Catholic Medical Quarterly

The Journal of the Catholic Medical Association (UK)

Building knowledge. Building faith. Protecting the vulnerable.

Catholic Medical Quarterly Volume 63(2) May 2013

Editorial
The Papacy and medical ethics

Dr Adrian Treloar FRCP, MRCPsych MRCGP

Pope Benedict Photo

Summary

As Pope John Paul II stated so deafeningly in Poland, and during his pontificate, each individual is of worth and we will win debates by love. If we hate, the evil we fight will merely return in another way. The triumph does indeed, come through love. The same is true in medicine and ethics. In her teaching on medical ethics, the Church guides, supports and grows us towards a better way of living.

Introduction

This article was written at a time of “Sede Vacantis”, after the abdication of Pope Benedict XVI and before the election of our Pope Francis whom we so warmly welcome to the Chair of St Peter. With the succession of Pope Benedict XVI by Pope Francis we are bound to look forward to the discussions that will inevitably draw the Papacy into issues of medical ethics.

An increasing number of people may ask why the Church should interfere into peoples’ personal and especially their medical lives. In her work on medical ethics, the Church has always emphasised the centrality and infinite worth of each individual. Be it in a GP surgery, in learning disability settings, in totalitarian states, in embryology units or in a simple outpatient clinic, the Church repeatedly attests that every human being is of infinite worth and that no human life may be sacrificed for another. In doing so our Holy Mother the Church has flown into direct conflict with communism, fascism and the values on human life, death, abortion and contraception etc that the West has adopted since winning the Second World War. And that is precisely why the Church remains duty-bound to stand up for the weakest and most vulnerable members of our society. No wonder then that the Church is seen by the outside world as being a problem in medical ethics and modern medicine. No wonder too that the GMC consultation on personal beliefs was so strongly slanted towards a denial of conscience and requirements that doctors do things that they consider unethical [1].

The Church’s teaching resonates more loudly than we can ever really understand into abortion, embryology, euthanasia and contraception and many more fields of medicine.

We see that the lowest maternal mortality happens in countries (such as Ireland, Malta and Poland) where abortion is illegal or very limited [2]. And one cannot but see the scandals around poor care of the elderly, and terminal care recently aired in the British press as evidence that we fail to value the frail, the elderly and the dying as we should. Scandals occur precisely because they document the abuse and neglect of societies weakest and most vulnerable members.

Pope Pius XII set out very ably the principles of good palliative care, accepting and defining the doctrine of double effect and informing medical ethics for the whole of the second half of the 20th Century. He also emphasised the importance of great care around deprivation of consciousness. [3]

Paul VI taught with extraordinary clarity and brevity upon contraception. Humane Vitae specifically prophesied the breakdown of family life as a result of artificial contraception. And we also see population decline as a result of contraception too, with it severe economic and social consequences. The breakdown of family life so tragically seen in Western Societies cannot be assessed in isolation from contraception, which has so profoundly changed the most intimate parts of family life [4].

Pope John Paul II PhotoPope John Paul  II wrote huge amounts on medical ethics including  a key document on withdrawal of fluids [5]. He also  approved  clear  teaching on  the gift of life through Donum Vitae [6],  which was approved for publication by  Pope John Paul II but actually written by  Cardinal  Ratzinger (later Pope Benedict) while he was prefect of the CDF.  And during his papacy  Benedict  XVI  approved  Dignitas Personae  (written by  Cardinal  Levada) further strengthening the Church’s teaching IVF and embryo research [7].

Pope Benedict XVI is seen as having contributed enormously to the restoration of liturgy but also spoke loudly at times on medical ethics. In particular he saw medical relativism as a threat to good care and faith in our hospitals [8] and strongly emphasised the combination of faith and reason whose centrality to Catholic teaching and medical ethics he so clearly saw [9].

While some saw his statement on condoms and homosexual prostitutes as being a rebuttal of Humanae Vitae [10], he in fact rather elegantly stated at least one key difference between that intercourse between a man and woman and two people of the same sex. While teaching , of course, that intercourse between a man and a woman can be rendered wrong by the use of a condom, he pointed out that homosexual intercourse is wrong regardless of whether or not a condom is used. Intercourse between two men cannot be open to life and therefore cannot be subject to Humanae Vitae at all. A great tragedy of our current age is that HIV infections among homosexual men are now higher than they have ever been [11]. Could it be that the Church’s deeply unpopular assertion [12] that condoms are not the answer to the AIDS crisis is turning out to be true?

What is the purpose of Papal teaching on medical ethics?

Many have seen the effect of Papal teaching simply as a prohibition on some behaviours. If we took the example of euthanasia, we see that the Church absolutely prohibits killing. Some then claim that this causes people to suffer. Actually, we see that allowing killing may make good care more optional while the prohibition on killing really leads to a stronger requirement to provide the best care. And the Church then provides clear teaching on the ethics of relieving pain and deprivation of consciousness [3] So in Her wisdom the Church sets out a better path. Good care of the dying, good care and respect of the elderly are in fact central tenets of Church teaching. In her teaching on homosexuality (again written by Cardinal Ratzinger) [13] the Church sees pastoral care of a group of people (who do indeed suffer significantly with high rates of mental disorder, relationship breakdown and tragic infections etc.) as central  issues.

An analogy

Why do we all drive on the left in the UK?
Because it’s illegal to drive on the other side. Or because it is safer, gets you there quicker and is enormously less stressful.

An analogy of the Church’s teaching might be to ask why, in the UK we all drive on the left. One answer to that question (which society often sees in Church teaching) is because it is illegal to drive on the other side. Society has banned driving on the right and if you do, you will go to prison.

While that cannot be disrupted, it is even more true that driving on the correct side is safer, gets you there quicker and is enormously less stressful. By analogy, while the Church is seen as banning killing, or human experimentation etc, She in fact is setting out a better, surer and safer way. When we see the breakdown of good marriages, we cannot delude ourselves that a society which so strongly rejects Humanae Vitae is truly better or less stressful. Societies that legalise killing demean all the individuals in that society

In Her wisdom, Church teaching guides, supports and grows us towards a better way of living.

In Her wisdom therefore , the Church guides, supports and grows us towards a better way of living. To this add Pope Benedict’s repeated emphasis of the need to combine faith and reason and we see that we must explain clearly, with evidence bases, the logic and science behind Church teaching.

Winning the debate

Discussing Nazism in Poland while under fire, Pope John Paul II was once told by a wise man that “We will win with love, not with fire."
Karol Woytila replied : “Can you say that with the Nazis just outside your door?
The wise man responded: “Nazism will end, evil will devour itself, but…
Karol Woytila: "But… if love doesn’t triumph, Nazism will return even with another name."
Exactly”, replied the wise man. [14]

As Pope John Paul II stated so deafeningly in Poland, and during his pontificate, each individual is of worth and we win by love. If we hate, the evil we fight will merely return in another way. The triumph does indeed, come through love. The same is true in medicine and ethics.

How can we contribute to the teaching of the Church on medical Ethics?

Just as surely as we need the Church, the Church therefore needs doctors nurses and others to help her to build the teaching and scientific knowledge upon which we depend. Pope Paul VI asked for this most eloquently in Humanae Vitae [14] when he asked scientists to develop knowledge of Natural Family Planning.

“So the men of science, and especially the Catholic scientists will contribute to demonstrate in practice that, as the Church teaches, "there can be no real contradiction between the divine laws pertaining to the transmission of life and those which promote an authentic conjugal love”.[14] He knew that he needed our help in developing the real care and support of the faithful.

So the men of science, and especially the Catholic scientists will contribute to demonstrate in practice that, as the Church teaches, "there can be no real contradiction between the divine laws pertaining to the transmission of life and those which promote an authentic conjugal love.

So in fact, Catholic doctors and nurses are central to the development of faith, reason, and Catholic doctrine. Indeed this is what they have done for many years. The doctors who pioneered the science of Natural Family Planning in response to Humanae Vitae are but one example.

The CMA (UK) became worried about the ethics of IVF before any pontifical statements upon the issue. And we were very clear about withdrawal of food and fluid long before Pope John Paul II’s statement. Our representation through national medical bodies, via the Bishops Conferences, and through pontifical academies has served well the cause of medical ethics. One can even think that, hearing our thoughts via pontifical Academies and the Curia, the Vatican has followed the lead of associations such as ours. We can be proud of our record on all this but must also do more to protect the vulnerable.
And we must pray always.

Wanted and valued?

Photo of Mother TheresaFinally, we would do well to remember that every person is wanted and valued and most of all, we must cherish each and every one of them. Perhaps one of the most influential pictures of the 20th Century was that of Mother Theresa holding up an abandoned baby in Calcutta. Nothing could have stated more eloquently the dignity and worth of that every individual. Blessed Mother Theresa was an ardent supporter of Papal teaching on medical ethics.

In all our ethical work, we must value and cherish each and every person for whom we care. That will not always mean giving them what they ask for and it will never involve killing them or giving material support to other things that are wrong. But it must always focus upon that individual and how we support them towards the fullest possible potential.

References

  1. CMA submission to General medical Council on personal choice http://cmq.org.uk/Submissions/Submissions_index.html
  2. https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html accessed 13.3.13
  3. Pius XII, ADDRESS of September 9, 1958: AAS 50 (1958), p. 694
  4. Janet Smith (1993). Pope Paul VI as prophet: have Humanae Vitae's bold predictions come true? http://www3.nd.edu/~afreddos/courses/264/popepaul.htm accessed 13.3.13
  5. Instruction on respect for human life in its origin and on the dignity of procreation replies to certain questions of the day http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html
  6. John Paul II, 2004 To the participants in the International congress on "Life-sustaining treatments and vegetative state: Scientific advances and ethical dilemmas" fluids. http://www.vatican.va/holy_father/john_paul_ii/speeches/2004/march/documents/hf_jp-ii_spe_20040320_congress-fiamc_en.html
  7. Congregation for the Doctrine of the Faith, 2008.  Dignitas Personae. http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_20081208_dignitas-personae_en.html
  8. EWTN news. May 4th 2012relativism
  9. Vatican news. Pope marks 50th anniversary of medical faculty at Gemelli teaching hospital http://en.radiovaticana.va/articolo.asp?c=584799
  10. Light of the World: Published Osservatore Romano, 2010
  11. BBC news. 29th Nov 2012. Highest-ever HIV diagnoses in gay men
  12. NBC news. 17th March 2009. Pope: Condoms not the answer in AIDS fight. http://www.nbcnews.com/id/29734328/#.UT5i-NZm_0c
  13. Congregation for the Doctrine of the Faith (1986) Letter to the bishops of the Catholic Church on the pastoral care of homosexual persons. http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19861001_homosexual-persons_en.html
  14. Extract from Karol, the man who became Pope
  15. Humanae Vitae (1968) http://www.vatican.va/holy_father/paul_vi/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae_en.html

Picture of Mother Theresa reproduced from http://avemomma.blogspot.co.uk/2012/10/an-opportunity-for-charity.html