FOR “MINISTERS OF LIFE” – The Vatican’s new charter for health care workers

Fausto Gomez OP

On February 11, 1985, St John Paul II founded the Pontifical Council for Pastoral Assistance to Health Care Workers. In 1994, this Pontifical Council issued the first Charter for Health Care Worker. Taking into account, on one hand, the rapid advances in science, biotechnology and biomedicine, and, on the other, the new documents on the matter from the magisterium of the Church, the Pontifical Council for Pastoral Assistance issued in 2016 an updated and expanded New Charter for Health Care Workers.

Like the previous Charter, the New Charter is divided into three major parts: Procreating (I), Living (II), and Dying (III). It opens with an Introduction entitled Ministers of Life (nos. 1-10), and closes with a brief Conclusion (pp. 125-126). A helpful Index of topics in four pages in alphabetical order follows the conclusion. The New Charter is printed in 133 pages and 171 numbers.

Instead of pointing out the many principal topics and sub-topics of the New Charter, and to provide a more accurate and complete list, let me enumerate the different themes discussed, which offers a wide-range of topics, sub-topics, and ideas on health care in ethical and theological perspective.

FIRST PART: PROCREATING (nos. 11-39, pp. 15-34). Sub-titles: Fertility regulation, Marital responses to marital infertility, Prenatal and preimplantation diagnosis, Freezing embryos and oocytes, and New attempts at human generation and procreation.

SECOND PART: LIVING. It is the longest part (nos. 40-143, pp. 37-101). Sub-titles: Human life inviolable and ‘indisposable,’ Abortion and the destruction of nascent life, Embryo reduction, Interception and contragestation, Ectopic pregnancies, Anencephalic fetuses, Conscientious objection, Defending the right to life, Prevention, Prevention and vaccines, Medical prevention and society, Sickness, Diagnosis, Gene therapy, Regenerative therapy, Treatment and rehabilitation, Prescription and appropriate use of pharmaceuticals, Access to available medication and technologies, Sustainable health, pharmaceutical companies, rare and neglected diseases, Pain relief treatments, Informed consent of the patient, Biomedical research and experimentation, Organ and tissue donation and transplantation, Determination of death, The removal of organs for pediatric donors, Xenotransplants, Transplantation and personal identity, Abuses in transplantation, Forms of dependence, Drug dependence, Alcoholism, Tobacco dependence, Psychotropic drugs, Psychology and psychotherapy, Pastoral care and the sacrament of the Anointing of the sick, Ethics committees and clinical ethics counseling,  Health care policies and the right to the preservation of health.

THIRD PART: DYING (nos. 144-171, pp. 105-122). Sub-titles: Dying with dignity,   Civil laws and conscientious objection, Nutrition and hydration, The use of analgesics in the terminal stage, Telling the truth to the dying person, Religious care of the dying person, Destroying life, and Euthanasia.

The New Charter for Health Care Workers is truly an excellent Church document on the issues and problems related, above all, to life ethics or bioethics. It remarkably summarizes and creatively explains the ecclesial texts on beginning and end life, and in-between both. The most important and relevant magisterial documents are appropriately quoted and explained. These are, according to the number of times referred to: St. John Paul II Evangelium Vitae, EV, or the Gospel of Life (March 25, 1995), which is the pace-setting Encyclical on bioethics, and is quoted about thirty eight (38) times. EV is followed by the Vatican Congregation for the Doctrine of the Faith Instructions Dignitas Personae, or the Dignity of the Person, issued on September 8, 2008 (quoted 21 times), and Donum Vitae, or On Respect for Human Life at its Origin and for the Dignity of Procreation (quoted 12 times), issued on February 22, 1987; the Catechism of the Catholic Church (1992 and 1997), cited 20 times; Pope Francis Evangelii Gaudium, or the Joy of the Gospel, the Apostolic Exhortation issued on November 24, 2013 (7 times); Blessed Paul VI Encyclical Humanae Vitae, On the Regulation of Birth (July 25, 1968), six times, and Vatican II  Gaudium et Spes, the Pastoral Constitution on the Church in the Modern World (1965), quoted about five times. The New Charter quotes, moreover, from other papal Encyclicals and Addresses of Pius XII, Paul VI, John Paul II, Benedict XVI, Pope Francis, and the Declarations on Procured Abortion (1974) and Euthanasia (1980) by the Congregation from the Doctrine of Faith. Some Letters from different national Episcopal Conferences, and texts from the Pontifical Academy for Life are also cited.

The New Charter for Health Care Workers is directly addressed to all Bishops throughout the world. It concerns primarily health care workers, namely, physicians, nurses, physical and occupational therapists, pharmacists, chaplains, lawyers, and especial volunteers and others concerned. All workers should be “suitable trained health workers” (n. 23). In a real sense, the New Charter concerns all of us, in particular believers, who are asked by others to give an account of their faith and its basic implications, and – as God’s stewards – to care respectfully and responsibly for their own health, and give informed consent or substitute consent to health care professionals, and promote ethical health care policies.

Truly, the New Charter is excellent in content and clear in form. It is complete and very helpful with its careful explanation of not well-known terms on the matter. Moreover, this reviewer thanks the enlightening explanatory footnotes of the translators of the original Italian text to the English language. This English edition (2017), which is the Official Vatican English Translation, was meticulously prepared by the National Catholic Bioethics Center, NCBC (Philadelphia, USA), 

The New Charter is indeed an outstanding Church document. It contains so many enlightening concepts and ideas that could be underlined. Let me highlight the following: the right to conscientious objection (New Charter, nos. 59-60, 151); the distinction – related to abortion – between interceptive methods (before implantation of the embryo), and contraceptive methods (after implantation) (no. 56); contraception and abortion are “fruits of the same tree,” and “contraception does not decrease abortion” (nos. 20-21); respect for nature (no. 83), and for health care justice (no. 92); informed and presumed consent (nos. 96-98); xenotransplants (transplantation of organs and tissues derived from animals) (no. 118); drug, alcohol and tobacco dependence (nos. 121-127), and dying with dignity (nos. 149-150).

One minor suggestion for the next edition of the New Charter could, perhaps, be this: to add a bibliography, with the Church documents cited in the New Charter and corresponding authors, in chronological order. With due respect, I wish to propose another suggestion, which I personally consider not so minor, for the next edition: to speak explicitly against capital punishment. The New Charter is obviously for the right to life from conception “until natural death” (no. 63). Certainly, it may be concluded that the New Charter is implicitly against the death penalty, which is not a natural but violent death. However, the New Charter is explicitly silent on the death penalty as an expression of the culture of death, and ought to be added – I humbly submit – to abortion, euthanasia, suicide and homicide.

In the context of the New Charter, which is addressed principally to Health Care Workers, who are ministers of life and never agents of death (no. 167), it is important to note that branches of health care professionals, in particular doctors and nurses, are explicitly forbidden by their respective code of ethics to participate in any execution of persons on death row. The nurses, moreover, are also told to promote the abolition of capital punishment throughout the world. The magisterium of the Church today is undoubtedly and clearly against the death penalty. In a memorable Homily on January 27, 1999 in St. Louis, Missouri, St. John Paul II closed completely the door to exceptions to capital punishment, when he said: Human life must never be taken away, even in the case of someone who has done great evil… The death penalty is cruel and unnecessary. For his part, Pope Francis has said repeatedly that he is absolutely against the imposition of the death penalty in any situation, to the point that he has already proposed a change to no. 2267 of the Catechism of the Catholic Church (1997): The death penalty is never an absolute necessity, nothing can justify it, and therefore should be condemned absolutely (Pope Francis, Address on the Celebration of the 25th Anniversary of the publication of CCC, the Vatican, October 11, 2017).

Above all, I underline the New Charter clear defense – convincingly arguing from reason and faith – of the right to life of every person. Human life is “sacred” (no. 44), “inviolable,” and “indisposable” (nos. 47-49), and the right to life is “fundamental, original and inalienable good, root and prerequisite of every other right of the human person” (n. 63). The right to life implies “the right to live with human dignity” (no. 63), and “the right to the protection of health” (no. 66).

In closing, I hope and pray that the New Charter for Health Care Workers may become a source of enlightenment, hope and encouragement for the health care workers and for all us, co-pilgrims on the journey of life. For the followers of the Name, drawing near to Christ helps (New Charter, footnote 37).

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