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Vol. 3. Núm. 1.
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Vol. 3. Núm. 1.
Páginas 4-20 (enero - junio 2017)
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In defense of the vulnerable in medicine and the life sciences
En defensa de los vulnerables en medicina y las ciencias de la vida
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114
John M. Haas
National Catholic Bioethics Center, Philadelphia, USA
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Abstract

International declarations on human dignity and human rights are recalled, such as United Nations Universal Declaration of Human Rights (1948), and UNESCO Universal Declaration on Bioethics and Human Rights (2005). Instances of violations of such rights in the areas of medicine and life sciences are denounced, such as trade in living human organs, the “reproductive technology industry”, legalized killing of human embryos and assisted suicide. The fact that such rights are currently granted or suppressed by people who have the political power to do so is shown as the cause for such violations, and the need to acknowledge a transcendent source of human dignity and rights is proposed, by which the acceptance of dogmatic teachings of any particular religion is not implied, but rather the acknowledgment, through natural reason, of a Creator who has bestowed worth, dignity and meaning on human beings.

Keywords:
Vulnerability
Person
Bioethics
Medicine
Ethics
Resumen

Se citan declaraciones internacionales sobre la dignidad y los derechos humanos, tales como la Declaración Universal de los Derechos Humanos de las Naciones Unidas (1948) y la Declaración Universal sobre Bioética y Derechos Humanos de la UNESCO (2005). Se señalan ejemplos de violación de dichos derechos en las áreas de medicina y ciencias de la vida, incluyendo prácticas como el comercio de órganos humanos, la “industria de tecnología reproductiva”, el asesinato legalizado de embriones humanos y el suicidio asistido. Se señala como causa de dichas violaciones el hecho de que tales derechos actualmente los otorgan o los cancelan personas que tienen el poder político para hacerlo, y se propone la necesidad de reconocer una fuente trascendente de la dignidad y los derechos humanos, lo cual no implica la aceptación de las enseñanzas dogmáticas de ningún religión en particular, sino más bien el reconocimiento, por la razón natural, de un Creador que ha otorgado valor, dignidad y sentido a los seres humanos.

Palabras clave:
Vulnerabilidad
Persona
Bioética
Medicina
Ética
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Introduction

Today there is universal talk of human dignity and human rights. The terms are imbedded in international protocols, conventions and declarations. The United Nations 1948 Universal Declaration on Human Rights insists upon the innate dignity of all human beings stating simply: “All human beings are born free and equal in dignity and rights.”

The 2005 UNESCO Universal Declaration on Bioethics and Human Rights (“Universal Declaration on Bioethics and Human Rights: UNESCO”, 2005) speaks repeatedly of human dignity. One of the aims of the Declaration is “to promote respect for human dignity and protect human rights, by ensuring respect for the life of human beings, and fundamental freedoms, consistent with international human rights law”. The Declaration continues: “States should respect and promote solidarity between and among States, as well as individuals, families, groups and communities, with special regard for those rendered vulnerable by disease or disability or other personal, societal or environmental conditions and those with the most limited resources.”

In these documents particular solicitude is usually expressed toward those who are vulnerable. Ours indeed is, fortunately, a cultural tradition that values defense of the weak and the vulnerable rather than their elimination or exploitation.

And yet despite various international protocols and declarations, we see countless examples today of violations of human dignity and exploitation of the vulnerable in the areas of medicine and the life sciences. For example, there is a flourishing international trade in living human organs. A man in New York needs a kidney. His physician contacts a broker in Israel who contacts his supplier in Manila. The man in Manila goes into the slums and finds a healthy young man and pays him, perhaps, $1500 for his kidney with little or no follow-up medical care. The kidney is flown to South Africa where the man from New York receives it as a transplant. The man from New York has paid $75,000 for his kidney. The young man in Manila has received $1500, has one less kidney and can suffer medical complications because of a lack of follow-up care. This is a global exploitation of the vulnerable.

There are attempts to address such problems of course. In 2008 a Summit on Organ Trafficking and Transplant Tourism was held in Istanbul, which issued a Declaration signed by 100 nations denouncing the practice. It stated that transplant commercialism should be prohibited because it targets impoverished and vulnerable populations to obtain organs for the wealthy, constituting international acts of injustice and inequity. Yet the commercialism persists and the guidelines from the Declaration are often ignored.

A 2013 article in the Medical Daily cited a report by Global Financial Integrity that the illegal organ trade still generates profits between $600 million and $1.2 billion in profits annually (Scutti, 2013). That same article pointed out that wealthy patients can pay up to $190,000 for a single kidney. It will come as no surprise that the leading recipient nations of these organs are the United States, Canada, the United Kingdom, Israel and Japan. The nations from which these kidneys come are referred to as the “donor nations”. It would be more accurate to describe them as the “exploited nations”, and they include impoverished countries in South America, Africa, Asia and Eastern Europe.

What emerges clearly here is a picture of exploitation arising from a vast differential between wealth and power and poverty and weakness despite the many international protocols against the exploitation of the vulnerable.

Another area of significant abuse today can be seen in the so-called reproductive technology industry which has arisen to address problems of infertility, principally in the developed world. Many of the procedures mine women's bodies to procure eggs for IVF procedures or draw women into commercial contracts to place their bodies at the disposal of the wealthy to carry their children, often at considerable health risks to themselves and invariably in violation of the marital bonds of the women who gestate the fetuses of other people or give their eggs to be fertilized by someone other than their husbands.

Invariably the means offered to overcome the problems of infertility are expressed in terms of generosity and solicitude for those who have difficulty conceiving. People are more easily lured into the infertility business because it is made to appear altruistic, and it is human nature to want to help others. Classical philosophy tells us that it is a constant characteristic human beings to act on behalf of the good and to avoid evil. Consequently there is then a natural tendency on the part of those who become involved in the fertility business to attribute their decisions to selflessness even if that hides what are in fact more base motives, such as a desire to make a profit at the expense of the vulnerable.

Pope John Paul II acknowledged this in his encyclical The Gospel of Life where he said we try to hide the true nature of our immoral actions by naming them in a less than honest manner. “... [We] need... to have the courage to look the truth in the eye and to call things by their proper name, without yielding to convenient compromises or to the temptation of self-deception” (“Evangelium Vitae (25 March 1995) | John Paul II”, 1995).

Yet we engage in this self-deception all the time. The procurement of gametes from donors for in vitro fertilization for the sake of engendering a child for a couple who cannot have a their own child is invariably presented in terms of “donation” and “gift” despite the exchange of considerable sums of money. For example, a broker in Boston seeking to purchase and sell women's ova states on his website:

We truly appreciate what a wonderful thing you are considering doing to help someone have the family they so much desire. We are committed to making the egg donation process as rewarding and enjoyable an experience for you as possible. We will be available to assist you throughout the entire matching and egg donor cycle and will take the time to explain what is involved... Egg donation can be a great option for infertile couples, gay couples and others to become the parents that they have longed to be (“Center For Surrogacy and Egg Donation - CSEDINC”, 2016).

However, this man is not involved in facilitating an egg “donation” but rather the purchasing of the ova from young women and then selling them. It is a financial transaction in which the broker or recipient can offer up to $100,000 for an egg from a woman with desired traits such as a high IQ. And the young woman must then be subjected to receiving a hyper-ovulatory stimulation drug, with some significant risks to her health, so that a number of eggs mature at the same time and can then be retrieved (“Overview – Ovarian hyperstimulation syndrome – Mayo Clinic”, 2016). It is often the case that a young woman in need of money is tempted to sell her eggs which can involve a long and complicated process of taking hormones at inconvenient hours and significantly altering her life-style. A compelling documentary called Eggsploitation has been developed by the Center for Bioethics and Culture about the dangers involved for women who are used by the multi-billion dollar fertility business. After watching the documentary the former president of the National Organization for Women, Donna Ireland, wrote: “Lured by promises of sometimes desperately needed money and a chance to help another woman, vulnerable young women face unknown dangers to their health in an unregulated industry” (“eggsploitation: the infertility industry has a dirty little secret...”, 2016).

This is an area of tremendous exploitation of the weak and vulnerable on every side. The very name by which we refer to these practices demonstrates its dehumanizing and depersonalizing character. We speak of the “reproductive technology industry”. Human beings in fact procreate, lower animals reproduce. Further there is reference to the endgendering of new human life as a “technology” whereas in fact the child should come as a gift arising from the marital embrace of a husband and wife. It is technicians who manipulate the raw material of eggs and sperm to bring about new life in the sterility of a petri dish. And finally human life is looked upon as an industrial product, if you will, subjected to quality control and eliminated if it is found to be in any way defective. Attempts are made to implant only the healthiest embryos from the petri dish and to discard the rest or to freeze them in liquid nitrogen for future use.

The usual practice in IVF procedures is to place at least three embryos in the uterus with the hope that one will implant and grow to viability. However, if all three implant and the mother wants only one child, the technicians engage in so-called “fetal reduction”. They decide which of the children in the womb is the healthiest and strongest and then take a syringe filled with potassium chloride and inject it into the chest cavity of the two children they do not want and kill them. They in fact abort the two children who are not as robust as the one they want to keep. If all are equally healthy, they eliminate the ones who are easiest to reach.

In this case, vulnerabilities are exploited on all sides. The infertile couple pays large sums of money for procedures which are sometime ineffective. Young women in need of money are tempted to sell their eggs at risks to their own health. All involved are willing at times to violate the integrity of the marital union of the infertile couple by introducing into the intimacy of that union children who are not their own or by placing the reproductive powers of their bodies at the disposal of another who is not their spouse. And the child coming into being has his or her right to be born of the loving embrace of a husband and wife violated at his or her very conception. Furthermore, every child engendered in a petri dish is vulnerable to the life and death decisions made on his or her behalf by laboratory technicians. In the United States and Mexico these practices are entirely unregulated leaving human embryos vulnerable not only in a petri dish but even in the uterus of their mother. Yet the terms used to describe the various aspects of these lucrative practices are altruistic ones such as “donation”, “gift”, “generosity”, “assistance to others in need”.

Costa Rica had attempted to safeguard those who are vulnerable in the infertility business by outlawing in vitro fertilization in 2000. The constitution of Costa Rica protects human beings from the moment of conception. However, fifteen years later the Inter-American Court of Human Rights ruled against Costa Rica in a case brought by infertile couples. The court insisted that Costa Rica must legalize IVF. The court decision was fought by the government for two years which was finally forced to allow the practice. An international court chose to remove from the protection of the state an entire class of human beings who are vulnerable and susceptible to exploitation.

Broad, international utilitarian social attitudes have become so strong that even sovereign states cannot resist their influence today. The utilitarian principle attributes value to persons based on their social utility, on the contributions they can make to society. The moral correctness of an action is based on the judgment of what brings about the greatest good for the greatest number. It is obvious that those who make that determination are the ones who have coercive power in a society, leaving the weak and those at the margins of society at greatest risk of exploitation.

The practice of IVF has also given rise to surrogacy, another potentially exploitative practice against vulnerable women. There are two general types of surrogacy. In one case an infertile couple contracts with a woman to serve as a surrogate. The woman customarily has already had children and has demonstrated that she could effectively carry their child to term as a surrogate. The so-called surrogate will have several mature eggs extracted after the use of hyperovulatory stimulation drugs. The eggs are then fertilized in a petri dish by the sperm of the husband. The healthiest embryos are then implanted, carried to term and handed over to the infertile couple. This arrangement is fraught with injustices and the exploitation of the vulnerable. First of all, a human life becomes the object of a financial transaction. The infertile couple contracts with the so-called surrogate mother for a specified sum of money to become impregnated and to carry the child to term. However, the so-called surrogate mother in this case is not a surrogate; she is the actual mother of the child since it was her own ovum which has been fertilized with the sperm of husband of the infertile couple. Further, this has become a species of adultery since the woman is being impregnated by a man other than her husband. This constitutes an injustice against the infertile wife, even if she consents to it because her husband has used his procreative powers with another woman, and the act is an injustice against the marriage itself. The child in the womb of the surrogate is monitored. If it is found that the child is unhealthy or defective, the infertile couple can order the woman to have an abortion. If she refuses to abort her child, the contract can be voided and the so-called surrogate mother becomes liable for all the costs of the pregnancy and delivery and the raising of the child to adulthood. And finally, the practice actually involves trafficking in human lives since the mother of the child is in fact surrendering HER child to the infertile couple for a specified sum of money, $40,000 to $55,000 (“Surrogate Mother Pay | Compensation for Surrogate Mothers”, 2016).

There is a second type of surrogacy in which the surrogate mother has embryos implanted in her womb who actually have been engendered using other people's gametes. This type of surrogacy can also arise because some women desperate for money are willing to assume the considerable risks associated with the practice such as miscarriages or the inability to have an embryo implant, even after a couple of cycles.

It is instructive to note that in the United States 20% of the surrogate babies born each year are carried by military wives, a group that actually represents less than 1% of the female population of childbearing age (Howard, 2015). Their husbands are often away from home for extended periods of time and military pay is very low. These women often need the additional money for their families and so the practice leave them vulnerable to exploitation.

IVF procedures, the purchasing of women's ova, and the practice of surrogacy not only place at risk vulnerable women, but, as already noted, embryonic human beings are particularly at risk. Several embryos are engendered in a petri dish for implantation and only the healthiest, usually three, are chosen for implantation. The rest are used in research, frozen for future use or for donation or are thrown away.

In 2013 it was reported that in Great Britain alone 1.3 million embryos were discarded in the 21 years since records were kept. More than 3.5 million embryos had been engendered in that time and only 7% led to live births. Of the embryos created, 839,325 were put into storage for future use and 2071 were stored for donation to others. A further 5876 were set aside for scientific research (“1.7 million embryos created for IVF have been thrown away, and just 7 per cent lead to pregnancy”, 2012). According to the Human Fertilisation and Embryology Authority in England, roughly 200,000 persons have been born through IVF. But one can only be appalled at the incredible wastage of embryonic human life that results from a procedure that engendered 3.5 million human lives which finally led to only 200,000 live births.

Yet despite the virtually industrial approach to the engendering of new human beings, those who work in fertility clinics invariably sense that these microscopic human beings, these embryos, have some inherent worth. In August 2001 an article appeared on the front page of The New York Times with the headline: “The Job Nobody at the Fertility Clinic Wants” (Kolata, 2001). That “job” of course is the destruction of the embryos that remain after the IVF procedure. Dr. Richard Rawlins, the laboratory director at the Rush Centers for Advanced Reproductive Care in Chicago said that he usually had to discard the embryos himself because the staff found the task so distasteful.

There are simply no laws regulating fertility clinics that might indicate that there are some human values involved in these procedures that deserve protection. Yet fertility clinic staff sense that these embryos indeed have an inherent worth, and they are reluctant to destroy them. It is as if the moral law is written in their hearts. And of course we know that it is.

I have already referred to John Paul II speaking of the tendency to call an immoral act by a name that hides its true character. For example, he spoke of the use of the expression “termination of pregnancy” rather stating that in abortion one is dealing with the direct taking of an innocent human life. However, he actually saw such circumlocutions as the source of hope because it showed that the moral law, which is inherent to everyone, was still exerting its influence. He wrote: “Perhaps this linguistic phenomenon is itself a symptom of an uneasiness of conscience. But no word has the power to change the reality of things: procured abortion is the deliberate and direct killing, by whatever means it is carried out, of a human being in the initial phase of his or her existence, extending from conception to birth.” The reluctance of fertility clinic workers to destroy the lives of embryonic human beings is clearly a “symptom of an uneasiness of conscience” of which John Paul II spoke.

Despite the great destruction of vulnerable human lives, international protocols and government regulations are still drawn up to give the appearance of the protection of the weak and vulnerable. However, they invariably exclude from protection classes of human beings those in power consider to be expendable. Consequently, these protocols not infrequently end up being illogical. One can see this is the 2013 funding provisions for the National Research Institutes of the United States government. In the section dealing with fetal research one reads that a non-viable living human fetus “in utero” may not be subjected to research unless it “(1) may enhance the well-being or meet the health needs of the fetus or enhance the probability of its survival to viability; or (2) will pose no added risk of suffering, injury, or death to the fetus and the purpose of the research or experimentation is the development of important biomedical knowledge which cannot be obtained by other means” (“42 USC 289: Institutional review boards; ethics guidance program”, 2014).

The next section of the document goes on to say that these risk standards will “be the same for fetuses which are intended to be aborted and fetuses which are intended to be carried to term”. So the federal regulations make provisions for no harm being done to a fetus in utero in the course of research – that is, up until the moment it is killed by abortion. It is obvious that such attempts to provide protections to the vulnerable unborn are ineffective and indeed illogical. Yet the attempt is still made.

What accounts for this illogic? I believe there are three factors. First of all, we continue to draw up protocols to protect the vulnerable because the natural moral law is still operative in our hearts and because we have inherited this respect for the innate dignity of the human person from our cultural traditions. Secondly, however, as our culture is becoming increasingly secularized and relativized, we have lost a true understanding of the terms we are using. The philosopher Alisdair McIntyre addressed this in his book After Virtue. We have received words from the tradition such as “virtue” or “justice” or “dignity”. However, we have long lost the philosophical and indeed cultural context in which these terms arose so that they no longer have the meanings they once did. An obvious example is the rise of “rights” language so that rights are appealed to in order to justify any given choice of action. However, the concept of “right” never stood alone in our tradition but was always a correlative term with the concept of “obligation”. A “right” was understood as the moral claim to the means necessary to fulfill an obligation. With the disappearance of natural obligations the claim to “rights” became unbridled.

I can give just one example from the United States. A father has an obligation to protect the life of his child. Yet in the United States, if a wife chooses to abort their child the father of the child can do nothing to exercise his obligation to protect the child. Because of decisions of our Supreme Court, the right of the mother to choose an abortion overrides her obligations as a mother, her husband's obligations as a father, and the baby's very right to life.

And I believe the third reason many of these protocols and declarations to protect the vulnerable become ineffective and even illogical is because of the growing Godless materialism in the powerful developed world. During his reign as pontiff, John Paul II spoke of the theoretical atheism of the communist states. But he also spoke of the practical atheism of western nations that had Christian roots but had lost them. In a Godless, atheistic society the weak and marginalized becomes very vulnerable.

To counteract this global tendency John Paul invited the leaders of all the world's major religions to Assisi in 1986 to pray for peace. Forty-two different religious groups or movements gave testimony to the natural human quest of the supernatural. In 2008 Pope Benedict severely criticized statements marking the 50th anniversary of the founding of the European Union for making no mention of God and of the continent's Christian roots. He stated: “A community that builds itself without respecting the true dignity of the human being, forgetting that each person is created in the image of God, ends up doing good for no one” (Pullella, 2007). Both he and John Paul II were critical of the constitution of the European Union for making no mention of God.

One of the problems with international protocols and declarations, which insist upon the dignity of the human person, is that there is never any reference to the source of that dignity. “Human dignity” is simply affirmed with the result that it becomes an arbitrary concept imbued with the meaning that the craftsmen of language want it to have. This can account in part for the illogical character of insisting on human rights in countless international documents but then establishing policies which are indeed grotesque violations of human dignity.

The arbitrary determination as to which human beings enjoy dignity results when there is no understanding of the source of human dignity. Who is it then who qualifies as a person to enjoy the protection of the state, particularly in their vulnerability? Frankly, it is the ones in power who choose who should qualify as persons with inviolable dignity.

There are many places where policies and practices become illogical if there is not an understanding of the source, and hence the nature, of human dignity. I have already mentioned the illogic of protecting the unborn child from the harms of non-therapeutic research – until it is killed! This illogic can be seen clearly in many other of the political and cultural situations in the United States. Breweries are required to put warning labels on bottles of beer that the consumption of alcohol by pregnant women may adversely affect the health of their unborn child. Federal regulations restrict the use of research money only to projects that do not put the unborn child at risk. They are treated as persons and are protected – unless the mother should decide she wants to abort the child and then the vulnerable child is no longer treated as a person with inviolable dignity. But these decisions are made quite arbitrarily.

When the United States Supreme Court eliminated all state laws which protected the unborn child from direct killing, Justice Harry Blackmun who issued the decision wrote: “If personhood is established, the case for legalized abortion collapses, for the fetus’ right to life would be guaranteed by the [the constitution itself].”

However, in the court decision an arbitrary decision was made not to regard the unborn child as a person deserving of the protection of the state. It had no worth by virtue of its very being.

Germany, on the other hand, in 1990 passed the Embryonenschutzgesetz, the Embryo Protection Law, which protects the embryo from the moment of the fusion of the nuclei of the two gametes. Personhood was extended to the embryo even to the extent that pre-implantation genetic diagnosis was outlawed. Pre-implantation genetic testing is done on embryos following their being engendered through IVF by plucking a cell from the embryo and testing it for a genetic disorder. If a disorder is discovered the embryo is discarded. Germany forbad the practice because it was looked upon as a form of eugenics which was of course one of the worst abuses that took place in Germany under the National Socialists.

Because of its past experience with National Socialism, Germany is very reluctant to allow any activities which could be seen as violating a vulnerable human being. In the late 1980s one of the statements of the Green Party read: “We Germans, in light of the experiences during the years 1933 through 1945, should be sensitive, even supersensitive” to the threats to human dignity in the area of biotechnology.

One of the problems with so many international protocols with language protecting the dignity of the human person is that no mention is made of the source of human dignity. Consequently dignity is bestowed by the state arbitrarily on one class of human beings and not on another, such as the unborn or those in a persistent vegetative state or those who are dying. The UNESCO Universal Declaration on Bioethics and Human Rights makes no allusion whatsoever to the source of human dignity and hence human rights. One of the aims of the Declaration is “to promote respect for human dignity and protect human rights, by ensuring respect for the life of human beings” but then allows states to exclude categories of human beings as having innate dignity because the source of human dignity is not acknowledged.

In 1948 the United Nations issued its Universal Declaration of Human Rights. It declared that “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act toward one another in a spirit of brotherhood.”

I do not want to read into the text what is not there but the Declaration does speak of human beings being “endowed” with reason and conscience and that they should act toward one another in a spirit of “brotherhood”. This clearly implies, if rather obliquely, that all persons were given reason and conscience, that these are attributes, which have been bestowed on them by what, must be a higher, creative power. What else could “endow” mean?

One of the founding documents of the United States of America speaks quite explicitly to the source of human dignity. The signers of the Declaration of Independence stated: “We hold these truths to be self-evident, that all men were created equal, that they were endowed by their Creator with certain inalienable rights, that among these are life, liberty and the pursuit of happiness.” Here there is not only an allusion to the source of our innate human dignity but a forthright and clear affirmation of it. Our rights, our dignity, have been bestowed on us by a Creator. The final source of our dignity is the ultimate Source of all that is, the Creator Himself. This is not to make a sectarian, religious claim. Rather the existence of a Creator God is indeed the inescapable reasonable conclusion of our natural reason. With the acknowledgment of a Creator there is an implicit acknowledgment of our objective, created nature and of an objective order within which we can live and flourish. Natural reason recognizes an inherent, innate disposition to distinguish between right and wrong and to choose what is right. Our natural disposition to choose good and avoid evil is an expression of our created nature and of our moral worth.

The awe and reverence which accompany an acknowledgment of one's fellow human being as a person with dignity have a certain commonality with the sentiments aroused by religious experience. When one experiences the presence of the divine in some place, Mt. Sinai, for example, or Tepeyac, the natural response is to establish a shrine there and to mark off a certain space as sacred ground. A taboo is often put up as a way of avoiding any violation of the sacred place. Religious taboos exist to protect the sacred from being violated, even inadvertently.

In a sense, moral absolutes in medicine and the life sciences exist to protect the innocent from violation. Primum non nocere. First of all, do no harm. That is an absolute that protects the integrity and dignity of every person who would come to a physician for help, particularly in his or her vulnerability.

It is perhaps in the universal phenomenon of religious experience that one can find a clue to the source of the dignity which is associated with human persons. Simply as animals, human beings would elicit no sense of reverence. Human beings, like other animals, are contingent, unnecessary beings. They are finite and mortal. They do not explain themselves. There must be some explanation for their existence other than themselves. Consequently one can reasonably posit an extrinsic source of their existence, an outside cause, a Creator – if you will, a transcendent Person.

Human beings are contingent beings who cannot explain their own existence. It comes from beyond them. The UNESCO Declaration on Bioethics does not allude, even obliquely, to a divine source of human dignity and worth. But it does speak of human attributes which clearly transcend the simply natural. It points to the “unique capacity of human beings to reflect upon their own existence and on their environment; to perceive injustice;.... to assume responsibility.... to exhibit the moral sense that gives expression to ethical principles.” These are all qualities which vastly transcend the natural order and show that we are here dealing with a person with dignity, not simply a natural being. Furthermore, these qualities could not arise merely from the natural order for there is nothing in the natural order, which exhibits a “moral sense”.

One does not have to embrace a particular religion to acknowledge this truth which can be known by reason, i.e., that human beings have been created by a transcendent being, a Person, who bestows gifts and powers on them which enable them to transcend all the rest of creation. As the German poet Rainer Maria Rilke puts it in his Ninth Duino Elegy: “Are we, perhaps, here just for saying: House, Bridge, Fountain, Gate,.... – possibly: Pillar, Tower?... but for saying, remember, oh, for such saying as never the things themselves hoped so intensely to be.”

It is the consciousness of human persons, which takes in and elevates even inanimate objects to a level of dignity, which they themselves simply could not have. The human person shares in both the natural and the spiritual order thereby bestowing even upon things, as Rilke puts it, an “intensity of being” which they would not have without their being taken up by the perceiving powers of human persons.

Human beings transcend the natural order through self-awareness and moral judgment which manifest an immortal quality since these qualities are spiritual and non-corporeal and inhere in a person by virtue of his or her very being, not by virtue of what he or she can do. This spiritual quality, which imparts to human beings the dignity of personhood is a divine, spiritual quality which could only be bestowed by the one who Himself is pure spirit and creator of all that is.

Human persons recognize in others traces of the divine Person which is ultimately the source of their dignity. They recoil from violating another because to do so would constitute a violation of the sacred, the source of their own dignity, the source of their being, the source of their special status in the cosmos. To violate the inviolability of another human being, then, is to commit a kind of sacrilege against God Himself.

If there is no reference to the divine source of human personhood, and hence human dignity, then personhood becomes a status, which is arbitrarily and subjectively attributed to one human being by another – the one with the power and capability to do the attributing. The danger here is that ultimately those who wield power in society become the ones to decide if this or that human being has the attributes, which are valued. Today, in the absence of a supernatural source of human dignity, it is the utilitarian principle that comes to bestow value. A person has value if the person is of social utility, if he or she can contribute something of perceived value to the broader society. The vulnerable indeed are seen as having no innate worth and hence can even be disposed of by the larger society.

It is in the advanced, secularized, dare one say, Godless societies of the West in which the vulnerable are increasingly at risk. In 2002 the Netherlands became the first country to legalize physician-assisted suicide and euthanasia, followed by Belgium the same year. There were 235 cases of euthanasia in 2003 in the Netherlands, which rose to 1807 a decade later (”Euthanasia and assisted suicide laws around the world“, 2014). Usually the law provides for euthanasia or physician-assisted suicide if death is imminent and if the person is suffering from intractable pain. However, in practice this has not usually been the case. In the United States there are four states that permit physician-assisted-suicide: Oregon, Wyoming, Montana, and California.

It was reported in August of this year that in Oregon the principal reason people sought physician-assisted-suicide was consideration of the quality of life, not pain and suffering. “Loss of autonomy, or not being able to care for oneself and make one's own decisions, is reported in 100% of cases of [assisted suicide] in Oregon. Closely following are the loss of one's dignity and the loss of being able to participate in enjoyable activities, both reported in 86% of [assisted suicide] cases in Oregon” (Morrow, 2016).

These reasons indicate that people are seeking physician assisted suicide because of a sense of vulnerability which could be addressed by the support of family and friends along with appropriate palliative care.

And of course it is well known that in September, the first minor was euthanized in Belgium. This places children with disabilities at considerable danger in Belgium. The children who seek euthanasia are supposed to be capable of discernment. However, there is no adequate discernment that can justify the direct taking of an innocent life. The Belgian law also extends the supposed right to euthanasia to those with dementia. But if a patient has dementia one must ask how he or she could even exercise any kind of discernment.

This unique horror, which has developed in Belgian, arose on a continent, which as Benedict XVI said, has committed apostasy against itself and its own Christian roots.

Once the unique dignity of human persons is lost in a secularized society, there are no longer any moral absolutes which can serve to protect them. The unique dignity of human beings has long been compromised in the West by so many practices which have now become commonplace. The unique dignity of a husband and wife engendering new life through a loving marital embrace has been lost through our utilization of life-denying techniques which were once used only for animals, such as surgical sterilizations or devices placed in the uterus. The unique dignity of a husband and wife procreating human life has almost been lost through the use of laboratory technicians to engender life in a petri dish. The unique dignity of assisting a loved one through the dying process has been replaced with direct acts of killing which were once used on dogs or horses. Once the supernatural, sacred source of our dignity has been forgotten, we run the risk of losing our dignity and the moral absolutes which would protect it.

The Second Vatican Council of the Catholic Church addressed this problem. In the document Gaudium et spes it states: “For without the Creator, the creature would disappear.... When God is forgotten... the creature itself becomes unintelligible” (”Evangelium Vitae (25 March 1995) | John Paul II”, 1995). With no awareness of a Creator and the purposefulness with which He endowed His creation, we can no longer even understand the natural order and subsequently the moral order. Without the supernatural, the natural degenerates into the unnatural. There must be a higher guarantor of moral rectitude and of human dignity than the laws of nation states or the conventions of international organizations.

We need protocols and declarations in bioethics of course. But they themselves will be manipulated to serve the interests of the powerful if there is not an acknowledged objective moral order deriving from a supernatural source.

The irony is that as the human person has wanted to assert himself as the highest of all beings with none higher, he has lowered himself to the level of animals and is treated as such by his fellow human beings.

In order to protect the weak and the vulnerable in medicine and the life sciences today there must be a general societal acknowledgment of the source of humanity's incomparable dignity. This is not a matter of accepting the dogmatic teachings of any particular religious body, including the Catholic Church. It does mean, at a minimum, the acknowledgment through natural reason of a Creator who has bestowed worth, dignity and meaning on us and on the world we inhabit.

The National Catholic Bioethics Center

Philadelphia, September 2016

Conflicts of interest

The author has no conflicts of interest to declare.

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