Dignitas Personae

By Eamonn Keane

On December 12th 2008, the Congregation for the Doctrine of the Faith (CDF) released its Instruction Dignitas Personae: On Certain Bioethical Questions (DP henceforth). Its title Dignitas Personae means The Dignity of the Human Person. Its opening two sentences read:

"The dignity of the human person must be recognised in every human being from conception to natural death. This fundamental principle expresses a great 'yes' to human life and must be at the center of ethical reflection on biomedical research, which has an ever greater importance in today's world" (DP 1).

DP "is addressed to the Catholic faithful and to all who seek the truth" (DP 3). The context for its publication is "the urgent need to mobilize consciences in favour of life..." (DP 35). Issued by the CDF and explicitly approved by Pope Benedict XVI, DP thereby falls within the category of documents that "participate in the ordinary Magisterium [teaching authority] of the successor of Peter" (Donum veritatis, n. 18).

Pro-Science and in solidarity with the oppressed

The contents of DP have already been frequently misrepresented in various publications. The February 7, 2009 online edition of NewScientist, for example, contained an article headlined: "Why the Catholic church can't ignore science." Misrepresenting Catholic teaching on various questions, the general tone of this article appeared in its opening sentence which said: "In December, with great fanfare, the Vatican released Dignitas Personae, its latest report on bioethics. Sad to say, the document demonstrates once more that a morality rooted in outdated, pre-scientific understanding is not appropriate to modern realities."

As the above quotation from NewScientist illustrates, prophetic voices can be easily misconstrued as being out of touch with reality, especially when they seek to vindicate the rights of the weak and oppressed. DP remarks that just as a century ago the Church raised its voice in defense of the inalienable rights of workers who "were oppressed in their fundamental rights...by proclaiming the sacrosanct rights of the worker as a person," so again today, "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" (DP 37). It adds that the Church's voice "is always an evangelical cry in defense of the world's poor, those who are threatened and despised and whose human rights are violated" (DP 37).

The progress of science needs to be guided by the natural moral law if it is to respect the integral dignity of the human person. Otherwise it will degrade man and undermine justice and solidarity in society. Hence it is expressive of moral blindness to regard as 'progress' the development of medical procedures which depend on the laboratory production of human embryos for the purpose of destroying them in experiments.

Rather than being anti-science, DP calls on scientists and medical personnel to take cognizance of the deepest foundations of their most noble profession. It states that medical science "participates in the creative power of God and is called to transform creation by ordering its many resources toward the dignity and wellbeing of all human beings and of the human person in his entirety" (DP 36). It adds that "in this way, man acts as the steward of the value and intrinsic beauty of creation" (DP 36). Hence, the instruction expresses the hope that "many Christians will dedicate themselves to the progress of biomedicine and will bear witness to their faith in this field" (DP 3). It also expresses the desire that the benefits of biomedical research will "be made available in areas of the world that are poor and afflicted by disease, so that those who are most in need will receive humanitarian assistance" (DP 3).

The instruction notes that the Catholic Church in presenting moral principles and evaluations regarding biomedical research, "draws upon the light both of reason and of faith and seeks to set forth an integral vision of man and his vocation, capable of incorporating everything that is good in human activity, as well as in various cultural and religious traditions which not infrequently demonstrate a great reverence for life" (DP 3). Building on this integral vision of man and stressing that progress in the treatment of disease is desirable in itself, DP thereby reminds us that the creation of a humane and just society demands that good science and good ethics march hand-in-hand together.

Fundamental principles

DP reaffirms ethical principles outlined in the CDF's 1987 Instruction Donum Vitae (The Gift of Life) and in Pope John Paul II's 1995 encyclical Evangelium Vitae (The Gospel of Life) to evaluate recent developments in biomedical technologies. The first principle it affirms is: "The human being is to be respected and treated as a person from the moment of conception; and 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" (DP 4). The second principle it affirms is: "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. Procreation which is truly responsible vis-à-vis the child to be born must be the fruit of marriage" (DP 6).

While stating that the natural moral law which is known through reason "deserves to be recognised as the source that inspires the relationship between the spouses in their responsibility for the begetting of children," further to which "the transmission of life is inscribed in nature and its laws stand as an unwritten norm to which all must refer" (DP 6), the instruction adds however that "it is only in the mystery of the Incarnate Word [Jesus Christ] that the mystery of man truly becomes clear" (DP 7). Hence there is no conflict between what is human and what faith affirms: "It is the Church's conviction that what is human is not only received and respected by faith, but is also purified, elevated and perfected" (DP 7).

After stating that the basis of human dignity lies in the fact that "God has created every human being in his own image, and his Son has made it possible for us to become children of God" (DP 8), DP adds that "man has unassailable value: he possesses an eternal vocation and is called to share in the trinitarian love of the living God" (DP 8). In regard to the natural and supernatural dimensions of life, DP says:

"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. 'God, who is love and life, has inscribed in man and woman the vocation to share in a special way in his mystery of personal communion and in his work as Creator and Father' " (DP 9, internal quotation from Donum vitae 3).

IVF, frozen embryos and embryo experimentation

In regard to techniques for assisting fertility, DP states that "new medical techniques must respect three fundamental goods which are:

a) "The right to life and to physical integrity of every human being from conception to natural death;

b) "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;

c) "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 [act of marital sexual intercourse] specific to the love between spouses" (DP 12).

DP states that "techniques which act as an aid to the conjugal act and its fertility are permitted" on grounds that in such procedures the "medical intervention respects the dignity of persons when it seeks to assist the conjugal act either in order to facilitate its performance or in order to enable it to achieve its objective once it has been normally performed" (DP 12). As opposed to this, it condemned as gravely immoral all forms of IVF. It said: "The Church...holds that it is ethically unacceptable to dissociate procreation from the integrally personal context of the conjugal act: human procreation is a personal act of a husband and wife, which is not capable of substitution" (DP 16).

DP also condemned intracytoplasmic sperm injection (ICSI) which is a new form of artificial fertilization. It described it as "intrinsically illicit [evil]: it causes a complete separation between procreation and the conjugal act" (DP 17; cf. nn. 12-16).

The Instruction has nothing to say about the fertility treatment technique known as "gamete interfallopian tube transfer" (GIFT). There are conflicting opinions amongst Catholic moralists faithful to the magisterium as regards to the moral licity of the technique.

Condemned as intrinsically immoral by DP are all forms of destructive interventions on human life at its initial stages of existence: including freezing of embryos, use of embryos for research purposes or for the treatment of disease, embryo reduction (intentional selective abortion) after implantation, qualitative selection and consequent destruction of embryos prior to implantation (cf. DP 18-22).

DP also condemned "interceptive" and "contragestative" methods which are directed at interfering with or destroying embryos. Examples of interceptives are IUDs and morning-after pills which interfere with the embryo before implantation. A form of contragestation is RU486 which causes the destruction and expulsion of the embryo after implantation. Branding these methods are gravely immoral, DP says "Therefore, the use of means of interception and contragestation fall within the sin of abortion and are gravely immoral" (DP 23). These moral prescriptions follow logically from an earlier affirmation in the instruction where it says that the human embryo has from its very beginning "the dignity proper to a person" (DP 5).

Regarding the question of what should be done with frozen embryos, DP stated that the proposal to place such embryos at the disposal of infertile couples as a form of fertility treatment "is not ethically acceptable for the same reasons which make artificial heterologous procreation [IVF] illicit as well as any form of surrogate motherhood," adding that "this practice would also lead to other problems of a medical, psychological and legal nature" (DP 19).

As to the proposal to allow "prenatal adoption" of abandoned embryos "solely in order to allow human beings to be born who are otherwise condemned to destruction," DP says: "This proposal, praiseworthy with regard to the intention of respecting and defending human life, presents however various problems not dissimilar to those mentioned above" (DP 19). It concludes its discussion of this question by saying that it needs to be recognised "that the thousands of abandoned embryos represent a situation of injustice which in fact cannot be resolved" (DP 19). In this regard, it goes on to recall the words of Pope John Paul II when he appealed "to the conscience" of the world's scientific communities "that the production of human embryos be halted" (DP 19).

In regard the freezing of oocytes (women's eggs), DP states that while it is not in itself immoral, nevertheless when it takes place "for the purpose of being used in artificial procreation" it is "to be considered morally unacceptable" (n. 20).

Genetic engineering, cloning, stem cell research, hybridization, use of human 'biological material' of illicit origin

DP states that gene therapy commonly refers to "techniques of genetic engineering applied to human beings for therapeutic purposes...with the aim of curing genetically based diseases" (DP 25). It said somatic cell gene therapy "seeks to eliminate or reduce genetic defects on the level of somatic cells" (DP 25). It added that germ line cell therapy "aims at correcting genetic defects present in germ line cells with the purpose of transmitting the therapeutic effects to the offspring of the individual" (DP 25).

The Instruction states that from an ethical point of view: "Procedures used on somatic cells for strictly therapeutic purposes are in principle morally licit. Such actions seek to restore the normal genetic configuration of the patient or to counter damage caused by genetic anomalies or those related to other pathologies" (DP 26). However, it cautioned that in deciding to proceed to a therapeutic intervention, "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 to the gravity of the pathology for which a cure is sought" (DP 26). It added the proviso that "the informed consent of the patient or his legitimate representative is also required" (DP 26).

Regarding germ line cell therapy, DP states that since "the risks connected to any genetic manipulation are considerable and as yet not fully controllable," it thereby follows that "in the present state of research, it is not morally permissible to act in a way that may cause possible harm to the resulting progeny" (DP 26). Regarding using techniques of genetic engineering to improve the gene pool, DP states that such interventions would promote a "eugenic mentality" and would introduce an "indirect social stigma with regard to people who lack certain qualities, while privileging qualities that happen to be appreciated by a certain culture or society; such qualities do not constitute what is specifically human" (DP 27). It added that "in the attempt to create a new type of human being one can recognise an ideological element in which man tries to take the place of his Creator" (DP 27).

DP condemned as intrinsically evil both reproductive and therapeutic cloning. It said human cloning is "intrinsically illicit in that...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 and abuses gravely injurious to human dignity" (DP 28).

In regard to therapeutic stem cell research, DP said that it is morally licit provided methods are used "which do not cause serious harm to the subject from whom the stem cells are taken," adding that "this is generally the case when tissues are taken from: a) an adult organism; b) the blood of the umbilical cord at the time of birth; c) fetuses who have died of natural causes" (DP 32). The same cannot be said however for stem cells taken from a living embryo. Since this "invariably causes the death of the embryo," it is thereby "gravely illicit" (DP 32). Also, "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" (n. 32).

In regard to two proposed new scientific techniques known as "human parthenogenesis, altered nuclear transfer" (ANT) and "oocyte assisted reprogramming" (OAR), which claim to be able to produce embryo-type stem cells without bringing an embryo into existence later to be destroyed, DP says:

"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" (DP 30, internal quotation from EV 60).

In regard to hybridization (attempts to create human-animal hybrid embryos), DP states that "from the ethical standpoint, 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" (DP 33).

In reference to the situation where researchers us "biological material" of "illicit origin" (e.g. derived from aborted fetus or cloned embryos) "which has been produced apart from their research centre or which has been obtained commercially," DP first recalls an important principle formulated in Donum vitae which is:

"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" (DP 35; citing Donum vitae, I, 4).

In regard to the point made above, DP cautions against the inadequacy as a moral criterion of what has become known as the "criterion of independence." Formulated by some ethics committees, this criterion asserts that "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" (DP 35). Describing the insufficiency of this criterion, DP says:

"The criterion of independence is not sufficient to avoid a contradiction in the attitude of the person who says that he does not approve of the injustice perpetrated by others, but at the same time accepts for his own work the 'biological material' which the others have obtained by means of that injustice. When the illicit action is endorsed by the laws which regulate healthcare and scientific research, it is necessary to distance oneself from the evil aspects of that system in order not to give the impression of a certain toleration or tacit acceptance of actions which are gravely unjust. 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" (DP 35).

Indeed, DP goes further in regard to the criterion of independence by stating that "there is a duty to refuse to use such 'biological material' even when there is no close connection between the researcher and 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" (DP 35). It adds: "This duty springs from the necessity to remove oneself, within the area of one's own research, from a gravely unjust legal situation and to affirm with clarity the value of human life. Therefore, the above-mentioned criterion of independence is necessary, but may be ethically insufficient" (DP 35, italics in original).

DP does allow for grave reasons the use of products utilising illicitly obtained biological material. In referring to "different degrees of responsibility," it says: "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" (DP 35).

The Church speaks truth to consciences

In its moral teaching, the Catholic Church serves conscience by holding up to it the truth for which it was created to embrace. In this regard, DP reminds "everyone" of their moral duty to protect and respect "the dignity and the fundamental and inalienable rights of every human being, including those in the initial stages of their existence" (DP 37). It says that "the fulfillment of this 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" (DP 37).

Vatican II stated that the spread of atheism is facilitated by Christians who are "careless about their instruction in the faith," or who "present its teaching falsely," or who fail to bear witness to it in their "religious, moral, or social life" (Gaudium et spes, n. 19). By the same token, the "culture of death" is facilitated and spread by Catholics who dissent from the Church's moral doctrine.

In its concluding comments, DP says: "The Christian faithful will commit themselves to the energetic promotion of a new culture of life by receiving the contents of this Instruction with the religious assent of their spirit, knowing that God always gives the grace necessary to observe his commandments and that, in every human being, above all in the least among us, one meets Christ himself (cf. Mt 25:40)" (DP 37). It adds that "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" (DP 37).

© Eamonn Keane