Charter for Health Care Workers
Pontifical Council for Pastoral Assistance
114. For the health care worker, serving life means assisting it right up
to its natural completion.
Life is in God's hands: He is the Lord, He alone decides the final
moment. Every faithful servant guards this fulfillment of God's will in the
life of every person entrusted to his care. He does not consider himself the
arbiter of death, just as and because he does not consider himself the
arbiter of anyone's life.
115. When the state of one's health deteriorates to an irreversible and
fatal condition, a person enters into a terminal state of earthly existence.
For him life is particularly and progressively precarious and painful. To
illness and physical suffering is added the psychological and spiritual
drama of detachment which death signifies and implies.
As such, the terminally ill patient is one who needs human and Christian
accompaniment, and it is here that doctors and nurses are called on to make
their expert and unrenounceable contribution. What is in question is special
medical assistance for the dying person, so that also in dying he must know
and will as a living human being. "Never more than in the proximity of death
and in death itself is life to be celebrated and extolled. This must be
fully respected, protected and assisted even in one who is experiencing its
natural end.... The attitude to the terminally ill is often the acid test of
a sense of justice and charity, of the nobility of mind, of the
responsibility and professional ability of health care workers, beginning
116. Dying is part of life as its ultimate phase. It should be cared for,
then, as belonging to it. Hence it calls for the therapeutic responsibility
of the health care worker just as much and no less than every other moment
in human life.
The dying person should not be dismissed as incurable and abandoned to
his own resources and those of the family, but should be re-entrusted to the
care of doctors and nurses. These, interacting and integrating with the
assistance given by chaplains, social workers, relatives and friends, allow
the dying person to accept and live out his death.To
help one to die means to help him to live intensely the final experience of
his life. Where possible and when the one concerned wishes, he should be
given the opportunity of spending his last days at home with suitable
117. A terminally ill person should be given whatever medical assistance
helps to alleviate the pain accompanying death. This would include the
so-called palliative or symptomatic treatment.
The most important assistance is "loving presence" at the bedside of the
There is a proper medical-health presence which, though not deceiving
him, makes him feel alive, a person among persons, because he is receiving,
like every being in need, attention and care. This caring attention gives
confidence and hope to the patient and makes him reconciled to death.
This is the unique contribution which doctors and nurses, by their being
human and Christian-more than by their expertise-can and should make to the
dying person, so that rejection becomes acceptance and anguish gives way to
In this way human dying is withdrawn from the phenomenon of "being overly
medicalized," in which the terminal phase of life "takes place in crowded
and activity-dominated environments, controlled by medical health personnel
whose principal concern is the biophysical aspect of the illness." All of
this "is being seen increasingly as disrespectful to the complex human state
of the suffering person."
118. "Before the mystery of death we are powerless; human certainties
waver. But it is precisely in the face of such a checkmate that Christian
faith...becomes a fount of serenity and peace.... What seems meaningless
takes on meaning and worth."
When this "checkmate" takes place in the life of a person, in this
decisive hour of his existence, the witness of the health care worker's
faith and hope in Christ has a determining role. It displays new horizons of
meaning, that is, of resurrection and life, to the one who sees the
prospects of earthly existence being closed to him.
"Over and above all human consolations, no one can be blind to the
enormous help given to the dying and to their families by faith in God and
the hope of eternal life."
To make faith and hope present is for doctors and nurses the highest form of
humanizing death. It is more than alleviating a suffering. It means applying
one's skills in order to "make going to God easy for the patient."
119. The right to life is specified in the terminally ill person as "a
right to die in total serenity, with human and Christian dignity."
This cannot be interpreted as the power to kill oneself or to give this
power to others, but to experience dying in a human and Christian way and
not flee from it "at any cost." This right is being explicitly expressed by
people today in order to safeguard themselves at the point of death against
"the use of techniques that run the risk of becoming abusive."
Contemporary medicine, in fact, has at its disposal methods which
artificially delay death, without any real benefit to the patient. It is
merely keeping one alive or prolonging life for a time, at the cost of
further, severe suffering. This is the so-called "therapeutic tyranny,"
which consists "in the use of methods which are particularly exhausting and
painful for the patient, condemning him in fact to an artificially prolonged
This is contrary to the dignity of the dying person and to the moral
obligation of accepting death and allowing it at last to take its course.
"Death is an inevitable fact of human life":it
cannot be uselessly delayed, fleeing from it by every means.
120. Aware that he is "neither the lord of life nor
the conqueror of death," the health care worker, in evaluating means,
"should make appropriate choices, that is, relate to the patient and be
guided by his real condition."
Here he will apply the principle-already stated-of "appropriate medical
treatment," which can be specified thus: "When inevitable death is imminent,
despite the means used, it is lawful in conscience to decide to refuse
treatment that would only secure a precarious and painful prolongation of
life, but without interrupting the normal treatment due to the patient in
similar cases. Hence the doctor need have no concern; it is not as if he had
failed to assist the person in danger."
The administration of food and liquids, even artificially, is part of the
normal treatment always due to the patient when this is not burdensome for
him: their undue suspension could be real and properly so-called euthanasia.
121. For the doctors and their assistants it is not a question of
deciding the life or death of an individual. It is simply a question of
being a doctor, that is, of posing the question and then deciding according
to one's expertise and one's conscience regarding a respectful care of the
living and the dying of the patient entrusted to him. This responsibility
does not always and in all cases involve recourse to every means. It might
also require the renunciation of certain means to make way for a serene and
Christian acceptance of death which is inherent in life. It might also mean
respect for the wishes of the patient who refuses the use of such means.
122. Among the medicines administered to terminally ill patients are
painkillers. These, which help to make the course of the illness less
dramatic, contribute to the humanization and acceptance of death.
This, however, does not constitute a general norm of behavior.
"Heroic behavior" cannot be imposed on everyone.And
then, very often, "pain diminishes the moral strength" of the person:
sufferings "aggravate the state of weakness and physical exhaustion,
impeding the impulse of the spirit and debilitating the moral powers instead
of supporting them. The suppression of pain, instead, brings organic and
psychic relief making prayer easier and enabling one to give oneself more
"Human and Christian prudence suggests the use for most patients of
medicines which alleviate or suppress pain, even if this causes torpor or
reduced lucidity. With regard to those who are unable to express their
wishes, one can reasonably suppose that they wish to take painkillers and
these can be administered according to medical advice."
The use of painkillers with the dying, however, is not without its
123. First, their use might have the effect, of not only alleviating
pain, but also of hastening death.
When "proportionate reasons" so require, "it is permitted to use with
moderation narcotics which alleviate suffering, but which also hasten
In this case "death is not intended or sought in any way, although there is
a risk of it for a reasonable cause: what is intended is simply the
alleviation of pain in an effective way, using for that purpose those
painkillers available to medicine."
124. There is also the possibility that painkillers will cause
unconsciousness in the dying person. This use must receive special
"Without serious reasons, the dying person must not be deprived of
Sometimes the systematic use of narcotics which reduce the consciousness of
the patient is a cloak for the frequently unconscious wish of the health
care worker to discontinue relating to the dying person. In this case it is
not so much the alleviation of the patient's suffering that is sought as the
convenience of those in attendance. The dying person is deprived of the
possibility of "living his own life," by reducing him to a state of
unconsciousness unworthy of a human being.This
is why the administration of narcotics for the sole purpose of depriving the
dying person of a conscious end is "a truly deplorable practice "
It is a different matter when there is a serious clinical case for the
administration of analgesics which suppress consciousness, as when there is
violent and unbearable pain. In this case the anesthetic is said to be
licit, provided certain conditions are fulfilled: that the dying person has
fulfilled or could still fulfill his moral, family and religious
Telling the truth to a
125. Telling the truth about the diagnosis and prognosis to the dying
person, and more generally to those suffering from an incurable illness,
poses a problem of communication.
To inform someone that they are dying is difficult and dramatic, but this
is not an exemption from being truthful. Communication between a dying
person and those in attendance cannot be based on pretense. This is never a
human possibility for the dying person and does not contribute to the
humanization of dying.
The person has a right to be informed of their condition. This right is
not lessened where there is a diagnosis and prognosis of a terminal illness,
rather, it is heightened.
This information, in fact, is linked to important responsibilities which
cannot be delegated to another. There are responsibilities bearing on the
treatment to be applied with the informed consent of the patient.
With the approach of death comes the responsibility to fulfill certain
duties in one's relationship with the family, settling possible legal
matters, resolving obligations to a third party. For a believer the approach
of death requires that he be fully aware when he performs certain actions,
especially the reconciling encounter with God in the sacrament of Penance.
The person cannot be abandoned to unconsciousness in the decisive "hour"
of his life, taking him away from himself and from his final and most
important decisions. "Death is too essential a moment for its prospect to be
126. The duty of being truthful with the terminally ill patient demands
discernment and human tact on the part of medical personnel.
It cannot consist of a detached and indifferent communication of the
diagnosis and relevant prognosis. The truth must not remain unspoken, but
neither must it be given in all its bare, crude reality. It should be given
in line with love and charity, calling all those who assist the patient in
various ways to be attuned to this communion.
There is the need to establish a relationship of trust, receptivity and
dialogue with the patient, seeking the appropriate time and words. There is
a way of speaking that is discerning and respectful of the patient's moods,
and it should be in harmony with these. There is a form of conversation
wherein questions are tactfully handled and even provoked, so that the
patient is gradually brought to an awareness of his condition. If one tries
to be present to the patient and sensitive to his lot one will find the
words and the replies which make it possible to communicate in truth and in
charity: "giving the truth in love" (Eph 4:15).
127. "Each case has its own requirements, depending on the sensitivity
and ability of each person, of his or her relationship with the patient and
the patient's condition; to provide for the patient's possible reactions
(rebellion, depression, resignation, etc.), one will prepare oneself to face
them calmly and tactfully."It
is not the exactness of what is said that is important, but the relationship
of solidarity with the patient. It is not simply a matter of giving clinical
facts, but of meaningful communication.
In this relationship the prospect of death is not presented as
inescapable, and it loses its anguishing power: the patient does not feel
isolated and condemned to death. When the truth is presented to him in this
way he is not left without hope, because it makes him feel alive in a
relationship of sharing and communion. He is not alone with his illness: he
feels truly understood, and he is at peace with himself and with others. He
is himself as a person. His life, despite everything, has meaning, and dying
unfolds with optimistic and transcendent meaning.
128. The use of resuscitative technology and the need for vital organs
for transplant operations pose anew today the problem of diagnosing when
Death is seen and experienced by people as a decomposition, a
dissolution, a rupture.
"It comes when the spiritual principle which governs the unity of the
individual is no longer able to exercise its functions on and in the
organism and the elements of the latter, left to themselves, dissociate.
Certainly, this destruction does not effect the entire human being. The
Christian faith-and not it alone-affirms the continuance, beyond death, of
man's spiritual principle." Faith nourishes in the Christian the hope of
again finding his personal integrity transfigured and definitively possessed
in Christ" (1 Cor 15:22).
This faith filled with hope does not prevent "death [from] being a
painful rupture." But "the moment of this rupture is not directly
perceptible, and the problem is to identify the signs."
To ascertain and interpret these signs is not a matter for faith or morals
but for medical science: "it is for the doctor...to give a clear, precise
definition of death and of the moment of death."
"Scientists, analysts and scholars must continue their research and their
studies to determine in the most precise way possible the exact moment and
the irrefutable sign of death."
Once this determination has been achieved, in its light the questions and
moral conflicts arising from new technologies and new therapeutic
possibilities can be resolved. Moral theology, in fact, cannot but
acknowledge the biomedical determination as the decisive criterion.
129. With regard to this determination, the Pontifical Academy of
Sciences has made an authoritative contribution. First with regard to the
biomedical definition of death: "a person is dead when he has irreversibly
lost all ability to integrate and coordinate the physical and mental
functions of the body."
Second, with regard to the precise moment of death: "death comes when: a)
the spontaneous functions of the heart and breathing have definitively
ceased, or b) the irreversible arrest of all brain activity." In reality
"brain death is the true criterion of death, although the definitive arrest
of cardio-respiratory activity very quickly leads to brain death."
Faith and morals accept these findings of science. However, they demand
of health care workers the most accurate use of the various clinical and
instrumental methods for a certain diagnosis of death so that a patient is
not declared dead and treated as such when in fact he is not dead.
130. The crisis which the approach of death involves prompts the
Christian and the Church to be a bearer of the light of truth which faith
alone can cast on the mystery of death.
Death is an event which brings one into the life of God, and revelation
alone can pronounce a word of truth about it. This truth must be brought in
faith to the dying person. The annunciation "full of grace and truth" (Jn
1:14) of the Gospel accompanies the Christian from the beginning to the end
of life. The last word of the Gospel is the word of life that conquers death
and opens up the greatest hope to the dying person.
131. Death, then, must be evangelized: the Gospel must be announced to
the dying person. It is a pastoral duty of the ecclesial community in each
one of its members, according to the responsibilities of each. The hospital
chaplain has a special obligation here, since he is called to minister to
the dying within the broader limits of the pastoral care of the sick.
For him this duty implies not only the role he personally carries out at
the side of the dying entrusted to his care, but also the promotion of this
pastoral activity, through organizing religious services, forming and
sensitizing health care workers and involving relatives and friends.
The announcement of the Gospel to the dying finds especially expressive
and effective forms in charity, prayer and the sacraments.
132. Charity means that giving and receptive presence which establishes
with the dying person a communion born of attention, comprehension, concern,
patience, sharing and selflessness.
Charity sees in the dying person, as in no other, the face of the
suffering and dying Christ calling out for love. Charity to the dying
person-this "poor one" who is renouncing all the goods of this world-is a
privileged expression of love of God in one's neighbor (cf. Mt 25:31-40).
Loving the dying with Christian charity is helping them to recognize and
feel vividly the mysterious presence of God at their side: in the charity of
a brother the love of God becomes visible.
133. Charity enables the relationship with the dying person to expand in
prayer, that is, in communion with God. In this communion one relates to God
as the Father who welcomes his children returning to Him.
To help the dying person to pray and to pray with him means opening up to
him the horizons of divine life. It means, at the same time, entering into
that "communion of saints" in which all the relationships, which death seems
to break irreparably, are re-knit in a new way.
134. A privileged moment of prayer with the dying person is the
celebration of the sacraments: the grace-filled signs of God's salvific
Foremost is the sacrament of the Anointing of the Sick through which the
Holy Spirit, completing in the Christian his assimilation to Christ begun in
baptism, makes him participate definitively in the paschal triumph over
sickness and death.
Viaticum is eucharistic nourishment, the bread of communion with Christ
which gives the dying person the strength to face the final and decisive
stage of life's journey.
Penance is the sacrament of reconciliation: at peace with God, the dying
person is at peace with himself and with his neighbor
135. In this faith, filled with charity the powerlessness experienced
when faced with the mystery of death is not agonizing and paralyzing. The
Christian finds hope and in it the possibility, despite everything, to live
and not suffer death.
136. The inviolability of human life means and implies in the last
analysis the unlawfulness of every act which directly suppresses human life.
"The inviolability of the right to life of the innocent human being from
conception to death is a sign and a requirement of the very inviolability of
the person, to whom the Creator has given the gift of life."
God himself "is the vindicator of every innocent life." "He will call man
to account for the life of man: each one will have to answer for his
brother" (Gen 9:5; cf. Mt 19:18; Rom 13:9). And his commandment is
categorical: "Thou shalt not kill" (Ex 20:13): "Do not kill the innocent or
the just one because I will not absolve the guilty one" (Ex 23:7).
137. This is why "no one can make an attempt on the life of an innocent
person without opposing God's love for that person, without violating a
fundamental, unrenouncable and inalienable right."
This is a right that one has come directly from God (not from others:
parents, society, human authority). "Hence there is no one, no human
authority, no science, no medical, eugenic, social, economic or moral
'indicator' which can show or give a valid juridical justification for
direct, deliberate disposal of an innocent human life, that is, a disposal
aimed at its destruction, either as an end or as a means to another end
which in itself may not be at all illicit."
In particular "nothing and no one can authorize the killing of an
innocent human being, whether it is a fetus or an embryo, a child or an
adult, elderly, ill, incurable or dying. Moreover, no one can request this
homicidal act for themselves or for another for whom they are responsible,
nor can they consent to it explicitly or implicitly. No authority can
legitimately impose it or permit it. It is, in fact, a violation of divine
law. an insult to the dignity of the human person, a anti-life crime, an
attempt on humankind "
138. "Ministers of life and never agents of death,"
it is for health care workers "to safeguard life, to be watchful over its
evolution and development throughout its whole existence, respecting the
plan drawn up by the Creator."
This vigilant ministry of safeguarding human life rejects homicide as a
morally grave act, contrary to the medical mission, and opposes voluntary
death, suicide, as "unacceptable," dissuading anyone tempted to do so from
carrying it out
Among the modalities of the suppression of life, homicide or suicide,
there are two-abortion and euthanasia-against which this ministry should be
particularly vigilant and in a certain way prophetic, due to the cultural
and legislative context which is rather frequently insensitive if not,
indeed, favorable to their propagation.
139. The inviolability of the human person from conception prohibits
abortion as the suppression of prenatal life. This is "a direct violation of
the fundamental right to life of the human being"
and is "an abominable crime."
There is need to make explicit reference to suppression of life by
abortion and its moral gravity because of the ease of recourse to this
homicidal practice today and the ethical indifference towards it induced by
a hedonistic and utilitarian culture-offspring of theoretical and practical
materialism-which has spawned a truly abortionist mentality.
The elimination of the unwanted pregnancy has become a wide-spread
phenomenon, financed by taxpayer's money and facilitated by permissive and
All of this is the fatal cause for many people to avoid taking
responsibility for the expected child and so to banalize a serious sin.
"Unfortunately, this disturbing state of affairs, far from decreasing, is
expanding.... At the same time a new cultural climate is developing and
taking hold, which gives crimes against life a new and-if possible-even more
sinister character, giving rise to further grave concern: broad sectors of
public opinion justify certain crimes against life in the name of the rights
of individual freedom, and on this basis they claim not only exemption from
punishment but even authorization by the state, so that these things can be
done with total freedom and indeed with the free assistance of health care
140. The Church, like every person who holds life dear, cannot become
accustomed to this mentality, and she raises her voice in defense of life,
especially that of the defenseless and unknown, which embryonic and fetal
She calls health care workers to professional loyalty, which does not
tolerate any action which suppresses life, despite "the Ask of
incomprehension, misunderstanding, and serious discrimination" which this
consistency might cause.Fidelity
to medical health de-legitimizes every intervention, surgical or
pharmaceutical, intended to interrupt the pregnancy at any stage.
141. It is also true that in certain cases, by refusing an abortion,
other important goods-which it is only normal that one would want to
safeguard-are put in jeopardy. These could be: danger to the mother's
health, the burden of another child, a serious malformation of the fetus, a
pregnancy caused by rape.
These problems cannot be ignored or minimized, nor the reasons supporting
them. But it must also be affirmed that none of them can objectively give
the right to dispose of another's life, even in the initial phase. "Life, in
fact, is too fundamental a good for it to be compared with certain
disadvantages, even if they be very great."
142. Ethical delegitimization applies to all forms of direct abortion,
since it is an intrinsically blameworthy act. The use of substances or means
which impede the implantation of the fertilized embryo or which cause its
premature detachment is also an act of abortion. A doctor who would
knowingly prescribe or apply such substances or means would cooperate in the
If the abortion follows as a foreseen but nor intended or willed but
merely tolerated consequence of a therapeutic act essential for the mother's
health, this is morally legitimate. The abortion in this case is the
indirect result of an act which is not in itself abortive.
143. If the health care worker is faced with legislation favorable to
abortion he "must refuse politely but firmly."
"One can never obey a law that is intrinsically immoral, and this is so in
the case of a law which admits, in principle, the lawfulness of abortion."
As a result, doctors and nurses are obliged to be conscientious
objectors. The great, fundamental value of life makes this obligation a
grave moral duty for medical personnel who are encouraged by the law to
carry out abortions or to cooperate proximately in direct abortion.
Awareness of the inviolable value of life and of God's law protecting it,
is antecedent to all positive human law. When the latter is contrary to
God's law, conscience affirms its primary right and the primacy of God's
law: "One must obey God rather than men" (Acts 5:29).
"It is not always easy to follow one's conscience in obedience to God's
law. It may entail sacrifice and disadvantages, and one can in no way
discount this cost; sometimes heroism is called for if one is to be faithful
to these demands. Nevertheless, it must be clearly stated that the road of
genuine progress for the human person passes through this constant fidelity
to a conscience upholding rectitude and truth."
144. As well as being a mark of professional loyalty, conscientious
objection on the part of the health care worker, for the right reasons, is
highly meaningful as a social condemnation of a legal injustice against
innocent and defenseless life.
145. The gravity of the sin of abortion and the ease with which it is
carried out, supported by law and the modern mentality, prompts the Church
to threaten the penalty of excommunication for the Christian who procures
it: "One who procures an effective abortion incurs latae sententiae
The excommunication has an essentially preventative and pedagogical
significance. It is a forceful call from the Church, meant to arouse
insensitive consciences, to dissuade people from an act which is absolutely
incompatible with Gospel demands, and to awaken unreserved fidelity to life.
One cannot be in ecclesial communion and at the same time disregard the
Gospel of life through the practice of abortion.
The protection and acceptance of the expected child, its preference to
all other values, is a decisive and credible witness which the Christian
must give no matter what.
146. Health care workers have special obligations with regard to aborted
An aborted fetus, if it is still alive, should be baptized if at all
A dead aborted fetus must be given the same respect as a human corpse.
This means that it cannot be disposed of as just another item of rubbish. If
at all possible it should be appropriately interred.
Likewise, the fetus cannot be used for experimentation or transplant if
the abortion was caused voluntarily. To do so would be an unworthy
instrumentalization of a human life.
147. A mentality ever less ready to recognize life as a value in itself,
relative to God alone, independent of how it came into being; a concept of
the quality of life in terms of efficiency and psychophysical satisfaction,
incapable of seeing any meaning in suffering and handicap, and hence to be
avoided at any cost and by every means; a vision of death as an absurd end
to a life still to be enjoyed, or as a liberation from an existence already
considered meaningless; all of this-within a culture which, leaving God
aside, makes man responsible to himself alone and to freely established laws
of society-is the soil of the euthanasia culture. Where these convictions
are disseminated "it could seem logical and 'human' to end one's own life or
that of another 'peacefully', when all that is left to it is suffering and
"But this is really absurd and inhuman."
Euthanasia is a homicidal act, which no end can justify. By euthanasia is
meant an action or omission which of its nature or by intention causes
death, in order that all suffering may be eliminated. Euthanasia's terms of
reference, therefore, are to be found in the intention of the will and in
the methods used."
The pity aroused by the pain and suffering of terminally ill persons,
abnormal babies, the mentally ill, the elderly, those suffering from
incurable diseases, does not authorize any form of direct euthanasia, active
or passive. This is not a question of helping a sick person, but rather the
intentional killing of a person.
148. Medical and paramedical personnel-faithful to the task of "always
being at the service of life and assisting it to the end"
cannot cooperate in any euthanistic practice even at the request of the one
concerned, and much less at the request of the relatives. In fact, the
individual does not have the right to euthanasia, because he does not have a
right to dispose arbitrarily of his own life. Hence no health care worker
can be the executive guardian of a non-existent right.
It is a different matter when there is question of the right, already
mentioned, of dying with human and Christian dignity. This is a real and
legitimate right which medical personnel are called on to safeguard by
caring for the patient and accepting the natural termination of life. There
is a radical difference between "death dealing" and "consent to dying": the
former is an act suppressing life, the latter means accepting life until
149. "The pleas of gravely ill persons who sometimes ask for death are
not to be understood as implying a true desire for euthanasia; in fact it is
almost always a case of an anguished plea for help and love. What a sick
person needs, besides medical care, is love, the human and supernatural
warmth with which the sick person can and ought to be surrounded by those
close to him or her, parents and children, doctors and nurses."
The sick person who feels surrounded by a loving human and Christian
presence does not give way to depression and anguish as would be the case if
one were left to suffer and die alone and wanting to be done with life. This
is why euthanasia is a defeat for the one who proposes it, decides it and
carries it out. Far from being an act of mercy to the patient, euthanasia is
a gesture of individual and social self-pity and an escape from an
150. Euthanasia upsets the doctor-patient relationship. On the part of
the patient, because he relates to the doctor as one who can assure him of
death. On the part of the doctor, because he is no longer the absolute
guarantor of life: the sick person will be afraid that the doctor may cause
his death. The doctor-patient relationship is a life-trusting one and this
is how it should remain.
Euthanasia is a "crime" in which health care workers, who are always and
only guardians of life, can in no way cooperate.
For medical science it marks "a backward step of surrender, as well as an
insult to the personal dignity of the one who is dying."
Its being depicted as a "further harbor of death after abortion" should be
understood as a "dramatic appeal" for effective, unreserved fidelity to