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World Day of the Sick
by The Most Reverend John C. Nienstedt Your Eminences, Excellencies, Reverend Clergy and Religious, Distinguished Colleagues in the field of Health Care, Friends all, Introduction
In the eighth chapter of the Gospel of St. Matthew (8:5-11),
Jesus is approached by a Roman centurion as he is entering the city
of Capernaum. Clearly this man was a Gentile, someone who stood
outside the context of revealed truth found in Jewish faith. Yet the
man had a desperate problem on his mind because one of the servants
of his household was "paralyzed and suffering painfully."
(v. 6) Now Jesus was not a medical doctor and yet his reputation as
an itinerant rabbi carried with it accounts of several healings he
had performed. 1
The military officer was so confident in
Jesus’ power to cure his servant that he refuses Jesus’
suggestion to visit the patient and bids him: "Say but the word
and my boy will get better." (v. 8) The word of Jesus, as a
response to the faith-filled supplication of the centurion, at once
brings healing to that servant. (v. 13)
This scriptural account depicts a symbol of secular humanity
(the Gentile centurion) placing all its confidence in the symbol of
religious authority (Jesus) in order to achieve physical healing.
What is even more remarkable, the religious authority praises the
faith of the secular request.
How much different from the time of Jesus is our society today
as we enter the Third Millennium? In the modern field of science and
technology, physical healing is brought about largely by the
competence of skill and research as well as the availability of
medical state-of-the-art equipment and pharmaceutical supplies. The
spiritual realm is recognized as something over and apart. Rarely
would one find from our contemporary secular society an appeal to
religious authority for a medical cure, so separate have the worlds
of the scientific and the religious become. And yet, it is the
conviction of the Church, with her mandate to carry on the mission of
Jesus in the world today, that she has something to offer the
fields of medicine and biotechnological research. It is that
conviction that brings us here for this Eleventh World Day of the
Sick. The focus of our gathering centers on the question of what
word does our secular world need to hear from the Church to ensure
that a holistic healing is achieved, a healing that is truly
beneficial both to the person and to humanity itself.
Part I
From a purely institutional point of view, it is easy to
establish that the contribution of the Catholic Church has been a
substantial one. In the field of health care, the Church
administrates:
In all, the number of Catholic health care institutions
throughout the world totals 110,9542.
Speaking to the participants of the 17th annual international
conference on health care pastoral ministry at the Vatican last
November, Pope John Paul II reminded his listeners that the reason
the Church exercises sponsorship of such institutions is precisely
her response to fulfilling the Lord’s will and contributing to
the realization of the Kingdom of God. This is in fact, the Holy
Father noted, the heart of the Church "where the supreme law is
love." 3
While such institutional statistics are impressive in terms of
the outreach to the sick and suffering, an equally important
contribution that the Church seeks to offer society is a holistic
vision of the human person that demonstrates the ends to which men
and women are destined. In light of those ends, then, the role of
science and technology finds its proper ethical response in how to
provide true benefit both to the individual and to humanity. Without
this broader context, science and technology cannot by themselves
determine the meaning of human existence or how it should be
achieved. That broader context must speak to the very nature of the
person and of his dignity. This then is precisely the word that the
Church needs to speak and society to hear in order to achieve real
progress that is truly beneficial to human healing. 4
Part II
If you would allow me to digress for a moment here, I
would like to make reference a well-known story by Washington Irving
in which a farmer named Rip Van Winkle is out walking in the woods in
the Catskill Mountains when he meets some mysterious people who offer
him a taste of their strange liquor. He drinks some of the brew and
then settles down to sleep for a while. When he awakes, twenty years
have passed. Rip Van Winkle soon discovers that his world has indeed
changed a great deal in those twenty years.
I finished my doctoral dissertation on the Moral Aspects of
In-Vitro Fertilization and Embryo Transfer at the Alphonsianum
Institute of Moral Theology in Rome in 1984, nearly twenty years ago.
While I don’t believe I have been asleep for the last nineteen
years, I do think back to the questions that were confronting
bioethicists at that time and I marvel at how much things have
changed in that area of research and how quickly things continue to
change.
At the time, public interest on my topic had peaked on July
25, 1978 with the birth of Louise Brown in London as the first
"test-tube" baby. The baby’s parents, John and Leslie
Brown, were assisted in overcoming their infertility with the help of
Doctors Patrick Steptoe and Robert Edwards.
The complex process used by those doctors may be summarized by
three developmental steps:
1) the procuring of ova from the woman’s ovary by a method
called laparoscopy (a laparoscope is a long jointed metal microscope
with an attached miniature flashlight, which together with a pair of
fine forceps and an aspiration needle is inserted into the
woman’s abdomen through three small incisions), the washing of
the ova which had been harvested and their placement in Petri dishes;
2) the procurement of the husband’s semen through
masturbation, the washing of the semen and its placement in those
same Petri dishes, each containing an ovum;
3) the subsequent conception of an embryo and its transfer by
means of a narrow transparent catheter into the wife’s uterus.
5
The first recorded experimentation with IVF and ET was with
animals and was publicized as early as 1937. 6 But there was
little progress made until the development of the laparoscopic
technique in the early 1970’s. 7 Unquestionably, it was this
method that made it both possible and feasible to remove theprocess
of human reproduction from the human womb and transfer it to the
antiseptic context of the scientific laboratory.
Today, some eighteen years later, laparoscopy is being used by
surgeons to remove kidneys, gall bladders and livers. I, myself, less
than two months ago had a section of my colon removed by this very
technique. It is less invasive of the body, less painful and the
recuperation period is much shorter, all of which is of great benefit
to the patient.
At the same time, however, that application, which began by
overcoming a diseased or nonfunctional Fallopian tube in a woman so
that she and her husband could conceive their own child, has now
given way to a whole host of possible scenarios:
1) artificial insemination with donor embryo or donor sperm (a
practice which gives rise to embryo and sperm banks);
2) the hiring of surrogate mothers to carry a child to birth,
often for convenience and financial considerations;
3) screening for defective zygotes so that only the most
perfect are chosen for implantation in the womb;
4) the harvesting of embryonic stem cells to be used for the
potential benefit of persons requiring treatment for leukemia,
Parkinson’s disease or relief from paralysis due to a
spinal-cord injury;
5) the cloning of human beings in order to recreate an existing
or previously existing life or to supply human body parts to a living
human subject;
6) genetic engineering technologies which replace or alter
individual genes within the DNA, creating new human life according to
predetermined specifications;
7) the experimentation on or the discarding of so-called
"spare" embryos, which are not transferred to the
uterus.
Suddenly, Aldous Huxley’s Brave New World does not
seem so far fetched. Where the Hebrews once used the term,
"begetting," the Greeks used the expression, "coming
into being" and the Christians introduced the term,
"procreation," today’s world can speak of
"reproduction" almost as a form of manufacturing, which is
not too far from Huxley’s own expression of
"decantation" as an alternative to natural gestation.
8
In the present realm of research, each technological
achievement serves as a precedent for the next and then that second
achievement allows for a third. Pretty soon, as I have experienced
even in this brief period since 1984, we awake like Rip Van Winkle to
find a whole host of new bioethical challenges facing human
society.
Part III
Fortunately, the teaching of the Catholic Church has not
been asleep as science and technology have been making advances in
the area of human reproduction and experimentation. In particular,
our Holy Father, Pope John Paul II, has consistently encouraged
biological research and its technological application, but with the
caveat that it should always be accomplished "in full
respect for the norms of morality, safeguarding the dignity of people
and their freedom and equality." 9 Chief among his concerns are
the exploitation of the human embryo and the separating of the link
that joins procreation to the biological, as well as the spiritual,
well-being of the parents within the bond of marriage.
10
As recently as this past November, Pope John Paul II in an
address to the Italian Episcopal Conference urged the bishops to
address the fundamental values that are at risk for humanity when
technology, relying on its resources alone, embarks on experiments of
radical manipulation.
The Pope stated:
"the great challenge developing in recent years
[revolves] around the crucial question, . . . ‘Who is man?’
This is an old yet a new challenge because the ever present
tendencies to deny or forget the oneness of our being and our
vocation, as creatures made in the image of God, receive a new
impulse today from the pretense of being able to adequately explain
man with empirical scientific methods alone. And this occurs when it
is actually more than ever necessary to have a clear and firm
conviction of the inviolable dignity of the human person, in order to
face the risks of radical manipulation that would occur if the
resources of technology were applied to man leaving aside the
fundamental parameters and anthropological and ethical criteria
written in his very nature." The Holy Father then added that
the awareness of man’s dignity is "the sole principle on
which a truly humanistic society and civilization can be built."
11
In this singular quotation, the Holy Father has outlined the
integral points of concern that constitute the Church’s
reflection on the ultimate benefit or harm that is posed by the
biomedical challenges of our day. These can be categorized into three
areas of understanding:
1) An anthropological understanding of "man"
12as made in the image of God;
2) An understanding of human dignity that flows from a full
understanding of man and hence a more correct understanding of how
human life is intended to be transmitted;
3) An understanding of the value and rights of man that flow
from his proper dignity, impacting on the role of scientific
technology to choose either to assist and promote the natural
processes or to dominate and replace them.
The anthropological question, "Who is man?" has
been central to the teaching and writing of Pope John Paul II since
the beginning of his Pontificate. In his first encyclical,
Redemptor Hominis, he makes the claim:
"Man is the primary route that the church must travel in
fulfilling her mission: He is the primary and fundamental way for the
church, the way traced out by Christ himself." 13
Yet the question of man’s identity persists. I recently
picked up a popular men’s magazine advertising an article on
"The Male Anatomy." The writer attempts to describe the
various parts of the body (the brain, the heart, the stomach, the
reproductive organs, etc.), how they work and how they are best
maintained. What was extremely telling, however, were the pictures of
each section of the body being described over which was superimposed
a mechanical tool or machine part. The obvious implication is that
our bodies are well designed machines which if regularly maintained
will function in proper order. 14
This mechanistic notion of the body is completely foreign to
the Biblical understanding of an "animated body" (or an
embodied spirit), created by God as one undivided unity. Man,
therefore, is not a composite of body and soul as if those two
entities could be separated or opposed to each other. Rather the
nature of man is essentially one and therefore indivisible.
15 Within this understanding, then, the body is not
perceived as a part of man distinct from the soul, but rather is an
expression of the whole person. In the Biblical understanding, the
whole person is destined for eternal life. 16
This Biblical understanding of man is affirmed by the teaching
of the Second Vatican Council:
"Each human person, in his absolutely unique singularity,
is constituted not only by his spirit, but by his body as well. Thus,
in the body and through the body, one touches the person himself in
his concrete reality. To respect the dignity of man consequently
amounts to safeguarding this identity of the man ‘corpore et
anima unus." 17
The unity of man as "an animated body" (or embodied
spirit), then, decidedly links the exercise of reason and free will
to all the bodily and sense faculties. According to the Platonic and
Cartesian tradition, however, the body was placed outside the realm
of subjectivity. This separation of the body from the realm of the
ego (spirit or soul) is easily permitted by the scientific eye
which so often views the body from a third-person perspective. In
this sense, the body becomes the object of external observation,
whether that be for purposes of taking one’s pulse or measuring
one’s cholesterol. 18
In the reflections of Pope John Paul II, however, the body is
seen in terms of a first person viewpoint. In this context,
understanding one’s human subjectivity includes the utilization
of the body in such a way that a "language of the body" can
be formulated that has practical consequences for the person’s
affective behavior. The Holy Father describes the notion in this
way:
"The spiritual and immortal soul is the principle of
unity of the human being, whereby it exists as a whole —
corpore et anima unus — as a person. These definitions
not only point out that the body, which has been promised the
resurrection, will also share in glory. They also remind us that
reason and free will are linked with all the bodily and sense
faculties." 19
Thus, the Holy Father conceives the body as "the vehicle
of the person in the world," that which expresses the
person’s ego (or spirit). The distinction between the ego or
center of self-consciousness (or spirit) and the body exists but
their bondedness is held in creative tension. This is not, therefore,
a self-consciousness that is merely attached to a body but rather
incarnated in it. The body is, then, one of the inescapable
dimensions of subjectivity. 20 Any viewpoint that would
separate the body from its realm of subjectivity, then, runs the risk
of manipulating the body without reference to the total human person.
In such a viewpoint, the mind could perceive the body merely as an
object of the person and therefore conclude that it can use the body
in any way it chooses. 21
The Pope himself articulates how fundamental the understanding
of this unity is for correctly perceiving the dignity of man’s
actions:
"The substantial unity between spirit and body, and
indirectly with the cosmos, is so essential that every human
activity, even the most spiritual one, is in some way permeated and
colored by the bodily condition; at the same time the body must in
turn be directed and guided to its final end by the spirit."
22
This Biblical understanding of the "language of the
body" leads the Pope to develop a theology of the body which he
applies to the complementarity of the masculine and feminine body,
resulting in an understanding of the "nuptial meaning of the
body." 23
While it is not possible here to summarize the totality of the
Pope’s teaching on this topic, it is important to note that in
reflecting on the Yahwistic account of creation from the Book of
Genesis, the Holy Father finds in man’s own self-understanding
of himself to the world (through the experience of his solitude) a
basic desire for reciprocity that leads him to interpersonal
communion. It is this sense of a desire for communion that
specifically reflects the "image of God" in every man and
woman. Thus the characteristics of masculinity and femininity, even
prior to their sexual meaning, express the body’s language as
being meant for mutual enrichment. 24
The nuptial meaning of the body then flows from the capacity
of man and woman for self-giving which constitutes the most radical
characteristic of their personhood. Since God, as creator who is
himself substantially self-giving, makes man in his own image, then
it follows that man’s existence is only fulfilled in his
self-giving to another. 25
Within this understanding, the Pope concludes that the human
body becomes a sacrament, making visible the invisible spiritual
intention of God. Thus the definition of the "nuptial meaning of
the body" lies in the fact that to be a person is to be someone
whose self-fulfillment consists in self-giving. 26 As a vehicle
for man’s being in the world, the human body takes on a nuptial
character which is expressed in love, man’s gift of self which
verifies the deepest meaning of his existence. 27
Part V
If our understanding of man as made in God’s image is
essentially defined in his self-gift to another, then the dignity
that redounds on man’s activity in the world must be reflected
in the manner in which that self-giving is exercised. With regard to
the transmission of human life, then, the Pope argues for a nuptial
context that is the only appropriate context for the
fulfillment of man’s self-gift.
Earlier, Pope John XXIII had taught why the transmission of
life must enjoy a special character of its own:
"The transmission of human life is entrusted by nature to
a personal and conscious act and as such is subject to the all-holy
laws of God: immutable and inviolable laws which must be recognized
and observed. For this reason one cannot use means and follow methods
which could be licit in the transmission of the life of plants and
animals." 28
The Second Vatican Council likewise explicitly teaches that
the unique character of the transmission of human life is through the
responsible sexual union of married spouses:
"When it is a question of harmonizing married love with
the responsible transmission of life, the moral character of
one’s behavior does not depend only on the good intention and
the evaluation of the motives: the objective criteria must be used,
criteria drawn from the nature of the human person and human acts,
criteria which respect the total meaning of mutual self-giving and
human procreation in the context of true love."
29
This same theme is taken up by Pope John Paul II and, not
surprisingly, is significantly enriched by his theology of the body.
I quote the Holy Father at length because of the importance of the
development of his thought:
"Consequently, sexuality, by means of which man and woman
give themselves to one another through the acts which are proper and
exclusive to spouses, is by no means something purely biological, but
concerns the innermost being of the human person as such. It is
realized in a truly human way only if it is an integral part of the
love by which a man 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 and fruit of a total personal self-giving, in
which the whole person, including the temporal dimension, is present:
if the person were to withhold something or reserve the possibility
of deciding otherwise in the future, by this very fact he or she
would not be giving totally.
This totality which is required by conjugal love also
corresponds to the demands of responsible fertility. This fertility
is directed to the generation of a human being, and so by its nature
it surpasses the purely biological order and involves a whole series
of personal values. For the harmonious growth of these values a
persevering and unified contribution by both parents is necessary.
The only "place" in which this self-giving in its
whole truth is made possible is marriage, the covenant of conjugal
love freely and consciously chosen, whereby man and woman accept the
intimate community of life and love willed by God himself, which only
in this light manifests its true meaning. The institution of marriage
is not an undue interference by society or authority, nor the
extrinsic imposition of a form. Rather it is an interior requirement
of the covenant of conjugal love which is publicly affirmed as unique
and exclusive, in order to live in complete fidelity to the plan of
God, the Creator." 30
It, therefore, stands to reason that the transmission of human
life outside the bodies of the married spouses would fail to provide
the meaning and values inherent in the "nuptial meaning of the
body" that is meant to be expressed by the union of human
persons. 31
In this context, then, extra corporeal reproduction radically
alters the "language of the body" that is meant to speak of
mutual self-giving, unity and committed fruitful love. While it may
respond in the short term to the desires of the couple faced with
sterility or the single person who wishes to be a parent or the
scientific researcher who seeks a medical breakthrough, nevertheless
it cannot in the long run promote the happiness and well-being of
those individuals because extracorporeal reproduction will never
adequately respond to the question, "who is man?"
Part VI
Understanding the dignity of the nature of man, the
language of the body and his essential responsibility to transmit the
gift of life within the corporeal context of marriage leads us to
reflect on scientific interventions involving the human embryo,
zygote or fetus which are diagnostic and therapeutic or experimental
and commercial. Another way of stating the concern is whether the
technology employed seeks to promote and assist the natural processes
of the human person or to dominate and replace them.
In 1987, Pope John Paul II approved an Instruction on
Respect for Human Life In Its Origin and on the Dignity of
Procreation: Replies to Certain Questions of the Day which
bishops, theologians, doctors and scientists had requested concerning
specific biomedical techniques. The document is the most
comprehensive statement to date by the Holy See on various forms of
technologies already mentioned above. It applies the teaching of Pope
John Paul II on the theology of the body and makes specific
application to five areas of research:
1) prenatal diagnosis;
I shall briefly comment on each of the techniques proposed.
1) Prenatal diagnosis:
Responding to the question of whether prenatal diagnosis is
morally licit, the answer is affirmative provided such a diagnosis
respects the life and integrity of the embryo.
The positive merits of such diagnosis are that certain
therapeutic, medical or surgical procedures can be anticipated
earlier. But the negative aspect would be the temptation to induce
abortion, which is always gravely opposed to the moral law.
32
2) Therapeutic procedures on human embryos:
In answer to the question of whether such procedures are
licit, the Instruction affirms those interventions that are
directed toward the
improvement of the health and survival of the individual. It
would condemn, however, any intervention aimed at harming the
integrity of the person or worsening his condition. 33
3) Moral Evaluation of research and experimentation on human
embryos and fetuses:
Here the Instruction bids great caution on any
procedure that would risk the embryo’s integrity or life. It
distinguishes between experimentation aimed at direct therapeutic
results and those that are not. Not even an intervention that has
great advantage for science can justify risking the dignity due an
unborn human being. 34
4) Research use of "spare" embryos obtained through
in-vitro fertilization:
Here the Instruction condemns as immoral the practice
of harvesting human embryos which are knowingly destined to be
disposed as "biological material." The destruction of all
human embryos is morally illicit, allowing scientists to usurp the
place of God. 35
5) Other forms of embryonic manipulation:
Under this category, the Instruction raises the various
possibilities of fertilization between human and animal gametes, the
gestation of human embryos in the uterus of animals, the construction
of artificial uteruses, cloning, the freezing of embryos
(cryopreservation) and the manipulation of genes or chromosomes.
Logically, all of these interventions are contrary to the moral law
since they violate the dignity and rights of the human person, as I
have earlier described. 36
Four years before this Instruction was published, Pope
John Paul II in an address to the World Medical Association called
for a careful "moral discernment" on the part of genetic
engineers as to which experiments follow God’s natural design
and which do not. The Holy Father states:
"To tell the truth, the expression "Genetic
Manipulation" remains ambiguous and ought to become the object
of genuine moral discernment, for on the one hand it covers
adventurous attempts aimed at promoting I know not what superman, and
on the other hand salutary efforts aimed at correcting anomalies,
such as certain hereditary maladies, not to mention beneficial
applications in the fields of animal and vegetable biology which can
be useful in food production." 37
In the same talk, however, the Holy Father reminds scientists
that when they exceed the bounds of strictly therapeutic
interventions, they must not violate the integrity of the human
person, whose unity as an "animated body" composed of body
and soul is essential to the dignity of that person. Again the Holy
Father speaks of a holistic vision:
"The biological nature of every human is untouchable, in
the sense that it is constituent of the personal identity of the
individual throughout the course of his history. Each human person
— in his or her absolutely unique singularity, is not
constituted only by the spirit, but also by the body. Thus in the
body and through the body, one touches the person itself, in its
concrete reality. Respecting the dignity of man consequently comes
down to safeguarding this identity of man "corpore et anima
unus" (one in body and soul) as the Vatican Council II says
(Gaudium et Spes, 44). It is on the basis of this anthropologic view
that the fundamental criteria have to be found for making decisions
if it is a question of interventions not strictly therapeutic, for
example, aimed at improving the human biological condition."
38
Thus, it is that our investigation comes full circle as the
ethical criteria to evaluate certain technological interventions
reflect the overall consideration of the question, "who is
man?"
From this brief analysis, it should be clear that the word the
Church needs to speak to society in this area of scientific
technology is not subject to whim or caprice. Rather her argument in
response to present biomedical challenges forms a solid logic that
holds together from the realm of the philosophical to the details
surrounding practical procedures.
While the possibilities in the field of biotechnology grow,
the message of the Church reflects essentially the teaching of Jesus,
in that "man’s dignity transcends his biological
condition" 39 and man must always remain
"the master, not the product, of his technology."
40In light of these principles, the Church appeals to
man’s reason and reason carries an authority of its own.
Is it too much to hope that today’s world of science and
indeed society as a whole could be convinced by the "word"
that the Church is compelled to speak? Well, perhaps the centurion
from Matthew 8 needs to remind us: that a holistic approach to the
health of a human person requires an understanding of "who is
man" as well as an acknowledgement of that transcendent
authority which has called him into being and provided for him a
noble destiny.
Thank you for your attention.
FOOTNOTES
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(January 1984), 47.
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