The Charter for Health Care Workers: A Synthesis of
Hippocratic Ethics and Christian Morality
This paper of mine . . . seeks . . . to show
immediately how the Charter is in very practical terms a synthesis of
Hippocratic ethics and Christian morality.
I have the honor rather than the task of presenting the
Charter for Health Care Workers to
this international conference. When I thought about the best way of doing
this it seemed to me opportune as well as useful to take a broad overall
view. With such an approach it would be possible to give a clear
presentation of the chief concern which pervades the text, namely that of
helping the health care worker to serve human life from its beginning until
its natural end. Such service is fully human and specifically Christian.
This paper of mine thus seeks, and this is a very important point, to show
immediately how the Charter is in very practical terms a synthesis of
Hippocratic ethics and Christian morality. In order to achieve this rather
ambitious goal I will begin by emphasizing the divine origins of each human
life and its destination towards God himself. After this I will describe how
the figure of the health care worker is a servant to this life and thus, and
above all else, to the Author of this life. Finally, I will trace the path
of human existence: generation, life, and death, all of which are central
reference points for ethical-pastoral reflection and thought.
1. God: The Alpha and Omega of Human Life
When there was no man who tilled the soil or who brought forth water from
the earth to irrigate its surface "the Lord God formed man of dust from the
ground, and breathed into his nostrils the breath of life; and man became a
From this creative act of God the Church derives her teaching that each
spiritual soul is created directly by God and is immortal--that is to say,
that it does not perish at the moment of its separation from the body at
death. Not only this but the Church also teaches that this soul is united
once again with the body at the moment of the final resurrection. The life
of the human being, of every human being, is not the product of parents or
of a laboratory projected and constructed by man. Human life, and the point
is not in the least open to discussion, has a divine origin.2
A sentence from the Book of Job is very significant here: "If he (the Lord)
should take back his spirit to himself, and gather to himself his
breath, all flesh would perish together, and man would return to dust."3
Of no less significance is Ezekiel's comment on the resurrection: "And I
shall put my spirit within you, and you shall live."4
Without the "vitalizing breath" of God man would indeed merely fall back
into nothing. But if God gives a soul to the body--that is to say, if he
gives life--then it is more than right that He, and only He, attributes to
Himself the inalienable and inviolable right to manage and order the life of
each human being from the moment of conception until natural death. John
Paul II does not hesitate for a moment to proclaim, with a certain
solemnity, the existence of this divine right: "Human life is sacred because
from its very beginning it bears the `creative action of God' and it always
remains in a special relationship with the Creator, its only end. Only God
is the Lord of life from its beginning until its end: nobody, in any
circumstances, can give to himself the right to directly destroy an innocent
Here we encounter the central feature of Christian morality in relation to
the sacredness and the inviolability of human life, of every human life, of
the human life of every man. This is why Jehovah, when he revealed the ten
commandments of the Covenant, put the commandment "Thou shalt not kill" at
the center of this Covenant, a fact which deserves special attention. God
makes himself not only judge of each violation of the commandment in
defense of life but also and above all else he makes himself the defender
of a commandment placed at the very basis of the whole of social
For good reasons, therefore, Christian morality has always proclaimed and
defended and still proclaims and defends today the incomparable value of the
life of each human person. But Hippocratic ethics, expressed in the ever
relevant and contemporary famous oath, have also proclaimed and defended
this value of each human life and has done so for over two thousand years.
It therefore comes as no surprise that within this permanently valid set of
ethics there are to be found four key features, as Cardinal Fiorenzo
Angelini has pointed out, and these are: "a profound respect for nature in
general; a unifying and integral conception of human life, or rather, of the
human being; a close and rigid relationship between personal ethics and
professional ethics; and a largely active vision of the practice of the art
For Hippocratic Ethics as for Christian morality, therefore, the life of
each human being is a value which cannot be called into question--it must be
defended and watched over. In a word, it must be served. If this imperative
applies to everybody, it must apply first and foremost and above all else to
health care workers. This is what the Charter makes clear, a
Charter which (as I have made clear above) I have the honor to present
to this great and august assembly present here today.
2. The Figure of the Health Care Worker
The activities of the health care worker are the expression of a deeply
human and Christian act of service precisely because such service is not
only of a technical character but also and above all else because it
involves devotion to, and love for, one's fellow man, one's neighbor. In
their care and concern for the lives of other people, health care workers
perform an action which involves the prevention, cure and rehabilitation of
human health and the stewardship of life, an action which is truly Christian
and human. For this reason the primary and emblematic form of such care is
to be found in their concerned and committed presence at the side of the
This is why medical and health care service implies an interpersonal
relationship which is very special: it is, indeed, an encounter between
trust and conscience. It is a relationship of "trust" on the part of the
person in need of treatment and care because he is afflicted by illness and
thus by suffering, and of "conscience" on the part of the person who is able
to respond to this need through a fusion of care, treatment and healing. For
the health care worker the sick person is never or at least should never be
a simple clinical case which should be examined "scientifically." He is
always a person who is in special need--because he is sick--of sympathy or
perhaps of empathy, in the etymological sense of these terms. "Scientific
and professional skill are not enough, personal participation in the
practical situations of each individual patient is what is needed." That is
to say one needs: "readiness to help, attention, understanding, sharing,
benevolence, patience and dialogue."9
In order to achieve a better and more precise understanding of this
Charter it is very important to observe that this total dedication on
the part of the health care worker to serving each sick person finds its
truest "objective" basis and its most pressing "subjective" basis--that is
to say its most involving basis--in an overall vision and understanding of
the sick man himself. Understood at their roots, illness and suffering are
in reality phenomena of human life which pose questions which transcend
medical science and technology. This is because they touch upon the
axiological essence of the existential condition of man on earth. From this
point of view the health care worker, if he is a Christian and thus a
follower of the Good Samaritan or even if he is not a Christian and thus a
follower of the most human "secular" figure of Hippocrates, easily
understands that his profession is a mission and thus a vocation. His
medical-health care activity is thereby a response to a transcendental call
which takes concrete form in the suffering and imploring face of the patient
entrusted to his care. His loving care for a sick person, characterized by
sympathy and empathy, becomes an act of service which is similar to that
related by the parable of the Good Samaritan and also that required
by the oath of the Hippocratic physician. This is why profession,
vocation and mission meet each other in the figure of each and every health
care worker, and in the light of the Christian vision of life and health
the health care worker is a minister of that God who in the Holy
Scriptures is presented as a "lover of life."10
To serve the life of the sick man becomes, indeed, service to God and also
cooperation with God: the gesture of loving welcome of the weak and sick
life in order to give health becomes the giving of praise and glory to God.11
It is no surprise, therefore, that the Church "has always seen medicine as
an important support of her own redemptive mission in relation to man.
Indeed, service to the spirit of man cannot take place fully if it does not
place itself at the service of his psycho-physical unity. The Church well
knows that physical ills imprison the spirit in the same way as the ills of
the spirit enslave the body."12
The figure of the health care worker is, and thus should always increasingly
become, a live image of Christ the Good Samaritan. "Doctors, nurses, other
workers in the world of health, and volunteers," John Paul II makes clear,
"are called upon to be the alive image of Christ and of his Church in love
towards the sick and the suffering: witnesses of the `gospel of life.'"13
3. Ethical-Moral Faithfulness and the Sacredness and Inviolability of
The profession, mission, and vocation of the health care worker naturally
requires a solid training and a constant ethical-religious formation in
moral questions in general and in questions relating to bioethics in
particular. In the presence of clinical cases which become ever more
complicated and intricate in character because of advances in the realm of
biotechnology, all health care workers--but especially medical
doctors--cannot and must not be left alone to be burdened by
responsibilities which can not be borne. This is becomes even more evident
if we reflect upon the fact that many of these advances are still at an
experimental stage and are of great social relevance when we come to
consider matter relating to the whole world of health and health policy.14
We can state with certainty that the true and authentic humanization
of medical science and technology is clearly at stake. In other words, it is
evident that in the field of medicine we need to bring about that
"civilization of love and of life without which the existence of individuals
and society loses its most authentically human meaning."15
Such, then, is the principal aim of this Charter: to guarantee the
ethical faithfulness of the health care worker so that he can build--both in
his choices and in his behavior--that civilization of love and life invoked
by the eminent author of the Evangelium Vitae. And it is for this
reason that the Charter takes as its reference point for ethical and
religious reflection and thought that path of human existence which consists
of being created, of living and of dying.16
3.1. Responsibility Towards the Dignity of Human Procreation
The creation of a new human being is an event which is both profoundly
human and highly religious. This is because it involves the unitive love of
the marriage partners, a reality which is itself an act of cooperation with
God the creator. Because of this it is more than evident that health care
workers are called upon to help the parents and marriage partners to
"procreate with responsibility, to favor the conditions of such procreation,
remove obstacles to it, and safeguard it against an invasive
`technologicalism' which is not worthy of human procreation."17
In this service true morality rightly distinguishes between the
therapeutic manipulation and the alternative manipulation of the
human genetic patrimony. "No social or scientific usefulness and no
ideological motivation could ever justify intervention on the human genome
which is not therapeutic in character, that is to say in itself directed
towards the natural development of the human being."18 The
reason for this "absolute no" is to be found in the very dignity of human
procreation, and this is because the new human being who is born from
conjugal union "carries with him a special image and likeness of God
himself: in the biology of generation is inscribed the genealogy of the
The conception and generation of a new human being is not the outcome of the
laws of biology but constitutes, rather, an event of conjugal cooperation in
the continuation of divine creation. Here the Charter makes clear
that the procreative cooperation practiced by the marriage partners is not
only the criterion behind the anthropological and moral difference between
natural and artificial methods of procreation but also constitutes the
evaluative criterion in matters relating to artificial procreation. "The
dignity of the human person requires that he comes into existence as a gift
of God and fruit of the conjugal act which belongs to, and is specific to,
the unitive and procreative love of the marriage partners, an act which by
its very nature cannot be substituted."20
This is why the appeal to the sense of responsibility of health care workers
to promote this Christian and human conception of sexuality is more than
right and just. In this way the knowledge required for behavior which is
responsible and respectful of the special dignity of human sexuality in
general, and the conjugal act in particular, is made accessible to marriage
partners and above all to young people.21
Health care workers should in the first place help marriage partners
to understand the anthropological and moral difference between natural
assistance and artificial substitution in matters relating to procreation.
In relation to the last question health care workers should stress the
wrongfulness of in vitro fertilization with embryo transfer, whether
it is heterologous or homologous in character. Obviously enough, this moral
judgment concerns only the methods of fertilization and not the human being
in question who must always be welcomed as a gift of God and brought up with
Service to life performed by health care workers begins, therefore, with the
promotion of this very great respect for the originality of the generation
of human beings.
3.2. Responsibility Towards Human Health and Life
The marvelous process of a new human life begins under the wise and
loving protection of love at the moment of fertilization. Health care
workers and in particular gynecologists and obstetricians should "watch with
great care over the wonderful and mysterious process of generation which
takes place in the maternal womb in order to follow its correct development
and promote its happy outcome through the coming into the light of a new
They must remind themselves first and foremost of the singular dignity of
each human life: the dignity of the person created in the image and likeness
of God. Health care workers must above all else be aware that each person is
a unity of body and soul, and realize that for this reason the person
himself in his practical reality becomes achieved through the body. "Each
intervention on the human body does not act only upon tissue, organs and
their functions, but involves the same person at different levels."24
From this it follows that the body, by being a reality which is a property
of the person because it reveals the person in his relationship with God,
with other human beings, and with the world, is the basis and source of
moral requirements. The body cannot be treated like an object which belongs
to somebody, like a thing or an instrument of which we are owners and
arbiters. This is the reason why not everything which is technically
possible can be considered morally acceptable."25
The intrinsic purpose of the profession of health care workers is the
upholding of the right of man to life and to his dignity. Their duty (which
flows from this reality) lies, therefore, in the preventive and therapeutic
stewarding and promotion of health and the improvement of the lives of
people. "Illness and suffering are not experiences which only affect the
physical dimension to man but man in his entirety and in his
Diagnosis, treatment and rehabilitation, therefore, not only aim at the
well-being and the health of the physical body but also seek the integral
well-being of the person in a more general sense. At this point there arises
the question of what happens when it is impossible to cure the sick person.
In such a case the health care worker is always required to effect and
practice all suitable forms of treatment and care but he can also quite
rightly interrupt forms of treatment and care which are not suitable or
Here the question of the humanization of pain through the use of analgesics
or anesthetics is very important. Even though for the Christian pain has a
great penitential and salvific significance, Christian charity itself also
calls upon health care workers to alleviate suffering.28
And here in more pressing fashion comes into play the fundamental right of
the sick person to pastoral care and to the sacrament of the anointing of
the sick. Each and every health care worker is required to create conditions
which will enable those who call for religious assistance, whether
implicitly or explicitly, to receive such assistance. "Indeed, experience
teaches us that man when in need of both preventive and therapeutic help
reveals needs which go beyond the confines of the pathology of the body
which afflicts him. He expects from the medical doctor not only adequate and
suitable care--care which sooner or later will be shown to be insufficient
and with obvious fatal consequences--but also the human support of a brother
who knows how to ensure that he participates in a vision of life which
provides him with a meaning--amongst other things--to the mystery of
suffering and death. And where can be found a peace-giving answer to the
supreme questions about existence if not in faith?"29
3.3. Care and Assistance Until the Natural Conclusion of Life
When conditions of health deteriorate to an irreversible and terminal
level, or rather when man enters into the final stage of his earthly
existence, health care workers are called upon to give special care and help
to the sick person. "Never should life be celebrated and exalted so much as
in nearness to death and at death itself... Behavior towards the terminally
sick is the acid test of the sense of justice and charity, of the nobility
of soul, of the responsibility and the professional ability, of health care
workers, beginning with the doctors themselves."30
This is the moment when dying should be withdrawn from the realm of
medicine, concerned as this is in large measure with the biophysical aspect
of the illness. At this stage the most important form of care lies in a
loving presence which is full of attention and concern, and which instills
trust and hope, replacing, thereby, a refusal of death with its acceptance.
Powerless as we are when faced with the mystery of death, Christian faith is
in such a context the only source of serenity and peace. For this reason,
the bearing of witness to faith and hope in Christ by the health care worker
is of crucial importance. The creation of a presence of faith and hope is
the highest form of humanization and Christianization of dying which doctors
and nurses can promote. In the case of the terminally ill the right to life
becomes the right to die in all serenity and with the greatest possible
human and Christian dignity. This right rules out every form of therapeutic
overkill and, to an even greater extent, every attempt to put an end to
upsets the relationship between patient and doctor. With regard to the
patient this occurs because the patient enters into a relationship with the
doctor which is based upon this latter providing death. With regard to the
doctor this occurs because the physician is no longer the guarantor of
life--the sick person fears, instead, that the physician will proffer death.
The relationship between the doctor and the patient is a relationship based
upon trust in life and it must remain as such. Euthanasia is a `crime' in
which health care workers who are always and only guarantors of life can
The same is true of abortion even if the health of the mother, a child too
many, a serious fetal deformation, and a pregnancy caused by sexual
violence, all involve very serious questions. Indeed, life is such a primary
and fundamental good that it can be placed on an equal footing (in a
situation of equality or even of inferiority) with certain very serious
Here the evident synthesis of Hippocratic ethics and Christian morality
cannot be contested -both Hippocratic ethics and Christian morality regard
all forms of direct abortion or direct (whether active or passive)
euthanasia as illegitimate because one is dealing with an act which destroys
a prenatal life and with an act of murder which nobody can justify.34
Hence the difference from the right to die with human and Christian dignity.
"This is a real and legitimate right which health care staff are called upon
to safeguard by taking care of the dying person and accepting the natural
ending of life. There is a radical difference between `putting to death' and
`allowing to die': the first is an act which destroys life; the second
accepts life until death."35
It is precisely in this acceptance of the end of earthly life that each
faithful servant of life watches over this fulfillment of the will of God.
He does not for any reason whatsoever consider himself the arbiter of death,
in the same way as he does not for any reason consider himself the arbiter
of somebody's life.36
Indeed, it is this context, more than at any other time, consoling for the
dying person when the health care worker bears witness to the fact that full
participation in divine life is the goal to which man on this earth is
called to and oriented towards. In such a context, more than at any other
time, is it comforting for the terminally ill to experience the sacramental
presence of Christ, "Word of life," through the anointing of the sick.
"The whole of man receives help through this sacrament to achieve
salvation. He feels strengthened by trust in God and gains new strength by
which to combat the temptations of evil and the anxieties of death."37
The same is even more true when we consider the Eucharistic encounter,
something which is a viaticum of the body and blood of Christ. In the words
of Christ it is a pledge of the resurrection: "who ever eats of my flesh and
drinks of my blood will have eternal life, and I will raise him up on the
I hope that I have demonstrated what our president, Cardinal Fiorenzo
Angelini, wrote in the preface: that none of the complicated and intricate
problems and questions raised by the inseparable existing relationship
between medicine and morality can, at the present time, be considered a sort
of neutral ground in relation to Hippocratic ethics and Christian morality.
For this reason, the Charter for Health Care Workers has given
rigorous respect to the need to offer an organic and complete synthesis by
the Church, beginning with Pius XII, on all matters concerning the
upholding, in the field of health policy and care, of the primary and
fundamental value of the life of each and every human being from the moment
of conception to natural death.38
I would like to conclude with a special reference to the progress and spread
of the medicine and surgery of transplants, phenomena which guarantee the
treatment and the cure of many sick people who until only recently found
themselves in a terminally ill condition. Here we encounter a challenge to
love of a totally unprecedented character: loving one's neighbor through the
donation of organs so that he can go on living. The removal of organs for
homoplastic transplants from live or dead donors can take place, but
naturally enough within the limits imposed by human nature.39
In the first case the removal is legitimate as long as the removal does not
imply serious and irreversible damage for the donor. In the second case the
body of the dead person must be respected as belonging to a human being,
even if it no longer has the dignity of an individual and the value bestowed
by a person who is still alive. The medical act of transplantation,
therefore, makes the act of oblation on the part of the donor possible, a
sincere giving of oneself which expresses one's essential human and
Christian call to love and communion.40
The intention of the Charter for Health Care Workers is paradigmatic
with regard to service to life, that is to say, in relation to responding to
the call of Christ: "Vade et fac similiter."
1. Genesis 2:7; see also 2:5-6.
2. Catechism of the Catholic Church, 366;
3. Job 34:14-15.
4. Ezekiel, 37:14.
5. JOHN PAUL II, Evangelium Vitae, 53;
7. FIORENZO ANGELINI, Quel Soffio sulla Creta,
(Rome, 1990), pp. 377-378.
8. Pontifical Council for Pastoral Assistance to
Health Care Workers, Charter for Health Care Workers (Vatican City,
1995), fourth edition, no. 1; hereafter Charter.
9. Charter, 2.
11. Cf. Charter, 4.
12. Charter, 5.
13. Quoted in Charter, 5.
14. Cf. Charter, 8.
15. EV, 27, quoted in Charter, 9.
16. Cf. Charter, 10.
17. Charter, 11.
18. JOHN PAUL II, "All'Unione Giuristi Cattolici
Italiani," 5 Dec. 1987, in Insegnamenti, X/3 (1987), 1295, quoted
in Charter, 13.
19. Charter, 15.
20. Charter, 22.
21. Cf. Charter, 20-23.
22. Cf. Charter, 24.30.
23. Charter, 36.
24. Charter, 40.
25. Cf. Charter, 44.
26. Charter, 53.
27. Cf. Charter, 64-5.
28. Cf. Charter, 68-71.
29. JOHN PAUL II, "To the World Congress of
Catholic Doctors," 3 October 1982, in Insegnamenti, V/3, 1982, p.
675, quoted in Charter, note 212.
30. Charter, 115.
31. Cf. Charter, 119; 147-8.
32. Charter, 150.
33. Cf. Charter, 141.
34. Cf. Charter, 139; 147.
35. Charter, 148.
36. Cf. Charter, 114.
37. Cf. Charter, 111.
38. Cf. Charter, p. 5.
39. Cf. Charter, 83.
40. Cf. Charter, 86-91.
(*) The quotations from the Charter for Health Care Workers have
been translated from the Italian edition. The English edition (Vatican City:
Pontifical Council for Pastoral Assistance to Health Care Workers, 1995) is
now available - ED).