogate and includes emotional, psychological,spiritual, and economic burdens as well as phys-ical ones. There is, however, no moral obligationto utilize treatments that are of little or no bene-fit to the patient or that impose burdens dispro-portionate to the benefits hoped for or obtained(CDF 1980).

Prior to the Vatican’s 1980 statement, forgo-ing treatment was usually discussed in terms of

“ordinary” and “extraordinary” means. Whethera treatment was ordinary or extraordinary wasdetermined by assessing its benefits and burdensto the patient, not the nature of the treatmentitself. For a particular patient, then, an IV, assimple and common as it is, could be considered“extraordinary means” if it would not benefitthe patient considered holistically or if it wouldimpose excessive burdens on the patient.Likewise, a ventilator could, in appropriate cir-cumstances, be considered “ordinary means” fora given patient. In other words, what makes atreatment ordinary or extraordinary is not thesimplicity or complexity of the treatment, itscommon use, or its availability but rather itsimpact upon the total well-being of the patient.Because of the ambiguity about the terminologyof ordinary and extraordinary means, the lan-guage of benefit and burden is preferable,though it must be kept in mind that what is abenefit and what a burden will vary from patientto patient and should be determined from theperspective of the patient (ERD, D. 57, 58).

A particular form of forgoing life-sustainingtreatment that is still a subject of discussion isthe withholding or withdrawal of artificiallyadministered nutrition and hydration. Whilethere is no definitive Catholic position on thisissue, a number of statements have been madeby various bishops and ecclesiastical bodies.Some believe that artificial nutrition and hydra-tion are to be considered medical treatments,and decisions about them should be made onthe basis of the principle of burden and benefit.Others believe that since nutrition and hydrationare so essential to life and such a basic form ofcare, they must always be provided. TheDirectives take the following position: “Thereshould be a presumption in favor of providingnutrition and hydration to all patients, includingpatients who require medically assisted nutritionand hydration, as long as this is of sufficientbenefit to outweigh the burdens involved to thepatient” (D. 58).


Suicide, assisted suicide, and active euthanasiaSuicide, assisted suicide, and active euthanasiaare forbidden in the Catholic tradition. On thematter of suicide, the CDF wrote in its“Declaration on Euthanasia” (1980):

Intentionally causing one’s own death, or suicide,is . . . equally as wrong as murder; such an actionon the part of a person is to be considered as arejection of God’s sovereignty and loving plan.Furthermore, suicide is also often a refusal of lovefor self, the denial of the natural instinct to live, aflight from the duties of justice and charity owedto one’s neighbor, to various communities, or tothe whole of society—although, as is generally rec-ognized, at times there are psychological factorspresent that can diminish responsibility or evencompletely remove it.

The church recognizes that most suicides occuras the result of psychiatric factors and, conse-quently, that the individual is usually not held tobe fully responsible for the act.

The Vatican “Declaration on Euthanasia”defines euthanasia as “an action or an omissionwhich of itself or by intention causes death, inorder that all suffering may in this way be elimi-nated” (CDF 1980). Hence, the key elements indetermining whether an action is euthanasia arethe intention implicit in the act and the means.These two elements are what distinguish “allow-ing to die” or “forgoing life-sustaining treat-ment” from euthanasia. In allowing to die, theintention of the external act is not directly tobring about death but rather to cease employingtreatments that are ineffective or burdensome,even though it may be known that the patientwill die sooner as a consequence. The principleof double effect is operative here. When a per-son is allowed to die, the cause of death is theunderlying pathology, whereas in euthanasia, itis the means itself (which is entirely extrinsic tothe pathology) that brings about death. Becausedeath is directly intended and brought about ineuthanasia, it is morally forbidden. It violates

the basic moral norm in Catholicism againsttaking innocent human life for the reasons dis-cussed above. In the words of the Vatican decla-ration (CDF, 1980):

It is necessary to state firmly once more that noth-ing and no one can in any way permit the killing ofan innocent human being, whether a fetus or anembryo, an infant or an adult, an old person, orone suffering from an incurable disease, or a per-son who is dying. Furthermore, no one is permittedto ask for this act of killing, either for himself orherself or for another person entrusted to his orher care, nor can he or she consent to it, eitherexplicitly or implicitly. Nor can any authority legiti-mately recommend or permit such an action. For itis a question of the violation of the divine law, anoffense against the dignity of the human person, acrime against life, and an attack on humanity.

This opposition to euthanasia is reiterated in atleast three recent statements by the currentpope (John Paul II, 1984b; 1985; 1995: n. 64-66; see also ERD, D. 60; CCC 1997: nos. 2276-83).

Autopsy and postmortem careAutopsy is morally permitted in Catholicism,provided that the body is not treated merely as athing and that consent has been obtained fromthe next of kin (Pius XII, 1954).

Last rites, burial, and mourning customsThe celebration of the Eucharist is central toCatholic belief and life and is likewise central toreligious rites for the deceased. There is a spe-cial funeral liturgy for Catholics who have died:the Mass of Christian Burial. This usually takesplace in the deceased individual’s parish church,with the body present, two or three days afterthe individual has died. In some locations, thevisitation, wake, or vigil takes place in thechurch prior to the funeral liturgy.

Prior to the Second Vatican Council, theCatholic funeral ritual was somber. This tonewas reflected in the prayers, hymns, and vest-


ments of the priest (black). Since Vatican II, thegeneral theme of the Catholic funeral servicehas been resurrection. Now one finds the use ofwhite vestments, hymns and prayers referring toChrist’s resurrection from the dead, and use ofthe Easter candle which symbolizes the risenChrist (CCC 1997: nos. 1680-90).

Burial is normally in the earth, though use ofmausoleums and even of cremation is permitted.Until 1969, cremation was banned because itwas used by some as a denial of the resurrec-tion. Today, however, it has become a practicalway of dealing with the corpse and does notusually carry with it a denial of resurrection.The Code of Canon Law permits cremation, pro-

vided that it has not been chosen “for reasonswhich are contrary to Christian teaching” (C.1176.3).

StillbirthsTwo issues arise in the case of stillbirths: bap-tism and burial. The practice of the church,reflected in an earlier Code of Canon Law (C.747), is that if a fetus is delivered clearly dead, itshould not be baptized. If, however, there is anydoubt that it is dead, it should be baptized con-ditionally. Stillborn fetuses should be buried, foraccording to the church’s teaching, they are considered human beings with all the rights ofpersons.

ATTITUDES TOWARD DIET AND THE USEOF DRUGS

Catholics are required to fast on Ash Wednesdayand Good Friday. On those days they cannottake solid foods between meals, and the smallermeals taken during the day cannot equal themain meal of the day. This applies to peoplebetween 18 and 59 years of age. Catholics mustalso abstain from eating meat on AshWednesday, the Fridays of Lent, and GoodFriday. Both fasting and abstinence are occa-sions for reflecting on one’s life, expressing sor-row for sin, and resolving to reform one’s life.The local pastor can grant dispensations fromthese requirements. Illness would normally be asufficient reason for such a dispensation.

In addition, Catholics must refrain from foodand drink, with the exception of water and med-icine, for at least one hour prior to receivingcommunion. This does not apply, according tothe Code of Canon Law (C. 919.3), to those ofadvanced age or to those “who suffer from anyinfirmity” and those who care for them. Thereare no other dietary observances or require-ments in Catholicism.

RELIGIOUS OBSERVANCES

Anointing of the sickThe sacrament of the sick or the “anointing ofthe sick” is among the seven sacraments thatthe church celebrates. The ritual part of thechurch’s pastoral care of the sick and the dying,the practice goes back to the early days of thechurch. Until 1972, when the rite was reformedin accordance with the Second Vatican Council,it was referred to as “extreme unction” or the“last anointing” and was usually reserved for theimminently dying. Today it is offered to anyCatholic who is experiencing illness or debilita-tion in order to provide spiritual strength as wellas to express the support of the community. Theritual consists primarily in praying and inanointing with oil (CCC 1997: nos. 1499-1525).

Sacrament of reconciliationThe sacrament of reconciliation, also one of theseven sacraments, involves the confession ofone’s sins to a priest, the representative ofChrist, in order to obtain forgiveness. It is theritual whereby sinners are reconciled with God,the church, and fellow human beings. It is an


SPECIAL CONCERNS

important part of the spiritual care of the ill, andof the terminally ill in particular (CCC 1997:nos. 1422-70).

EucharistEucharist can refer either to the liturgical cele-bration of the Eucharist, the commemoration ofChrist’s last supper with his disciples andCatholicism’s most important ritual, or to recep-tion of the wafer (holy communion), consecratedduring the celebration of the Eucharist andbelieved to be the body of Christ. This is a par-ticularly important spiritual observance forCatholics because it symbolizes and effectsunion with Christ and with members of theChristian community. Eucharist is especiallyimportant during a time of illness (CCC 1997:nos. 1322-1419).

Holy daysSunday is the primary day of worship forCatholics. On this day, Catholics are bound toparticipate in a celebration of the Eucharist (theMass) and to refrain from labors that might dis-tract them from the worship of God or impedephysical and mental relaxation. “Holy days ofobligation” are days that celebrate events in thelife of Christ or that honor his mother or thesaints (Christmas, the Ascension of Christ, Marythe Mother of God on January 1, theAssumption of Mary on August 15, theImmaculate Conception of Mary on December 8,

and the feast of All Saints on November 1). Onholy days of obligation Catholics are required toparticipate in the celebration of the Eucharist,though their pastor can give them dispensationfor a “just and reasonable cause.” Illness anddisability would normally be sufficient reasonsfor being granted dispensation from participat-ing in the Eucharist.

PrayerPrayer is an important part of Catholic life. Inaddition to praying to God, Catholics pray toMary, as the mother of Christ, and to the saints.Many Catholics make use of representations ofMary or the saints in the form of pictures orstatues. Two common forms of prayer amongmore traditional Catholics are the rosary and thenovena. The former consists in the use of beadswhich have five sets of ten beads each. Theprayer “Hail Mary” is said on each bead, andeach “decade” is introduced by the Lord’sPrayer and concluded with a prayer (theDoxology) that praises the three persons inGod—Father, Son, and Spirit. A novena consistsin repeating a particular prayer nine consecutivetimes (for example, nine days, nine Saturdays,nine first Fridays of each month). Usually nove-nas are prayed with a special intention.

FastingSee “Attitudes toward diet and the use of drugs,”above.


Amundsen, Darrel W. 1986. “The Medieval CatholicTradition.” In Numbers and Amundsen, eds.: 65-107.

Catechism of the Catholic Church. 1997. Second edition.Washington, D.C.: United States Catholic Conference.

Congregation for the Doctrine of the Faith (CDF). 1974.“Declaration on Procured Abortion.”

______. 1975a. “Declaration on Certain Problems ofSexual Ethics.”

______. 1975b. “Sterilization in Catholic Hospitals.”

______. 1980. “Declaration on Euthanasia.”

______. 1987. “Instruction on Respect for Human Life inIts Origin and on the Dignity of Procreation.”

John Paul II. 1980. “A Patient Is a Person.”

______. 1981. “The Christian Family in the ModernWorld.”

______. 1982. “Biological Experimentation.”

______. 1983. “The Ethics of Genetic Manipulation.”

______. 1984a. “Blood and Organ Donors.”

______. 1984b. “Opposing Euthanasia.”

______. 1985. “The Mystery of Life and Death.”

______. 1991. “Many Ethical, Legal, and Social QuestionsMust Be Examined in Greater Depth.”

______. 1995. “The Gospel of Life” (Evangelium vitae).New York: Random House.

Kelly, David. 1979. The Emergence of Medical Ethics inRoman Catholicism. New York: Edwin Mellon Press.

McBrien, Richard P. 1980. Catholicism. Vol. 2.Minneapolis: Winston Press.

Melton, J. Gordon. 1993. The Encyclopedia of AmericanReligions. Detroit: Gale Research.

National Conference of Catholic Bishops. 1980. “Statementon Tubal Ligations.” Washington, D.C.: United StatesCatholic Conference.

______. 1986. “The Rights of the Terminally Ill.” Origins16, no. 12 (4 September): 222-24.

______. 1996. “Moral Principles Concerning Infants withAnencephaly.” Origins 26, no. 17 (10 October): 276.

Numbers, Ronald L., and Darrel W. Amundsen, eds. 1986.Caring and Curing: Health and Medicine in theWestern Religious Traditions. New York: Macmillan.

1. The following sources inform this historical section:McBrien 1980: vol. 2, 569-655 (pt. 4, “The Church”);Melton 1993: vol. 1, 5-29 (chap. 1, “The LiturgicalFamily” [Western tradition]); and Numbers andAmundsen 1986: 40-145 (chaps. 2-4).

2. For further discussion of the development of Catholicmedical ethics, see Kelly 1979.

3. Unless otherwise noted, all quotations of ecclesiasticaldocuments have been taken from Kevin O’Rourke andPhilip Boyle’s Medical Ethics: Sources of CatholicTeaching (1993). This volume contains excerpts fromecclesiastical documents on a wide variety of topics inmedical ethics. The topics are arranged alphabetically.Additional bibliographical information on the ecclesi-astical documents can be found there.

4. Ethical and Religious Directives for Catholic HealthCare Services (ERD), revised and published by theUnited States Conference of Catholic Bishops in 2001,provides authoritative ethical guidance to all Catholichealthcare facilities. It can also serve as a helpfulresource for understanding a Catholic approach toethical issues in health care. The 1997 Catechism ofthe Catholic Church (CCC) is another helpful resourcefor gaining a better understanding of the beliefs andpractices of Catholicism.


NOTES

BIBLIOGRAPHY


O’Rourke, Kevin, and Philip Boyle. 1993. Medical Ethics:Sources of Catholic Teaching. Second edition.Washington, D.C.: Georgetown University Press.

Paul VI. 1968. “Encyclical Letter on Human Life.”

Pius XI. 1930. “Encyclical Letter on Christian Marriage.”

Pius XII. 1944. “Christian Principles and the MedicalProfession.”

______. 1949. “Christian Norms of Morality.”

______. 1951. “Fundamental Laws Governing ConjugalRelations.”

______. 1952. “The Intangibility of the Human Person.”

______. 1953. “Moral Aspects of Genetics.”

______. 1954. “Moral Problems in Medicine.”

______. 1956. “Tissue Transplantation.”

______. 1957. “The Prolongation of Life.”

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

Pontifical Council Cor Unum. 1981. Questions of EthicsRegarding the Fatally Ill and Dying.

Second Vatican Council. 1965. “The Church in the ModernWorld” (Gaudium et Spes).

United States Catholic Conference. 1978. “PastoralStatement of the United States Catholic Bishops onHandicapped People.” Washington, D.C.: United StatesCatholic Conference.

United States Catholic Conference Advisory Committee onEthical and Religious Directives for Catholic HealthFacilities. 1975. “Guidelines for the Determination ofBrain Death.” Hospital Progress 56 (December): 26.

United States Conference of Catholic Bishops. 2001.Ethical and Religious Directives for Catholic HealthCare Services. Washington, D.C.: United StatesConference of Catholic Bishops.

Vatican Congregation for Catholic Education. 1983.“Educational Guidance in Human Love.” Origins 13,no. 27 (15 December): 451-53.


Religious beliefs provide meaning for peopleconfronting illness and seeking health, partic-

ularly during times of crisis. Increasingly, healthcare workers face the challenge of providingappropriate care and services to people of differentreligious backgrounds. Unfortunately, manyhealthcare workers are unfamiliar with the reli-gious beliefs and moral positions of traditionsother than their own. This booklet is one of aseries that aims to provide accessible and practicalinformation about the values and beliefs of differ-ent religious traditions. It should assist nurses,physicians, chaplains, social workers, and adminis-trators in their decision making and care giving. Itcan also serve as a reference for believers whodesire to learn more about their own traditions.

Each booklet gives an introduction to the his-tory of the tradition, including its perspectives onhealth and illness. Each also covers the tradi-tion’s positions on a variety of clinical issues,with attention to the points at which moraldilemmas often arise in the clinical setting. Final-ly, each booklet offers information on specialconcerns relevant to the particular tradition.

The editors have tried to be succinct, objec-tive, and informative. Wherever possible, we haveincluded the tradition’s positions as reflected inofficial statements by a governing or other formalbody, or by reference to positions formulated byauthorities within the tradition. Bear in mindthat within any religious tradition, there may bemore than one denomination or sect that holdsviews in opposition to mainstream positions, orgroups that maintain different emphases.

The editors also recognize that the beliefs andvalues of individuals within a tradition may varyfrom the so-called official positions of their tradi-tion. In fact, some traditions leave moral deci-sions about clinical issues to individualconscience. We would therefore caution the read-er against generalizing too readily.

The guidelines in these booklets should notsubstitute for discussion of patients’ own reli-

gious views on clinical issues. Rather, theyshould be used to supplement information com-ing directly from patients and families, and usedas a primary source only when such firsthandinformation is not available.

We hope that these booklets will help practi-tioners see that religious backgrounds and beliefsplay a part in the way patients deal with pain, ill-ness, and the decisions that arise in the course oftreatment. Greater understanding of religious tra-ditions on the part of care providers, we believe,will increase the quality of care received by thepatient.

The Park Ridge Center explores andenhances the interaction of health, faith,

and ethics through research, education, andconsultation to improve the lives of

individuals and communities.

Introduction to the series

THE PARK RIDGE CENTERFOR THE STUDY OF HEALTH, FAITH, AND ETHICS

205 West Touhy Avenue ● Suite 203 ● Park Ridge, Illinois 60068-4202

© 2002 The Park Ridge Center. All rights reserved.

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