prepared by Fr JP Leonard

Parish Priest of St Clare of Assisi, Brookfield, Middlesbrough

A summary of the Instruction ‘Dignitas Personae’ issued on 12 Dec 2008 by The Congregation for the Doctrine of the Faith

This document follows on from a similar document ‘Donum Vitae’ issued by the same Congregation twenty years ago. This document reaffirms some very important points of Catholic moral teaching and also incorporates scientific discoveries in bio-medical research. The Church is keen to confirm that faith and reason work together. They are not enemies, but we as Catholics have a faith-based framework to determine the moral nature of scientific discoveries and techniques.

The document concentrates on several areas – the first being the initial stages of human life. It is a very important teaching of the Catholic Church that “the dignity of a person must be recognised in every human being from conception to natural death”. It is the first sentence of this new document.

Science has developed to such an extent we can understand the moment of conception in a new way, and actually create the conditions for conception outside of the womb, in laboratory conditions normally referred to as in vitro.

The Catholic understanding of the bringing together of the male sperm and female egg in the process of conception is that from the moment the zygote (the fertilized egg) is formed, this creation “demands the unconditional respect that is morally due to the human being in his bodily and spiritual totality”. (Donum vitae)

This is not the general view of the scientists who work in this area, and indeed the population as a whole do not easily accept that from the first moment of conception a new unique body has been created, that is a human being and has the rights of a human person.

This document is also clear in its teaching of procreation in the context of marriage and family life. The act of procreation is the proper reserve of the reciprocal love between a man and a woman who are married to each other, and are expressing their married love by an act of procreation open to the birth of sons and daughters.

Techniques of infertility treatment are not rejected immediately because they are artificial, but they have to respect the new creation and also the man and woman who have shared in the creation of the new life. It is therefore understandable that most developments in infertility treatment have caused concern in Catholic moral theology because of the three-fold goods to be respected in conception and the conjugal act:

1. The right to life and physical integrity of every human being from conception to natural death
2. The unity of marriage, which means reciprocal respect for the right within marriage to become father or mother only together with the other spouse
3. 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.

Therefore some techniques to overcome infertility are allowable because they are the authentic removal of obstacles to conception and once removed allow the married couple to engage in conjugal acts that will now hopefully be procreative. Such treatment is: types of hormonal treatment; surgery for limited endometriosis; unblocking of fallopian tubes or their surgical repair. Heterologous artificial fertilisation whereby sperm and eggs are from at least one donor other than the spouse is banned, and homologous artificial fertilisation whereby human conception is achieved by using sperm and egg of the two spouses may also be unsuitable if the substitute the conjugal act with some other technique.

In Vitro Fertilisation and the deliberate destruction of embryos

The process of in vitro fertilisation very frequently involves the destruction of embryos created at the same time as the embryo that is selected to undergo a full pregnancy. It is also common for a process of genetic selection to take place to identify the embryo the parents regard as most desirable. The Church wishes to remind the world that an embryo has rights because even at this early stage it is a human being and a person in its own right.

In vitro fertilisation has a contradiction running through it. Its purpose is to create new life, but in reality the new life involves the termination of new life created in the same process as the successful new life or baby. To put it starkly, every child born is at the expense of several brothers and sisters lost in the process.

The Church does recognise the legitimate desire for parents to have children. However, the fulfilment of that desire should not override the dignity of very human life to the point of absolute supremacy. The desire for a child cannot justify the ‘production’ of offspring and the desire to have a child cannot justify the abandonment or destruction of a child once it has been conceived.

The Church’s view is unpopular, but must be repeated. “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 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 is natural end.” (Benedict XVI, Address to the General Assembly of the Pontifical Academy for Life and International Congress [Footnote 31 of Dignitas Personae])

The document then considers specific techniques of Artificial Fertilisation:

Intracytoplasmic Sperm Injection (ICSI)

This is similar to other forms of in vitro fertilisation except the procedure of fertilisation in the test tube does not take place on its own, but rather the injection into the oocytes (egg) of a single sperm, selected earlier, or by the injection of immature germ cells taken from the man. This process of ICSI is intrinsically illicit. This is because it causes a complete separation between procreation and the conjugal act. Indeed the process takes place outside of the husband and wife by the action of a third party, normally a doctor. Therefore fertilisation is under the power of doctors and biologists and is an example of technology dominating the origin and destiny of the human person. It is contrary to the dignity of parents. It is not a process that enhances the conjugal act but replaces it, and fertilisation by the process “is neither willed nor an expression and fruit of the conjugal union”. (Donum Vitae)

Freezing Embryos

One of the methods for improving the chances of success in techniques of in vitro fertilisation is the multiplication of attempts. Therefore oocytes (eggs) are taken from the woman’s body by a single medical procedure. They are preserved by cryo-preservation and used to create a number of embryos in vitro. If the initial attempt to achieve pregnancy does not succeed, the process can be repeated. This involves freezing embryos created by the first transfer until the optimum time to repeat the implantation in the womb.

Cryo-preservation is incompatible with the respect owed to human embryos. The embryos are produced in vitro and are exposed to a serious risk of death or physical harm due to freezing and thawing. The majority of embryos that are not used remain as ‘orphans’. The parents who co-operated in their creation do not ask for them, or continue to take an interest in them. That is why there are thousand upon thousands of frozen embryos in almost all countries where in vitro fertilisation takes place. This does lead to the question: What to do with them?

In some countries cryo-preservation centres follow laws requiring centres to empty storage tanks periodically with no reflection upon the ethical nature of such an act. Proposals to use these embryos for research or for treatment of disease are unacceptable because this reduces embryos to mere ‘biological material’. The proposal to thaw such embryos without reactivating them and use them for research, as if the were normal cadavers, is also unacceptable. (Donum Vitae)

To use such embryos to help infertile couples is not ethically acceptable because this would be similar to heterologous procreation and a form of surrogate motherhood, with all medical, psychological and legal problems. A proposal of ‘pre-natal adoption’ is also complicated by our requirement to respect the embryo and also the nature of the conjugal act in creating life.

Pope John Paul II, aware of thousands of abandoned embryos throughout the world, 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’. (39 – Pope JPII Symposium on Evangelium Vitae and Law [24 May 1996])

The Freezing of Oocytes

Oocytes are eggs and to freeze them has become part of the process of in vitro fertilisation. Although oocytes are not fertilised beings it is still regarded as morally unacceptable to undertake cryo-preservation of oocytes for the purpose of artificial procreation.

The Reduction of Embryos

Some techniques used in artificial procreation require the transfer of multiple embryos into the mother’s womb. This can lead to multiple pregnancies. This has led to a practice of so-called embryo reduction, a procedure in which embryos in the womb are exterminated to leave one or two embryos to develop to full term in the womb. The decision to eliminate human life in the process of creating human life is a contradiction that can often lead to suffering and feelings of guilt lasting for years.

From an ethical view point embryo reduction is an intentional selective abortion. “It is in fact the deliberate and direct elimination of one or more innocent human beings in the initial phase of their existence and as such it always constitutes a grave moral disorder.” (Gaudium et Spes n 51, Evangelium Vitae 62)

This paper rejects ethical justification of embryo reduction by analogies to natural disorder or emergency situations where not everyone can be saved due to limited resources. There is a Catholic moral principle of double effect that does contain a proportionate clause to determine appropriate action, but the situation of embryo reduction is a man-made problem that cannot be resolved by belated appealing to moral values such as double effect.

It is never permitted to do something which is intrinsically illicit, not even in if a good cause may arise. The end does not justify the means. This last sentence is a very important statement in Catholic moral theology.

Pre-implantation Diagnosis

This process is connected with artificial means of fertilisation in which embryos formed in vitro are genetically diagnosed before transfer into a woman’s womb. Such diagnosis is done to ensure only embryos free from defects or having the desired sex or other particular qualities are transferred. This selection by quality of genetic information of an embryo and consequent destruction if it is not satisfactory constitutes an act of abortion.

This is an example of a eugenic mentality. “Such an attitude is shameful and utterly reprehensible, since it presumes to measure the value of human life only within the parameters of ‘normality’ and physical well-being, thus opening the way to legitimizing infanticide and euthanasia as well.” (Evangelium Vitae 63)

Pre-implantation diagnosis and the subsequent destruction of an embryo reduces an embryo from its human dignity to being mere ‘laboratory material’. As a Church we defend the dignity of every human person irrespective of its parents’ desires, social conditions, educational formation or level of physical development.

The Church reminds the world of other times in history when the concept and requirements of human dignity were denied by discrimination to people of certain race, religion or social condition. We believe today the embryo is the victim of discrimination by the non-recognition of ethical and legal status by so many of our governments and scientists.

New Forms of Interception and Contra-gestation

There is contraception which is a procedure to prevent conception after the sexual act. Interceptive techniques interfere with the embryo, the fertilised body either before or after implantation in the uterine wall. Contra-gestation is the elimination of the embryo once implanted into the uterus.

The range of pharmaceutical products that operate to prevent contraception or rather marketed as ‘contraceptives’ on scientific inspection they act on the fertilised egg, the embryo, to inhibit the successful implantation of the embryo to its next stage of development.

It must be noted that anyone who seeks to prevent the implantation of an embryo that may possibly have been conceived is seeking to abort an embryo. For example, where the menstrual cycle is delayed suggesting pregnancy, to take medicine to re-establish the menstrual cycle is in reality a process by which the embryo will be destroyed, and is therefore aborted. Abortion is ‘the deliberate and direct killing, by whatever means it is carried out, of a human being in the initial phase of his or her existence, extending from conception to birth’ (Evangelium Vitae S8). Therefore, the use of means of interception and contra-gestation fall within the sin of abortion and are gravely immoral.

Gene Therapy

This is understood as curing genetically-based diseases or diseases possibly inherited by genes but not necessarily, eg cancer. Gene therapy can be separated into somatic or normal body cells whereby the benefit is received by the patient himself, and germ line cell therapy which aims at correcting genetic defects present in a germ line with the purpose of transmitting the therapeutic effects to the offspring of the individual.

Procedures used on somatic cells for strictly therapeutic purposes are in principle morally licit. The process to be acceptable must be trying to restore a normal genetic configuration of the patient or to counter damage caused by genetic anomalies or those related to other pathologies. Normal medical considerations must still be made so the patient does not suffer excessive risks to his health or physical integrity in relation to the genetic problem and the detrimental effects it may cause the patient.

Germ line cell therapy is different. The treatment is for the benefit of any offspring. “Because the risks connected to any genetic manipulation are considerable and as yet not full controllable, 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.” For this reason, plus all the issues of in vitro fertilisation in its current state, germ line cell therapy in all its forms is morally illicit.

The document also expresses reservations over gene therapy that may not have a medical patient as the reason for treatment or action, rather the aim is the improving and strengthening of the gene pool. The document suggest such genetic engineering is “in contrast to the fundamental truth of the equality of all human beings, and would end sooner or later by harming the common good by favouring the will of some over the freedom of others”. (para 27)

It also contains an ideological element in which man tries to take the place of his creator. The Church would be worried that man would unjustly dominate other men of lesser technology and also endanger people of the future their proper genetic make-up as God intended.

Human Cloning

Human cloning is intrinsically illicit in that, by taking the ethical negativity of techniques of artificial fertilisation 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 links to sexuality. This leads to manipulation and abuses gravely injurious to human dignity. (Footnote 48 of Dignitas Personae).

The document acknowledges (footnote 47) two techniques of cloning. The first artificial embryo twinning, which consists in the artificial separation of individual cells or group of cells from the embryo in the earliest stage of development. These are then transferred into the uterus in order to obtain identical embryos in an artificial manner. Cell nuclear transfer or cloning properly speaking consists in introducing a nucleus taken from an embryonic or somatic cell into a de-nucleated oocyte (fertilised egg). This is followed by stimulation of the oocyte so that it begins to develop as an embryo.

Human cloning is a challenge or a denial of the originality of every person created uniquely in the image and likeness of God. This is due to a “particular relationship that exists between God and a human being from the first moment of his existence and carries with it the obligation to respect the singularity and integrity of each person, even on the biological and genetic levels. In the encounter with another person, we meet a human being who owes his existence and his proper characteristics to the love of God, and only the love of husband and wife constitutes a mediation of that love in conformity with the plan of the creator and heavenly Father”. (Para 29 Dignitas Personae)

The document also highlights the ethical objections to new techniques that are capable of creating artificially embryos to ‘harvest’ organs or cells from them to be used on other human beings. This is a gravely immoral sacrifice of human life. (Para 30)

It reminds the world of a statement from the Encyclical Evangelium Vitae that human cloning is a process that involves human life. “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.” (Footnote 50 of Dignitas Personae)

The above quotation can leave no one in any doubt that human cloning is not morally acceptable to the Catholic Church, because it does not respect human life from this first moment of conception, and also the nature of conjugal act required to cause conception. It also fails to respect the uniqueness of all human beings.

The Therapeutic use of Stem Cells

This is a topic made known to the world by widespread debate in the USA. Stem cells are undifferentiated cells with two basic characteristics:

1. The prolonged capability of multiplying themselves while maintaining the undifferentiated state;
2. They have a capability of producing transitory progenitor cells from which fully differentiated cells descend, for example nerve cells, muscle cells and blood cells.

There are two sources of stem cells. The first and most controversial is at the early stages of embryonic formation. It has fascinated scientists how this early collection of cells in an embryo differentiates itself into bone marrow, umbilical cord, brain cells etc. There are also adult stem cells which may have reduced capacity for renewal or plasticity as stem cells from an embryo, but they have allowed positive results from the work carried out on them.

There are three methods of collecting stem cells which are licit. 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) foetuses who have died of natural causes. (Para 32 of Dignitas Personae). “The obtaining of stem cells from a living human embryo, on the other hand, invariably causes the death of the embryo and is consequently gravely illicit.” (Para 32 of Dignitas Personae). The benefits from this research are not truly at the service of humanity because it denies the equal dignity of the embryo that will be destroyed by the collection of the stem cells.

However, the document concludes this section with the following statement: “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. Such use should be characterised by scientific rigour and prudence, by reducing to the bare minimum any risks to the patient and by facilitating the interchange of information among clinicians and full disclosure to the public at large. Research initiatives involving the use of adult stem cells, since they do not present ethical problems, should be encouraged and supported.” (Para 32 of Dignitas Personae).

Attempts at Hybridisation

This is a complex topic whereby animal oocytes (fertilized animal egg and sperm) is reprogrammed by removing the animal nuclei and replacing it with human nuclei or inserting an animal nucleus in a human cell in order to extract embryonic stem cells without using human oocytes.

This is described from an ethical standpoint, “an offence 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”. (Para 33 of Dignitas Personae). It is also dangerous because 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 human cytoplasm”. (Para 32 of Dignitas Personae).

The final consideration is the use of human ‘biological material’ of illicit origin. This is related to the ‘rumours’ or fact that certain beauty products, sun tan lotion or anti-ageing creams contain ‘biological materials’ from aborted foetuses. This horrific situation is condemned once more by reference to the relevant section of Donum Vitae: “The corpses of human embryos and foetuses, 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 risk of scandal be avoided.” (Footnote 56 of Dignitas Personae)

There is a general discussion on the responsibilities of all people in these areas of research to remember: “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 recognised by the ancient and still relevant Hippocratic Oath which requires every doctor to commit himself to absolute respect for human life and its sacredness”. (Footnote 58 of Dignitas Personae)

Conclusion

The Catholic Church recognises scientific knowledge as a gift from God. A gift from God given in freedom and love. This gift allows man to participate in the creative power of God and therefore it must be ordered to the dignity and well-being of all human beings and of the human person in his entirety. Man is a steward of creation.

However, in human history this harmony of creation has been lost. We see examples of people dying from hunger and disease due to a failure to share the world’s resources. Technological and industrial development risks damage to the eco-system. Many advances in physics, chemistry and biology are used for the purpose of waging war.

There have been advances in human understanding in prohibition of racism, slavery, unjust discrimination and marginalisation of women, children and ill and disabled people. This is a sign of the inalienable value and intrinsic dignity of every human being and is a sign of genuine progress in human history.

The Church would want to be identified with the defence of the working classes at the time of the industrial revolution, proclaiming the sacrosanct rights of the worker as a person; so now the Church wants to identify with the human person from the first moments of life. “The fulfilment 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. Behind every ‘no’ in the difficult task of discerning between good and evil, there shines a great ‘yes’ to the recognition of the dignity and undeniable value of every single and unique human being called into existence.” (Para 37 of Dignitas Personae)

The document concludes with a call to all physicians and researchers open to dialogue and desirous of knowing what is true, to safeguard the vulnerable condition of human beings in the first stages of life and to promote a more human civilisation.

Father John Paul Leonard