Katholieke Stichting Medische Ethiek
29 maart 2024

Beperken van antimicrobiële resistentie

Message of the Prefect of the Dicastery for Promoting Integral Human Development for World Antibiotic Awareness Week, 17.11.2018

The following is the Message of the prefect of the Dicastery for Promoting Integral Human Development, His Eminence Cardinal Peter K.A. Turkson, for World Antibiotic Awareness Week (WAAW), which takes place from 12 to 18 November 2018, on the theme Limiting the Emergence and Spread of Antimicrobial Resistance – A Call to Action:

Limiting the Emergence and Spread of Antimicrobial Resistance (AMR): A Call to Action

The World Antibiotic Awareness Week (WAAW), which takes place each November is an occasion to reiterate the urgent and global importance of this growing public health problem. The aim of this initiative is to “increase global awareness of antibiotic resistance (AMR) and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of antibiotic resistance.” (1)

Since their discovery, antibiotics have served as the cornerstone of modern medicine and have transformed human health by saving millions of lives and alleviating much human suffering. “However, the persistent overuse and misuse of antibiotics in human and animal health have encouraged the emergence and spread of AMR, which occurs when microbes, such as bacteria, become resistant to the drugs used to treat them.” (2) Unfortunately, the problem is growing worse and is propagated among others, by the inadequate programs for infection prevention and control, poor-quality medicines, insufficient regulation of the use of antimicrobial medicines in human and animal food, agriculture and aquaculture sectors, as well as lack of access to healthcare services, including diagnostics and laboratory tests, contamination of soil water, and crops with antimicrobial residues.

Antimicrobial resistance poses a great challenge to global public heath today, for it threatens the effective prevention and treatment of a growing number of infections caused by bacteria, parasites, viruses and fungi. If left unaddressed, the continued emergence and spread of drug-resistant diseases will put at risk the effectiveness of modern medicine and is therefore a challenge to the health and development of nations. It makes it more difficult to safeguard the health and well-being of people most vulnerable to life-threatening  infections, especially women giving birth, newborns, patients with certain chronic diseases and those undergoing chemotherapy or surgery.” (3) It also is a threat to “hundreds of millions of people who have no access to health care and are most susceptible to diseases related to antimicrobial resistance.” (4)

As Prefect of the Dicastery for Promoting Integral Human Development, I join the International Community to make this urgent call to action in order to limit the emergence and spread of antimicrobial resistance.

Yes our time is running out and we must act to initiate and animate the necessary behavior change; to strengthen awareness and action on infection prevention and control; and promote the appropriate stewardship of antimicrobials.

In this regard, the tens of thousands of Church-sponsored health care institutions and education centers and other faith based organizations are well positioned to encourage ongoing support, “mobilize individual and community action and advance social and medical practices to combat the emergence and spread of AMR…Faith communities, both at institutional and local levels, are well positioned to promote several effective and sustainable initiatives to address the problem.” (5)

While entrusting the clinical setting to the experts, I wish to point out some of those initiatives identified by Faith Based Organizations, for the engagement of communities in achieving immediate and sustained behavior change in order to reduce the emergence and spread of AMR:

  • “Enhance awareness and education on methods to prevent and control infections;
  • Create understanding of the individual and community impact of the misuses of and self-medication with antimicrobials;
  • Build trust within the community to enhance surveillance and improve infections prevention and control, particularly trust in vaccines;
  • Enable reliable and sustainable access to, and use of, water, sanitation, and hygiene.” (6)

These and other initiatives identified by policy makers and public health authorities, can indeed trigger the much needed behavior change in the communities, to address the emergence and spread of antimicrobial resistance. To the Blessed Virgin Mary, Salus Infirmorum, I entrust all our efforts to address this public health challenge of our times.

Cardinal Peter K.A. Turkson

 

Notes
1. WHO, Campaigns/World Antibiotic Awareness Week, 12-18 November 2018.
2. Ibid.
3. Card. Parolin, Statement on Antimicrobial Resistance, UN High-Level meeting, New York, 21 September 2016.
4. Ibid.
5. Workshop for Catholic-inspired and other faith-based organizations, Combating the Emergence and Spread of Antimicrobial Resistance: A Workshop to Strengthen Faith-Based Engagement, Rome Italy, December 12-15, 2016.
6. Ibid.


Pauselijke Academie voor het Leven publiceert Witboek over Palliatieve Zorg

Pontifical Academy for Life, Palliative Care Working Group

The Pontifical Academy for Life has published a white book on palliative care. The White Book was developed by the Vatican-based Pontifical Academy for Life (PAV) and describes the broad-based, expert-led effort to develop recommendations for improving global palliative care. Advances in palliative care are needed to aid the more than 25 million people who die each year with serious health-related suffering, as the current supply of palliative care cannot meet the growing demand. The White Book is a product of the work by a group of experts in palliative care advocacy who represent different faiths and were invited by the PAV to develop strategic recommendations to advance global palliative care. The expert group identified 43 recommendations and 13 stakeholder groups, targeting the most important recommendations for each stakeholder group. The English version of the White Book was presented in the Vatican in September 2018.


Abortus uit strafrecht beslissing met zware symbolische betekenis

In ons land is abortus sinds geruime tijd onder bepaalde voorwaarden gedepenaliseerd. In het Belgische parlement zijn nu verschillende voorstellen neergelegd om abortus volledig uit het strafrecht te verwijderen. De huidige praktijk zal daardoor wellicht niet veel veranderen. Toch gaat het om een beslissing met een zware symbolische betekenis. Want tegenover zwangerschapsafbreking zal dan fundamenteel anders worden aangekeken. En de gevolgen daarvan zijn aanzienlijk. Daarom stellen we ons vragen. Het zijn vragen die over de ideologische grenzen heen gesteld worden.

In een democratie staat het strafwetboek borg voor de bescherming van de menselijke waardigheid en de fysieke integriteit van iedere persoon. Mag deze bescherming over het hoofd worden gezien wanneer het om een menselijk leven gaat dat nog groeit naar de geboorte? Het leven waarnaar vele mensen verlangen, waarvoor velen opkomen en vechten, waarvoor de geneeskunde de grootste vooruitgang boekt, dat zo kostbare leven. Waarom zou dat leven in zijn prille begin niet beschermd moeten worden alsof het nog geen leven is?

Abortus zal nooit vanzelfsprekend worden. Ook niet als het uit het strafwetboek gehaald wordt. Het wordt nooit een gewone ‘ingreep’. Het zal nooit van harte gebeuren. Er zijn enkel maar verliezers. Zeker, omstandigheden kunnen mensen radeloos en uitzichtloos maken. Juist dan is een mens zo ontredderd en eenzaam. Als de wet dan alleen maar suggereert dat het om een gewone ingreep gaat, wordt geen recht gedaan aan wat de betrokkenen ervaren en beleven. Waarom dan nog raad of hulp vragen? De vragen zelf dreigen al van meet af aan niet ernstig genomen te worden. Het zal de ontreddering en de eenzaamheid alleen maar groter maken.

Dat is het gevaar waarop we willen wijzen: wanneer abortus uit het strafwetboek wordt gehaald, riskeert het een medische ingreep te worden als een andere. Het is dan geen overtreding meer in de gevallen die de wet voorziet. Het wordt een recht. Wie er vragen bij stelt of wie abortus weigert, zal zich dan moeten verantwoorden. En dat laatste geldt zowel voor de arts als voor de betrokken vrouw. Zelfs wanneer de clausule van de gewetensvrijheid wordt behouden, zal die alsmaar minder kunnen ingeroepen worden. Een medische handeling vergt immers een medische beslissing, en niet zozeer een gewetensbeslissing.

Onze samenleving heeft het steeds moeilijker met alles wat onze plannen doorkruist, met alles wat onze levenswijze verstoort. Dat geldt voor mensen die oud zijn of ziek, voor mensen die gehandicapt zijn, voor armen, vreemdelingen of mensen op de vlucht die bij ons terechtkomen. Dat geldt ook voor het ongeboren leven. In zijn encycliek Laudato Si’ zegt Paus Franciscus dat dit alles met elkaar te maken heeft: Wanneer de persoonlijke en gemeenschappelijke gevoeligheid voor het ontvangen van nieuw leven verloren gaat, verdorren ook andere vormen van verwelkoming die het sociale leven ten goede komen.

Kardinaal Jozef De Kesel en de bisschoppen van België

Overgenomen met toestemming van R.K. Documenten.nl


Palliatieve zorgen: overal en door iedereen. Palliatieve zorgen in alle streken. Palliatieve zorgen in alle godsdiensten en overtuigingen

Aan mgr. Vincenzo Paglia, president van de Pauselijke Academie van het Leven

Excellentie,

1. In naam van de Heilige Vader Paus Franciscus en in mijn persoonlijke naam, richt ik mijn hartelijke groeten zowel tot de organisatoren als aan de deelnemers van het congres over palliatieve zorgen. Het gaat om kwesties die de laatste ogenblikken van ons aardse leven betreffen en de mens in een grenssituatie plaatsen die onoverkomelijk lijkt voor de vrijheid en soms opstandigheid en angst verwekt. Daarom probeert men er in de huidige samenleving op talrijke manieren aan te ontkomen en ze te vermijden, en laat men na te luisteren naar een aanwijzing uit de psalm 90 (89), 12: “Leer ons onze dagen naar waarde te schatten en zo te komen tot wijsheid van hart”. (Ps. 90, 12) Zo beroven wij ons van de rijkdom die juist in eindigheid verborgen ligt en van een gelegenheid om een levenswijze te ontplooien die op persoonlijk en sociaal vlak zinvoller is.

Palliatieve zorgen daarentegen, geven niet toe aan deze afwijzing van de wijsheid die in eindigheid besloten ligt, en dit is een andere reden die wijst op het belang van dit onderwerp. Zij wijzen namelijk op een herontdekking van de diepste roeping van de geneeskunde, die er vooral één is van zorg dragen: het is haar taak altijd zorg te dragen, ook al is het niet altijd mogelijk te genezen. Zeker, de geneeskunde baseert zich op een onvermoeibaar engagement om nieuwe kennis te verwerven en een steeds groter aantal ziekten te bestrijden. Maar palliatieve zorgen getuigen binnen de hospitaalpraktijk van het bewustzijn dat een grenssituatie niet alleen moet bestreden en overstegen worden, maar dat zij ook dient erkend en aanvaard te wordenEn dat betekent niet de zieken aan hun lot over te laten, doch integendeel hen nabij te zijn en te begeleiden in de moeilijke beproeving die zich op het einde van het leven manifesteert.

2. Wanneer alle mogelijkheden van het “doen” uitgeput lijken, komt juist dan het belangrijkste aspect van menselijke relaties aan het licht, dat van het “zijn”: aanwezig zijn, nabij zijn, opvangen. Dat houdt ook in dat men deelt in de onmacht van degene die het uiterste punt van zijn leven bereikt heeft. Dan kan de grenssituatie van betekenis veranderen: niet meer een plaats van scheiding en eenzaamheid, maar een gelegenheid voor ontmoeting en gemeenschap. De dood zelf wordt in een symbolische horizont geplaatst waarbij zij niet zozeer verschijnt als het einde waarvoor het leven breekt en bezwijkt, maar eerder als de vervulling van een bestaan dat gratis ontvangen en met liefde gedeeld werd.

De logica van de verzorging herinnert namelijk aan deze dimensie van onderlinge afhankelijkheid in de liefde, die inderdaad bijzonder aan het licht komt bij ziekte en lijden, vooral bij het levenseinde, maar feitelijk loopt zij doorheen alle menselijke relaties en is zij er zelfs de meest specifieke eigenheid van. “Uw enige schuld blijve de onderlinge liefde. Wie zijn naaste bemint, heeft de wet vervuld” (Rom. 13, 8): zo luidt de aansporing en troost van de Apostel. Dan lijkt het redelijk een brug te slaan tussen de zorgen die men sinds het begin van het leven gekregen heeft en die iemand tot volle ontplooiing lieten komen en de zorgen die op een verantwoorde manier aan anderen gegeven worden, generaties lang, zodanig dat heel de mensenfamilie omvat wordt.

3. Het is op deze weg dat de vonk kan ontspringen, die de ervaring van een liefdevol delen van het leven tot aan het mysterieuze vertrek, verbindt met de Evangelieverkondiging die iedereen ziet als kinderen van dezelfde Vader en die in iedereen Zijn onschendbaar beeld erkent. Deze kostbare band verdedigt een menselijke en theologale waardigheid die niet ophoudt, zelfs niet bij het verlies van de gezondheid, sociale rol en controle over het eigen lichaam. Het is dan dat palliatieve zorgen hun waarde tonen, niet alleen voor de uitoefening van de geneeskunde – ook wanneer zij doeltreffend werkt en soms opzienbarende genezingen bewerkt, zodat men niet die grondhouding zou vergeten die aan de oorsprong van iedere zorgrelatie ligt – maar ook meer algemeen voor heel het menselijk samenleven.

4. Uw programma van deze dagen belicht goed de veelheid aan dimensies die bij de beoefening van palliatieve zorgen op het spel staan. Een taak die vele wetenschappelijke en organisatorische, relationele en communicatieve competenties mobiliseert, met inbegrip van spirituele begeleiding en gebed. Naast de verschillende professionele figuren, is op deze weg ook de familie belangrijk. Zij bekleedt een unieke rol als de plaats waar de solidariteit tussen de generaties een constitutief element is van het leven en waar onderlinge hulp ook ervaren wordt in momenten van lijden en ziekte. Het is precies daarom dat het familiaal netwerk, hoe kwetsbaar en afgebrokkeld het in de huidige wereld ook moge lijken, toch steeds een fundamenteel element is in de eindfase van het leven. Wij kunnen op dit punt zeker veel leren van culturen waar de familieband, zelfs in moeilijke momenten, sterk gewaardeerd wordt.

5. Een zeer actueel thema voor palliatieve zorgen is dat van de pijntherapie. Reeds Paus Pius XII had ze duidelijk legitiem verklaard, door haar te onderscheiden van euthanasie: namelijk het toedienen van pijnstillende middelen om onverdraaglijke pijnen te verlichten die anders niet kunnen behandeld worden, ook als zij in de fase van de nakende dood, oorzaak zouden zijn van een verkorting van het leven. (1) Vandaag, na vele jaren van onderzoek, is de verkorting van het leven niet langer een frequent neveneffect, maar wordt de vraag zelf opgeheven door nieuwe farmaceutische producten die inwerken op de bewustheidstoestand en die verschillende vormen van verdoving mogelijk maken. Het ethisch criterium verandert niet maar het gebruik van deze procedures vereist altijd grote zorgzaamheid en voorzichtigheid bij de  onderscheiding. Zij zijn voor de zieken, de naastbestaanden en het verzorgend personeel namelijk heel lastig: met verdoving, vooral wanneer zij langdurig en intensief is, wordt de relationele en communicatieve dimensie geannuleerd, die wij in de begeleiding door palliatieve zorgen cruciaal achten. Verdoving is dus altijd gedeeltelijk onvoldoende, zodat zij moet beschouwd worden als een extreme remedie na een onderzoek en zorgvuldige verduidelijking van de indicaties.

6. De complexiteit en het delicate aspect van deze thema’s van de palliatieve zorgverlening vereisen een aanhoudende reflectie en de verspreiding van de praktijk, zodat ze toegankelijker wordt: een plicht waar gelovigen steun kunnen vinden bij vele mensen van goede wil. En het is van betekenis dat u met dit perspectief, vertegenwoordigers van verschillende godsdiensten en culturen kan ontmoeten, zodat het engagement verdiept en gedeeld wordt. Ook in de opleiding van professionelen in de gezondheidssector, van wie verantwoordelijkheid in de openbare sector dragen en in heel de samenleving, is het belangrijk dat deze inspanningen samen geleverd worden.

Met de aanbeveling om voor zijn ambt te bidden, geeft de Heilige Vader u Excellentie, en u allen die aan het congres deelneemt, van harte de apostolische zegen. Hierbij sluit ik mij aan met mijn persoonlijke wensen en meest oprechte gevoelens.

Vanuit het Vaticaan, 27 februari 2018

Pietro Kardinaal Parolin
Staatssecretaris

Noten

  1. Paus Pius XII, Toespraak, Over drie godsdienstig zedelijke vraagstukken inzake anesthesie naar aanleiding van het Negende Nationaal Congres van de “Società Italiana di Anestesiologia”, Le IXe Congres National – Over de anesthesie (25 feb 1957)

Vertaling uit het Frans (zenit.org): maranatha-gemeenschap; alineaverdeling en -nummering: redactie

Overgenomen met toestemming van R.K. Documenten


Note on Italian vaccine issue

The Pontifical Academy for Life issued a document commenting on the Italian vaccine issue, in collaboration with the “Ufficio per la Pastorale della Salute” of Italian Bishops’ Conference and the “Association of Italian Catholic Doctors”, on July 31, 2017.

Clarifications on the medical and scientific nature of vaccination

The lack of vaccinations of the population indicates a serious health risk of diffusing dangerous and often lethal diseases and infections that had been eradicated in the past, such as measles, rubella, and chickenpox. As noted by the Italian National Health Institute, since 2013 there has been a progressive trend in decreasing vaccination coverage. Vaccination coverage data for measles and rubella decreased from 90.4% in 2013 to 85.3% in 2015, contrary to WHO indications that recommend 95% vaccination coverage to eliminate virus circulation.

In the past, vaccines had been prepared using cells from aborted human fetuses, however currently used cell lines are very distant from the original abortions. The vaccines being referred to, the ones most commonly used in Italy, are those against rubella, chickenpox, polio, and hepatitis A. It should be noted that today it is no longer necessary to obtain cells from new voluntary abortions, and that the cell lines on which the vaccines are based in are derived solely from two fetuses originally aborted in the 1960’s. From the clinical point of view, it should also be reiterated that treatment with vaccines, despite the very rare side effects (the events that occur most commonly are mild and due to an immune response to the vaccine itself), is safe and effective. No correlation exists between the administration of the vaccine and the onset of Autism.

Reflections on the ethical nature of vaccines:

In 2005 the Pontifical Academy for Life published a document entitled: “Moral reflections about vaccines prepared from cells of aborted human fetuses” which, in the light of medical advances and current conditions of vaccine preparation, could soon be revised and updated.

Especially in consideration of the fact that the cell lines currently used are very distant from the original abortions and no longer imply that bond of moral cooperation indispensable for an ethically negative evaluation of their use.

On the other hand, the moral obligation to guarantee the vaccination coverage necessary for the safety of others is no less urgent, especially the safety more vulnerable subjects such as pregnant women and those affected by immunodeficiency who cannot be vaccinated against these diseases.

As for the question of the vaccines that used or may have used cells coming from voluntarily aborted fetuses in their preparation, it must be specified that the “wrong” in the moral sense lies in the actions, not in the vaccines or the material itself.

The technical characteristics of the production of the vaccines most commonly used in childhood lead us to exclude that there is a morally relevant cooperation between those who use these vaccines today and the practice of voluntary abortion. Hence, we believe that all clinically recommended vaccinations can be used with a clear conscience and that the use of such vaccines does not signify some sort of cooperation with voluntary abortion. While the commitment to ensuring that every vaccine has no connection in its preparation to any material of originating from an abortion, the moral responsibility to vaccinate is reiterated in order to avoid serious health risks for children and the general population.

Rome, 31 July 2017
Pontifical Academy for Life – National Office for Health Pastoral Care (CEI) – Association of Italian Catholic Doctors


Encyclical of the Synod of Bishops of the Major Archbishopric of Kyiv-Halych of the Ukrainian Greek Catholic Church Concerning the Danger of Gender Ideology

Encyclical of the Synod of Bishops of the major Archbishopric of Kyiv-Halych of the Ukrainian Greek Catholic Church concerning the danger of gender ideology

Dearly Beloved in Christ!

Introduction

1. In the twentieth century, the people of Ukraine suffered from a godless Soviet regime that attempted to forcefully tear people from the roots of faith and impose an atheistic worldview. Presented as the only “scientific” one, this worldview denied human persons’ freedom of conscience and deprived them of the right to freely profess their religious beliefs. At the beginning of the twenty-first century, the world stands before similar challenges, which, however, are not accompanied by open and bloody persecution, but rather are served by hidden ideological means of destroying Christian faith and morality, as well as universal human values. Some of these challenges relate to areas of human sexuality and family life, and are not new to Ukraine; rather, they are accented or presented in public consciousness in a new manner. Others are entirely new and even far removed from the Ukrainian context, but certain forces are attempting to artificially impose them upon us.

2. In particular, gender theories are a significant threat today, attempting to destroy the perception of human sexuality as a gift from God that is naturally linked to the biological differences between man and woman, as well as introducing a dangerous disorder to human relationships and attacking the foundations of interpersonal communication. The concepts of human dignity and freedom are undergoing extensive manipulation and the true meaning of these essential moral categories is being displaced and distorted. All these efforts are being implemented very actively, systematically, and thoughtfully, using political expediency and populist slogans. However, their true nature and purpose remain hidden from the public. As a result, Ukrainian society—sensitive to asserting its dignity and freedom—is in danger of thoughtlessly accepting as truth questionable atheistic theories founded in attempts to affirm human dignity, to achieve equality among people, to defend the human right to freedom, and so on.

3. Under these circumstances, the Church-Mother seeks by means of this Encyclical to warn the faithful and all people of good will of the threats that are hidden behind gender ideology and similar worldview systems, and recall the traditional biblical, Christian, and universal values upon which interpersonal relationships and the way of organizing social life are based.

Human Dignity in God’s Plan

4. The whole history of salvation attests to the incredible love of God for the human person. From the very first pages of Holy Scripture we learn about the extraordinary greatness of the human person. While everything else arose from only one word of God, Church tradition speaks of a Divine “meeting” that preceded the creation of the human person: “Then God said, ‘Let us make man in our image, after our likeness’” (Gen. 1:26). Particular attention should be given to the phrase “in our image, after our likeness.” This is the basis of the concept of human dignity, which in the New Testament is emphasized in the Incarnation of the Son of God in human nature. The image of God is integral to the natural dignity and spiritual beauty of every human person, from the moment of conception until natural death. This is a common feature of all people that reflects their equal and infinite value.

5. The image of God is the foundation of not only personal uniqueness, but also the human community: “Then God said, ‘Let us make man in our image, after our likeness’…So God created man in his own image, in the image of God he created him; male and female he created them” (Gen. 1:26–27). Therefore, the “communion of the persons of the Trinity is the prototype of the human community.”  Pope Francis, commenting on this verse of Holy Scripture, says that “marriage is the most beautiful creation of God” because “man and woman, who become one flesh, are the image of God.” “Man is a person, man and woman equally so, since both were created in the image and likeness of the personal God. Each of the two sexes is an image of the power and tenderness of God, with equal dignity though in a different way.” The catechism Christ – Our Pascha, interpreting the biblical story of the creation of man and woman, says: “The image of the Most Holy Trinity in human community is the natural unity of human community that exists within the communion of the love between Adam and Eve. Complementing one another physically, psychologically, and spiritually, Adam and Eve are different, but at the same time, equal persons. In the wonderful image of Eve’s creation from the ‘rib of Adam’ (cf. Gen. 2:21), Holy Scripture describes the equality and difference between the man and the woman, who form the first community. Adam professes Eve to be his own: ‘This at last is bone of my bones and flesh of my flesh; this one shall be called Woman” (Gen. 2:23). Adam embraces Eve as person, his equal and simultaneously his companion for life (cf. Gen. 2:24).”  The Church teaches that “created in the image of the one God and equally endowed with rational souls, all men have the same nature and the same origin. Redeemed by the sacrifice of Christ, all are called to participate in the same divine beatitude: all therefore enjoy an equal dignity.”

6. Sexuality, as a gift to be man or woman (cf. Gen. 1:27) given by God during creation, integrally covers all the natural dimensions of existence of the human person: body, soul, and spirit. A person is called to accept God’s plan for themselves as expressed in their sex—because sex does not depend on human choice—and to embody it in their lives. Sexuality can only be comprehended in light of the Christian understanding of love as a vocation to the communion of persons and the self-giving of one person to another. “In marital life, a man and a woman open themselves to God through mutual love, which becomes the foundation of their indissoluble union, fidelity, and fruitfulness. In the virginal state of consecrated life, sexuality is transfigured in the Holy Spirit in order to serve God and one’s neighbour in love for the sake of the heavenly kingdom (cf. Matt. 19:12). Any selfish exploitation of another person as a means for obtaining sexual pleasure contradicts God’s gift of love, deforms the essence of sexuality, and deeply wounds the person.”

7. God subjects the earth and all that fills it (cf. Gen. 1:26,28) to the human person. This is why human beings are God’s greatest creation, which has a special vocation and mission in the world.  The Psalmist describes the greatness and dignity of the human person: “For I will look at the heavens, the works of your fingers, the moon and the stars which you fixed. What is man that you remember him? Or the son of man that you visit him? You have made him a little less than the angels; you have crowned him with glory and honour, and set him over the works of your hands. You have subjected all things under his feet…” (cf. Ps. 8:4–9). And St. John of Damascus, a Father of the Church, emphasizes that God created man as “a sort of second microcosm within the great world, another angel…king over the things of earth, but subject to a higher king, of the earth and of the heaven, temporal and eternal, belonging to the realm of sight and to the realm of thought, midway between greatness and lowliness, spirit and flesh…becomes deified by merely inclining himself towards God; becoming deified, in the way of participating in the divine glory and not in that of a change into the divine being.”

8. In God’s plan, the human person, created in the image of God, is appointed for eternal communion with the Creator. As St. Gregory of Nyssa says, “the purpose of a virtuous life is to become like God.”  With the Lord’s grace, a person reaches the height of its capabilities in likeness to God through “divinization” (theosis).  The Apostle Paul describes the outlook and purpose of human growth: “…until we all attain to the unity of the faith and of the knowledge of the Son of God, to mature manhood, to the measure of the stature of the fullness of Christ” (Eph. 4:13). Every human person in its growth toward the fullness of God’s likeness is an absolutely unique and inimitable individual. This inimitableness is caused by the grace of the Holy Spirit, who endows each of us with special personal gifts, talents, abilities, and disposition. Thus, the equality of all people in their dignity is at the same time inextricably linked to the uniqueness of each human person.

9. One of the features inherent in God’s image in the human person is free will, by which it can freely choose the good; however, it is also able to choose another way: “The most profound dimension of human freedom consists in being able to freely choose God and to be with him. This is the good. Yet with this same freedom, we can also reject our relationship with God—and this is evil.”  “The devil in Paradise lured Adam with a vain hope for divinization, proposing that he consider the measure of goodness resides not in God but within himself…The deceit of the Evil One is based on the premise that God is deceiving humankind with his commandment, thereby undercutting their freedom…”  From the biblical account of the fall of the progenitors, we conclude that a sinful choice has serious consequences for the person—the loss of paradise as a state of blessed communion and life with God and other creatures (cf. Gen. 3:4–14). The sin of the progenitors also obscured the truth about the human person as the image of God. Since then, human nature has also been marred by sin. The brokenness caused by sin continues in history, appearing in a variety of abuses in the area of sexuality.

10. But God so loved man that he did not abandon him, he did not take away from him his high calling even after the fall, but is constantly looking for him: “Adam, where are you?” (cf. Gen.3:9). Because of the fall, man’s movement toward God ceases, but God does not cease his movement toward man. Evidence of this is the history of salvation, as reflected in the Old Testament. Direct restoration of this movement was accomplished in the New Testament through Christ, who “gave himself as an exchange to death, by which we had been held captive, sold under sin. And when He had descended through the Cross into Hades, so that He might fill all things with Himself, He loosed the pangs of death. And rising on the third day and making a way for all flesh to the resurrection of the dead….”

11. Thus, the dignity and worth of man lies in the truth of his creation “in the image and likeness of God,” in its superiority over all creation and comprehension of the divine vocation to holiness. God’s likeness, in which man was created, points to the dynamism of his vocation. The dignity of man requires that he act not under the influence of instinctive impulses or external coercion, but under a conscious and free choice and mature personal convictions. This is reached when one is freed from the bondage of passions and aims for his goal, freely choosing good and using appropriate means for it.

The Concept of Gender

12. Human sexuality is, as already mentioned, a natural gift of God and precisely through it we discover the joy of being co-creators. However, the very vulnerable area of sexuality and marriage today belongs to the most manipulated aspects of human existence. The constant temptation to violate God’s statutes in this area is one of the consequences of the fall of our progenitors (cf. Gen. 3). Man abuses the possibility of a free choice when trying to “become free” of traditional values in the area of sexuality and married life, falsely treating them as some archaisms and obstacles to equality, dignity, and freedom. Some believe that obstacle to be biological sex, perceiving difference of sexes as the cause of societal degradation and violation of rights, the precondition for sexual violence in the family and outside it (by men against women). Instead, it should be remembered that the cause of these and other such societal problems is not sexuality itself, but its distorted perception and understanding.

13. Over the course of millennia, humankind has recognized the existence of two sexes based on biological criteria—male and female. Recently, worldviews that are contrary to the Christian faith, objective scientific reality, and natural law have become widespread and influential, namely theories of gender. Their basis is the distinction between biological sex, given to the person from conception, and gender, a certain personal choice of sexual behaviour. Consequently, gender identity is no longer considered a gift from God, but rather declared a matter of individual choice for each person. The person ”no longer understands its deep calling to eternal love, but considers it as a temporary diversion.”  While sexual identity is based on a biological, psycho-physical reality, gender identity abandons binary gender (male or female) in favour of a broad and free range of self-identification. Thus, sex is a natural phenomenon, whereas gender is the reality of psychological self-understanding often caused by social influence. Gender ideology insists that a person is free to choose and implement their sexual identity regardless of their biological sex. Such separation and opposition of sex and gender is dangerous, because it distorts the traditional foundations of society based on divine and natural law.

14. The concept of gender is constantly changing and transforming. If initially it was “constructed” in opposition to biological sex, indicating that a person could choose a gender (social) role of man or woman regardless of being physiologically male or female, it is now claimed that not only does biological sex not influence the choice of social role, but the public role of man or woman is not necessary. Because gender is entirely separated from binary biological sex, it can be determined by any differences in behaviour, biological characteristics, psychological characteristics, sexual drive or desire, and so on. The human person is understood as a kind of “incorporeal freedom” that is its own creator and constructs its own identity, including its physicality in sexual terms, as a tool for getting the most pleasure with the least responsibility.

15. This “theory” implies that everyone can have a gender based on a unique combination of characteristics, freely defined and given by that person itself. Gender can supposedly be chosen. Therefore, people are likely to choose one that matches their biological sex. But one can also choose a different one. The person is given the offer not to limit their biological sex to man or woman, or even the social role of man or woman, but instead to choose their gender and gender role from the plurality of possibilities (various gender ideologues identify from a few to dozens of such roles, for example, heterosexual, homosexual, transsexual, androgynous, bigender, agender, etc.). Thus it is not being someone that determines, but acting in the role of someone. In addition, gender is declared not as a static reality but a dynamic one that can be repeatedly changed throughout the course of one’s life. The consequence of such erroneous thinking is the conclusion that supposedly one can freely choose the ways of one’s own sexual life.

16. Of particular concern is the fact that gender ideologies are not just virtual worldview systems—they are aggressively imposed on public opinion, gradually introduced in legislation, and made ever more forcefully visible in different spheres of human life, especially in education and upbringing. “If these ideas circulated only in theory, they would not go beyond the right to private opinion and the possible existence of different philosophical views. The danger lies in the fact that such anti-human theories are trying to become the ruling ideology and be put into practice, sometimes by means of international pressures on the global community.”  Pope Francis states that “today a world war is being wagged to destroy marriage,” referring to the theory of gender as “destructive ideological colonization.”  That which was until recently considered sexual deviation is today proclaimed by gender theorists as not only normal, but as a rule of life to be followed under pain of ridicule, censure, and even punishment.

17. Therefore, at its present stage of development, gender theory begins to acquire the characteristics of totalitarian ideology and is similar to those utopian ideologies that in the twentieth century not only promised to create paradise on earth, supposedly building true equality between people, but also tried to forcibly introduce their own way of thinking, eradicating any alternative point of view. The tragic history of the twentieth century has shown us what such ideologies that promise “happiness to all humanity” turn into.

III. Destructive Outcomes of Gender Ideology

18. Gender theories envision the complete denial of human nature and natural moral law, with the result that the concept of human identity is steadily destroyed. Pope Benedict XVI confirms: “What is often expressed and understood by the term ‘gender’ ultimately ends up being man’s attempt at self-emancipation from creation and the Creator. Man wants to be his own master, and alone—always and exclusively—to determine everything that concerns him. Yet in this way he lives in opposition to the truth, in opposition to the Creator Spirit.”  Supporting gender theory, a person rejects the idea that his or her gender is granted by God and doubts the fact that God created people as male and female (cf. Gen. 1:27).

19. Gender theory denies the existence of human beings created as men and women, claiming that only the person has the ability of self-creation (self-transformation) into man, woman, or some other being. Therefore, it is not God, but the person who is proclaimed creator of man, woman, or some other being. Officially declaring the desire for equality, gender ideological systems in reality strive for uniformity. We should remember that equality should not be confused with uniformity. It is diversity that is the basis of equality, while uniformity is the basis for smoothing and unifying unique and specific natural traits and signs that are attractive to the sexes. Objecting to biological sex blurs the notion of humanity, which is expressed in masculinity or femininity; rather, sexuality gives the opportunity to build genuine social equality. One cannot simply be a human being—a human being is always either man or woman.

20. Gender ideology, which denies the existence of objective human nature, the complementarity of man and woman, and the values of marriage, actually denies the existence of the Creator and negates the truth of humans in his image. In such ideologies, there is no place for God, and therefore there is no place for the person in their uniqueness and dignity, because human uniqueness is grounded in its connection with the Creator. The biblical doctrine of the person, created by God, emphasizes the greatness and dignity of its origin and calling—from God and eternal life with him in holiness (divinization), while, according to gender theory, the person has a base origin and lowly potential—from itself and for temporary life, with a goal of its own pleasure. Therefore, one can say with conviction that gender theory is destructive and anti-human.

21. In addition to the fact that gender ideology clearly contradicts the teaching of Holy Scripture and Christian anthropology, it also does not correspond to objective scientific data, and is instead based on subjective hypotheses and pseudoscientific assertions made by interested parties. Objective researchers have concluded that gender ideologues ignore results of scientific research, medicine, psychology, anthropology, and bioethics that show the difference between men and women is based on the difference between the structure of the brain, hormonal balance, psychological nature…

22. Gender ideology denies the most obvious anthropological reality: people are born male and female, and the natural complementarity of the gifts of the two sexes is an extraordinary richness for all of humanity, which gives hope for progress. Promoting vague and undefined ideas of “gender identity” creates a dangerous psychological instability that leads to absurd conflicts between bodily and psychological sexuality, which naturally stems from the physical.

23. Gender theories destroy the concept of family as a community of husband and wife in which children are born and brought up. Adherents of this theory believe that the traditional family—which is based on divine and natural law, expresses the dignity of the human person, and is the foundation of fundamental rights and obligations —is only one possible form of family. And they suggest calling unions of people with different mixes of genders, in which to be a parent means simply to perform a certain role, equivalent to the traditional family.

24. Gender ideology promotes many forms of sexual identity and behavior that do not at all correspond to human nature. That is why gender theories lead to promiscuity and further demoralization of society. Such a situation leads to disappointment, anger, and the self-destruction of the human race, because its natural foundations and principles are undermined.

Proclaiming the Truth of Christ in the Context of an Expanding Gender Ideology

25. Ukrainian society is generally not acquainted with gender theories and this permits gender ideology to be quietly and insidiously imposed upon it. Indeed, the promotion and dissemination of this ideology is carried out covertly on various levels – in legislation, information, education, upbringing…. At the same time, indisputable facts about the dangers of gender ideology for mental and physical health, particularly among children and young people—to say nothing of the undermining of the very fundamentals of human and family life that come with such theories—are deliberately passed over in silence

26. In such circumstances, the Church issues a call to deeply and carefully assess the challenges in the field of sexuality and married life, not succumbing to social pressure in these important matters, and to defend human dignity and freedom. We strive to call to mind the truth regarding every human person’s dignity, regardless of sex, race, ethnicity, age, health, etc., that the Church of Christ has constantly and consistently proclaimed for centuries. Christians are called to bring to today’s world the truth about the dignity of the human being created in the image and likeness of God, about the dignity of marriage as a union of love between a man and a woman, and about the dignity of man and woman as they complement each other. We must deepen our knowledge of Holy Scripture and Tradition so that we can grow in faith and so that we know how to argue the Christian position in a secular environment. A Christian cannot afford to live a double life, but must consistently and persistently imitate Christ, embodying in their daily life God’s teaching and God’s laws, which are the only source of genuine human happiness, genuine dignity and freedom. As the Apostle Paul writes: “For the Son of God, Jesus Christ, whom we preached among you…was not Yes and No; but in him it is always Yes” (2 Cor. 1:19–20). We cannot rely on God in some cases, and ignore His commandments and precepts in others. We are called to witness to Christ in all the dimensions of our being. This applies to the private realm, family life, professional activity, the public sphere, political activism, and so on.

27. All people of good will should work together to defend the dignity of each person, to affirm their natural and God-given characteristics and freedoms, and also for the full protection and development of the family community on the foundation of God’s revelation, which is the real guarantor of human society’s development and worthy future. “Everyone, man and woman, should acknowledge and accept his sexual identity. Physical, moral, and spiritual difference and complementarity are oriented toward the goods of marriage and the flourishing of family life. The harmony of the couple and of society depends in part on the way in which the complementarity, needs, and mutual support between the sexes are lived out.”  At the same time, it is necessary to show greater vigilance and responsibility in order to prevent the spread of pernicious theories, which are the latest forms of ideological enslavement and destruction of the person, the family, and society as a whole.

28.It is necessary to delve into the essence of every matter and to recognize the true purpose of certain proposals or appeals, without letting oneself be deceived by that which is presented under the banner of an illusory dignity and freedom, or announced as “necessary steps” to implement a particular geopolitical course of the state. We have to remember that “the state cannot fulfil its functions if it violates the dignity of the individual and the moral principles of society.”  A human being cannot betray their vocation and destroy human dignity for the sake of dubious social or political projects, even if these projects are presented as a sign of “progress” and “modernity.” The Catechism of the UGCC Christ — Our Pascha teaches that “the criterion of the lawfulness of state power is its conformity to the Lord’s law. When state authority loses its legitimacy through its lack of conformity to God’s law, the people have a right to resist such a government and to oppose it. The Christian is bound to follow divine law even in difficult circumstances: ‘We must obey God rather than any human authority’ (Acts 5:29).”

Conclusion

29. The Lord calls people to salvation and the fullness of happiness, giving his Commandments as a guide on our earthly journey. We call the UGCC faithful and all people of good will to value and protect human dignity in the face of new ideological challenges and threats. Each of us is called to this, no matter what our position in society. For this reason:

31. we call to mind that “individuals should be endowed with this virtue [of chastity] according to their state in life: for some it will mean virginity or celibacy consecrated to God…. For others it will take the form determined by the moral law, according to whether they are married or single,”  and therefore should be properly and responsibly prepare for the choice of their state of life, based on the solid foundation of faith, morality, and divine and natural law;

  • we encourage parents to lead a good Christian life that will be an example for their children. Please take care of the Christian education of future generations, not only by transmitting the foundations of faith, but also through all manner of encouragement that they live a life in Christ and by warning them against the dangers of the false exercise of one’s free choice. Parents “are called to be gentle and wise guides. It is they who must lead the child on its path of discovering God’s gift of sexuality in himself or herself, revealing its nature and meaning in a manner appropriate to the age, needs, and depth of the child’s inquiry”;
  • we appeal to workers in the field of medicine, remembering that “the most important point of a physician’s oath is to serve human life from the moment of conception and to defend its health,”  to promote the dissemination of a culture of life, defending in particular the life of unborn children and the elderly or terminally ill;
  • we ask everyone, especially those working in the fields of information and education, to defend and disseminate traditional moral values regarding sexuality and the family, remembering that “nothing can justify recourse to disinformation for manipulating public opinion through the media”;
  • we ask all who are responsible for developing educational curricula to prepare them on the basis of natural and divine law, respectful of the truth, the qualities of the heart, and the moral and spiritual dignity of man,  avoiding any propaganda against sexual purity, marital fidelity, and the true identity of the human person;
  • we call upon scientists to remember that science and technology should recognize the basic criteria of morality and be “at the service of the human person, of his inalienable rights, of his true and integral good, in conformity with the plan and the will of God,”  and also encourage them to use available means to demonstrate the truth about gender ideology and other destructive ideologies, and point to the importance of adhering to traditional moral and ethical foundations;
  • we remind pastors of their sacred duty to care for the spiritual condition of the family—a community of love and a “domestic church” (cf. Rom 16:5; 1 Cor 16:19; Col. 4:15; Phil. 1:2; Eph. 5:19; Col. 3:16; 1 Tim. 2:8) that is “the primary cell of the Christian community” and “a school of social solidarity”  on which a healthy society is built. We also encourage them to accompany families at all stages of their existence, from preparation for married life, through support for young couples, diligent catechesis of families, and special care of families who are experiencing difficulties or crises. In addition, we ask pastors, while maintaining the teachings of the Church and observing a high level of spiritual and psychological maturity, to pay attention to pastoral work with people who have problems with the definition of their own sexual identity;
  • we call upon all people of good will, especially government officials and legislators, to be vigilant that the legislation of Ukraine not give way to implementing uncertain and untested concepts of human identity or family, or principles of gender education, remembering that “the ruling authority has as its aim to serve the common good, to preserve and protect the natural and true freedom of citizens, families, and community organizations.”  Legislation will only be firm and unshakable when it is based not on temporary and dubious theories, but on the natural law affirmed by divine revelation.

30. We invite all to pray that God help us all to live according to his commandments, trusting in his Divine Providence and not succumbing to the temptations of opposing his will. The Lord, having created human beings as “male and female,” looked at them and said that it was very good (Gen. 1:27,31). May he embrace each person and family in his loving and life-giving gaze, confirm us all in his truth and love, and send down upon all his Fatherly blessing!

On behalf of the Synod of Bishops of the Major Archbishopric of Kyiv-Halych of the UGCC

† SVIATOSLAV

Given in Kyiv at the Patriarchal Cathedral of the Resurrection of Christ, on the day of the holy martyrs Plato and Roman, 1 December (O.S. 18 November) 2016 A.D.


Embryo mens vanaf de conceptie

door mgr.dr. W.J.Eijk

Introduction
One of the central subjects in the discussion about whether abortion, experiments on embryos and so called therapeutic cloning is licit is that of the status of the embryo. The reaching of the status of a human individual or human person means that the embryo has a connected moral status, a dignity from which come the rights attributed to all human beings. Before reaching this status it is said to be licit to abort the embryo or use it as material for experiments, thereby eliminating it.

The difficulty is that many divergent opinions exist regarding the moment when one should attribute a moral status to the embryo. Thus indicators when an embryo becomes a real human being or a human person are variously identified as conception, nidation (after about two weeks), the beginning of cerebral activity, the ability to feel pain, having life outside the womb (in general from the twenty-fourth week of pregnancy),[1] birth, or a stage of development after birth.

In recent years there has been an increasingly widespread tendency to indicate a precise moment when an embryo is said to become a human individual and thus reference is made to a gradual progressive humanisation or a gradual growth in the dignity of the embryo. This means that a duty is said to exist to protect the embryo that is proportionate to its level of development. This was, amongst other things, the argument used by the Dutch government to legalise experiments with human embryos in 2002 – the early embryo has a dignity of such a character that the advance of medicine can compensate the loss of embryos for research.[2]

Apart from conception, the moments listed above concede few possibilities of attributing to the embryo before implantation the dignity of a human individual. The moments listed above, however, are conclusions that draw their validity from criteria employed to assess the status of the embryo. The criterion used depends upon the vision of man that is adopted as a point of departure. It is therefore necessary to make a net distinction between: 1) the moment when one attributes to the embryo the status of a human individual with all connected rights; 2) the criterion used to assess the status of the embryo; and 3) the anthropology that is the foundation of this criterion.

The great variety of moments that are seen as the beginning of the existence of the human individual makes the discussion about the status of the embryo rather difficult. When it is not clear which criterion is used and which anthropology is taken as a point of departure, the discussion, inevitably, becomes marooned. For this reason, we must first of all consider the various criteria employed, first and foremost in relation to the relevant biological data.

The distinction between extrinsic and intrinsic criteria helps us to clarify the terms of the question. The extrinsic criteria are those that do not derive from the embryo as such but from external factors. Both in the past and still today the following extrinsic criteria are to be encountered in the discussion about the status of the human embryo: 1) human relationships: the embryo becomes a human individual when it establishes relationships with other human beings; 2) positive law: the embryo becomes an individual when it is recognised as such by positive law; and 3) the decision to give to an embryo that has been created through in vitro fertilisation the possibility of further development. The intrinsic criteria, on the other hand, refer to certain characteristics of the embryo itself, namely: 1) independence from the body of the mother: the embryo becomes a human individual when it is no longer part of the organism of the mother; 2) human biological nature: the embryo is a human individual because of the simple fact that it is in biological terms a human being; 3) individuality: the embryo becomes a human individual only when it can no longer divide itself, thereby giving life to a twin or uniting itself to another embryo; 4) being a person: the embryo becomes a human individual with all connected rights when it becomes a human person; and 5) intrinsic finality: the embryo, even though it is not yet a human individual, must be respected as such because of its intrinsic finality, that is to say because of the fact that it will become a human individual.

Only after establishing the criterion to be employed can one indicate the moment in the development of the embryo when the embryo receives the moral status of being human: conception, the beginning of cerebral activity, the moment of birth or the moment when society recognises it as being a subject of rights. One should bear in mind that the criteria that have been listed above do not exclude each other. Certain currents of thought apply some of them contemporaneously. To achieve a detailed assessment, however, it is necessary to analyse them separately.


Extrinsic criteria
Human relationships: the embryo becomes a human individual when it establishes relationships with other human individuals

In the philosophy of the twentieth century, and especially in structuralism, there exists a strong tendency to look for the specific character of man not in what he is but in his relationships. Some thinkers even see the relationships of man as the only specific characteristic that distinguishes man from other living beings.

In the view of the French moralists Ribes, Pohier and Roqueplo, the embryo reaches a fully personal and human status only by having human relationships. The example is that of an embryo that previously was wanted by its parents and in a certain sense by society as well. When there is not this intentionality on the part of the parents to conceive the child, and they have also tried to prevent conception, the embryo is said not to have a specifically human status.[3] For this reason, the stages of the biological development of the embryo, in this vision, have no relevance.

Obviously, there are important objections to this approach. It implies that one could deny all respect even to an unwanted new born child, with the possibility of eliminating him or her. Indeed, one could not indicate a precise moment when the embryo begins to acquire a human status. In this way one could also deny the status of being human to certain adults. What should we thus think of the elderly Indian woman of Calcutta who was dumped in a garbage heap in a sack of plastic by her daughter? Did she for this reason cease to be a human person? And did she become a human person again when she was brought by the sisters of Mother Teresa to one of their homes to be looked after with love?

On the basis of its obvious shallowness and the extreme conclusions to which it leads, the reduction of the human being to pure rationality does not find many adherents.

Others are of the view that the status of a human being and the personality of the individual emerge at the moment of nidation: nidation, because it implies the beginning of a close relationship with the mother, makes clear transcendence towards the other, which is considered essential for the human person. The human body, in fact, is the foundation and the real symbol of this transcendence towards the other.[4] On the basis of this, Böckle and others, during the 1960s and 1970s, justified the use of interceptives and the day after pill: the fact that before nidation the embryo, not having human relationships, is not yet to be considered a human individual makes possible a comparative assessment of the values involved: the value of the embryo who is not yet a human person, on the one hand, and the welfare of the mother in situations of emergency, on the other. This implies that the use of the day after pill is acceptable in the case of rape and the use of the coil is also acceptable when there are grave reasons for birth control, such as the need to prevent a pregnancy, or demographic reasons.[5]

However, it is not correct to assign too much importance to the moment of nidation, as though an existential relationship did not exist between the mother and the embryo before this event. Such a relationship is already created with the fusion of the spermatozoon and the ovule following the sexual relationship of the parents. In addition, even before nidation the embryo receives necessary nutriments and oxygen for its growth from its mother. Thus nidation is not the beginning of a transcendental relationship with the mother that is said to characterise the embryo as a truly human individual.

The embryo becomes a human individual when it is recognised as such by positive law

It appears evident that positive law guarantees and protects the objective rights of every human individual. In our pluralistic society the only practical solution to the controversy about the status of the human embryo in the opinion of many is that the status of the embryo should be defined through democratic consensus. Thus whether the embryo merits respect is said to depend exclusively on what has been established in this field by law.

In the majority of cases procured abortion is allowed within the limit of a certain period of time and on certain conditions. In some countries experiments with human embryos before the time when they are implanted in the womb in natural conditions, that is to say up to fourteen days after conception, have been legalised (for example in England and the Netherlands[6]). In our society many people do not dwell upon the question of the objective status of the embryo but adapt to the positive law in force.

Hubert Marktl, formerly head of the Max-Plank-Gesellschaft, who presents as alternative the ideas that a human being is a purely biological fact or a concept that is recognised from a cultural point of view, refers to an act of recognition by which the living being during its development becomes a human being in the full sense.[7]

Civil law

In a democracy, compromise is often inevitable and in many cases acceptable. However, the truth, including that about the status of the embryo, cannot be established by means of a statistical inquiry. It would be extremely dangerous for a society to determine what status should be attributed to human persons or to certain stages of development through the establishment of a consensus. Even if in a nation, in line with a law accepted by the majority, expulsions were to take place, we would not conclude that the members of persecuted ethnic minorities were not persons with a moral status and connected rights.

Thus also the objection to that effect that unborn children, unwanted children or handicapped children have a low quality of life or will constitute a grave burden for their parents is not an objective reason to refuse then a moral status acknowledged by the law. Even people who request asylum in another country in which they have sought refuge are not always well accepted, nor can they expect an easy future. Despite this fact, even if forced to flee from their countries, they remain persons with the right to be aided and helped by the countries that receive them.

In this area one may notice that a doctrine such as the doctrine of the Church, which is based upon objective reality, is neither authoritarian nor intolerant. Ethical relativism, which is held by many to be an essential pre-condition for democracy, on the other hand, is. According to the encyclical Evangelium Vitae: It is precisely the issue of respect for life which shows what misunderstandings as contradictions, accompanied by terrible practical consequences, are concealed in this position. It is true that history has known cases where crimes have been committed in the name of ‘truth’. But equally grave crimes and radical denials of freedom have also been committed and are still being committed in the name of ‘ethical relativism’. When a parliamentary or social majority decrees that it is legal, at least under certain conditions, to kill unborn human life, is it not really making a ‘tyrannical’ decision with regard to the weakest and most defenceless of human beings? (n. 70).

Ethical relativism is not only a threat to the life of the weakest human beings, especially the unborn, who have no opportunity to vote, but also to democracy itself. Democracy is not an end in itself, but, like every other form of government, a means by which to ensure the common good. Obviously, the common good, which involves all the conditions that are necessary for each individual member of society to be able fulfil his or her destiny, requires respect for life, which is a fundamental good. Although freedom is a higher good than that of physical life, a human being cannot exercise his or her own freedom without being alive. Life is therefore is a fundamental good as regards freedom. The non-recognition of life as a fundamental good constitutes a grave threat to freedom and democracy: The value of democracy stands or falls with the values which it embodies and promotes. Of course, values such as the dignity of every human person, respect for inviolable and inalienable human rights, and the adoption of the ‘common good’ as the end and the criterion regulating political life. If as a result of the tragic obscuring of the collective conscience, an attitude of scepticism were to succeed in bringing into question even the fundamental principles of the moral law, the democratic system itself would be shaken in its foundations, and would be reduced to a mere mechanism for regulating different and opposing interests on a purely empirical basis. (ibid.).


Positive divine law

Amongst those that invoke Holy Scripture there are some who base the moral status of the embryo on a law held to be revealed, which in turn is based upon a specific translation of Genesis 9:6, that is to say: ‘whoever sheds the blood of man in man, his blood will be shed’,[8] instead of the usual translation ‘whoever sheds the blood of man, by man shall his blood be shed’ (my italics).[9] Genesis 9:6, translated in the first way, implies a prohibition on procured abortion. In combining a literal exegesis of isolated Biblical texts with a biological criterion, as some groups of Orthodox Jews do, there is an affirmation of the licit character of scientific research with embryos created by means of in vitro fertilisation, but not transferred into the maternal womb, in order to develop therapies for illnesses which as yet cannot be cured by man. The translation ‘the blood of man in man’ requires, in fact, only respect for the intrauterine embryo and not for the extrauterine embryo. In this way, the creation of human embryos for the purposes of research and ‘therapeutic’ cloning is also assessed as being admissible.

Does Genesis 9:6 justify therapeutic cloning? The usual translation ‘whoever sheds the blood of man, by man shall his blood be shed’ implies a general prohibition on the killing of human beings. The ‘by man’ in Hebrew is ‘ba’adam.’ The prefix ‘be’ can have two meanings: ‘in’, as a preposition to indicate a location, or ‘by’ in a causal sense. Which is the more correct translation?[10] First of all it is necessary to observe that the original text allows, in principle, both translations.[11] The translation ‘by man’ in the context of Genesis 9:6 is, however, more evident and is used by practically all the versions of Holy Scripture. Two arguments in favour of this interpretation are the following: 1) The phrase ‘ba’adam’ is found nineteen times and nowhere does it mean ‘in man’;[12] 2) secondly, Genesis 9:6 is constructed in the original Jewish text with a chiasm, a rhetorical device that involves the crossed arrangement of two words that are connected, like a mirror image: whoever sheds the blood of a man; by man shall his blood be shed. The words ‘blood’ and ‘man’ are used in an upside down way. This implies that the second part of the word ‘man’ does not apply to the relative, as appears in the translation ‘bled of man in man’, but to the principal sentence ‘by man shall his blood be shed’.

A second point, which is more important, concerns the use of Holy Scripture in theology in general and in moral theology and bioethics in particular. Even if the translation ‘man in man’, and thus the unborn human being in the maternal womb, were correct, Genesis 9:6 would not anyway constitute a justification for the killing and the exploitation of human embryos outside the womb:

1. Genesis 9:6 would then say explicitly that it is not licit to kill human embryos outside the maternal womb. But the fact that this is not explicitly said does not mean that it is licit to kill embryos outside the maternal womb. Such a conclusion is a logical error: one cannot draw a positive conclusion from a negative premise.

2. However much the human authors of the Bible were inspired by the Holy Spirit, the Bible is not a source for the natural sciences. For the authors of the Bible the possibility did not exist of creating embryos and saving their lives outside the maternal womb. In Revelation it was not realised that biotechnology would arrive at the point of generating humans outside the womb, in a laboratory. To make a comparison: the principles of the social doctrine of the Church are formulated on the basis of the social questions and issues of the nineteenth century which were characterised by industrialisation and the emergence of the proletariat. These principles without doubt have a Biblical foundation but as they are they were not formulated in Holy Scripture.

3. Biblical texts cannot be interpreted on their own – they must be interpreted in relation to the whole context of the Bible. Holy Scripture does not give a univocal answer to the question of what the status of the human embryo is.[13] Given that within the Bible we do not find explanatory criteria, supplementary criteria are required for a sound interpretation. In the Catholic Church the most important criteria are offered by Tradition and by the documents of the Magisterium.

The choice of giving an embryo created through in vitro fertilisation the possibility of further development

An embryo conceived through in vitro fertilisation which is not then implanted in the womb but which remains in the laboratory will live for at most nine or ten days given current technical possibilities. Only if the embryo is transferred into the womb will it have a possibility of developing. The decision not to implant it has important consequences for the status of the embryo, as Tauer observes: The question of ‘normal conditions’ for a zygote in a test tube, if one does not intend to proceed with the transfer of the embryo and its implantation, raises doubts. If the normal conditions of a zygote in a laboratory are essentially the same as the oocyte before fertilisation, something that appears to be true, then the zygote will never develop as a person. Thus it would be better to classify it as a ‘possible’ person, a person who could become such only on certain conditions that are possible from a causal point of view.’[14]

If the embryo were destined to be transferred into the uterus it would have a higher status. This means that it should be classified as a ‘potential person’ because it has a real possibility of developing. It would then have a value that is greater than a purely instrumental value.[15]

After concluding that a human embryo in a test tube, given that it is not able to feel and to act and is not conscious, has a weak moral status,[16] Meyer and Nelson conclude that the status of the embryo is determined by the gametes from which it comes, that is to say from its genetic parents. These last have the exclusive right to decide whether the embryos are to be used for the procreation of their own children, of the children of other people, for research, or whether they must be simply thrown away. The use of embryos created in a laboratory for more than fourteen days must be avoided because some people consider this moment as constituting the morally significant beginning of the individuation of the embryo.[17]

The status of the embryo, understood in this way, is determined according to the will of people, that is to say in a way that depends on the choices of others, first and foremost the researcher and the parents. One could argue that this choice can be made only during the stage prior to the implantation of the embryo and that in this case the intrinsic possibilities of the embryo are taken into consideration. However, an extrinsic criterion, that is to say the arbitrary decision taken by others, conditions judgement on the question as to whether the embryo has the same status as a gamete or whether it has a superior status. The intrinsic possibilities are thus decidedly denied.

Assessment

The extrinsic criteria are not suitable for indicating the moral status of an embryo because they are secondary to what an embryo is. Only on the basis of intrinsic criteria can one have an objective judgement on the respect due to an embryo. Apart from this and apart from the criticisms expressed above, there is yet another fundamental objection: in the extrinsic criteria biological factors either have no role or have only a marginal role. However, this is inadmissible given that a human being is a substantial unity with a spiritual and material dimension. The material aspect is an intrinsic dimension of a human being and thus it is impossible both to identify a human being with this dimension and to conceive of a human being in a way that leaves aside his or her physical/biological dimension and does not attribute to that dimension an intrinsic role.


Intrinsic criteria

From what has been said above it may be understood that one can employ intrinsic criteria alone to establish a definition of an embryo as a human individual and that these criteria must take into consideration the biological data as well.

The independence of the body from the mother: the embryo becomes a human individual when it is no longer a part of the organism of the mother

At the end of the 1960s and during the 1970s feminist groups upheld the right to procured abortion with the motivation that the unborn child forms a part of a woman’s body and thus a woman should be able do with it as she so pleases – ‘we are the governors of our tummies’.

This is not a new argument. Roman law laid down that an unborn child, given that he or she was still a part of his or her mother or her organs prior to the act of birth, was not yet a citizen with all connected rights (Ulpian, a Roman jurist, d. 228 AD).[18] This idea was also to be found in other peoples of that age, for example the Jews, and thus Roman jurists held it to be an element of the jus gentium.[19] The Stoics (Hempedocles) compared the relationship between the embryo and the womb to the relationship between a fruit and its plant: the fruit, until it falls or is picked, is a part of the plant. In the same way, before birth the embryo could not have its own existence separately from the existence of the mother. The embryo was said to acquire a soul when it began to breathe, that is to say a little time after birth, but not before birth.[20]

The discussion about the status of an embryo during the first seven days concerns, first and foremost, the ethical problems of in vitro experimentation on an embryo that has been created by artificial fertilisation and thus is not a part of its mother. The biological data provided by modern science, however, have made clear that the embryo, beginning with conception, has its own existence. It relies on its mother for food, liquids and the expulsion of organic matter. However, its development and its growth as an individual are guided from conception onwards by its own genome, which is different from the genome of its mother. For this reason, on the basis of contemporary genetic knowledge, one can in no way argue that an unborn child is a part of the body of the mother. On the basis of this argument it is not admissible for the mother to claim the right to dispose of the life of the embryo.

Human biological nature: the embryo is a human individual because of the simple fact that it is biologically a human being

The Wilkes based their rejection of procured abortion on the fact that human life, from a biological point of view, begins with conception. For them, theology and philosophy were of no use in solving the question of the status of the embryo given that in both disciplines there exist many divergent opinions on the subject.[21] The biological definition of the beginning of life, that is to say conception, which cannot be called into doubt by anyone, was, in the view of the Wilkes, thus the most solid criterion by which to attribute a moral status to the human embryo starting with conception.

This conclusion, however much it may be held to be interesting by the ‘pro-life’ movements, meets certain objections that are insuperable. It does not take into account the fact, for example, that, as will be seen below, many modern ethicists make a distinction between human beings in a strictly biological sense and human persons. The embryological and biological facts, in themselves, interpreted in various ways in the various visions of man, cannot provide a definitive answer about the status of the embryo. According to certain visions of man it is to be excluded that the embryo is a human being from conception. In addition, a purely biological definition would lead to a biologistic and materialistic conception of man which holds that man cannot have an intrinsic dignity but at the very most an instrumental value. An appeal to the mere biological presence of a human being, leaving aside other aspects such as the spiritual dimension and its intrinsic finality, is insufficient, as we will see below.

Individuality: the embryo becomes a human individual only from the moment at which it cannot divide itself and thus give life to a twin or unite itself to another embryo

In England in 1990, on the recommendation of the Warnock commission, a law was passed that allowed experiments on in vitro embryos on certain conditions until the fourteenth day after conception. In its report, which was published in 1984, this commission concluded that the early embryo, because it still had the possibility of dividing, could not be considered as being an individual being and thus could not be considered as being a human individual either.[22] Even some Catholic ethicists have adopted this approach.[23] The moralist Häring has stated that: ‘the greatest objection to the theory of animation at the moment of fertilisation is raised by the phenomenon of identical twins’.[24]

The Warnock commission held that the beginning of the individuality of the embryo was the moment of the formation of the primitive streak, after which the embryo is no longer able to divide into two individuals that are genetically identical. The primitive streak is the oblong concentration of cells at each end of the embryonic disk which emerges on the fourteenth or fifteenth day after conception. It is the first manifestation of the anteroposterior axis of the embryo and appears in the place where the nerve tube will develop after a short period of time, and from which the brain and the spine will form. In this place a number of strata of differentiated cells form after their migration. At the most two primitive streaks can form in the embryonic disc but because of the differentiation that has just begun this will not lead to the division of the embryo.

This period of two weeks coincides roughly with the period before the implantation of the embryo in the mucous of the embryo, which is completed between the eleventh and thirteenth day after conception. Nowadays, reference is often made to a ‘pre-embryo’, a term that suggests that the embryo is not yet a human individual and thus does not deserve to be respected as such.[25] This line of reasoning has its origin in the presumption that the embryo is not an individual as long as the possibility of scission exists and thus cannot even be considered a person because a person is the most complete individual being.

The question is: does the possibility of the separation of the embryo really exclude its individual being and thus its being a person? There is another interpretation that is possible, that is to say that man is able to procreate in an asexual way until the formation of the primitive streak. When I, when digging in the garden, cut a worm in two, both the parts of the worm carry on in their own way in an apparently undisturbed fashion. It appears a rather unattractive thought that something of the same kind can happen in man, but who can prove that the contrary is the case?

That asexual procreation is possible in man as well would appear to be demonstrated, or so assert Ashley and O’Rourke in the third edition of their textbook Health Care Ethics, by scientists who are able to clone human adults, who are without doubt seen as persons, through nuclear transplant.[26] We now know that is a concrete possibility given the success in the application of this technique to human beings. In the month of February 2004 a team of researchers at the National University of Seoul (South Korea) managed to produce thirty embryos from two-hundred and forty-two oocytes by using the method of nuclear transplant.[27]

A further argument that is said to exclude that the embryo during the first stages of its development is an individual focuses on the possibility of the recombination of embryos. In experiments with animals it has been demonstrated that it is possible to combine two or at the most three embryos into a single embryo that contains genetically different cells which come from the original embryos.[28] The discovery at the end of the 1960s of the existence of men with cells with a twofold chromosome X and cells with one chromosome X and one chromosome Y was an indication that recombination also takes place in human embryos.[29] But not even this phenomenon constitutes proof that the embryo during the first stages of its existence is not an individual. One could also well object that in the case of the recombination of the two embryos the body of one has been absorbed by the other, which managed to conserve its individuality, and thus the first embryo ceased to exist as an individual and died from a metaphysical point of view.

Many people see proof of the individuality of the early embryo in the fact that the composition of the genetic material of the chromosomes is established at the moment of fertilisation. Others object that the development programme that the chromosomes contain is not immediately active after conception. At the outset the energy in the embryo is provided by the Altmann’s granules, which come from the mother. Thus the development of the very first stages of the embryo is not guided by the DNA of the zygote but by the DNA of the Altmann’s granules which come from the mother, from the messenger RNA and from the proteins that were present in the spermatozoon and the ovule.[30] This, too, is not in itself a valid reason for doubting the individuality of the embryo. The development programme in the chromosomes, although it becomes active immediately or after only a few days, is established from conception onwards and will guide or regulate the successive development of the embryo if factors of disturbance do not intervene. The results of the most recent research indicate, however, that the DNA of the embryo begins to guide its development practically at the zygote stage, when a first gene that is responsible for gonadic differentiation is already active.[31]

The criterion for the individuality of the embryo is often likened to the criterion which observes that the embryo will become a person. This point will be discussed later in this paper. This implies that the embryo cannot be considered a person until it is an individual, an assumption that in itself is obviously right. Thus it is that Ford identifies the formation of the primitive streak with the moment of animation.[32]


The person being: the embryo becomes a human individual when it becomes a person

The question whether the embryo is a person or not seems to be a clear and simple one. If it is a person, it deserves respect as such. If it were only a ‘pre-embryo’ or a ‘potential person’, it would have less rights. However, the moment when the embryo becomes a person is very much debated. It depends first of all on the vision of man that one takes as a point of departure. In addition, even when there is a single vision of man there can be different ideas about the moment when the human embryo has to be seen as a person.

The criterion of animation

Until the recent past in the Catholic world the discussion about the moment when the human embryo becomes a person was connected with the moment of animation. For that matter, the traditional Christian vision of man, too, defending both direct animation and indirect or delayed animation, did not provide a definitive answer to the question as to when the embryo becomes a person.

The theory of direct animation which implies that the embryo is animated by a human soul from conception onwards has its origin in the writings of Hippocrates. In the view of Hippocrates (460?-370? BC) the embryo was born from the sperm of the father which coagulated in the womb. The blood that was there, not secreted during pregnancy as it is during menstruation, was used by the embryo to nourish itself.[33] The embryo was a human individual from the very beginning and thus had a human soul.

The opposing theory was that of ‘indirect’ or ‘delayed’ animation espoused by Aristotle (384/383-332 BC). In his thought the body of the embryo arose from the menstrual blood retained in the womb during pregnancy. This blood, understood as the material cause of the embryo, in Aristotle’s view, was coagulated by the sperm as an efficient and formal cause, like milk under the influence of fig juice or the curd of cheese.[34] Thus the blood was transformed into the body of the embryo. Through the sperm the menstrual blood received a vegetative soul: ‘thus the physical part, the body, comes from the woman and the soul from the man’.[35] In this way, at the end of the first week, the blood became a living being, comparable to a plant. The vegetative soul was replaced a little time afterwards by a sensitive soul, and this was borne out by the formation of sense organs. This soul was in turn replaced by a rational soul which came from outside and had to have a divine origin.[36] The rational soul could not be present from the outset because its activity required a certain level of development of the organs, especially the sense organs: ‘the soul is, therefore, the first act (perfection) of a body that has a life potentially. The body is such when it possesses organs…If we want to mention something common to every soul, it is that the soul is the first act of natural bodies that possess organs’.[37] On the basis of his observations of aborted embryos, Aristotle concluded that the male embryo was animated by the rational principle of life on the fortieth day and the female embryo on the eightieth day.[38]

The choice between the theory of indirect animation or the theory of direct animation was clearly determined by a difference at the level of the vision of the development of the embryo. Differently from Hippocrates, Aristotle, thinking that the body of the embryo arose from the menstrual blood, could not assume that the embryo was animated starting with conception. His belief that only an organic body could be animated made it unthinkable, in fact, that an amorphous piece of blood contained a human soul as a principle of life. Here Thomas Aquinas followed Aristotle, although not without modifications and additions to Aristotle’s thesis.[39] Until the last century there were still Thomists who supported the theory of delayed animation on the basis of the requisite of what they called a sufficient arrangement of matter to be animated by a rational soul, as is stated in number 15 of the twenty-four Thomist theses published by the Sacred Congregation of Studies on 27 July 1914: ‘On the contrary, the human soul exists on its own and when it can be infused in a subject sufficiently disposed, it is created by God, and by its nature it is incorruptible and immortal’.[40]

In 1827 Karl-Ernst von Baer discovered the ovule in mammals and in man and also the mechanism of fertilisation, as a result of which it was definitively proved that the human body does not begin as a coagulate of blood but as a fertilised ovule. For the majority of theologians this was the reason to believe that animation took place at the moment of conception and not later.[41]

However in order to defend procured abortion, theologians, moralists and ethicists took up the theory of delayed animation again from the 1960s onwards.[42] And given that today researchers have to deal with a fertilised ovule, with an embryo brought about by in vitro fertilisation, the theory of delayed animation also acts to justify experiments on embryos.

To support this theory, on the one hand reliance was placed on an Aristotelian argument according to which animation requires a certain development of the sensorial system: ‘the minimum that we should suppose before admitting the presence of a human soul is the availability of these organs: the senses, the nervous system, the brain and especially the cortex. Given that these organs are not yet mature during the very first stages of pregnancy, I think it is certain that a human person only exists after a few weeks’.[43]

On the other hand, theologians and ethicists often referred – and they still refer – to certain scientific discoveries in the field of embryology that were made last century: 1) the spontaneous loss of fertilised ovules to a notable degree; 2) the formation of monozygotic twins; and 3) the possibility of recombining two or three embryos into a single individual. This paper has already discussed the last two phenomena, but not the first.

On the basis of experimental observations, in the 1920s and 1930s Needham postulated that up to 50% of fertilised ovules were lost spontaneously. For many people this makes it improbable that the fertilised ovule is already animated.[44] This, in fact, would mean that one half of human persons with a soul created directly by God are lost during the first weeks to the first months of pregnancy. For that matter, this objection is not new but goes back to Anselm.[45] In the view of the time it was unthinkable that a conceived human at the very first stages of development was already animated because this would mean that such individuals did not have the possibility of being reconciled with God through baptism. This argument as such, however, is not necessarily in contrast with direct animation. The high mortality rate of children, which until the nineteenth century was around 50%, did not constitute an argument by which to call into question the fact that they were persons.[46]

From the moment when it is animated the embryo becomes a person and thus attains the highest level of a human being. The division of the embryo into twins, which is possible until the formation of the primitive streak at the fourteenth or fifteenth day after conception would, according to the Warnock Report, as we have seen, prove that the embryo during the first stages is not an individual and thus not even a person. The moral philosopher Norman Ford concludes, therefore, that animation can only take place after the formation of the primitive streak.[47] We have observed, however, that the possibility of twinning, or of recombination with other embryos, does not exclude the early embryo being a human individual.


The criterion of the manifestation of activity that is specifically human

In contemporary secular bioethics, discussion about the status of the embryo is shaped above all else by the anthropology of identity theory. This theory, which originated in Australia and which is accepted by many ethicists in the Anglo-Saxon world and – albeit unconsciously – by many medical doctors as well, is characterised by a strong dualism which separates the biological nature of man and the specific functions that render him a person. That which is specifically human is psychological consciousness, the rational faculty and the capacity for social communication. It is clear that in this vision the embryo could never be a person before a certain development of its nervous system.

Tauer thinks that when the nervous system has developed to the point of registering certain experiences that come from the environment the embryo has matured a ‘mental personality’ which draws the embryo near to being a person in the strict sense. These experiences can be unconscious but as we know from psychoanalysis they can already lead to the formation of memories that act subsequently on the consciousness. On the basis of this, Tauer thinks that there are sufficient reasons for attributing to the embryo in the seventh week not only a moral value but also the beginning of being a person in a morally significant sense.[48]

Others, such as McMahan, believe, instead, that the embryo becomes a human being at a subsequent moment: ‘I believe that the most credible view is that we are embodied minds… I began to exist when the brain of this body – my body – acquired for the first time the ability to have consciousness’.[49] This implies that the human being begins his or her existence between the twenty-eighth and the thirtieth week.

Engelhardt, on the other hand, in order to be able to speak about a person requires the actual presence of self-awareness, a manifest rational activity and a manifest capacity for social communication. Given that such functions are probably present only a notable time after birth, the unborn and the newly born – including mentally handicapped people who have never had a rational capacity – are said not to be human persons to the full with the accompanying connected moral status. Before being persons they are said to be only human beings in the biological sense.[50] This demonstrates the urgent need for careful anthropological reflection on the human biological nature of the early embryo.

This vision has various practical consequences for other fields of medical ethics as well. If applied strictly, a patient in a permanent vegetative state could no longer be seen as a person. And some have suggested that he or she could thus be seen as a donor of organs.[51]

A fundamental objection to identity theory is that it encounters difficulty in explaining the human person as a unity. The human being is considered in antithesis to the human person, like biological nature and spiritual nature, that is to say the rational capacity.

The intrinsic finality: the embryo, even were it not yet a human individual, must be respected as such because of its intrinsic capacity to become that individual

Assuming that the early embryo is not a human individual, would it not be obvious to conclude that its elimination by means of procured abortion and its use in research or in ‘therapeutic’ cloning are licit, specifically because of the fact that they do not involve the killing of a human individual? McMahan’s view is that ‘this would not amount to the killing of one of us but only the prevention of their existence’.[52] As an argument in favour of the licit character of procured abortion or experiments with embryos, reference is made to the fact that the Christian tradition preferred the theory of delayed animation until the nineteenth century.[53] This raises the question why Christian theologians, although accepting this theory, unanimously rejected abortion – until the second half of the century – even when it took place before the assumed moment of animation. Here the famous text of Tertullian is indicative: Given that killing is always forbidden, the destruction of a foetus during the period in which the blood is transformed into a human being is also illicit. The prevention of birth is the same as early killing; it makes no difference whether one kills life already born or interrupts life already on its way to birth and being developed: he who will be a man is already a man, just as the fruit is already in the seed.[54]

By the transformation of blood, Tertullian was alluding to conception as understood by Aristotle, in whose view the blood that was in the womb was not expelled during pregnancy, as was the case in normal periods of menstruation, but remained there and was transformed within the body into an embryo under the influence of the active force of the male semen. When this process was still under way, Tertullian affirmed, there was something in the womb that should be respected as a human individual, at least because it would become a human individual. As an argument to strengthen this thesis it was added that every fruit is already virtually present in the seed.

The fundamental argument in this text is that the process of the development of the embryo takes place in a way that has a purpose. In the conceived human being, and above all in the semen, there is the intrinsic finality of becoming a human individual. From this springs the need for respect. In his commentary on the Gospel According to St. Luke, Ambrose says that ‘to check your levity you recognise the hands of Your Author who forms a man in the womb. He is working and you violate with your lasciviousness the secret of the sacred womb?’[55] Here one is not dealing with abortion. Ambrose seems to state that unchecked sexual passions lead to sterility. Whatever the case, he teaches us that the formation of the embryo in the plan of the creative action of God is a process with a finality. We can find the same thought in St. Augustine: ‘And yet in all men who are born ill, God, in forming the body, in giving them life and nourishing them, does that which is good’.[56] He is not thinking of a direct intervention on the part of God upon the biological development of the embryo but of a transcendental causality that includes the direct biological causes (the causae secundae).[57] The same finality linked to the doctrine of the creation is evident in the way in which St. Thomas Aquinas describes the origin of man.[58]

The prevention of procreation has been seen by Christian theologians as a rejection of the fulfilment of a purpose of marriage which is established in the order of the Creation. And it was on the basis of this thought that the Fathers of the Church and medieval theologians placed on the same level the use of means to bring about sterilisation (contraceptives), the killing of a (both an animated and not yet animated) foetus, and infanticide: However they betray themselves when they reach the point of exposing their own children born against their will. They hate raising and keeping near to themselves those children that they feared to generate. When, therefore, dark inequity becomes cruel towards their own children, generated against their wishes, a clear inequity is brought to light and a secrete turpitude is bared by a manifest cruelty. At times, this voluptuous cruelty, or, if one wants, this cruel voluptuousness, is pushed to the point of obtaining contraceptive substances and in the case of failure to the killing in some way in the womb of the conceived foetuses and their expulsion, with the desire that their own child perishes before living or, when it is already living in the womb, that it is killed before being born. There can be no doubt: if both of them are of the same stamp, they are not spouses; and if they behave like that from the outset they do not unite in marriage but in lustfulness. If then it is not both of them who behave like this, I would venture to say that either she in a certain sense is the prostitute of the husband or he is the adulterer of the wife’.[59]

Although in the view of these theologians abortion before animation could not be held to be murder, nonetheless they refer to an illicit intervention because this violates the intrinsic finality of the embryo to reach the moment of animation. At the most in certain circumstances the abortion of the foetus, seen as being inanimate, is assessed in a less severe way[60] or, in a case where the life of the mother is in danger, it is explicitly allowed.[61]

The return of the theory of delayed animation amongst Christian theologians with the passing of the centuries does not in any way, however, support the conclusion which holds that on the basis of Christian Tradition abortion or the elimination of embryos for research purposes is legitimate. This Tradition also attributed to the inanimate embryo a moral status and a connected dignity because of its intrinsic finality. According to contemporary biology, this is to be found in the development programme that is carried out under the guidance of the chromosomes, whose composition has been established since conception. If one wanted to use one element from Tradition, why are the other elements of Tradition neglected, elements that are compatible with the data of contemporary embryology?


Assessment

Which intrinsic criterion and which basic anthropology should we take as a point of departure in considering the embryo during the first week after conception? From what has been observed hitherto in this paper it emerges that the embryo during the first seven days of its life is 1) a being with its own life that is separate from the life of the mother; 2) a human being from a biological point of view; 3) an individual and 4) a being with an intrinsic finality.

However, can we also conclude that the embryo before implantation is a human individual or a human person? In his assessment of the status of the embryo in his encyclical Evangelium Vitae John Paul II, avoiding declaring expressly that the moment of animation coincides with conception, refers to the conclusions of modern biological science with a rhetorical question: Even if the presence of a spiritual soul cannot be ascertained by empirical data, the results themselves of research on the human embryo provide a ‘valuable indication for discerning by the use of reason a personal presence at the moment of the first appearance of human life: how could a human individual not be a human person? [Donum Vitae I,1][62] (Evangelium Vitae n. 60).

Taking as a point of departure the contemporary knowledge of embryology and above all of modern genetics, how can one not identify, by the use of reason, the early embryo with the human individual or with the human person?

The identification of the early embryo with the human individual or the human person

A solely materialistic explanation, such as that which typifies ‘identity theory’, on the specific functions of the human mind, is insufficient. The process of thinking, which is developed with abstract ideas, although dependent upon sensorial information, is in the final analysis an immaterial function. The same may be said of freedom: material processes, like chemical processes, which unfold according to a pre-determined model, do not explain freedom. Without a spiritual dimension, human freedom would not exist. Both man’s capacity for reason and his freedom pre-suppose that in him there is a spiritual principle of life. To be a human individual or a human person, the embryo must have both a spiritual dimension and a physical dimension. However, the presence of a spiritual dimension cannot be demonstrated through the method of research of the positive sciences. In an empirical way the spiritual dimension is ascertained only in the actualised capacity to perform functions that have in the final analysis their origin in the spirit of man.

In the embryo before implantation and after conception, manifest signs of a spiritual dimension are lacking. The process of thinking and the process of willing are functions in which both the spiritual dimension and the corporeal dimension of man have their own role, but in an integrated way. The content of rational consciousness is the symbols that derive from the sensorial experience of the environment and a person’s own body. The fact that this content is absent in the early embryo because of the fact that the sensorial organs are not sufficiently developed does not in itself exclude the possibility that the capacity to think and to will are already present in potential terms, a potential that will be gradually actualised in a way that is proportionate to the development of the senses. Indeed, we will attempt to demonstrate that it is difficult to think that the spiritual dimension is not present from the moment when the embryo manifests itself as a human being in a biological sense, that is to say from conception.

The specific identity

To return to the embryo before implantation, we must ask ourselves the following question: can we identify a being whose human biological nature alone is observed as a human individual or human person or not? According to the passage from the encyclical Evangelium Vitae quoted above, the contemporary knowledge of embryology and of genetics can provide a ‘valuable indication for discerning by the use of reason a personal presence at the moment of the first appearance of human life’ (EV, n. 60). How can these sciences be useful in discovering a personal presence in the human embryo from conception?

Whatever the case, the contemporary knowledge of embryology contradicts the classic notion in opposition to direct animation (and thus humanisation), a notion according to which the human embryo is said to begin its development as a coagulate of blood, that is to say as a non-living being, and thus a being that is not animated. Contemporary embryology confirms the view which holds that the human embryo, from conception, is a biologically human living being. To this should be added the fact that from conception the development of the embryo takes place in an autonomous, co-ordinated, continuous and gradual way.[63] There are no caesuras in the successive process of development as there could be if there intervened during the course of the development of the embryo another mechanism of co-ordination or integration of the life of the embryo, to be interpreted as a moment when the embryo truly becomes a human individual by receiving a spiritual dimension.

Genetics has discovered the mechanism of this development of the embryo: beginning with conception the embryo is guided by the genome, the conception constitutes the result of the fusion of the chromosomes of the ovule with the chromosomes of the spermatozoon. Knowing that the genome is the most important foundation of the biological identity of a human being, we can ask ourselves what indications genetics can provide, in addition to the indications provided by embryology, to hold that the human embryo is a human person from fertilisation. In other words: is the presence of a fundamental biological identity conceivable without there being present the spiritual dimension that makes the embryo a human person?

The answer to this question depends on the anthropology that is taken as the point of departure. A dualistic anthropology such as identity theory identifies the human person with the mind or the human spirit. From this point of view, the presence of a biologically human being in itself does not imply the presence of a human person. A certain biological development can and must take place before the biological human being becomes a human person with a mind or human spirit. The physical/biological dimension is not seen as an intrinsic dimension of the human person.

According to the doctrine of the Church, which sees the human spirit (the soul) as the substantial (or better subsistent) form of the human individual,[64] both the human spirit and the body are intrinsic dimensions of the human person. The genome as the deepest biological foundation of the body has, therefore, an intrinsic ‘role’ as regards the specific identity of man as an ‘embodied spirit’. Within this framework it is difficult to think of a stage in the development of the human embryo when the spiritual dimension does not exist, whereas the material dimension of the specific identity of man, or at least the biological-genetic identity, is already present. It is difficult to think this above all else because the human genome, as has already been observed in this paper, guides a development that is biologically human that is gradual, continuous and co-ordinated and which does not involve some caesura that could be indicated as the moment when a principle of truly human life, that is to say spiritual subsistent form, from that moment on takes on the guidance of further development.

The numeric identity

This argument also applies to the numeric identity, that is to say the identity by which human persons are distinguished from each other. In reading in a newspaper of the death of ten people because of a train crash I come to know about the generic character, the specific identity, of the victims, that is to say that they are human beings. In fact, however, they are individuals who, in having their own numeric identity, actualise this generic identity in a different way. In essential terms, the numeric identity means that this concrete individual with his or her own characteristics is a human person, independently of the state of his or her development, of his or her physical perfection, of his or her success or his or her defects.[65] The numeric identity, at least from the external angle, can differ considerably during the various different stages of life. The cause of this is that the numeric identity depends upon the material/biological dimension of the human person.

Thomas Aquinas illustrates this when he explains a particular aspect of the numeric identity, that is to say intellectual capacity: this can differ notably between the various individuals of the human species and in the same human individual during the various stages of his or her development.[66] What explains these differences? Taking as a premise that the human spirit (the soul) is the substantial form (or better the subsistent form) of the human individual, a human spirit that was different between human beings would have as a consequence that they, in not having the same generic identity, would not belong to the same species. Whatever the case, the capacity to think employing abstract concepts and the capacity to act freely are not in themselves different amongst human beings. The difference in intellectual capacity is explained with reference to the differences in the neuronal networks of the brain as a result of which the capacity to compute sensorial data can vary notably. In the final analysis the difference lies not in the capacity to think employing abstract concepts in itself but in the disposition of the material dimension of the human individual. The material dimension, therefore, is of determining important for the numeric identity.

Although the numeric identity, anyway externally, differs during life, what determines it fundamentally, although not solely, is the human genome, which is present and active from conception onwards. One understands that during the pre-implantation stage the embryo does not yet possess these neuronal networks given that the nervous system begins its development from the twenty-first day onwards. However, all the neuronal structures are already present in a virtual sense in the DNA from conception, including their contribution in a biological sense to the numeric identity of the human individual. We know that the neuronal networks are present in a virtual sense in the genome (even though other environmental factors also probably have their role in the anatomical and functional development of the brain). The DNA contains the biological basis of all the features that characterise the human being from conception until death.

We have seen that the presence of the genome from conception onwards is a sign of the presence of the spiritual dimension of that event. If this principle of human life is present the embryo from conception onwards has the specific identity of a human person. This means that the embryo is a human person under way, not a human person potentially, as regards its specific identity. The basis of the numeric identity is also actualised. This does not remove, however, the fact that the numeric identity involves a broad potential that is to be actualised. All the changes during the development of the numeric identity, because they do not involve a change in the specific identity, are not, however, substantial, but accidental.

An objection of Lanza and Donceel to this argument is that this implies a coincidence of a formal causality with an efficient causality of the spiritual dimension: the spiritual dimension, if present since conception, would be both the formal cause and the efficient cause of the human body.[67] The formal cause cannot be the efficient cause of the generation of the thing of which it is the substantial form. Here it is useful to distinguish between generation and growth.[68] Development subsequent to the moment of the beginning of existence is different from generation – it is growth. Growth is a process of a living being that has already been generated. The spiritual dimension, once the human body has been formed, is the moving principle, that is to say the efficient cause, of life. It is the root of all the processes of life, including the process of growth of the embryo.

In reflecting on this we can find a response to identity theory which is today the most widespread theory in secular bioethics and which says that there is a human person only when there is a presence of a manifest rational consciousness. The error of identity theory is that it confuses the manifest rational and autonomous consciousness, an aspect of the numeric identity that develops much later than conception, with specific identity, which has already been actualised since conception. It seems to be a contradiction but the manifest rational and autonomous consciousness is an accidental characteristic: an adult human person remains a human person with all connected rights even when the rational and autonomous consciousness has not yet developed or has never developed because of a grave mental handicap or has been irreversibly lost because of an injury to the higher part of the brain (the cortex or the higher cerebral nuclei). It is significant here that the adherents of identity theory on the basis of the belief that a human being deprived forever of a rational and autonomous consciousness is not a human person have proposed that anencephalic foetuses[69] and patients in an irreversible coma (that is to say in a state of partial brain death) should be sources of organs for transplants.[70] Although the numeric identity of anencephalic foetuses and patients in an irreversible coma differs a great deal from the numeric identity of human persons who have developed a normal rational and autonomous consciousness, they have, nonetheless, the actualised specific identity of a human person.


Conclusion

In the assessment of the various and different criteria that are employed to assess the status of the human embryo it is of essential relevance that this embryo has a biologically human status from conception. This status already implies the intrinsic finality of the generation of a human person, leaving aside the question of whether the embryo is a human person from conception. Whatever the case, the embryo is a living being whose development, guided by the genome that is present and active from conception onwards, takes place in an autonomous, co-ordinated, continuous and gradual way. An indirect humanisation is hardly compatible with the fact that the specific identity of the human being is intrinsically made up both of the spiritual dimension and the material dimension, above all given that the biological foundation of the physical dimension, the DNA, is present from conception onwards. Embryology and genetics provide indications that the embryo is a person under way. With respect to the specific identity, it is a human person. In addition, the DNA is the biological basis of the numeric identity. As regards its numeric identity, the embryo has a broad potential that still has to be actualised. This, however, does not remove the fact that it is already a human being under way. Although it is impossible to demonstrate empirically a personal presence from conception, philosophical reflection on the bio-anthropological state of the human embryo indicates an incongruence of indirect or gradual humanisation with the vision of the human individual as a substantial unity of spirit and body.


Notes
1. This is what the American Nobel prize winner, Harold Varmus, asserts. In his view one cannot provide an answer to the question as to the moment when a human being begins to exist. He agrees with the idea proposed by those who see the embryo as a human from the moment the neurons begin to develop, the blood begins to circulate, and the embryo can then survive outside the womb. ‘One can state that there is full individuality only after birth’, see the interview with him in ‘Ich sehe eine moralische Pflicht zum Embryoverbrauch’, Frankfurter Allgemeine Zeitung (2001), 25 August, p. 43.
2. Tweede Kamer (Dutch Parliament), vergaderjaar 2000-2001, 27 423, n. 5, pp. 4-6. This assessment of the status of the embryo i salso very widespread in the Protestant world, see M. Honecker, ‘Divergenzen in der evangelischen Ethik beim Untergang mit Embryonen’, Zeitschrift für Medizinische Ethik 49 (2003), n. 2, pp. 123-136, especially p. 127.
3. Avortement et respect de la vie humaine (Colloque du Centre catholique des médecins français, commission conjuga­le) (Editions du Seuil, Paris, 1972), pp. 93-104, 174-184, 194-204.
4. F. Böckle, ‘Um den Beginn des Lebens’, Arzt und Christ 14 (1968), p. 70; P. Sporken, Voorlopige diagnose. Inleiding tot een medische ethiek, (Ambo, Utrecht, 1969), pp. 68-69 (Sporken uses other arguments to indicate that nidation is the initial moment of human life: the possibility of the division of embryos which then gives rise to twins and the large loss of embryos prior to nidation – these are subjects to which I will return later in this paper. In his book Ethiek en Gezondheidszorg, (Ambo, Baarn, 1977), p. 118 he moderates this idea and argues that nidation is a first, albeit fundamental step, in the gradual process of the hominisation of the embryo side by side with the stage of the differentiation of the neurons of the brain.
5. F. Böckle, ‘Um den Beginn des Lebens’; P. Sporken, Voorlopige diagnose. Inleiding tot een medische ethiek, op. cit., pp. 94-97; P. Sporken, Ethiek en Gezondheidszorg, pp. 154-158.
6.
7. ‘Von Caesar lernen heißt forschen lernen’, Frankfurter Allgemeine Zeitung (2001), 25 June, p. 52.
8. The Dutch Rabbi Evers, for example, is convinced that the human embryo, on the basis of this particolar translation of the text of Genesis 9:6, when outside the womb does not deserve to be protected: ‘Analysing the text one reads only ‘whoever sheds the blood of man in man, his blood will be shed’. The obligation to protect life is subordinated to staying in the maternal womb’. see R. Evers and A.P. Evers, ‘Bijbel positief over klonen van embryo’s’, Trouw (2004), 19 February, p. 14. The authors see the embryo before forty days after conception as ‘inanimate life’. In vitro embryos, because they cannot go on living without artificial aid, are thus said not to be living humans. As regards the experimental use of in vitro embryos being inanimate is not, however, important – embryos within the maternal womb are not yet animated. What is important is the translation of Genesis 9:6 in which the authors see a law that attributes the right to protection only to the embryo that is in the maternal womb.
9. Taken from Bibbia di Gerusalemme (Edizioni Dehoniane, Bologna, 1996; 14a ed.).
10. W.J. Eijk, ‘Therapeutisch’ kloneren nog problematischer dan reproductief kloneren: een bijdrage vanuit katholiek-bijbels perpectief’, Pro Vita Humanae 12 (2005), n. 2, 47-53.
11. Cf. J. Connery, Abortion: The Development of the Roman Catholic Perspective (Loyola University Press, Chicago, 1977), p. 13.
12. Gen 6:3; 9:6 ; Ex 8:13,14; 9:10; 13:2 ; Num 8:17; 17,15; 31:11,26 ; Lev. 24:20; 2 Sam. 23:3 ; Jer. 32:20; 9:15; Mic. 7:2; Ps 68,18; 78,60; 118,8; Qo. 2:24. On this point I have consulted J. Liesen, Professor of Exegesis at the Higher Seminary of Rolduc and member of the International Theological Commission who bases his reply on Abraham Eben-Shoshan, Qonqordantsia chadasha (Kiryat-Sefer, Jerusalem, 1986).
13. W.J. Eijk, ‘Embryo en christelijke mensvisie: wanneer wordt het embryo een menselijke persoon?’, Pro Vita Humana 1 (1994), n. 3, pp. 107-116.
14. Carol A. Tauer, ‘Personhood and Human Embryos and Fetuses’, The Journal of Medicine and Philosophy 10 (1985), p. 264.
Ibid., pp. 263-264.
16. This conclusion is based upon the seven intrinsic and relational criteria advanced by Warren to indicate the moral status of every being: 1) the living being should not be killed without good reason; 2) a feeling being should not be treated cruelly; 3) moral agents have full and equal rights to life and freedom; 4) human beings who can feel but not act have the same moral rights as those human beings who act morally; 5) ecologically important (living or non-living) entities have a sronger moral status that the status they would have if they were independent of the eco-system; 6) animals that are a part of human community have a stronger moral status than the status they would have on their own; and 7) within the framework of the first six criteria moral agents must respect the recognition of moral status by other (‘transitivity of respect’), see Mary Anne Warren, Moral Status: Obligations to Persons and other Living Things (Oxford University Press, Oxford, 1997), pp. 148-177.
17. M.J. Meyer and L.J. Nelson, ‘Respecting what we Destroy. Reflections on Human Embryo Research’, The Hastings Center Report 31 (2001), n. 1, pp. 16-23.
18. Ulpian, Digesta, 25,4,1,1: ‘Partus, antequam edatur, mulieris portio est vel viscerum’.
19. J. Connery, Abortion: the Development of the Roman Catholic Perspective, pp. 22-23.
20. Tertullian, De Anima, 25,2 (CSEL 20, pp. 340-341).
21. J. Wilke and B. Wilke, Abortion: Questions and Answers (Hayes Publishing Company, Cincinnati, 1988), pp. 5-6.
22. The Warnock Report, nn. 11.5 and 11.22, in M. Warnock, A Question of Life. The Warnock Report on Human Fertilisation and Embryology ( Basil Blackwell, Oxford, 1985), pp. 59 and 66.
23. N.M. Ford, When Did I Begin? (Cambridge University Press, Cambridge, 1988); T.A. Shannon and A.B. Wolter, ‘Reflections on the Moral Status of the Pre-embryo’, Theological Studies 51 (1990), pp. 612-614; L.S. Cahill, ‘The Embryo and the Fetus: New Moral Contexts’, Theological Studies 54 (1993), pp. 127-130.
24. B. Häring, Medical Ethics (St. Paul Publications, Middlegreen, 1991, 3rd revised edition), p. 73.
25. Some are of the opinion that the term ‘pre-embryo’ does not suggest this because according to classic embryology one can speak of an embryo only after its implantation in the mucous of the womb. Before that moment one should speak about blastogenesis and subsequently of the genesis of the embryo. However, the term ‘pre-embryo’ was never used in classic embryology and was introduced recently.
26. B.M. Ashley and K.D. O’Rourke, Health Care Ethics. A Theological Analysis (The Catholic Health Associa­tion of the United States, St. Louis, 1989, 3rd ed.), p. 212.
27. Online edition of Science: www.sciencemag.org./cgi/content/abstract/1094515; G. Vogel, ‘Scientists Take Step Toward Therapeutic Cloning’, Science 303 (2004), 13 February, pp. 937-938.
28. W.J. Eijk, The Ethical Aspects of Genetic Engineering of Human Beings (Kerkrade, 1990), pp. 37-39.
29. A. Hellegers, ‘Fetal Development’, Theological Studies 31 (1970), p. 5.
30. T.A. Shannon and A.B. Wolter, ‘Reflections on the Moral Status of the Pre-embryo’, Theological Studies 51 (1990), p. 608.
31. E. Pergament, M. Fiddler, N. Cho, D. Johnson, and W.J. Homgren, ‘Sexual Differentation and Preimplantation Growth’, Human Reproduction 9 (1994), pp. 1730-1732; M. Fiddler, B. Abdel-Rahman, D.A. Rappolee, and E. Pergament, ‘Expression of SRY Transscripts in Preimplantation Human Embryos’, American Journal of Medical Genetics 55 (1995), pp. 80-84.
32. N.M. Ford, When Did I Begin?, pp. 170-177.
33. Hippocrates, Du foetus de sept mois, 7 (E. Littré, Paris, 1851), tome 7, p. 492.
34. Aristotle, The Generation of Animals, ed. and transl. by A.L. Peck (Harvard University Press/William Heinemann, Cambridge/London, 1979) (The Loeb Classical Library no. 366), I, XIX-XX, 727 a -729 a, pp. 95-111
35. Ibid., II, IV, 738 b, pp. 184/185.
36. Ibid., II, III, 736 b, pp. 170/171.
37. Aristotle, De Anima, II, I, 412 a 27 – 412 b 1, and 4-6, in Aristotelis de anima, ed. and transl. by Paulus Siwek, Romae: apud sedes Pont. Universitatis Gregorianae 1954, vol II, (Series Philosophica 9), pp. 92/93.
38. Aristotle, De animalibus historiae, VII, III, in Aristo­telis, Opera omnia (Paris, 1927), vol. III, pp. 137-138.
39. St. Thomas discusses these issues in the following works: Scriptum super libros sententiarum Petri Lombardi, 2, d. 18, q. 2, a. 3; De potentia, q. 3, ad 9; Summa contra gentiles, 2, 87-89; Summa Theologica, 1, q. 76, a. 3, ad 3, and 1, q. 118, a. 2, ad 2; De spiritualibus creaturis, a. 3, ad 12.
40. Sacra Studiorum Congregatio, ‘Theses quaedam, in doctrina Sancti Thomae Aquinatis contentae, et a philosophiae magistris propositae, adprobantur,’ no. XV, AAS 6 (1914), p. 385: ‘Contra, per se subsistit anima humana, quae, cum subiecto sufficienter disposito potest infundi, a Deo creatur, et sua natura incorruptibilis est atque immortalis’, DH n. 3615. Cf. Hyacinthus-M. Hering, ‘De tempore animationis foetus humani’, Angelicum 28 (1951), 18-29; Antonio Lanza, La questione del momento in cui l’anima razionale è infusa nel corpo (Istituto Grafico Tiberino, Rome, 1939).
41. J.P. Gury, Compendium theologiae moralis, Romae/Taurini, 1866 (17e ed.), vol. I, p. 431; E. Genicot, I. Sals­mans, Institutio­nes theolo­giae moralis (Leu­ven/Brussel, 1931), 12th ed., vol. I, n. 375; D.M. Prümmer, Manuale theologiae mora­lis (Her­der, Barcelona, 1945), 10th ed., vol. II, n. 138.
42. J.F. Donceel, ‘Immediate Animation and Delayed Homini­za­tion’, Theological Studies 31 (1970), pp. 76-105.
43. Ibid., p. 101.
44. Karl Rahner, ‘The Problem of Genetic Manipulation’, in Theological Investigations (Darton, Longman and Todd, London, 1981) 2nd ed., vol. IX, p. 226, footnote on page 2. Cf. J.F. Don­ceel, ‘Immediate Animation and Delayed Hominization’, pp. 99-100; J.J. Diamond, ‘Abortion, Animation, and Biolo­gical Hominization’, Theological Studies 36 (1975), pp. 312-313.
45. Anselm, De conceptu virginali, 7 (PL 158, 440): ‘Quod autem mox ab ipsa conceptione rationalem animam habeat, nullus humanus suscipit sensus. Sequitur enim ut quoties susceptum semen humanum, etiam ab ipso momento susceptionis perit antequam perveniat ad humanam figuram; toties damnetur in illo anima humana; quoniam non reconciliatur per Christum: quod est nimis absurdum.’
46. N.M. Ford, When Did I Begin?, p. 180-181.
47. Ibid., pp. 170-177.
48. C.A. Tauer, ‘Personhood and Human Embryo and Fetuses’, pp. 253-266.
49. J. McMahan, ‘Cloning, Killing, and Identity’, Journal of Medical Ethics 25 (1999), n. 2, pp. 77-86, quotation from p. 83.
50. H. Tristram Engelhardt, ‘Viability and the Use of the Fetus’, in Abortion and the Status of the Fetus, ed. W.B. Bondeson, H.Tristram Engelhardt et al., (D. Reidel, Dordrecht, 1983) (Philosophy and Medicine, vol. 13), pp. 184-191; H. Tris­tram Engelhardt, The Foundations of Bioethics (Oxford University Press, New York/­Ox­ford, 1996), 2nd ed., pp. 135-140.
51. R.D. Truog and J.C. Fletcher, ‘Brain Death and the Anen­cep­halic Newborn’, Bioethics 4 (1990), pp. 199-215.
52. J. McMahan, ‘Cloning, Killing, and Identity’, p. 83.
53. G.R. Dunstan, ‘The Human Embryo in the Western Moral Tradition’, in The Status of the Human Embryo. Perspectives from Moral Tradition, ed. by G.R. Dunstan and M.J. Seller, (King Edward’s Hospital Fund for London, London, 1990), p. 55.
54. Tertullian, Apologeticus adversus gentes pro christi­anis, c. IX (PL 1, 319-320): ‘Nobis vero, homicidio semel interdicto, etiam conceptum utero, dum adhuc sanguis in homi­nem delibatur, dissolvere non licet. Homicidii festinatio est prohibere nasci; nec refert natam quis eripiat animam, an nascentem disturbet: homo est, et qui est futurus; etiam fructus omnis jam in semine est.’
55. Ambrose, Expositio Evangelii secundum Lucam, l. I, 44 (PL 15, 1632): ‘Ad cohibendam petulantiam tuam, manus quasdam tui auctoris in utero hominem formantis advertis. Ille opera­tur, et tu sacri uteri secretum incestas libidine?’ An indication of this thought is already to be found in the first Christian texts, for example in the Letter of Barnabus (between the first and second centuries) XX, 2, in which the author says that those who follows ‘the way of the shadows’ are, amongst other things ‘killers of children, destroyers of the plasma created by God’ (PG 1,1230; here quoted from I Padri Apostolici, translated by A. Quacquarelli (Città Nuova Editrice, Rome, 1986) 5th ed., [Collana di Testi Patristici 5], p. 213). Cf. Didachè (+ 100 d.C) V,2: on the way of death there walk amongst others ‘killers of children, destroyers of the creatures of God’ (PG I Padri Apostolici, p. 33).
56. Augustine, Sermo CLVI, c. II (PL 38, 851): ‘Et tamen in omnibus qui nascuntur infirmis Deus quod bonum est opera­tur, formando corpus, vivificando corpus, alimenta praebendo’ Cf. Idem, Contra Julianum Pelagianum l. V, 34 (PL 44, 804): ‘Ut autem concipiatur fetus atque nascatur, divini est operis, non humani.’
57. Augustine, De anima et ejus origine, l. I, c. XVI (PL 44, 488-489).
58. Thomas Aquinas, Scriptum super libros sententiarum Petri Lombardi, 2, d. 18, q. 2, a. 3; De potenti­a, q. 3, ad 9; Summa contra genti­les, 2, 87-89; Summa Theologica, 1, q. 76, a. 3, ad 3, en 1, q. 118, a. 2, ad 2; De spiritualibus crea­turis, a. 3, ad 12; De anima, a. 11.
59. Augustine, De nuptiis et concupiscentia, l. I, c. XV (PL 44, 423-424): ‘Produntur autem quando eo usque progrediuntur, ut exponant filios, qui nascunutur invitis. Oderunt enim nutrire vel habere, quos gignere metuebant. Itaque cum in suos saevit, quos nolens genuit tenebrosa iniquitas, clara iniquitate in lucem promitur, et occulta turpitudo manifesta crudelitate convincitur. Aliquando eo usque pervenit haec libidinosa crudelitas, vel libido crudelis, ut etiam sterilitatis velenam procuret; et si nihil valuerit, conceptos fetus aliquo modo intra viscera exstinguat ac fundat, volendo suam prolem prius interire quam vivere; aut si in utero jam vivebat, occidi antequam nasci. Prorsus si ambo tales sunt, conjuges non sunt: et si ab initio tales fuerunt, non sibi per connubium, sed per struprum potius convenerunt. Si autem non ambo sunt tales, audeo dicere, aut illa est quodammodo meretrix mariti, aut ille adulter uxoris; Petrus Lombardus, Sententiae, l. IV, d. 31, c. 3-4; Thomas Aquinas, Scrip­tum super libros senten­tiarum Petri Lombardi, IV, d. 31, Expositio textus.
60. J. Connery, Abortion: The Development of the Roman Catho­lic Perspective (Loyola University Press, Chicago, 1977), pp. 142-148.
61. G. Grisez, Abortion: the Myths, the Realities, and the Arguments (Corpus Books, New York, 1970), pp. 165-184.
62. Congregation for the Doctrine of the Faith, Donum vitae, I,1, AAS 80 (1988), pp. 78-79.
63. A. Serra and R. Colombo, ‘Identità e statuto dell’embrione umano: il contributo della biologia’, in Identità e statuto dell’embrione umano, J. Carassco de Paula, R. Colombo. M. Cozzoli, L. Eusebi, J. Lafitte, S. Leone, R. Lucas Lucas, L. Melina, L. Palazzani, A. Pessina, E. Sgreccia (Task-Force of the Pontifical Academy for Life) (Libreria Editrice Vaticana, Vatican City, 1998), pp. 143-146.
64. This Aristotelian-Thomist thesis was taken up by the doctrine of the Catholic Church during the Council of Vienna of 1312 (DS n. 902), during the Lateran Council of 1512-1517 (ibid., n. 1440) and in the encyclical Veritatis Splendor (nn. 48ss).
65. Many people, hearing the word ‘identity’, spontaneously think of identity cards or police records. This meaning of identity involves data such as skin colour, hair colour, eye colour, height and weight, physical size and possible mental characteristics. Sociology makes a distinction between ‘natural identity’ and ‘conventional’ identity. By natural identity is means the ability of people to say ‘I’, to see all things in relationship to themselves and to enter into conversation with other people. Conventional identity or role identity is the result of the social integration of a human individual which makes him or her a member of a community. A third concept of identity could be added to these two, that is to say the concept of the ‘identity of the autonomous self’, which is derived from the Kantian conception of an autonomous person: this concerns the identity of the person who manages to subject himself or herself freely to the laws and the general conventions of society. All the various kinds of identity hitherto listed which we think of spontaneously or which are employed by sociology do not apply to the embryo before implantation. For this reason the early embryo, because it cannot appeal to a feeling of solidarity between individuals or to society with other human beings in general is in a situation that in a certain sense is disadvantaged. The foundation of solidarity, in fact, is that one recognises in one’s neighbour something of oneself. However, all these types of identity cannot be seen as being totally independent of what the embryo is: they do not concern, in fact, the deepest level of the identity of the human person. The physical and mental characteristics of police records, the natural and social identity of the description provided by sociology, and also the identity of the autonomous self, which must grow in all of us, can change and indeed they do change during life. These types of identity are accidental. It is necessary to find the ontological identity of the person who is the subject of all these changes. The concept of identity of the social sciences and the ontological concept of Boethius complete each other. The human individual is perhaps able to develop various social identities but only thanks to his or her generic identity and numeric identity, which also provide the limits to the possibilities of developing a social identity. In limiting oneself to social identity and forgetting about ontological identity one runs the risk of attributing being a person only to those people who are able to achieve a social identity in line with a certain standard.
66. In relation to this whole question Thomas Aquinas has fascinating and inspired ideas. For him, the subsistent form is the same for all human persons. Indeed, beings with a different form belong to different species. However, although it is true that all men have the same form, how then can the differences between them be explained? This question is a fascinating one and concerns above all else the evident difference between human beings in their capacity to understand things, a capacity that is directly linked to the spiritual form of man. The answer of Thomas Aquinas is that the difference in form between men can only be accidental: ‘There is a dual formal variety. There is the variety of the form in itself as regards its essential contents; and such diversity leads to a variety of species: However, there is also a variety of the form not in itself, but in an accidental way, which derives from the variety of matter, in the sense that a better arranged matter will participate in the form in a more worthy way; and such variety does not cause a distinction between species and this is the variety of souls’ (Scriptum super libros sententiarum, II, d. 32, q. 2, a. 3, ad 1). This provides the basis for his explanation of the differences between individuals within the same species, that is to say the ‘numeric distinction’ of individuals: ‘the difference of form that comes solely the different arrangement of matter does not make a diversity according to the species but only according to the number. Indeed, there are different forms of different individuals, diversified according to matter’ (Summa Theologica, 1, q. 85, a. 8, ad 3: “… differentiae formae quae non provenit nisi ex diversa dispositione materiae, non facit diversitatem secundum speciem, sed solum secundum numerum; sunt enim diversorum individuorum diversae formae, secundum materiam diversificatae”). Thus it is also explains why a man can understand himself better than someone else, even though they have the same spiritual form: intellectual capacity also depends on the disposition of the lower faculties which the intellect needs for its activity, that is to say the imagination, the cognitive faculty and the sense memory (Summa Theologica, 1, q. 85, a. 7 in c.).
67. A. Lanza, La questione del momento in cui l’anima razionale è infusa nel corpo, pp. 230-231; J.F. Donceel, ‘Immediate Animation and Delayed Hominization’, p. 101.
68. A. Chollet, ‘Animation’, in Dictionnaire de Théologie Catholique (Paris, 1923), vol. I, 2, p. 1314.
69. R.D. Truog and J.C. Fletcher, ‘Brain death and the Anencephalic Newborn’. Bioethics 4 (1990), n. 3, pp. 199-215; J.W. Walters, ‘Anencephalic Infants as Organ Sources’, Bioethics 5 (1991), n. 4, pp. 326-341.
70. J. McMahan, ‘The Metaphysics of Brain Death’, Bioethics 9 (1995), n. 2, pp. 91-126


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Morele reflectie op vaccins geproduceerd op cellijnen van geaborteerde menselijke foetussen

Moral reflections on vaccines prepared from cells derived from aborted human foetuses

Pontifical Academy for Life

The matter in question regards the lawfulness of production, distribution and use of certain vaccines whose production is connected with acts of procured abortion. It concerns vaccines containing live viruses which have been prepared from human cell lines of foetal origin, using tissues from aborted human foetuses as a source of such cells. The best known, and perhaps the most important due to its vast distribution and its use on an almost universal level, is the vaccine against Rubella (German measles).

Rubella and its vaccine

Rubella (German measles)1 is a viral illness caused by a Togavirus of the genus Rubivirus and is characterized by a maculopapular rash. It consists of an infection which is common in infancy and has no clinical manifestations in one case out of two, is self-limiting and usually benign. Nonetheless, the German measles virus is one of the most pathological infective agents for the embryo and foetus. When a woman catches the infection during pregnancy, especially during the first trimester, the risk of foetal infection is very high (approximately 95%). The virus replicates itself in the placenta and infects the foetus, causing the constellation of abnormalities denoted by the name of Congenital Rubella Syndrome. For example, the severe epidemic of German measles which affected a huge part of the United States in 1964 thus caused 20,000 cases of congenital rubella2, resulting in 11,250 abortions (spontaneous or surgical), 2,100 neonatal deaths, 11,600 cases of deafness, 3,580 cases of blindness, 1,800 cases of mental retardation. It was this epidemic that pushed for the development and introduction on the market of an effective vaccine against rubella, thus permitting an effective prophylaxis against this infection.

The severity of congenital rubella and the handicaps which it causes justify systematic vaccination against such a sickness. It is very difficult, perhaps even impossible, to avoid the infection of a pregnant woman, even if the rubella infection of a person in contact with this woman is diagnosed from the first day of the eruption of the rash. Therefore, one tries to prevent transmission by suppressing the reservoir of infection among children who have not been vaccinated, by means of early immunization of all children (universal vaccination). Universal vaccination has resulted in a considerable fall in the incidence of congenital rubella, with a general incidence reduced to less than 5 cases per 100,000 livebirths. Nevertheless, this progress remains fragile. In the United States, for example, after an overwhelming reduction in the number of cases of congenital rubella to only a few cases annually, i.e. less than 0.1 per 100,000 live births, a new epidemic wave came on in 1991, with an incidence that rose to 0.8/100,000. Such waves of resurgence of German measles were also seen in 1997 and in the year 2000. These periodic episodes of resurgence make it evident that there is a persistent circulation of the virus among young adults, which is the consequence of insufficient vaccination coverage. The latter situation allows a significant proportion of vulnerable subjects to persist, who are a source of periodic epidemics which put women in the fertile age group who have not been immunized at risk. Therefore, the reduction to the point of eliminating congenital rubella is considered a priority in public health care.

Vaccines currently produced using human cell lines that come from aborted foetuses

To date, there are two human diploid cell lines which were originally prepared from tissues of aborted foetuses (in 1964 and 1970) and are used for the preparation of vaccines based on live attenuated virus: the first one is the WI-38 line (Winstar Institute 38), with human diploid lung fibroblasts, coming from a female foetus that was aborted because the family felt they had too many children (G. Sven et al., 1969). It was prepared and developed by Leonard Hayflick in 1964 (L. Hayflick, 1965; G. Sven et al., 1969)3 and bears the ATCC number CCL-75. WI-38 has been used for the preparation of the historical vaccine RA 27/3 against rubella (S.A. Plotkin et al, 1965)4. The second human cell line is MRC-5 (Medical Research Council 5) (human, lung, embryonic) (ATCC number CCL-171), with human lung fibroblasts coming from a 14 week male foetus aborted for “psychiatric reasons” from a 27 year old woman in the UK. MRC-5 was prepared and developed by J.P. Jacobs in 1966 (J.P. Jacobs et al, 1970)5. Other human cell lines have been developed for pharmaceutical needs, but are not involved in the vaccines actually available6.

The vaccines that are incriminated today as using human cell lines from aborted foetuses, WI-38 and MRC-5, are the following:7

A) Live vaccines against rubella8:

  • the monovalent vaccines against rubella Meruvax®!! (Merck) (U.S.), Rudivax® (Sanofi Pasteur, Fr.), and Ervevax® (RA 27/3) (GlaxoSmithKline, Belgium);
  • the combined vaccine MR against rubella and measles, commercialized with the name of M-R-VAX® (Merck, US) and Rudi-Rouvax® (AVP, France);
  • the combined vaccine against rubella and mumps marketed under the name of Biavax®!! (Merck, U.S.),
  • the combined vaccine MMR (measles, mumps, rubella) against rubella, mumps and measles, marketed under the name of M-M-R® II (Merck, US), R.O.R.®, Trimovax® (Sanofi Pasteur, Fr.), and Priorix® (GlaxoSmithKline UK).

B) Other vaccines, also prepared using human cell lines from aborted foetuses:

  • two vaccines against hepatitis A, one produced by Merck (VAQTA), the other one produced by GlaxoSmithKline (HAVRIX), both of them being prepared using MRC-5;
  • one vaccine against chicken pox, Varivax®, produced by Merck using WI-38 and MRC-5;
  • one vaccine against poliomyelitis, the inactivated polio virus vaccine Poliovax® (Aventis-Pasteur, Fr.) using MRC-5;
  • one vaccine against rabies, Imovax®, produced by Aventis Pasteur, harvested from infected human diploid cells, MRC-5 strain;
  • one vaccine against smallpox, AC AM 1000, prepared by Acambis using MRC-5, still on trial.

The position of the ethical problem related to these vaccines

From the point of view of prevention of viral diseases such as German measles, mumps, measles, chicken pox and hepatitis A, it is clear that the making of effective vaccines against diseases such as these, as well as their use in the fight against these infections, up to the point of eradication, by means of an obligatory vaccination of all the population at risk, undoubtedly represents a “milestone” in the secular fight of man against infective and contagious diseases.

However, as the same vaccines are prepared from viruses taken from the tissues of foetuses that had been infected and voluntarily aborted, and the viruses were subsequently attenuated and cultivated from human cell lines which come likewise from procured abortions, they do not cease to pose ethical problems. The need to articulate a moral reflection on the matter in question arises mainly from the connection which exists between the vaccines mentioned above and the procured abortions from which biological material necessary for their preparation was obtained.

If someone rejects every form of voluntary abortion of human foetuses, would such a person not contradict himself/herself by allowing the use of these vaccines of live attenuated viruses on their children? Would it not be a matter of true (and illicit) cooperation in evil, even though this evil was carried out forty years ago?

Before proceeding to consider this specific case, we need to recall briefly the principles assumed in classical moral doctrine with regard to the problem of cooperation in evil 9, a problem which arises every time that a moral agent perceives the existence of a link between his own acts and a morally evil action carried out by others.

The principle of licit cooperation in evil

The first fundamental distinction to be made is that between formal and material cooperationFormal cooperation is carried out when the moral agent cooperates with the immoral action of another person, sharing in the latter’s evil intention. On the other hand, when a moral agent cooperates with the immoral action of another person, without sharing his/her evil intention, it is a case of material cooperation.

Material cooperation can be further divided into categories of immediate (direct) and mediate (indirect), depending on whether the cooperation is in the execution of the sinful action per se, or whether the agent acts by fulfilling the conditions – either by providing instruments or products – which make it possible to commit the immoral act. Furthermore, forms of proximate cooperation and remote cooperation can be distinguished, in relation to the “distance” (be it in terms of temporal space or material connection) between the act of cooperation and the sinful act committed by someone else. Immediate material cooperation is always proximate, while mediate material cooperation can be either proximate or remote.

Formal cooperation is always morally illicit because it represents a form of direct and intentional participation in the sinful action of another person.10 Material cooperation can sometimes be illicit (depending on the conditions of the “double effect” or “indirect voluntary” action), but when immediate material cooperation concerns grave attacks on human life, it is always to be considered illicit, given the precious nature of the value in question11.

A further distinction made in classical morality is that between active (or positive) cooperation in evil and passive (or negative) cooperation in evil, the former referring to the performance of an act of cooperation in a sinful action that is carried out by another person, while the latter refers to the omission of an act of denunciation or impediment of a sinful action carried out by another person, insomuch as there was a moral duty to do that which was omitted12.

Passive cooperation can also be formal or material, immediate or mediate, proximate or remote. Obviously, every type of formal passive cooperation is to be considered illicit, but even passive material cooperation should generally be avoided, although it is admitted (by many authors) that there is not a rigorous obligation to avoid it in a case in which it would be greatly difficult to do so.

Application to the use of vaccines prepared from cells coming from embryos or foetuses aborted voluntarily

In the specific case under examination, there are three categories of people who are involved in the cooperation in evil, evil which is obviously represented by the action of a voluntary abortion performed by others: a) those who prepare the vaccines using human cell lines coming from voluntary abortions; b) those who participate in the mass marketing of such vaccines; c) those who need to use them for health reasons.

Firstly, one must consider morally illicit every form of formal cooperation (sharing the evil intention) in the action of those who have performed a voluntary abortion, which in turn has allowed the retrieval of foetal tissues, required for the preparation of vaccines. Therefore, whoever – regardless of the category to which he belongs — cooperates in some way, sharing its intention, to the performance of a voluntary abortion with the aim of producing the above-mentioned vaccines, participates, in actuality, in the same moral evil as the person who has performed that abortion. Such participation would also take place in the case where someone, sharing the intention of the abortion, refrains from denouncing or criticizing this illicit action, although having the moral duty to do so (passive formal cooperation).

In a case where there is no such formal sharing of the immoral intention of the person who has performed the abortion, any form of cooperation would be material, with the following specifications.

As regards the preparation, distribution and marketing of vaccines produced as a result of the use of biological material whose origin is connected with cells coming from foetuses voluntarily aborted, such a process is stated, as a matter of principle, morally illicit, because it could contribute in encouraging the performance of other voluntary abortions, with the purpose of the production of such vaccines. Nevertheless, it should be recognized that, within the chain of production-distribution-marketing, the various cooperating agents can have different moral responsibilities.

However, there is another aspect to be considered, and that is the form of passive material cooperation which would be carried out by the producers of these vaccines, if they do not denounce and reject publicly the original immoral act (the voluntary abortion), and if they do not dedicate themselves together to research and promote alternative ways, exempt from moral evil, for the production of vaccines for the same infections. Such passive material cooperation, if it should occur, is equally illicit.

As regards those who need to use such vaccines for reasons of health, it must be emphasized that, apart from every form of formal cooperation, in general, doctors or parents who resort to the use of these vaccines for their children, in spite of knowing their origin (voluntary abortion), carry out a form of very remote mediate material cooperation, and thus very mild, in the performance of the original act of abortion, and a mediate material cooperation, with regard to the marketing of cells coming from abortions, and immediate, with regard to the marketing of vaccines produced with such cells. The cooperation is therefore more intense on the part of the authorities and national health systems that accept the use of the vaccines.

However, in this situation, the aspect of passive cooperation is that which stands out most. It is up to the faithful and citizens of upright conscience (fathers of families, doctors, etc.) to oppose, even by making an objection of conscience, the ever more widespread attacks against life and the “culture of death” which underlies them. From this point of view, the use of vaccines whose production is connected with procured abortion constitutes at least a mediate remote passive material cooperation to the abortion, and an immediate passive material cooperation with regard to their marketing. Furthermore, on a cultural level, the use of such vaccines contributes in the creation of a generalized social consensus to the operation of the pharmaceutical industries which produce them in an immoral way.

Therefore, doctors and fathers of families have a duty to take recourse to alternative vaccines13 (if they exist), putting pressure on the political authorities and health systems so that other vaccines without moral problems become available. They should take recourse, if necessary, to the use of conscientious objection14 with regard to the use of vaccines produced by means of cell lines of aborted human foetal origin. Equally, they should oppose by all means (in writing, through the various associations, mass media, etc.) the vaccines which do not yet have morally acceptable alternatives, creating pressure so that alternative vaccines are prepared, which are not connected with the abortion of a human foetus, and requesting rigorous legal control of the pharmaceutical industry producers.

As regards the diseases against which there are no alternative vaccines which are available and ethically acceptable, it is right to abstain from using these vaccines if it can be done without causing children, and indirectly the population as a whole, to undergo significant risks to their health. However, if the latter are exposed to considerable dangers to their health, vaccines with moral problems pertaining to them may also be used on a temporary basis. The moral reason is that the duty to avoid passive material cooperation is not obligatory if there is grave inconvenience. Moreover, we find, in such a case, a proportional reason, in order to accept the use of these vaccines in the presence of the danger of favouring the spread of the pathological agent, due to the lack of vaccination of children. This is particularly true in the case of vaccination against German measles15.

In any case, there remains a moral duty to continue to fight and to employ every lawful means in order to make life difficult for the pharmaceutical industries which act unscrupulously and unethically. However, the burden of this important battle cannot and must not fall on innocent children and on the health situation of the population – especially with regard to pregnant women.

To summarize, it must be confirmed that:

  • there is a grave responsibility to use alternative vaccines and to make a conscientious objection with regard to those which have moral problems;
  • as regards the vaccines without an alternative, the need to contest so that others may be prepared must be reaffirmed, as should be the lawfulness of using the former in the meantime insomuch as is necessary in order to avoid a serious risk not only for one’s own children but also, and perhaps more specifically, for the health conditions of the population as a whole – especially for pregnant women;
  • the lawfulness of the use of these vaccines should not be misinterpreted as a declaration of the lawfulness of their production, marketing and use, but is to be understood as being a passive material cooperation and, in its mildest and remotest sense, also active, morally justified as an extrema ratio due to the necessity to provide for the good of one’s children and of the people who come in contact with the children (pregnant women);
  • such cooperation occurs in a context of moral coercion of the conscience of parents, who are forced to choose to act against their conscience or otherwise, to put the health of their children and of the population as a whole at risk. This is an unjust alternative choice, which must be eliminated as soon as possible.

References

  1. E. Banatvala, D.W.G. Brown, Rubella, The Lancet, 3rd April 2004, vol. 363, No. 9415, pp.1127-1137
  2. Rubella, Morbidity and Mortality Weekly Report, 1964, vol. 13, p.93. S.A. Plotkin, Virologic Assistance in the Management of German Measles in Pregnancy, JAMA, 26th October 1964, vol.190, pp.265-268
  3. Hayflick, The LimitedIn Vitro Lifetime of Human Diploid Cell Strains, Experimental Cell Research, March 1965, vol.37, no. 3, pp. 614-636.
    G. Sven, S. Plotkin, K. McCarthy, Gamma Globulin Prophylaxis; Inactivated Rubella Virus; Production and Biological Control of Live Attenuated Rubella Virus Vaccines, American journal of Diseases of Children, August 1969, vol. 118, no. 2, pp.372-381.
  4. A. Plotkin, D. Cornfeld, Th.H. Ingalls, Studies of Immunization With Living Rubella Virus, Trials in Children With a Strain coming from an Aborted Fetus, American Journal of Diseases in children, October 1965, vol. 110, no. 4, pp.381-389.
  5. P. Jacobs, C.M. Jones, J.P. Bailie, Characteristics of a Human Diploid Cell Designated MRC-5, Nature, 11th July 1970, vol.277, pp.168-170.
  6. Two other human cell lines, that are permanent, HEK 293 aborted fetal cell line, from primary human embryonic kidney cells transformed by sheared adenovirus type 5 (the fetal kidney material was obtained from an aborted fetus, in 1972 probably), and PER.C6, a fetal cell line created using retinal tissue from an 18 week gestation aborted baby, have been developed for the pharmaceutical manufacturing of adenovirus vectors (for gene therapy). They have not been involved in the making of any of the attenuated live viruses vaccines presently in use because of their capacity to develop tumorigenic cells in the recipient. However some vaccines, still at the developmental stage, against Ebola virus (Crucell,NV and the Vaccine Research Center of the National Institutes of Health’s Allergy and Infectious Diseases, NIAID), HIV (Merck), influenza (Medlmmune, Sanofi pasteur), Japanese encephalitis (Crucell N.V. and Rhein Biotech N.V.) are prepared using PER.C6® cell line (Crucell N.V., Leiden, The Netherlands).
  7. Against these various infectious diseases, there are some alternative vaccines that are prepared using animals’ cells or tissues, and are therefore ethically acceptable. Their availability depends on the country in question. Concerning the particular case of the United States, there are no options for the time being in that country for the vaccination against rubella, chickenpox and hepatitis A, other than the vaccines proposed by Merck, prepared using the human cell lines WI-38 and MRC-5. There is a vaccine against smallpox prepared with the Vero cell line (derived from the kidney of an African green monkey), ACAM2000 (Acambis-Baxter) ( a second-generation smallpox vaccine, stockpiled, not approved in the US), which offers, therefore, an alternative to the Acambis 1000. There are alternative vaccines against mumps (Mumpsvax, Merck, measles (Attenuvax, Merck), rabies (RabAvert, Chiron therapeutics), prepared from chicken embryos. (However serious allergies have occurred with such vaccines), poliomyelitis (IPOL, Aventis-Pasteur, prepared with monkey kidney cells) and smallpox (a third-generation smallpox vaccine MVA, Modified Vaccinia Ankara, Acambis-Baxter). In Europe and in Japan, there are other vaccines available against rubella and hepatitis A, produced using non-human cell lines. The Kitasato Institute produce four vaccines against rubella, called Takahashi, TO-336 and Matuba, prepared with cells from rabbit kidney, and one (Matuura) prepared with cells from a quail embryo. The Chemo-sero-therapeutic Research Institute Kaketsuken produce one another vaccine against hepatitis A, called Ainmugen, prepared with cells from monkey kidney. The only remaining problem is with the vaccine Varivax® against chicken pox, for which there is no alternative.
  8. The vaccine against rubella using the strain Wistar RA27/3 of live attenuated rubella virus, adapted and propagated in WI-38 human diploid lung fibroblasts is at the centre of present controversy regarding the morality of the use of vaccines prepared with the help of human cell lines coming from aborted foetuses.
  9. M. Prummer O. Pr., De cooperatione ad malum, in Manuale Theologiae Moralis secundum Principia S. Thomae Aquinatis, Tomus I, Friburgi Brisgoviae, Herder & Co., 1923, Pars I, Trat. IX, Caput III, no. 2, pp. 429-434.
    .K.H. Peschke, Cooperation in the sins of others, in Christian Ethics. Moral Theology in the Light of Vatican II, vol.1, General Moral Theology, C. Goodliffe Neale Ltd., Arden Forest Industrial Estate, Alcester, Warwickshire, B49 6Er, revised edition, 1986, pp. 320-324.
  10. Fisher, Cooperation in Evil, Catholic Medical Quarterly, 1994, pp. 15-22.
    .D. Tettamanzi, Cooperazione, in Dizionario di Bioetica, S. Leone, S. Privitera ed., Istituto Siciliano di Bioetica, EDB-ISB, 1994, pp.194-198.
    .L. Melina, La cooperazione con azioni moralmente cattive contra la vita umana, in Commentario Interdisciplinare alia “Evangelium Vitae”, E. Sgreccia, Ramon Luca Lucas ed., Libreria Editrice Vaticana, 1997, pp.467-490.
    .E. Sgreccia, Manuale di Bioetica, vol. I, Reprint of the third edition, Vita e Pensiero, Milan, 1999, pp.362-363.
  11. John Paul II, Enc. Evangelium Vitae, no. 74.
  12. 1868 of the Catechism of the Catholic Church.
  13. The alternative vaccines in question are those that are prepared by means of cell lines which are not of human origin, for example, the Vero cell line (from monkeys) (D. Vinnedge), the kidney cells of rabbits or monkeys, or the cells of chicken embryos. However, it should be noted that grave forms of allergy have occurred with some of the vaccines prepared in this way. The use of recombinant DNA technology could lead to the development of new vaccines in the near future which will no longer require the use of cultures of human diploid cells for the attenuation of the virus and its growth, for such vaccines will not be prepared from a basis of attenuated virus, but from the genome of the virus and from the antigens thus developed (G. C. Woodrow, W.M. McDonnell and F.K. Askari). Some experimental studies have already been done using vaccines developed from DNA that has been derived from the genome of the German measles virus. Moreover, some Asiatic researchers are trying to use the Varicella virus as a vector for the insertion of genes which codify the viral antigens of Rubella. These studies are still at a preliminary phase and the refinement of vaccine preparations which can be used in clinical practice will require a lengthy period of time and will be at high costs. .D. Vinnedge, The Smallpox Vaccine, The National Catholic Bioethics Quarterly, Spring 2000, vol.2, no. 1, p. 12. .G.C. Woodrow, An Overview of Biotechnology As Applied to Vaccine Development, in «New Generation Vaccines), G.C. Woodrow, M.M. Levine eds., Marcel Dekker Inc., New York and Basel, 1990, see pp.32-37. W.M. McDonnell, F.K. Askari, Immunization, JAMA, 10th December 1997, vol.278, no.22, pp.2000-2007, see pp. 2005-2006.
  14. Such a duty may lead, as a consequence, to taking recourse to “objection of conscience” when the action recognized as illicit is an act permitted or even encouraged by the laws of the country and poses a threat to human life. The Encyclical Letter Evangelium Vitaeunderlined this “obligation to oppose” the laws which permit abortion or euthanasia “by conscientious objection” (no.73)
  15. This is particularly true in the case of vaccination against German measles, because of the danger of Congenital Rubella Syndrome. This could occur, causing grave congenital malformations in the foetus, when a pregnant woman enters into contact, even if it is brief, with children who have not been immunized and are carriers of the virus. In this case, the parents who did not accept the vaccination of their own children become responsible for the malformations in question, and for the subsequent abortion of foetuses, when they have been discovered to be malformed.

Responses to questions proposed concerning “uterine isolation” and related matters

The Cardinal Members of the Congregation for the Doctrine of the Faith in answer to the questions examined in ordinary session decreed the following replies:

  1. Q. 1.When the uterus becomes so seriously injured (e.g., during a delivery or a Caesarian section) so as to render medically indicated even its total removal (hysterectomy) in order to counter an immediate serious threat to the life or health of the mother, is it licit to perform such a procedure notwithstanding the permanent sterility which will result for the woman?
  2. R. Affirmative.
  3. Q. 2.When the uterus (e.g., as a result of previous Caesarian sections) is in a state such that while not constituting in itself a present risk to the life or health of the woman, nevertheless is foreseeably incapable of carrying a future pregnancy to term without danger to the mother, danger which in some cases could be serious, is it licit to remove the uterus (hysterectomy) in order to prevent a possible future danger deriving from conception?
  4. R. Negative.
  5. Q. 3.In the same situation as in no. 2, is it licit to substitute tubal ligation, also called “uterine isolation,” for the hysterectomy, since the same end would be attained of averting the risks of a possible pregnancy by means of a procedure which is much simpler for the doctor and less serious for the woman, and since in addition, in some cases, the ensuing sterility might be reversible?
  6. Negative.

Explanation

In the first case, the hysterectomy is licit because it has a directly therapeutic character, even though it may be foreseen that permanent sterility will result. In fact, it is the pathological condition of the uterus (e.g., a hemorrhage which cannot be stopped by other means), which makes its removal medically indicated. The removal of the organ has as its aim, therefore, the curtailing of a serious present danger to the woman independent of a possible future pregnancy.

From the moral point of view, the cases of hysterectomy and “uterine isolation” in the circumstances described in nos. 2 and 3 are different. These fall into the moral category of direct sterilization which in the Congregation of the Doctrine of the Faith’s document Quaecumque Sterilizatio (AAS LXVIII 1976, 738-740, no. 1) is defined as an action « whose sole, immediate effect is to render the generative faculty incapable of procreation ». And the same document continues: « It (direct sterilization) is absolutely forbidden … according to the teaching of the Church, even when it is motivated by a subjectively right intention of curing or preventing a physical or psychological ill-effect which is foreseen or feared as a result of pregnancy ».

In point of fact, the uterus as described in no. 2 does not constitute in and of itself any present danger to the woman. Indeed the proposal to substitute “uterine isolation” for hysterectomy under the same conditions shows precisely that the uterus in and of itself does not pose a pathological problem for the woman. Therefore, the described procedures do not have a properly therapeutic character but are aimed in themselves at rendering sterile future sexual acts freely chosen. The end of avoiding risks to the mother, deriving from a possible pregnancy, is thus pursued by means of a direct sterilization, in itself always morally illicit, while other ways, which are morally licit, remain open to free choice.

The contrary opinion which considers the interventions described in nos. 2 and 3 as indirect sterilizations, licit under certain conditions, cannot be regarded as valid and may not be followed in Catholic hospitals.

During an audience granted to the undersigned Prefect, the Sovereign Pontiff John Paul II approved these responses adopted in an ordinary session of the Congregation for the Doctrine of the Faith, and ordered them to be published.

Rome, at the Congregation for the Doctrine of the Faith, the 31st of July 1993.

+ Joseph Card. Ratzinger
Prefect

+ Alberto Bovone
Titular Archbishop of Caesarea in Numidia
Secretary