Saving lives from womb to tomb

Saving Lives from Womb to Tomb
Maria Fidelis Manalo, MD, MSc.
Far Eastern University-Dr. Nicanor Reyes Medical Foundation &
The Medical City
Philippines

SavingLives
fromWomb
toTomb
OUTLINE
▪ Human Life & Human Dignity
▪ Beginning of Life Issues
▪ Abortion
▪ In Vitro Fertilization
▪ End of Life Issues
▪ Euthanasia
▪ Physician Assisted Suicide
▪ Allowing Natural Death

Life:A
Fundamental
Goodofthe
Person
▪ In the natural order, human life is a
gift that is so great and so full of
possibilities that everyone values it.
▪ Life is a fundamental good of every
man converting him into an owner, a
possessor of a fundamental right.
▪ Man is not the absolute owner of
life; he is but its steward. However,
in the eyes of men, man has dominion
over his own life.This means that
neither the State nor society nor any
individual has the right to attempt
against it.
Monge, MA, 1994, Ethical Practices In Health And Disease: A Primer on Health Care Ethics

Sanctityof
HumanLife
▪ "Human life is sacred because from
its beginning it involves the creative
action of God and it remains for ever
in a special relationship with the
Creator, who is its sole end.
▪ God alone is the Lord of life from its
beginning until its end: no one can
under any circumstance claim for
himself the right directly to destroy
an innocent human being.“
- Catechism of the Catholic Church, 2258

RighttoLife
FromWomb
UntilDeath
▪ The inalienable right to life of every
innocent human individual is a
constitutive element of a civil society
and its legislation.
▪ These human rights depend neither on
single individuals nor on parents; nor do
they represent a concession made by
society and the state; they belong to
human nature and are inherent in the
person by virtue of the creative act from
which the person took his origin.
▪ Among such fundamental rights one
should mention in this regard every
human being's right to life and
physical integrity from the moment
of conception until death.

TheDutyto
Preserveand
ProtectLifeis
NotAbsolute
▪ At times, it is subordinated to the
fulfillment of higher duties, for the
glory of God and the service of
others, i.e., non-transferable
professional obligations.
▪ In these cases, there exists the right
and also the duty to accept death or
gravely risk one’s health or even life.
▪ Such is the case of the exercise of
attending physicians, nurses, and so
on when giving medical attention to
contagious patients during
epidemics/pandemics, etc.

“Thoushall
notkill”
▪ This includes all attempts against
human life whether it be one’s own
(suicide) or another’s (homicide).
▪ Abortion and Euthanasia are
qualified forms of homicide.
▪ All interventions which endanger life
without a just cause, likewise
constitute a negative attempt against
it.
▪ In order to evaluate adequately, one
must consider the need for taking
action, its end, the contingencies and
gravity of the foreseen risks, and so
on.
RespectForHumanLife

Human
Dignity
▪ Each life has the same value and
dignity for everyone: the respect of
the life of another is the same as the
respect owed to one’s own life.
▪ All ethical decisions (including those
involved in health care) must aim at
human dignity, i.e., the maximum,
integrated satisfaction of the innate
and cultural needs of every human
person, including his or her
biological, psychological, social, and
spiritual needs as a member of the
world community and national
communities.
“Samaritanus bonus” Congregation for the Doctrine of the Faith, 22.09.2020

RighttoLife
ofthe
Unborn
Child
▪ Human life must be respected and
protected absolutely from the
moment of conception.
▪ From the first moment of his
existence, a human being must be
recognized as having the rights of a
person - among which is the
inviolable right of every innocent
being to life.

ISSUESATTHE
BEGINNINGOFHUMANLIFE

Abortion
▪ Defined as the spontaneous or
induced termination of pregnancy
before fetal viability.
▪ The World Health Organization all
define abortion as pregnancy
termination before 20 weeks’(5
months’) gestation.

Theaspiration(suction)abortionisthemost
prevalentprocedure,legalinall50statesintheU.S.

SurgicalAbortion:
DilatationandEvacuation(D&E)

Abortion
Complications
▪ Most complications are considered minor:
▪ Pain
▪ Bleeding
▪ Infection
▪ Post-anesthesia complications
▪ Major complications:
▪ Uterine atony and subsequent hemorrhage
▪ Uterine perforation
▪ Injuries to adjacent organs (bladder or bowels)
▪ Cervical laceration
▪ Failed abortion
▪ Septic abortion
▪ Disseminated Intravascular Coagulation (DIC)
▪ Hemorrhage
▪ Sepsis
▪ Peritonitis
▪ Deep vein thrombosis
▪ Death
Sajadi-Ernazarova KR, Martinez CL, StatPearls, 2020
https://www.ncbi.nlm.nih.gov/books/NBK430793/

Abortion
Complications
▪ “Women who had undergone an
abortion experienced an 81 percent
increased risk of mental health
problems, and nearly 10 percent of
the incidence of mental health
problems was shown to be directly
attributable to abortion.” (Priscilla K.
Coleman, British Journal of Psychiatry, 2011)
▪ After an abortion, women can
experience
▪ Guilt feelings
▪ Nervous symptoms
▪ Sleep disturbance
▪ Regrets
▪ Post-Traumatic Stress Disorder (PTSD)
▪ Mood disorders, attempts of self-harm
▪ Substance abuse
▪ Suicide Earll CG, Focus on the Family, 2013
https://www.focusonthefamily.com/pro-life/abortion-complications/

NOTEVEN
WHENTHE
CHILDMIGHT
HAVEA
DISABILITY?
▪ When abortion is used to solve the
problem of a disability, it is
discrimination of the most severe
kind.
▪ These children are not merely
discriminated against for their
disability; they are killed because of
it.
▪ Consider the suggestion of killing a
person with Down’s syndrome in
order to “cure” him. To most people,
the idea is repugnant.
▪ Preborn children diagnosed with
disabilities deserve to be treated
with the same respect as born
people with or without a disability.
ABORTION

WHATIFTHE
BABYWILLDIE
ANYWAY?
▪ There is a difference between
parents who abort a severely
handicapped child, and those who
love a handicapped child to the end,
accepting death when it comes.
▪ Parents who know that they allowed
God to have control over the life of
their little baby have a much easier
time grieving the loss of their baby
than those parents who caused the
death of their child through abortion.
▪ It is against the very nature of
parents to harm their own children,
and abortion is the ultimate child
abuse.
ABORTION

NOTEVEN
WHENTHE
PREGNANCYIS
THERESULTOF
RAPE?
▪ Will abortion erase the memory of
the rape or heal the emotional and
physical pain of the assault? Will
abortion, in effect, erase the rape of a
woman? Hardly.
▪ Rape is an act of violence inflicted
upon a woman. She is an innocent
victim, and this knowledge may
someday help her come to terms
with the rape and rebuild her life.
▪ Abortion, on the other hand, is an act
of violence that a mother inflict on
her own child.
▪ Though abortion, the mother
becomes the aggressor, and this
knowledge may haunt her long after
she has dealt with the rape.
ABORTION

NOTEVEN
WHENTHE
PREGNANCYIS
THERESULTOF
RAPE?
▪ Abortion only re-victimizes women
who have been raped.
▪ This new human being, who is
uniquely the mother’s child, may well
be the only good---the only healing--
-that will come to this woman from
her rape experience.
▪ Her baby is not a monster, and telling
a woman that her best option is to get
rid of her baby as soon as possible
may only reinforce in her mind the
idea that she is dirty, or a monster,
herself.
▪ It is a cruel irony that while a father
cannot receive the death penalty for
the crime of rape, his preborn child
conceived in that rape can be
executed without trial, jury or judge.
ABORTION

NOTEVEN
WHENTHE
PREGNANCY
THREATENSTHE
LIFEOFTHE
MOTHER?
▪ Sir Albert William Liley, the father of
modern fetology, teaches:
▪ No matter how severe the mother’s
heart disease, renal complaint,
diabetes or mental illness, no one
would be suggesting abortion was
essential if the mother wanted the
baby.
▪ In 1967, former Planned Parenthood
president Alan Guttmacher said:
▪ Today, it is possible for almost any
patient to be brought through
pregnancy alive, unless she suffers
from a fatal disease such as cancer or
leukemia, and if so, abortion would be
unlikely to prolong, much less save
the life of the mother.
▪ Abortion will not “cure” any life-
threatening condition a mother might
have.
▪ In certain circumstances, pregnancy
may, in fact, relieve a medical
condition.
ABORTION

IN-VITRO
FERTILIZATION
Artificial Fertilization

Respect
fortheLife and
Integrityofthe
HumanEmbryo
▪ Since it must be treated from conception as a
person, the embryo must be defended in its
integrity, cared for, and healed, as far as
possible, like any other human being.
▪ It is immoral to produce human embryos
intended for exploitation as disposable
biological material.
▪ Certain attempts to influence chromosomic or
genetic inheritance are not therapeutic but are
aimed at producing human beings selected
according to sex or other predetermined
qualities.
▪ Such manipulations are contrary to the
personal dignity of the human being and
his integrity and identity which are unique
and unrepeatable.
- Catechism of the Catholic Church, 2274, 2275

In-Vitro
Fertilization
▪ In vitro fertilization consists in
putting spermatocytes or “male
gametes” in contact with oocytes or
“female gametes” inside a test tube.
▪ The oocytes are obtained from the
mother or a donor by puncture of the
ovary; the sperms, ordinarily, by
masturbation.
▪ Once fertilization takes place inside
the test tube with consequent fusion
of the pronuclei, division begins. The
fertilized ova (zygotes) already in the
embryonic stage are then transferred
to the uterus; there they continue
their normal development.

Homologous
Artificial
Insemination
▪ Utilizes the husband’s semen and the
wife’s ovum.
▪ The “zygote” produced is implanted
in the uterus of the wife.

Other
Methodsof
Artificial
Insemination
▪ Fertilization of the ova of the wife with
the sperm of an anonymous donor
▪ Fertilization of the ova of the wife with
the sperm of the husband but the
“embryo” produced is transferred to
the uterus of another woman
(“surrogate” mother or mother “for
hire”)
▪ Fertilization of the ovum of a donor by
the sperm of the husband and the
“embryo “ is transferred to the uterus
of the wife
▪ Fertilization of the ovum of a female
donor with the sperm of a male donor
and the “embryo” is transferred into
the uterus of the wife

▪ The possibilities and interchanges
may be multiplied leading to
varied situations including aberrant
ones: “post-mortem” insemination
of a single woman who wants a
child “without father”, etc.
▪ A test tube baby can have up to 5
parents: the mother and the father
who paid the donors; the donors of
the gametes (who are the genital
parents), and the “surrogate”
mother who received the embryo
and incubated it until it is
delivered.
In-Vitro
Fertilization

▪ One to 4 embryos are transferred to
the uterus because the probability of
pregnancy is 7%, 21%, and 28%
when 1, 2, or 3 embryos are
transferred, respectively.
▪ The transfer of more than 4 embryos
increases the risk of multiple
pregnancy; therefore, it is not
advised.
In-Vitro
Fertilization

In-Vitro
Fertilizationis
Unethical
▪ A large number of embryos must be
produced in order to proceed with IVF.
▪ “What happens to the embryos that
are not transferred to the uterus?”
Some embryos are discarded, others
conserved, frozen to be transferred to
the same patient in another session or
to another patient with the consent of
the donor couple.The embryos are
also utilized in scientific research.
▪ IVF involves manipulation of human
beings. Therefore, it is unethical!!!

Letter
“Samaritanusbonus”
OnTheCareOfPersonsInTheCriticalAndTerminalPhasesOfLife
Congregation for the Doctrine of the Faith
22.09.2020
End of Life Issues

Euthanasia
▪ Consists of an act or omission which,
of itself or by intention, causes death
in order to eliminate suffering.
▪ Constitutes a murder gravely
contrary to the dignity of the human
person and to the respect due to the
living God, his Creator.
▪ The death caused by euthanasia is
not part of the natural process of
dying of a terminally ill person.
▪ Whatever its motives and means,
direct euthanasia consists in putting
an end to the lives of handicapped,
sick, or dying persons.
▪ Morally unacceptable

▪ Euthanasia is killing on request and is
defined as a doctor intentionally
killing a person by the
administration of drugs, at that
person’s voluntary and competent
request.
▪ Physician-assisted suicide is defined
as a doctor intentionally helping a
person to commit suicide by
providing drugs for self-
administration, at that person’s
voluntary and competent request.
Euthanasia&
AssistedSuicide
- Materstvedt et al, Palliative Medicine 2003

▪ When a request for euthanasia rises
from anguish and despair,“although
in these cases the guilt of the
individual may be reduced, or
completely absent, nevertheless the
error of judgment into which the
conscience falls, perhaps in good
faith, does not change the nature of
this act of killing, which will always
be in itself something to be
rejected”.
▪ The same applies to assisted suicide.
▪ Such actions are never a real service
to the patient, but a help to die.
Euthanasia&
AssistedSuicide
- Congregation for the Doctrine of the Faith, “Samaritanus bonus,” 22.09.2020.

The Role of the Family,
Palliative and Hospice Care

Theroleofthe
familyiscentral
tothecareof
theterminallyill
patient
▪ “The family’s presence sustains the patient,
and their love represents an essential
therapeutic factor in the care of the sick.
▪ It is the mother, the father, brother, sisters, and
godparents who guarantee care and help one
to heal.” – Pope Francis
▪ It is essential that the sick under care do not
feel themselves to be a burden, but can sense
the intimacy and support of their loved ones.
▪ Health care facilities should not neglect but
instead integrate the family’s human and
spiritual accompaniment in a unified program
of care for the sick person.

Whatis
Palliative
Care?
▪ An approach that improves the quality of life of
patients and their families facing the problems
associated with life-threatening illness
▪ Through the prevention and relief of suffering
▪ By means of early identification and
impeccable assessment and treatment of pain
and other problems, physical, psychosocial
and spiritual.

Whatis the
Goal
of Palliative
Care?
▪ To anticipate, prevent, and reduce
suffering and to support the best
possible quality of life for patients,
families, and caregivers,regardless
of the stage of the disease or the
need for other therapies.

PalliativeCare:
TotalPainControl

The
Roleof
HospiceCare
▪ Hospice is a specific type of palliative
care for people who likely have 6
months or less to live.
▪ Can be given at home, in the hospital,
or in a hospice center.
▪ Terminally ill people are accompanied
with qualified medical, psychological
and spiritual support, so that they can
live with dignity, comforted by the
closeness of loved ones, in the final
phase of their earthly life.
▪ Hospice centers should be places
where the ‘therapy of dignity’ is
practiced with commitment, thus
nurturing love and respect for life.

Basic Care:
The Requirement
Of Nutrition And
Hydration

Continuity Of Care For The
Essential Physiological Functions
 In particular, required
basic care for each
person includes the
administration of the
nourishment and fluids
needed to maintain
bodily homeostasis,
insofar as and until this
demonstrably attains
the purpose of providing
hydration and nutrition
for the patient.
- Congregation For The Doctrine Of The Faith, Responses to certain questions of the U. S. Conference of Catholic Bishops
concerning artificial nutrition and hydration (1 August 2007): AAS 99 (2007), 820

Obligatory Nutrition & Hydration
 Nutrition and hydration do not constitute
medical therapy in a proper sense, which is
intended to counteract the pathology that
afflicts the patient.
 They are instead forms of obligatory care
of the patient, representing both a
primary clinical and an unavoidable
human response to the sick person.
 Can at times be administered artificially,
provided that it does not cause harm or
intolerable suffering to the patient.
 The withdrawal of this sustenance is an
unjust action that can cause great suffering
to the one who has to endure it.
- Pontifical Council for Pastoral Assistance to Health Care Workers, New Charter for Health Care Workers, n. 152

Potential Reasons To WITHHOLD or
WITHDRAW Artificial Hydration or
Nutrition
 When they no longer benefit the patient,
because the patient’s organism either
cannot absorb them or cannot metabolize
them.
 In this way, one does not unlawfully
hasten death through the deprivation of
the hydration and nutrition vital for
bodily function, but nonetheless respects
the natural course of the critical or
terminal illness.

Analgesic
Therapy And
Loss Of
Consciousness
“Samaritanus bonus”
Congregation for the Doctrine of the Faith,
22.09.2020

Palliative Care and Sedation
 To mitigate a patient’s pain, the Church affirms
the moral liceity of the use of analgesics and
sedation, always, to the extent possible, with
the patient’s informed consent, even though it
may accelerate the inevitable onset of death.
 This is part of patient care to ensure that the
end of life arrives with the greatest possible
peace and in the best internal conditions.
 The sedation must exclude, as its direct purpose,
the intention to kill. Any administration that
directly and intentionally causes death is a
euthanistic practice and is unacceptable.
- John Paul II, Encyclical Letter Evangelium vitae (25 March 1995), 65: AAS 87 (1995), 476

Palliative Sedation
vs. Euthanasia
 In terminal or palliative sedation of
those imminently dying:
 The intention is to relieve
intolerable suffering
 The procedure is to use a sedating
drug for symptom control
 The successful outcome is the
alleviation of distress
 In euthanasia:
 The intention is to kill the patient
 The procedure is to administer a
lethal drug
 The successful outcome is immediate
death
- Materstvedt et al, Palliative Medicine 2003

The Vegetative
State And The
State Of Minimal
Consciousness

Care of PVS patients
 It is always completely false
to assume that the
vegetative state, and the
state of minimal
consciousness, in subjects
who can breathe
autonomously, are signs that
the patient has ceased to be
a human person with all of
the dignity belonging to
persons as such.
 On the contrary, in these
states of greatest weakness,
the person must be
acknowledged in their
intrinsic value and assisted
with suitable care.
John Paul II, Address to the participants in the International Congress
“Life sustaining treatments and vegetative state. Scientific progress and ethical dilemmas”
(20 March 2004), 3: AAS 96 (2004), 487.

Adequate Support
to PVS Patient’s
Families
The fact that the sick person can remain for years
in this anguishing situation without any prospect
of recovery undoubtedly entails suffering for the
families who bear the burden of long-term care
for persons in these states.
The support should seek to allay their
discouragement and help them to avoid
seeing the cessation of treatment as
their only option.

Nutrition & Hydration in PVS Patients
One must never forget in such painful
situations that the patient in these
states has the right to nutrition and
hydration, even administered by
artificial methods that accord with the
principle of ordinary means.
In some cases, such measures can
become disproportionate, because their
administration is ineffective, or
involves procedures that create an
excessive burden with negative results
that exceed any benefits to the patient.

The Moral
Obligation To
Exclude Aggressive
Medical Treatment

Foregoing Extraordinary
Means to Prolong the
Life of a Dying Patient
 When death is
imminent, and
without interruption
of the normal care
the patient requires
in such cases, it is
lawful according to
science and
conscience to
renounce treatments
that provide only a
precarious or painful
extension of life.
- Congregation For The Doctrine Of The Faith, Declaration Iura et bona (5 May 1980), IV: AAS 72 (1980), 550-551
- John Paul II, Encyclical Letter Evangelium vitae (25 March 1995), 65: AAS 87 (1995), 475

Determining whether a treatment is ordinary
or extraordinary depends upon the balance
between two sets of factors:
If the good outweighs the harm, then
it can be reasonably affirmed that
the means is morally ordinary.
If the harm outweighs the good, then
disproportion probably exists and
means is probably morally
extraordinary. (“disproportionate”).
The principle of proportionality refers to the
overall well-being of the sick person.

Foregoing Extraordinary Means to
Prolong the Life of a Dying Patient
Extraordinary means usually refer to highly
specialized, physically difficult, psychologically
draining or very expensive measures used in order to
delay the imminent death and prolong the life of the
dying patient.
These extraordinary means no longer correspond to
the real situation of the patient, either because they
are by now disproportionate to any expected results
or because they impose an excessive burden on the
patient and his family.

Catechism of the Catholic Church, 2278
Discontinuing medical
procedures that are
burdensome,
dangerous,
extraordinary, or
disproportionate to the
expected outcome can
be legitimate
It is the refusal of
"over-zealous"
treatment.
Foregoing Extraordinary Means to
Prolong the Life of a Dying Patient

Catechism of the Catholic Church, 2278
Here one does not
will to cause death;
one's inability to
impede it is merely
accepted.
The decisions should be made by
the patient if he is competent and
able or, if not, by those legally
entitled to act for the patient,
whose reasonable will and
legitimate interests must always be
respected.
Foregoing Extraordinary Means &
Allowing Natural Death

RecommendedVideos
ABORTION FILMS:
• UNPLANNED (2019): https://www.youtube.com/watch?v=bhgCvUyZSHs
• The Silent Scream (w/ Dr. Bernard Nathanson)
• Eclipse of Reason: Live Abortion Documentary ~ Dr Bernard Nathanson
• Why I Left the Abortion Industry (Part 1) - Abby Johnson, Sue Thayer, and
Annette Lancaster
• A Conversation with a Former Abortionist: Full Interview with Dr. Anthony
Levatino
EUTHANASIA FILMS:
• Vatican explains problems of euthanasia and assisted suicide
• Euthanasia: Mercy or Murder
• Euthanasia Deception, EWTN, C1 up to C14

Acknowledgement REFERENCES
▪ Monge, Michael A, 1994, Ethical
Practices In Health And Disease:A
Primer on Health Care Ethics
▪ Congregation for the Doctrine of the
Faith, Letter “Samaritanus bonus,” on
the care of persons in the critical and
terminal phases of life, 22.09.2020.
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