Dignitas Personae for the Cattolica Medicine Test

The Instruction opens with its fundamental principle: "The dignity of a person must be recognized in every human being from conception to natural death" (§1). Twenty years after Donum vitae (1987), whose teaching "remains completely valid", the Congregation addresses the questions raised by new biomedical technologies, above all research on human embryos, the use of stem cells for therapy and other areas of experimental medicine (§1). It drew on the Pontifical Academy for Life, on scientific experts and on John Paul II's Veritatis splendor and Evangelium vitae (§2), and it notes both those who see medicine as a service to human fragility "in the spirit of the Hippocratic Oath" and those who view biomedical advances from "an essentially eugenic perspective" (§2).

The Church draws on "the light both of reason and of faith" (§3). She "views scientific research with hope", hopes that its results will reach poor regions afflicted by disease, and seeks to bring comfort, light and hope to those who suffer (§3). The Instruction is addressed to "the Catholic faithful and to all who seek the truth" and has three parts: anthropological, theological and ethical elements; new problems regarding procreation; and new procedures involving the manipulation of embryos and the human genetic patrimony (§3).

Advances in medicine are positive when they "serve to overcome or correct pathologies" and negative when they destroy human beings or use means contrary to the dignity of the person (§4); the human body, from its first stages, "can never be reduced merely to a group of cells" (§4). The first principle is Donum vitae's criterion: the fruit of human generation, "from the moment the zygote has formed, demands the unconditional respect that is morally due to the human being in his bodily and spiritual totality" (§4). Reason can recognise it as part of the natural moral law, and it "should be the basis for all legislation in this area" (§5). Donum vitae did not define the embryo as a person, but the human being's reality excludes "either a change in nature or a gradation in moral value": "The human embryo has, therefore, from the very beginning, the dignity proper to a person" (§5).

The second principle concerns the origin of life, which "has its authentic context in marriage and in the family": responsible procreation "must be the fruit of marriage" (§6). Faith receives what is human and also "purified, elevated and perfected" it; in the Incarnation the Son of God confirmed the dignity of body and soul, so there is "no contradiction between the affirmation of the dignity and the affirmation of the sacredness of human life" (§7). "This value belongs to all without distinction", and discrimination based on "biological, psychological, or educational development, or based on health-related criteria, must be excluded" (§8). The acts by which a man and a woman give themselves to each other are a reflection of trinitarian love (§9).

The Church "does not intervene in the area proper to medical science itself" but recalls that the ethical value of biomedical science "is gauged in reference to both the unconditional respect owed to every human being at every moment of his or her existence, and the defense of the specific character of the personal act which transmits life" (§10).

Infertility treatments must respect three goods: the right to life and physical integrity of every human being from conception to natural death, the unity of marriage, and the specifically human values of sexuality (§12). They "are not to be rejected on the grounds that they are artificial", but all heterologous techniques, and homologous ones "which substitute for the conjugal act, are to be excluded", while techniques that aid the conjugal act are permitted (§12). Treatments "aimed at removing obstacles to natural fertilization" (hormonal treatment, surgery for endometriosis, unblocking the fallopian tubes) are licit; adoption and the prevention of sterility should be encouraged (§13).

Experience has shown that "all techniques of in vitro fertilization proceed as if the human embryo were simply a mass of cells to be used, selected and discarded": about a third of women have a baby, but the number of embryos sacrificed "is extremely high" (§14). Many losses are "foreseen and willed", and multiple embryo transfer "implies a purely utilitarian treatment of embryos" (§15). The Church "recognizes the legitimacy of the desire for a child", but it "cannot justify the 'production' of offspring" (§16). ICSI, a variety of IVF, is "intrinsically illicit" because it separates procreation completely from the conjugal act (§17). Freezing embryos "is incompatible with the respect owed to human embryos" (§18). For those already frozen, the Instruction rejects research, treatment, donation to infertile couples and, despite its good intention, "prenatal adoption": they are "a situation of injustice which in fact cannot be resolved" (§19). Freezing oocytes for artificial procreation is "morally unacceptable" (§20).

Embryo reduction is "an intentional selective abortion", and neither analogies with disasters nor the principles of the lesser evil or double effect justify it: "the end does not justify the means" (§21). Preimplantation diagnosis "is directed toward the qualitative selection and consequent destruction of embryos" and is "the expression of a eugenic mentality" (§22); "sick and disabled people are not some separate category of humanity" (§22). Interceptive methods act on the embryo before implantation and contragestative ones eliminate it once implanted; both "fall within the sin of abortion and are gravely immoral" (§23).

Research on embryonic stem cells has so far produced no effective results, "as distinct from research on adult stem cells" (§24). In gene therapy, "Procedures used on somatic cells for strictly therapeutic purposes are in principle morally licit", with proportionate risks and informed consent (§26); germ line changes pass to offspring with risks not yet controllable, so "in its current state, germ line cell therapy in all its forms is morally illicit" (§26). Genetic engineering to improve the gene pool "would promote a eugenic mentality", and in it "man tries to take the place of his Creator" (§27).

Human cloning, the "asexual or agametic reproduction of the entire human organism", is "intrinsically illicit" because it gives rise to a new human being without any link to the spouses' self-giving or to sexuality (§28). Reproductive cloning would impose "a form of biological slavery" (§29); "so-called therapeutic cloning is even more serious", because "To create embryos with the intention of destroying them, even with the intention of helping the sick, is completely incompatible with human dignity" (§30). For alternative techniques whose product's status is in doubt, the Instruction recalls Evangelium vitae: "the mere probability that a human person is involved would suffice to justify an absolutely clear prohibition of any intervention aimed at killing a human embryo" (§30).

"Methods which do not cause serious harm to the subject from whom the stem cells are taken are to be considered licit": adult tissues, cord blood at birth, fetuses who died of natural causes; taking them from a living embryo is "gravely illicit", and research on adult stem cells "should be encouraged and supported" (§32). Hybrid cloning with animal oocytes is "an offense against the dignity of human beings" (§33). On "biological material" of illicit origin, the criterion of independence "is necessary, but may be ethically insufficient"; there are "differing degrees of responsibility", and "danger to the health of children could permit parents to use a vaccine which was developed using cell lines of illicit origin", while making their disagreement known (§34–35).

To those who say the Church's moral teaching contains "too many prohibitions", the Instruction answers that it rests on "the recognition and promotion of all the gifts which the Creator has bestowed on man: such as life, knowledge, freedom and love", and that "the legitimacy of every prohibition is based on the need to protect an authentic moral good" (§36). As a century ago for the working classes, the Church speaks "on behalf of those who have no voice" (§37). "Behind every 'no' in the difficult task of discerning between good and evil, there shines a great 'yes'" to the dignity of every human being; the faithful are asked to receive the Instruction "with the religious assent of their spirit" and to promote "a new culture of life" (§37).