Erds & Dignitas Personae.Pps
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    Erds & Dignitas Personae.Pps Erds & Dignitas Personae.Pps Presentation Transcript

    • Preamble General Introduction
    • PART ONE The Social Responsibility of Catholic Health Care Services
    • Directives
      • A Catholic institutional health care service is a community that provides health care to those in need of it. This service must be animated by the Gospel of Jesus Christ and guided by the moral tradition of the Church.
      • Catholic health care should be marked by a spirit of mutual respect among care-givers that disposes them to deal with those it serves and their families with the compassion of Christ, sensitive to their vulnerability at a time of special need.
    • Directives
      • In accord with its mission, Catholic health care should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination: the poor; the uninsured and the underinsured; children and the unborn; single parents; the elderly; those with incurable diseases and chemical dependencies; racial minorities; immigrants and refugees. In particular, the person with mental or physical disabilities, regardless of the cause or severity, must be treated as a unique person of incomparable worth, with the same right to life and to adequate health care as all other persons.
    • from the Vatican’s 12/08 “Dignitas Personae”
    • (Human Dignity)
      • “ The dignity of a person must be recognized in every human being from conception to natural death.
      • “ This fundamental principle expresses a great ‘yes’ to human life….”
    • Directives
      • A Catholic health care institution, especially a teaching hospital, will promote medical research consistent with its mission of providing health care and with concern for the responsible stewardship of health care resources. Such medical research must adhere to Catholic moral principles.
    • from the Vatican’s 12/08 “Dignitas Personae”
    • (We must be aware of competing philosophies: The Hippocratic Oath v. Eugenic Mentality)
      • “ a considerable number of scientists and philosophers, in the spirit of the Hippocratic Oath, see in medical science a service to human fragility aimed at the cure of disease, the relief of suffering and the equitable extension of necessary care to all people.
      • “ At the same time, however, there are also persons in the world of philosophy and science who view advances in biomedical technology from an essentially eugenic perspective.”
    • Directives
      • Catholic health care services must adopt these Directives as policy, require adherence to them within the institution as a condition for medical privileges and employment, and provide appropriate instruction regarding the Directives for administration, medical and nursing staff, and other personnel.
    • from the Vatican’s 12/08 “Dignitas Personae”
    • ( Teaching Based on Faith AND Reason & Directed to ALL People)
      • “ the Catholic Church draws upon
          • the light both of reason and of faith &
      • seeks to set forth an integral vision of man & his vocation, capable of incorporating everything that is good in human activity, as well as in various cultural & religious traditions….
      • “ The Church…views scientific research with hope and desires that many Christians will dedicate themselves to the progress of biomedicine and will bear witness to their faith in this field.
      • “ She hopes moreover that the results of such research may also be made available in areas of the world that are poor and afflicted by disease….
      • “ the Church seeks to draw near to every human being who is suffering, whether in body or in spirit, in order to bring not only comfort, but also light and hope….”
    • (Dignitas Personae is a 3 Part Document)
      • “ anthropological, theological & ethical elements of fundamental importance…
      • “ new problems regarding procreation…
      • “ new procedures involving the manipulation of embryos & the human genetic patrimony.”
    • Directives
      • A Catholic health care organization should be a responsible steward of the health care resources available to it. Collaboration with other health care providers, in ways that do not compromise Catholic social and moral teaching, can be an effective means of such stewardship. 10
    • An explanation from the Vatican's Pontifical Academy about &quot;cooperation” < http://www.zenit.org/article-13676?l=english>
    • An explanation from the Vatican's Pontifical Academy about &quot;cooperation” < http://www.zenit.org/article-13676?l=english>
    • An explanation from the Vatican's Pontifical Academy about &quot;cooperation” < http://www.zenit.org/article-13676?l=english>
    • Directives
      • A Catholic health care institution must treat its employees respectfully and justly. This responsibility includes: equal employment opportunities for anyone qualified for the task, irrespective of a person's race, sex, age, national origin, or disability; a workplace that promotes employee participation; a work environment that ensures employee safety and well-being; just compensation and benefits; and recognition of the rights of employees to organize and bargain collectively without prejudice to the common good.
    • Directives
      • Catholic health care institutions have a unique relationship to both the Church and the wider community they serve. Because of the ecclesial nature of this relationship, the relevant requirements of canon law will be observed with regard to the foundation of a new Catholic health care institution; the substantial revision of the mission of an institution; and the sale, sponsorship transfer, or closure of an existing institution.
      • Employees of a Catholic health care institution must respect and uphold the religious mission of the institution and adhere to these Directives. They should maintain professional standards and promote the institution's commitment to human dignity and the common good.
    • PART TWO The Pastoral and Spiritual Responsibility of Catholic Health Care
    • Directives
      • A Catholic health care organization should provide pastoral care to minister to the religious and spiritual needs of all those it serves. Pastoral care personnel—clergy, religious, and lay alike—should have appropriate professional preparation, including an understanding of these Directives.
    • from the Vatican’s 12/08 “Dignitas Personae”
    • (“respect for the individual…, which reason requires, is further enhanced and strengthened in the light…of faith”)
      • “ By becoming one of us, the Son makes it possible for us to become ‘sons of God’ ( Jn 1:12), ‘sharers in the divine nature’ ( 2 Pet 1:4). This new dimension does not conflict with the dignity of the creature which everyone can recognize by the use of reason, but elevates it into a wider horizon of life which is proper to God, giving us the ability to reflect more profoundly on human life and on the acts by which it is brought into existence….
      • “ respect for the individual human being, which reason requires, is further enhanced and strengthened in the light of these truths of faith….
    • (“respect for the individual…, which reason requires, is further enhanced and strengthened in the light…of faith”)
      • “ By taking the interrelationship of these two dimensions, the human and the divine, as the starting point, one understands better why it is that man has unassailable value: he possesses an eternal vocation and is called to share in the trinitarian love of the living God.
      • “ This value belongs to all without distinction. By virtue of the simple fact of existing, every human being must be fully respected….At every stage of his existence, man, created in the image and likeness of God, reflects
        • ‘ the face of his Only-begotten Son… This boundless and almost incomprehensible love of God for the human being reveals the degree to which the human person deserves to be loved in himself, independently of any other consideration – intelligence, beauty, health, youth, integrity, & so forth. In short, human life is always a good, for it ‘ is a manifestation of God in the world, a sign of his presence, a trace of his glory ’ ( Evangelium vitae ,  34)”.
    • from the Vatican’s 12/08 “Dignitas Personae”
    • (“ethical value…is gauged in reference to both the unconditional respect owed to every human being at every moment of his or her existence, & the defense of the specific character of the personal act which transmits life.”)
      • “ These two dimensions of life, the natural and the supernatural, allow us to understand better the sense in which the acts that permit a new human being to come into existence, in which a man and a woman give themselves to each other, are a reflection of trinitarian love….
      • “ Christian marriage is rooted
        • ‘ in the natural complementarity that exists between man and woman, and is nurtured through the personal willingness of the spouses to share their entire life-project, what they have and what they are: for this reason such communion is the fruit and the sign of a profoundly human need. But in Christ the Lord, God takes up this human need, confirms it, purifies it and elevates it, leading it to perfection through the sacrament of matrimony: the Holy Spirit who is poured out in the sacramental celebration offers Christian couples the gift of a new communion of love that is the living and real image of that unique unity which makes of the Church the indivisible Mystical Body of the Lord Jesus’….
    • (“ethical value…is gauged in reference to both the unconditional respect owed to every human being at every moment of his or her existence, & the defense of the specific character of the personal act which transmits life.”)
      • “ The Church…calls everyone to ethical & social responsibility for their actions. She reminds them 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.”
    • Directives
      • Pastoral care personnel should work in close collaboration with local parishes and community clergy. Appropriate pastoral services and/or referrals should be available to all in keeping with their religious beliefs or affiliation.
      • For Catholic patients or residents, provision for the sacraments is an especially important part of Catholic health care ministry. Every effort should be made to have priests assigned to hospitals and health care institutions to celebrate the Eucharist and provide the sacraments to patients and staff.
    • Directives
      • Particular care should be taken to provide and to publicize opportunities for patients or residents to receive the sacrament of Penance.
      • Properly prepared lay Catholics can be appointed to serve as extraordinary ministers of Holy Communion, in accordance with canon law and the policies of the local diocese. They should assist pastoral care personnel—clergy, religious, and laity—by providing supportive visits, advising patients regarding the availability of priests for the sacrament of Penance, and distributing Holy Communion to the faithful who request it.
      • Responsive to a patient's desires and condition, all involved in pastoral care should facilitate the availability of priests to provide the sacrament of Anointing of the Sick, recognizing that through this sacrament Christ provides grace and support to those who are seriously ill or weakened by advanced age. Normally, the sacrament is celebrated when the sick person is fully conscious. It may be conferred upon the sick who have lost consciousness or the use of reason, if there is reason to believe that they would have asked for the sacrament while in control of their faculties.
    • Directives
      • All Catholics who are capable of receiving Communion should receive Viaticum when they are in danger of death, while still in full possession of their faculties. 12
      • Except in cases of emergency (i.e., danger of death), any request for Baptism made by adults or for infants should be referred to the chaplain of the institution. Newly born infants in danger of death, including those miscarried, should be baptized if this is possible. 13 In case of emergency, if a priest or a deacon is not available, anyone can validly baptize. 14 In the case of emergency Baptism, the chaplain or the director of pastoral care is to be notified.
      • When a Catholic who has been baptized but not yet confirmed is in danger of death, any priest may confirm the person. 15
      • A record of the conferral of Baptism or Confirmation should be sent to the parish in which the institution is located and posted in its Baptism/Confirmation registers.
    • Directives
      • Catholic discipline generally reserves the reception of the sacraments to Catholics. In accord with canon 844, §3, Catholic ministers may administer the sacraments of Eucharist, Penance, and Anointing of the Sick to members of the oriental churches that do not have full communion with the Catholic Church, or of other churches that in the judgment of the Holy See are in the same condition as the oriental churches, if such persons ask for the sacraments on their own and are properly disposed. With regard to other Christians not in full communion with the Catholic Church, when the danger of death or other grave necessity is present, the four conditions of canon 844, §4, also must be present, namely, they cannot approach a minister of their own community; they ask for the sacraments on their own; they manifest Catholic faith in these sacraments; and they are properly disposed. The diocesan bishop has the responsibility to oversee this pastoral practice.
    • Directives
      • The appointment of priests and deacons to the pastoral care staff of a Catholic institution must have the explicit approval or confirmation of the local bishop in collaboration with the administration of the institution. The appointment of the director of the pastoral care staff should be made in consultation with the diocesan bishop.
      • For the sake of appropriate ecumenical and interfaith relations, a diocesan policy should be developed with regard to the appointment of non-Catholic members to the pastoral care staff of a Catholic health care institution. The director of pastoral care at a Catholic institution should be a Catholic; any exception to this norm should be approved by the diocesan bishop.
    • PART THREE The Professional-Patient Relationship
    • Directives
      • The inherent dignity of the human person must be respected and protected regardless of the nature of the person's health problem or social status. The respect for human dignity extends to all persons who are served by Catholic health care.
    • Directives
      • In compliance with federal law, a Catholic health care institution will make available to patients information about their rights, under the laws of their state, to make an advance directive for their medical treatment. The institution, however, will not honor an advance directive that is contrary to Catholic teaching. If the advance directive conflicts with Catholic teaching, an explanation should be provided as to why the directive cannot be honored.
      • Each person may identify in advance a representative to make health care decisions as his or her surrogate in the event that the person loses the capacity to make health care decisions. Decisions by the designated surrogate should be faithful to Catholic moral principles and to the person's intentions and values, or if the person's intentions are unknown, to the person's best interests. In the event that an advance directive is not executed, those who are in a position to know best the patient's wishes—usually family members and loved ones—should participate in the treatment decisions for the person who has lost the capacity to make health care decisions.
    • Directives
      • The free and informed consent of the person or the person's surrogate is required for medical treatments and procedures, except in an emergency situation when consent cannot be obtained and there is no indication that the patient would refuse consent to the treatment.
      • Free and informed consent requires that the person or the person's surrogate receive all reasonable information about the essential nature of the proposed treatment and its benefits; its risks, side-effects, consequences, and cost; and any reasonable and morally legitimate alternatives, including no treatment at all.
      • Each person or the person's surrogate should have access to medical and moral information and counseling so as to be able to form his or her conscience. The free and informed health care decision of the person or the person's surrogate is to be followed so long as it does not contradict Catholic principles.
    • Directives
      • All persons served by Catholic health care have the right and duty to protect and preserve their bodily and functional integrity. 16 The functional integrity of the person may be sacrificed to maintain the health or life of the person when no other morally permissible means is available. 17
      • The transplantation of organs from living donors is morally permissible when such a donation will not sacrifice or seriously impair any essential bodily function and the anticipated benefit to the recipient is proportionate to the harm done to the donor. Furthermore, the freedom of the prospective donor must be respected, and economic advantages should not accrue to the donor.
    • Directives
      • No one should be the subject of medical or genetic experimentation, even if it is therapeutic, unless the person or surrogate first has given free and informed consent. In instances of nontherapeutic experimentation, the surrogate can give this consent only if the experiment entails no significant risk to the person's well-being. Moreover, the greater the person's incompetency and vulnerability, the greater the reasons must be to perform any medical experimentation, especially nontherapeutic.
    • Directives
      • While every person is obliged to use ordinary means to preserve his or her health, no person should be obliged to submit to a health care procedure that the person has judged, with a free and informed conscience, not to provide a reasonable hope of benefit without imposing excessive risks and burdens on the patient or excessive expense to family or community. 18
    • From the Catechism of the Catholic Church
    • Directives
      • The well-being of the whole person must be taken into account in deciding about any therapeutic intervention or use of technology. Therapeutic procedures that are likely to cause harm or undesirable side-effects can be justified only by a proportionate benefit to the patient.
      • Health care providers are to respect each person's privacy and confidentiality regarding information related to the person's diagnosis, treatment, and care.
      • Health care professionals should be educated to recognize the symptoms of abuse and violence and are obliged to report cases of abuse to the proper authorities in accordance with local statutes.
    • Directives
      • Compassionate and understanding care should be given to a person who is the victim of sexual assault. Health care providers should cooperate with law enforcement officials and offer the person psychological and spiritual support as well as accurate medical information. A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum. 19
    • from the Vatican’s 12/08 “Dignitas Personae”
    • (Some “Contraceptives” [already excluded] can actually act as abortifacients)
      • “ Alongside methods of preventing pregnancy …which prevent conception following from a sexual act, there are other technical means which act after fertilization, when the embryo is already constituted, either before or after implantation in the uterine wall. Such methods are
        • “ interceptive if they interfere with the embryo before implantation &
        • “ contragestative if they cause the elimination of the embryo once implanted….
    • (Some “Contraceptives” [already excluded] can actually act as abortifacients)
      • “ anyone who seeks to prevent the implantation of an embryo which may possibly have been conceived & who therefore either requests or prescribes such a pharmaceutical, generally intends abortion.
      • “ When there is a delay in menstruation, a contragestative is used, usually one or two weeks after the non-occurrence of the monthly period. The stated aim is to re-establish menstruation, but what takes place in reality is the abortion of an embryo which has just implanted….
      • “ the use of means of interception & contragestation fall within the sin of abortion and are gravely immoral. Furthermore, when there is certainty that an abortion has resulted, there are serious penalties in canon law.”
    • (As per Directive 45, abortion “in its moral context, includes the interval between conception and implantation of the embryo.” )
    • Pope Benedict XVI’s 10/29/07 address to the International Congress of Catholic Pharmacists
    • Directives
      • An ethics committee or some alternate form of ethical consultation should be available to assist by advising on particular ethical situations, by offering educational opportunities, and by reviewing and recommending policies. To these ends, there should be appropriate standards for medical ethical consultation within a particular diocese that will respect the diocesan bishop's pastoral responsibility as well as assist members of ethics committees to be familiar with Catholic medical ethics and, in particular, these Directives.
    • PART FOUR Issues in Care for the Beginning of Life
    • from the Vatican’s 12/08 “Dignitas Personae”
    • (Critiquing Medical Advances, as to Respect for Human Dignity)
      • “ medical science has made significant strides in understanding human life in its initial stages….
        • “ These developments are certainly positive & worthy of support when they serve to overcome or correct pathologies and succeed in re-establishing the normal functioning of human procreation….
        • “ they are negative & cannot be utilized when they involve the destruction of human beings or when they employ means which contradict the dignity of the person or when they are used for purposes contrary to the integral good of man.
      • “ The body of a human being, from the very first stages of its existence, can never be reduced merely to a group of cells.”
    • (Unconditional Respect for Human Life is Demanded from the Very First Moment of Conception)
      • “ the fundamental ethical criterion… :
        • ‘ Thus the fruit of human generation, from the first moment of its existence, that is to say, from the moment the zygote has formed, demands the unconditional respect that is morally due to the human being in his bodily & spiritual totality. The human being is to be respected & treated as a person from the moment of conception; & therefore from that same moment his rights as a person must be recognized, among which in the first place is the inviolable right of every innocent human being to life”
    • Sidebar: It must be noted that some are using a changed definition of “conception”, to claim that certain activities are “contraceptive” when they are actually “abortifacient.”
    • (Children are meant to be born via the loving, open-to-life marital embrace of Mom & Dad, who are husband & wife)
      • “ The origin of human life has its authentic context in marriage and in the family, where it is generated through an act which expresses the reciprocal love between a man and a woman….
      • “ Marriage, present in all times and in all cultures,
        • ‘ is in reality something wisely and providently instituted by God the Creator with a view to carrying out his loving plan in human beings….
        • ‘ husband and wife, through the reciprocal gift of themselves to the other – something which is proper & exclusive to them – bring about that communion of persons by which they perfect each other, so as to cooperate with God in the procreation & raising of new lives’.
    • (Children are meant to be born via the loving, open-to-life marital embrace of Mom & Dad, who are husband & wife)
      • “ In the fruitfulness of married love, man and woman ‘make it clear that at the origin of their spousal life there is a genuine ‘’yes’’, which is pronounced & truly lived in reciprocity, remaining ever open to life...
      • “ Natural law, which is at the root of the recognition of true equality between persons and peoples, deserves to be recognized as the source that inspires the relationship between the spouses in their responsibility for begetting new children.
      • “ The transmission of life is inscribed in nature and its laws stand as an unwritten norm to which all must refer”….
      • “ In the mystery of the Incarnation, the Son of God confirmed the dignity of the body and soul which constitute the human being. Christ did not disdain human bodiliness, but instead fully disclosed its meaning and value”
    • Directives
      • When the marital act of sexual intercourse is not able to attain its procreative purpose, assistance that does not separate the unitive and procreative ends of the act, and does not substitute for the marital act itself, may be used to help married couples conceive. 27
      • Those techniques of assisted conception that respect the unitive and procreative meanings of sexual intercourse and do not involve the destruction of human embryos, or their deliberate generation in such numbers that it is clearly envisaged that all cannot implant and some are simply being used to maximize the chances of others implanting, may be used as therapies for infertility.
    • Directives
      • Heterologous fertilization (that is, any technique used to achieve conception by the use of gametes coming from at least one donor other than the spouses) is prohibited because it is contrary to the covenant of marriage, the unity of the spouses, and the dignity proper to parents and the child. 28
      • Homologous artificial fertilization (that is, any technique used to achieve conception using the gametes of the two spouses joined in marriage) is prohibited when it separates procreation from the marital act in its unitive significance (e.g., any technique used to achieve extra-corporeal conception). 29
      • Because of the dignity of the child and of marriage, and because of the uniqueness of the mother-child relationship, participation in contracts or arrangements for surrogate motherhood is not permitted. Moreover, the commercialization of such surrogacy denigrates the dignity of women, especially the poor. 30
      • A Catholic health care institution that provides treatment for infertility should offer not only technical assistance to infertile couples but also should help couples pursue other solutions (e.g., counseling, adoption).
    • from the Vatican’s 12/08 “Dignitas Personae”
    • (Guaging Infertility Treatments)
      • “ With regard to the treatment of infertility, new medical techniques must respect three fundamental goods:
        • the right to life and to physical integrity of every human being from conception to natural death;
        • the unity of marriage, which means reciprocal respect for the right within marriage to become a father or mother only together with the other spouse;
        • the specifically human values of sexuality which require ‘that the procreation of a human person be brought about as the fruit of the conjugal act specific to the love between spouses’….
      • “ all techniques of heterologous artificial fertilization, as well as those techniques of homologous artificial fertilization which substitute for the conjugal act, are to be excluded….
      • techniques which act as an aid to the conjugal act & its fertility are permitted”
    • (Licit Treatments)
      • “ techniques aimed at removing obstacles to natural fertilization, as for example,
        • hormonal treatments for infertility,
        • surgery for endometriosis,
        • unblocking of fallopian tubes or their surgical repair,
      • are licit….once the problem causing the infertility has been resolved, the married couple is able to engage in conjugal acts resulting in procreation, without the physician’s action directly interfering in that act itself. None of these treatments replaces the conjugal act….
      • “ to come to the aid of the many infertile couples who want to have children, adoption should be encouraged, promoted and facilitated….
      • “ research and investment directed at the prevention of sterility deserve encouragement.
    • (“ In vitro  fertilization & the deliberate destruction of embryos”)
      • “ all techniques of in vitro fertilization proceed as if the human embryo were simply a mass of cells to be used, selected and discarded….
      • “ Embryos produced in vitro which have defects are directly discarded….
      • “ techniques of in vitro fertilization are accepted based on the presupposition that the individual embryo is not deserving of full respect in the presence of the competing desire for offspring….
      • “ the ‘various techniques of artificial reproduction, which would seem to be at the service of life… actually open the door to new threats against life’….
    • (“ In vitro  fertilization & the deliberate destruction of embryos”)
      • “ human procreation is a personal act of a husband and wife, which is not capable of substitution. The blithe acceptance of the enormous number of abortions involved in the process of in vitro fertilization vividly illustrates how the replacement of the conjugal act by a technical procedure…leads to a weakening of the respect owed to every human being. Recognition of such respect is, on the other hand, promoted by the intimacy of husband and wife nourished by married love….
      • “ The desire for a child cannot justify the ‘production’ of offspring, just as the desire not to have a child cannot justify the abandonment or destruction of a child once he or she has been conceived….
      • “’ God’s love does not differentiate between the newly conceived infant still in his or her mother’s womb and the child or young person, or the adult and the elderly person. God does not distinguish between them because he sees an impression of his own image and likeness ( Gen 1:26) in each one…Therefore, the Magisterium of the Church has constantly proclaimed the sacred and inviolable character of every human life from its conception until its natural end”.
    • SIDEBAR: The success rates in achieving pregnancy through Church approved “NaPro Technology” is FAR higher than IVF!
    • (“Intracytoplasmic sperm injection (ICSI)”)
      • “ Just as in general with in vitro fertilization, of which it is a variety, ICSI is intrinsically illicit:  it causes a complete separation between procreation and the conjugal act….
      • “ Conception in vitro is the result of the technical action which presides over fertilization.”
    • (“Freezing embryos”)
      • “ Cryopreservation is incompatible with the respect owed to human embryos ; it presupposes their production in vitro ; it exposes them to the serious risk of death or physical harm, since a high percentage does not survive the process of freezing and thawing; it deprives them at least temporarily of maternal reception and gestation; it places them in a situation in which they are susceptible to further offense and manipulation.
      • “ The majority of embryos that are not used remain ‘orphans’. Their parents do not ask for them and at times all trace of the parents is lost. This is why there are thousands upon thousands of frozen embryos in almost all countries where in vitro fertilization takes place….
      • “ Proposals to use these embryos for research or for the treatment of disease are obviously unacceptable because they treat the embryos as mere ‘biological material’ and result in their destruction. The proposal to thaw such embryos without reactivating them and use them for research, as if they were normal cadavers, is also unacceptable.
    • (“Freezing embryos”)
      • “ The proposal that these embryos could be put at the disposal of infertile couples as a treatment for infertility is not ethically acceptable for the same reasons which make artificial heterologous procreation illicit as well as any form of surrogate motherhood; this practice would also lead to other problems of a medical, psychological and legal nature.
      • “ It has also been proposed, solely in order to allow human beings to be born who are otherwise condemned to destruction, that there could be a form of ‘prenatal adoption’. This proposal, praiseworthy with regard to the intention of respecting and defending human life, presents however various problems not dissimilar to those mentioned above.
      • “ All things considered, it needs to be recognized that the thousands of abandoned embryos represent a situation of injustice which in fact cannot be resolved. Therefore John Paul II made an ‘appeal to the conscience of the world’s scientific authorities and in particular to doctors, that the production of human embryos be halted, taking into account that there seems to be no morally licit solution regarding the human destiny of the thousands and thousands of ‘’frozen’’ embryos which are and remain the subjects of essential rights and should therefore be protected by law as human persons’”.
    • (“The freezing of oocytes” & “The reduction of embryos”)
      • “ cryopreservation of oocytes for the purpose of being used in artificial procreation is to be considered morally unacceptable.”  
      • “ Some techniques used in artificial procreation, above all the transfer of multiple embryos into the mother’s womb, have caused a significant increase in the frequency of multiple pregnancy. This situation gives rise in turn to the practice of so-called embryo reduction, a procedure in which embryos or fetuses in the womb are directly exterminated….
      • “ From the ethical point of view, embryo reduction is an intentional selective abortion”
    • (“Preimplantation diagnosis”)
      • “ Preimplantation diagnosis – connected as it is with artificial fertilization, which is itself always intrinsically illicit – is directed toward the qualitative selection and consequent destruction of embryos, which constitutes an act of abortion. 
      • “ Preimplantation diagnosis is therefore the expression of a eugenic mentality that ‘accepts selective abortion in order to prevent the birth of children affected by various types of anomalies. Such an attitude is shameful and utterly reprehensible, since it presumes to measure the value of a human life only within the parameters of ‘‘normality’’ and physical well-being, thus opening the way to legitimizing infanticide and euthanasia as well’….
      • “ If at other times in history, while the concept and requirements of human dignity were accepted in general, discrimination was practiced on the basis of race, religion or social condition, today there is a no less serious and unjust form of discrimination which leads to the non-recognition of the ethical and legal status of human beings suffering from serious diseases or disabilities. It is forgotten that sick and disabled people are not some separate category of humanity; in fact, sickness and disability are part of the human condition and affect every individual, even when there is no direct experience of it. Such discrimination is immoral and must therefore be considered legally unacceptable, just as there is a duty to eliminate cultural, economic and social barriers which undermine the full recognition and protection of disabled or ill people.”
    • Directives
      • A Catholic health care institution should provide prenatal, obstetric, and postnatal services for mothers and their children in a manner consonant with its mission.
      • Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. Catholic health care institutions are not to provide abortion services, even based upon the principle of material cooperation. In this context, Catholic health care institutions need to be concerned about the danger of scandal in any association with abortion providers.
      • Catholic health care providers should be ready to offer compassionate physical, psychological, moral, and spiritual care to those persons who have suffered from the trauma of abortion.
    • Directives
      • Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.
      • In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion. 31
      • In an “ectopic” pregnancy, the new embryo implants somewhere other than the mom’s uterus – often in a fallopian tube. The incidence of ectopic pregnancy is on the rise; the Mayo Clinic acknowledges several risk factors, including:
        • Previous Ectopic Pregnancy
        • Inflammation or Infection, which can be associated with a history of gonorrhea or Chlamydia
        • Use of medications to stimulate the ovaries
        • Use of birth control pills or an IUD (cf., <www.mayoclinic.com/health/ectopic-pregnancy/DS00622/DSECTION=risk-factors>)
      • Citing the principle of “double effect,” Catholic health care has allowed the removal of a fallopian tube to save a mother’s life, in the case of an ectopic pregnancy. This unintentionally and indirectly results in the death of the preborn child.
      • As per Father Tad, &quot;Of the three commonly performed procedures for addressing ectopic pregnancies, two raise significant moral concerns while the third is morally acceptable.
        • &quot;The first procedure involves a drug called methotrexate, which targets the most rapidly growing cells of the embryo.... A significant number of Catholic moralists hold that the use of methotrexate is not morally permissible because it constitutes a direct attack on the growing child in the tube and involves a form of direct abortion.
        • &quot;Another morally problematic technique [i.e., salpingostomy] involves cutting along the length of the fallopian tube where the child is embedded and 'scooping out' the living body of the child, who dies shortly thereafter....This approach, like the use of methotrexate...directly causes the death of the child....
      • &quot; a morally acceptable approach would involve removal of the whole section of the tube on the side of the woman’s body where the unborn child is lodged....the section of tube around the growing child has clearly become pathological and constitutes a mounting threat with time. This threat is addressed by removal of the tube, with the secondary, and unintended effect, that the child within will then die. In this situation, the intention of the surgeon is directed towards the good effect, which is removing the damaged tissue to save the mother's life, while only tolerating the bad effect, death of the ectopic child....We may never directly take the life of an innocent human being, though we may sometimes tolerate the indirect and unintended loss of life that comes with trying to properly address a life-threatening medical situation.“
      • As per Directive # 48, “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion”
    • Directives
      • For a proportionate reason, labor may be induced after the fetus is viable.
      • Prenatal diagnosis is permitted when the procedure does not threaten the life or physical integrity of the unborn child or the mother and does not subject them to disproportionate risks; when the diagnosis can provide information to guide preventative care for the mother or pre- or postnatal care for the child; and when the parents, or at least the mother, give free and informed consent. Prenatal diagnosis is not permitted when undertaken with the intention of aborting an unborn child with a serious defect. 32
    • “ We Can Recapture the Spirit that Cherishes All Human Life” (Bucks Cty Courier Times, 11/16/06)
    • “We Can Recapture the Spirit that Cherishes All Human Life” (Bucks Cty Courier Times, 11/16/06)
    • Directives
      • Nontherapeutic experiments on a living embryo or fetus are not permitted, even with the consent of the parents. Therapeutic experiments are permitted for a proportionate reason with the free and informed consent of the parents or, if the father cannot be contacted, at least of the mother. Medical research that will not harm the life or physical integrity of an unborn child is permitted with parental consent. 33
    • from the Vatican’s 12/08 “Dignitas Personae”
    • (“New Treatments which Involve the Manipulation of the Embryo or the Human Genetic Patrimony”)
      • “ research on embryonic stem cells and its possible future uses have prompted great interest, even though up to now such research has not produced effective results, as distinct from research on adult stem cells ….
      • “ a whole range of questions has emerged in the area of gene therapy, from cloning to the use of stem cells, which call for attentive moral discernment.”
    • (“Gene therapy”)
      • “ In theory, it is possible to use gene therapy on two levels:….
        • “ Somatic cell gene therapy seeks to eliminate or reduce genetic defects on the level of somatic cells, that is, cells other than the reproductive cells….It involves procedures aimed at certain individual cells with effects that are limited to a single person. 
        • “ Germ line cell therapy aims instead at correcting genetic defects present in germ line cells with the purpose of transmitting the therapeutic effects to the offspring of the individual. Such methods of gene therapy, whether somatic or germ line cell therapy, can be undertaken on a fetus before his or her birth as gene therapy in the uterus or after birth on a child or adult…..
      • “ Procedures used on somatic cells for strictly therapeutic purposes are in principle morally licit…. it is necessary to establish beforehand that the person being treated will not be exposed to risks to his health or physical integrity which are excessive or disproportionate….The informed consent of the patient or his legitimate representative is also required….
      • “ in its current state, germ line cell therapy in all its forms is morally illicit....
      • “ The question of using genetic engineering for purposes other than medical treatment also calls for consideration…. the prospect of such an intervention would end sooner or later by harming the common good, by favouring the will of some over the freedom of others. Finally it must also be noted that in the attempt to create a new type of human being one can recognize an ideological element in which man tries to take the place of his Creator….the Church also recalls the need to return to an attitude of care for people and of education in accepting human life in its concrete historical finite nature.”
    • Directives
      • Catholic health institutions may not promote or condone contraceptive practices but should provide, for married couples and the medical staff who counsel them, instruction both about the Church's teaching on responsible parenthood and in methods of natural family planning.
    • Directives
      • Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available. 34
    • As per Ann Carey’s 7/08 article,
      • There has been “a four-decade tussle over the ‘Ethical and Religious Directives for Catholic Health Care Services’ (ERDs)…. In addition to moral confusion and scandal, experts say the situation has provided ammunition to those who want to force Catholic medical institutions to provide immoral services....the section that has received the most attention is the one on the beginning of life, particularly the directives that deal with sterilization. Church teaching specifically prohibits ‘direct sterilization’ -- a procedure such as tubal ligation -- to prevent future pregnancy. The Church does, of course, permit necessary medical procedures -- like removal of a cancerous uterus -- that have a side effect of causing sterility, and this is called ‘indirect sterilization’….
    • As per Ann Carey’s 7/08 article,
      • “ When Catholic hospitals acquire or merge with non-Catholic hospitals, the new entity is required to abide by the ERDs…. To allow mergers to go forward, Catholic hospitals sometimes agreed to a ‘carve-out,’ or ‘hospital within a hospital,’ arrangement and permitted an outside group to rent space in the Catholic hospital to continue sterilization services….
      • “ the CDF [i.e., the Vatican’s Congregation for the Doctrine of the Faith] has ruled that such arrangements are unacceptable…. When Pope John Paul II addressed the bishops of Texas, Arkansas and Oklahoma during their 1998 ‘ad limina’ visit, he told them that ‘abortion, sterilization or euthanasia are always inadmissible’ and prohibited at Catholic health care facilities. ‘As bishops,’ he said, ‘you must remind everyone involved -- hospital administrations and medical personnel -- that any failure to comply with this prohibition is both a grievous sin and a source of scandal’….
    • As per Ann Carey’s 7/08 article,
      • “ In a 2001 revision[of the ERDs], the bishops added a paragraph specifically prohibiting Catholic facilities from engaging in ‘immediate material cooperation in actions that are intrinsically immoral, such as abortion, euthanasia, assisted suicide and direct sterilization’….Non-Catholic doctors often don't know or understand the Catholic teaching on sterilization, so they expect to do them in the Catholic hospitals where they practice, explained John Haas, president of the National Catholic Bioethics Center. And he agreed that many Catholics don't understand the teaching either….
      • “ according to attorney Denise Burke, vice-president and legal director of Americans United for Life. ‘A hospital has the right to follow its corporate conscience’….‘In the case of Catholic hospitals, that's the ERDs and other guidance from the bishops and the Vatican. It makes it harder to make that argument when there's a handful of hospitals that are, in essence, doing their own thing and defying the corporate conscience.’”
    • Directives
      • Genetic counseling may be provided in order to promote responsible parenthood and to prepare for the proper treatment and care of children with genetic defects, in accordance with Catholic moral teaching and the intrinsic rights and obligations of married couples regarding the transmission of life.
    • from the Vatican’s 12/08 “Dignitas Personae”
    • (“Human cloning”)
      • “ Cloning is proposed for two basic purposes:
        • “ reproduction ….
        • “ Therapeutic cloning…has been proposed as a way of producing embryonic stem cells with a predetermined genetic patrimony in order to overcome the problem of immune system rejection; this is therefore linked to the issue of the use of stem cells….
      • “ Human cloning is intrinsically illicit in that, by taking the ethical negativity of techniques of artificial fertilization to their extreme, it seeks to give rise to a new human being without a connection to the act of reciprocal self-giving between the spouses and, more radically, without any link to sexuality.  This leads to manipulation & abuses gravely injurious to human dignity…. 
      • “ If cloning were to be done for reproduction…. The fact that someone would arrogate to himself the right to determine arbitrarily the genetic characteristics of another person represents a grave offense to the dignity of that person as well as to the fundamental equality of all people….
    • (“Human cloning”)
      • “ From the ethical point of view, so-called therapeutic cloning is even more serious. To create embryos with the intention of destroying them, even with the intention of helping the sick, is completely incompatible with human dignity, because it makes the existence of a human being at the embryonic stage nothing more than a means to be used and destroyed. It is gravely immoral to sacrifice a human life for therapeutic ends.
      • The ethical objections raised…to therapeutic cloning and to the use of human embryos formed in vitro have led some researchers to propose new techniques which are presented as capable of producing stem cells of an embryonic type without implying the destruction of true human embryos. These proposals have been met with questions of both a scientific and an ethical nature regarding above all the ontological status of the ‘product’ obtained in this way. Until these doubts have been clarified, the statement of the Encyclical Evangelium vitae needs to be kept in mind: ‘what is at stake is so important that, from the standpoint of moral obligation, 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’.
    • SIDEBAR: While some have enthusiastically applauded iPS (Induce Pluripotent Stem Cell) research, Dr. Dianne Irving asks cautiously: &quot;Are… iPS cells just 'embryo- like' , or are they - at least sometimes - really single- or multiple-cell early human 'embryos', or even human totipotent cells that have the natural capacity to revert back to new whole human embryos?&quot;
    • from the Vatican’s 12/08 “Dignitas Personae”
    • “ The therapeutic use of stem cells”
      • “ Stem cells are undifferentiated cells with two basic characteristics:
        • the prolonged capability of multiplying themselves while maintaining the undifferentiated state;
        • the capability of producing transitory progenitor cells from which fully differentiated cells descend, for example, nerve cells, muscle cells and blood cells….
      • “ new prospects [have] opened for regenerative medicine, which have been the subject of great interest among researchers throughout the world.
      • “ Among the sources for human stem cells which have been identified thus far are:
        • the embryo in the first stages of its existence,
        • the fetus,
        • blood from the umbilical cord &
        • various tissues from adult humans… &
        • amniotic fluid. 
      • At the outset, studies focused on embryonic stem cells…. Numerous studies…show that adult stem cells also have a certain versatility…. advanced scientific studies and experimentation indicate that these cells give more positive results than embryonic stem cells….
    • “ The therapeutic use of stem cells” [continued]
      • “ Methods which do not cause serious harm to the subject from whom the stem cells are taken are to be considered licit. This is generally the case when tissues are taken from:
        • an adult organism;
        • the blood of the umbilical cord at the time of birth;
        • fetuses who have died of natural causes. 
      • The obtaining of stem cells from a living human embryo…invariably causes the death of the embryo and is consequently gravely illicit….
      • “ The use of embryonic stem cells or differentiated cells derived from them – even when these are provided by other researchers through the destruction of embryos or when such cells are commercially available – presents serious problems from the standpoint of cooperation in evil and scandal.
      • “ There are no moral objections to the clinical use of stem cells that have been obtained licitly; however, the common criteria of medical ethics need to be respected….
      • “ Research initiatives involving the use of adult stem cells…should be encouraged and supported.”
    • “ Attempts at hybridization”
      • “ Recently animal oocytes have been used for reprogramming the nuclei of human somatic cells – this is generally called hybrid cloning – in order to extract embryonic stem cells from the resulting embryos without having to use human oocytes.
      • “ such procedures represent an offense against the dignity of human beings on account of the admixture of human and animal genetic elements capable of disrupting the specific identity of man.  The possible use of the stem cells, taken from these embryos, may also involve additional health risks, as yet unknown, due to the presence of animal genetic material in their cytoplasm. To consciously expose a human being to such risks is morally and ethically unacceptable.”
    • “ The use of human ‘biological material’ of illicit origin [continued]
      • “ there is a duty to refuse to use such ‘biological material’ even when there is no close connection between the researcher & the actions of those who performed the artificial fertilization or the abortion, or when there was no prior agreement with the centers in which the artificial fertilization took place….
      • “ Of course, within this general picture there exist differing degrees of responsibility . Grave reasons may be morally proportionate to justify the use of such ‘biological material’. Thus, for example, danger to the health of children could permit parents to use a vaccine which was developed using cell lines of illicit origin, while keeping in mind that everyone has the duty to make known their disagreement and to ask that their healthcare system make other types of vaccines available. Moreover, in organizations where cell lines of illicit origin are being utilized, the responsibility of those who make the decision to use them is not the same as that of those who have no voice in such a decision.
      • In the context of the urgent need to mobilize consciences in favour of life, people in the field of healthcare need to be reminded that ‘their responsibility today is greatly increased. Its deepest inspiration and strongest support lie in the intrinsic and undeniable ethical dimension of the health-care profession, something already recognized by the ancient and still relevant Hippocratic Oath, which requires every doctor to commit himself to absolute respect for human life and its sacredness’”.
    • “ The use of human ‘biological material’ of illicit origin
      • “ For scientific research and for the production of vaccines or other products, cell lines are at times used which are the result of an illicit intervention against the life or physical integrity of a human being….
      • “ the category of abortion ‘is to be applied also to the recent forms of intervention on human embryos which, although carried out for purposes legitimate in themselves, inevitably involve the killing of those embryos. This is the case with experimentation on embryos, which is becoming increasingly widespread in the field of biomedical research and is legally permitted in some countries…  [T]he use of human embryos or fetuses as an object of experimentation constitutes a crime against their dignity as human beings who have a right to the same respect owed to a child once born, just as to every person’. These forms of experimentation always constitute a grave moral disorder….
      • “’ The corpses of human embryos and fetuses, whether they have been deliberately aborted or not, must be respected just as the remains of other human beings. In particular, they cannot be subjected to mutilation or to autopsies if their death has not yet been verified and without the consent of the parents or of the mother. Furthermore, the moral requirements must be safeguarded that there be no complicity in deliberate abortion and that the risk of scandal be avoided’….
      • “ the criterion of independence as it has been formulated by some ethics committees is not sufficient . According to this criterion, the use of ‘biological material’ of illicit origin would be ethically permissible provided there is a clear separation between those who, on the one hand, produce, freeze and cause the death of embryos and, on the other, the researchers involved in scientific experimentation…. Any appearance of acceptance would in fact contribute to the growing indifference to, if not the approval of, such actions in certain medical and political circles….
    • PART FIVE Issues in Care for the Dying
    • Directives
      • Catholic health care institutions offering care to persons in danger of death from illness, accident, advanced age, or similar condition should provide them with appropriate opportunities to prepare for death. Persons in danger of death should be provided with whatever information is necessary to help them understand their condition and have the opportunity to discuss their condition with their family members and care providers. They should also be offered the appropriate medical information that would make it possible to address the morally legitimate choices available to them. They should be provided the spiritual support as well as the opportunity to receive the sacraments in order to prepare well for death.
      • Why do bad things happen to good people ?
      • If God is All Mighty, why is there any evil?
      • Why do people suffer ?
      • In creation, God first showed His almighty love and wisdom and announced His loving plan. The 1st people, our first parents, lived in perfect holiness & perfect justice: their relationships with God, with each other, with themselves, & with their environment - were all in perfect harmony. There was no death or suffering.
      • People abused their freedom & rejected what God had given. The first people lost that original holiness & justice - not just for themselves, but for all people. We rejected God's offer & struck out on our own. Not born into that original holiness & justice - our situation is called &quot;original sin.&quot; Our powers are now more weak: We can be ignorant; we suffer; we die; we sin.
      • While the 1st people rejected God's perfect world for all people, that's not the end: Christ's victory over sin gave us greater blessings than those that original sin took away! Jesus' Redemption is better than what we lost!
      • Jesus experienced evil, & He suffered. Through His death & Resurrection, He overcame evil. We can unite our sufferings to His - suffering can have redemptive value. God wouldn't permit any evil if He didn't allow for good to come from the same evil.
    • Directives
      • A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community. 40
      • A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient's judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community. 41
      • There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient.
      • The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching.
    • From the Catechism of the Catholic Church
    • ADDRESS OF JOHN PAUL II TO THE PARTICIPANTS IN THE INTERNATIONAL CONGRESS ON &quot;LIFE-SUSTAINING TREATMENTS AND VEGETATIVE STATE: SCIENTIFIC ADVANCES AND ETHICAL DILEMMAS&quot;  Saturday, 20 March 2004
      • “ I should like particularly to underline how the administration of water & food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary & proportionate , and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.”
    • Directives
      • Euthanasia is an action or omission that of itself or by intention causes death in order to alleviate suffering. Catholic health care institutions may never condone or participate in euthanasia or assisted suicide in any way. Dying patients who request euthanasia should receive loving care, psychological and spiritual support, and appropriate remedies for pain and other symptoms so that they can live with dignity until the time of natural death. 42
    • Recognizing the Immorality of Cooperating in So- Called “Mercy Killing” Was NOT Always So Counter-Cultural….
    • Directives
      • Patients should be kept as free of pain as possible so that they may die comfortably and with dignity, and in the place where they wish to die. Since a person has the right to prepare for his or her death while fully conscious, he or she should not be deprived of consciousness without a compelling reason. Medicines capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person's life so long as the intent is not to hasten death. Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.
    • Directives
      • The determination of death should be made by the physician or competent medical authority in accordance with responsible and commonly accepted scientific criteria.
      • Catholic health care institutions should encourage and provide the means whereby those who wish to do so may arrange for the donation of their organs and bodily tissue, for ethically legitimate purposes, so that they may be used for donation and research after death.
    • In September 2006, the Vatican hosted international experts on neurology for discussion of the latest evidence of &quot;The Signs of Death.”
    • Directives
      • Such organs should not be removed until it has been medically determined that the patient has died. In order to prevent any conflict of interest, the physician who determines death should not be a member of the transplant team.
      • use of tissue or organs from an infant may be permitted after death has been determined and with the informed consent of the parents or guardians.
      • Catholic health care institutions should not make use of human tissue obtained by direct abortions even for research and therapeutic purposes. 43
    • From the Catechism of the Catholic Church
    • PART SIX Forming New Partnerships with Health Care Organizations and Providers
    • The World in which we live….
      • &quot;In terms of its practical effect, the widespread prevalence of dissent among both religious and lay Catholics may make it more difficult for Catholic health care institutions to persuade policymakers that they should be exempt from laws of general application requiring the provision of sterilizations and abortions. And, of course, the situation of Catholic health care institutions has become even more problematic since it has become commonplace for high-profile Catholic politicians to be openly and avowedly `pro-choice'&quot; (p. 32).
    • The World in which we live….
      • &quot;compliance with the ERDs has been uneven when it comes to contraception and sterilization. Typically, obstetrician-gynecologists practicing in Catholic hospitals and physician office buildings owned by Catholic hospitals provide prescriptions for contraceptives to their patients&quot; (p. 53).
      • &quot;By 2003, at least two Catholic hospital systems were performing early induction of labor...where the baby had a condition that would significantly shorten its life....it seems clear that these policies are not morally licit under Directives 48 and 49 of the 2001 ERDs&quot; (p. 77).
    • Directives
      • Decisions that may lead to serious consequences for the identity or reputation of Catholic health care services, or entail the high risk of scandal, should be made in consultation with the diocesan bishop or his health care liaison.
      • Any partnership that will affect the mission or religious and ethical identity of Catholic health care institutional services must respect church teaching and discipline. Diocesan bishops and other church authorities should be involved as such partnerships are developed, and the diocesan bishop should give the appropriate authorization before they are completed. The diocesan bishop's approval is required for partnerships sponsored by institutions subject to his governing authority; for partnerships sponsored by religious institutes of pontifical right, his nihil obstat should be obtained.
    • A Price to pay….
      • &quot;Occasionally, in order to reduce opposition to a merger or affiliation, Catholic hospitals have entered into arrangements to allow continuation of services such as surgical sterilizations in separate facilities to be provided by unrelated organizations&quot; (p. 88).
      • While some Catholic health &quot;systems have entered into arrangements to provide services such as direct sterilizations and abortion referrals....The existence of such arrangements increases the risk of scandal & could embolden those who favor a mandate requiring all hospitals...to provide a full range of [so-called] reproductive services&quot; (p. 102).
    • Directives
      • If a Catholic health care organization is considering entering into an arrangement with another organization that may be involved in activities judged morally wrong by the Church, participation in such activities, must be limited to what is in accord with the moral principles governing cooperation.
      • Catholic health care organizations are not permitted to engage in immediate material cooperation in actions that are intrinsically immoral, such as abortion, euthanasia, assisted suicide, and direct sterilization. 44
    • A Price to pay….
      • &quot;If legal protection for individual conscience erodes, then this also endangers legal protection for institutions that refuse to perform sterilizations and abortions....any argument in favor of exemption from laws requiring a hospital to provide these services may be substantially undermined by the fact that the Catholic hospital is already, in some fashion, involved in either providing those services - as in the case of sterilizations - or involved in partnerships with entities providing such services&quot; (pp. 132, 137).
    • Directives
      • The possibility of scandal must be considered when applying the principles governing cooperation. 45 Cooperation, which in all other respects is morally licit, may need to be refused because of the scandal that might be caused. Scandal can sometimes be avoided by an appropriate explanation of what is in fact being done at the health care facility under Catholic auspices. The diocesan bishop has final responsibility for assessing and addressing issues of scandal, considering not only the circumstances in his local diocese but also the regional and national implications of his decision. 46
    • A Price to pay….
      • &quot;Catholics may have to focus their future efforts on the creation of alternatives to acute care hospitals such as free clinics, specialized centers for reproductive medicine, and hospices for end-of-life care that could reinvigorate health care ministry&quot; (p. 19).
    • Directives
      • The Catholic partner in an arrangement has the responsibility periodically to assess whether the binding agreement is being observed and implemented in a way that is consistent with Catholic teaching.
    • from the Vatican’s 12/08 “Dignitas Personae”
    • “ Conclusion”
      • “ Human history shows…how man has abused & can continue to abuse the power & capabilities which God has entrusted to him, giving rise to various forms of unjust discrimination and oppression of the weakest & most defenseless ….
      • “ At the same time, human history has also shown real progress in the understanding and recognition of the value and dignity of every person as the foundation of the rights and ethical imperatives by which human society has been, and continues to be structured….for example, there are legal and political – and not just ethical – prohibitions of racism, slavery, unjust discrimination and marginalization of women, children, and ill and disabled people….
    • “ Conclusion”
      • “‘ Just as a century ago it was the working classes which were oppressed in their fundamental rights, & the Church courageously came to their defense by proclaiming the sacrosanct rights of the worker as person, so now, when another category of persons is being oppressed in the fundamental right to life, the Church feels in duty bound to speak out with the same courage on behalf of those who have no voice. Hers is always the evangelical cry in defense of the world’s poor, those who are threatened and despised and whose human rights are violated’….
      • The fulfillment of…duty implies courageous opposition to all those practices which result in grave and unjust discrimination against unborn human beings, who have the dignity of a person, created like others in the image of God….
      • “ all persons of good will, in particular physicians and researchers open to dialogue and desirous of knowing what is true, will understand and agree with these principles and judgments, which seek to safeguard the vulnerable condition of human beings in the first stages of life and to promote a more human civilization.”