1. The work of health care persons is a very
valuable service to life. It expresses a profoundly
human and Christian commitment, undertaken and
carried out not only as a technical activity but
also as one of dedication to and love of neighbor.
It is "a form of Christian witness."
"Their profession calls for them to be guardians and
servants of human life" (Evangelium Vitae
Life is a primary and fundamental good of the
human person. Caring for life, then, expresses,
first and foremost, a truly human activity in
defense of physical life.
It is to this that professional or voluntary
health care workers devote their activity. These are
doctors, nurses, hospital chaplains, men and women
religious, administrators, voluntary care givers for
those who suffer, those involved in the diagnosis,
treatment and recovery of human health. The
principal and symbolic expression of "taking care"
is their vigilant and caring presence at the
sickbed. It is here that medical and nursing
activity expresses its lofty human and Christian
2. Health care activity is based on an
interpersonal relationship of a special kind. It is
"a meeting between trust and conscience."
The "trust" of one who is ill and
suffering and hence in need, who entrusts himself to
the "conscience" of another who can help him in his
need and who comes to his assistance to care for him
and cure him. This is the health care worker.
For him "the sick person is never merely a
clinical case"-an anonymous individual on whom to
apply the fruit of his knowledge-"but always a 'sick
person,' towards whom" he shows a sincere attitude
of "sympathy," in the ethymological sense of the
This requires love: availability, attention,
understanding, sharing, benevolence, patience,
dialogue. "Scientific and professional expertise" is
not enough; what is required is "personal empathy
with the concrete situations of each patient."
3. To safeguard, recover and better the state of
health means serving life in its totality. In fact,
"sickness and suffering are phenomena which, when
examined in depth, ask questions which go beyond
medicine to the essence of the human condition in
this world. It is easy to see, therefore, how
important in socio-medical service is the
presence...of workers who are guided by an holistic
human vision of illness and hence can adopt a wholly
human approach to the suffering patient."
In this way, the health care worker, if animated
by a truly Christian spirit, will more easily become
aware of the demanding missionary dimension of his
profession: "his entire humanity comes into play"
here "and nothing less than complete commitment is
required of him."
To speak of mission is to speak of vocation:
the response to a transcendent call which takes
shape in the suffering and appealing countenance of
the patient in his care. To care lovingly for a sick
person is to fulfill a divine mission, which alone
can motivate and sustain the most disinterested,
available and faithful commitment, and gives it a
he presents the heart of his redemptive mission,
Jesus says: 'I came that they may have life, and
have it abundantly' (Jn 10:10).... It is precisely
in this 'life' that all the aspects and stages of
human life achieve their full significance" (Evangelium
The health care worker is the good Samaritan of
the parable, who stops beside the wounded person,
becoming his "neighbor in charity (cf. Lk 10:29-37).
4. This means that health-care is a ministerial
instrument of God's outpouring love for the
suffering person; and, at the same time, it is an
act of love of God, shown in the loving care for the
person. For the Christian, it is an actualized
continuation of the healing love of Christ, who
"went about doing good and healing everyone" (Acts
And at the same time it is love for Christ: he is
the sick person-"I was sick"-who assumes the face of
a suffering brother; since he considers as done to
himself-"you did it to me"-the loving care of one's
brother (cf. Mt 25: 3140).
Profession, vocation and mission meet and, in the
Christian vision of life and health, they are
mutually integrated. Seen in this light, health care
assumes a new and more exalted meaning as "service
to life" and "healing ministry."
Minister of life,the
health care worker is "the minister of that God, who
in Scripture is presented as 'a lover of life"' (Wis
To serve life is to serve God in the person: it is
to become "a collaborator with God in restoring
health to the sick body"
and to give praise and glory to God in the loving
welcome to life, especially if it be weak and ill.
5. The Church, which considers "service to the
sick as an integral part of its mission,"
assumes it as an expression of its ministry.
"The Church...has always seen medicine as an
important support for its own redeeming mission to
humanity." In fact, "service to man's spirit cannot
be fully effective except it be service to his
psycho-physical unity. The Church knows well that
physical evil imprisons the spirit, just as
spiritual evil subjects the body."
It follows that the <therapeutic ministry> of
health care workers is a sharing in the pastoral
work of the Church. Service to life becomes a
ministry of salvation, that is, a message that
activates the redeeming love of Christ. "Doctors,
nurses, other health care workers, voluntary
assistants, are called to be the living image of
Christ and of his Church in loving the sick and the
witnesses of "the gospel of life."
6. Service to life is such only if it is faithful
to the moral law, which expresses exigently its
value and its tasks. Besides technico-professional
competence, the health care worker has ethical
responsibilities. "The ethical law, founded on
respect for the dignity of the person and on the
rights of the sick, should illuminate and govern
both the research phase and the application of the
In fidelity to the moral law, the health care worker
actuates his fidelity to the human person whose
worth is guaranteed by the law, and to God, whose
wisdom is expressed by the law.
He draws his behavioral directives from that
field of normative ethics which nowadays is called
bioethics. Here, with vigilant and careful
attention, the magisterium of the Church has
intervened, with reference to questions and disputes
arising from the biomedical advances and from the
changing cultural ethos. This bioethical magisterium
is for the health care worker, Catholic or
otherwise, a source of principles and norms of
conduct which enlighten his conscience and direct
him-especially in the complexity of modern
bio-technical possibilities-in his choices, always
respecting life and its dignity.
7. The continuous progress of medicine demands of
the health care worker a thorough preparation and
ongoing formation so as to ensure, also by personal
studies, the required competence and fitting
Side-by-side with this, they should be given a
solid "ethico-religious formation,"
which "promotes in them an appreciation of human and
Christian values and refines their moral
conscience." There is need "to develop in them an
authentic faith and a true sense of morality, in a
sincere search for a religious relationship with
God, in whom all ideals of goodness and truth are
"All health care workers should be taught
morality and bioethics."To
achieve this. those responsible for their formation
should endeavor to have chairs and courses in
bioethics put in place.
8. Health care workers, especially doctors,
cannot be left to their own devices and burdened
with unbearable responsibilities when faced with
ever more complex and problematic clinical cases
arising from biotechnical possibilities-many of
which are at an experimental stage-open to modern
medicine, and from the socio-medical import of
To facilitate choices and to keep a check on
them, the setting up of ethical committees in the
principal medical centers should be encouraged. In
these commissions, medical competence and evaluation
is confronted and integrated with that of other
presences at the patient's side, so as to safeguard
the latter's dignity and medical responsibility
9. The sphere of action of health care workers
consists, in general, of what is contained in the
terms and concepts of health and medicine
The term and concept of health embraces all that
pertains to prevention, diagnosis, treatment and
rehabilitation for greater equilibrium and the
physical, psychic and spiritual well-being of the
person. The term and concept of medicine, on the
other hand, refers to all that concerns health
policy, legislation, programming and structures.
The full concept of health reflects directly on
that of medicine. In fact, "institutions are very
important and indispensable; however, no institution
can of itself substitute for the human heart, human
compassion, human love, human initiative, when it is
a question of helping another in his suffering."
The meeting and the practical synthesis of the
demands and duties arising from the concepts of
health and medicine are the basis and way for
<humanizing> medicine. This must be present both at
the personal-professional level-the doctor-patient
relationship-and at the socio-policy level so as to
safeguard in institutional and technological
structures the human-Christian interests in society
and the institutional and technological
infrastructures. The first but not without the
second, since such humanization as well as being a
love-charity task is "an obligation of justice."
"[This humanization strengthens] the bases of the
'civilization of life and love,' without which the
life of individuals and of society itself loses its
most genuinely human quality" (Evangelium Vitae
10. The present charter wants to guarantee the
ethical fidelity of the health care worker: the
choices and behavior enfleshing service to life.
This fidelity is outlined through the stages of
human existence: procreation, living, dying, as
reference points for ethical-pastoral reflections.
11. "In the biblical narrative, the difference
between man and other creatures is shown above all
by the fact that only the creation of man is
presented as the result of a special decision on the
part of God, a deliberation to establish a
particular and specific bond with the Creator: 'Let
us make man in our image, after our likeness' (Gen
1:26). The life which God offers to man is a gift by
which God shares something of himself with his
"'God himself who said, <t is not good for man to
be alone (Gen 2:18) and who made man from the
beginning male and female (Mt 19:4), wished to share
with man a certain participation in his own creative
work. Thus he blessed male and female saying:
Increase and multiply"'(Gen 1:28). The generation of
a new human being is therefore "an event which is
deeply human and full of religious meaning, insofar
as it involves both the spouses, who form 'one
flesh' (Gen 2:24), and God who makes himself
Health care workers lend their service when" ever
they help the parents to procreate responsibly,
supporting the conditions, removing obstacles and
protecting them from invasive techniques unworthy of
12. The ever-widening knowledge of the human genetic
patrimony (genome), the individuation and mapping of
the activity of the genes, with the possibility of
transferring them, modifying them or substituting
them, opens up untold prospects to medicine and at
the same time creates new and delicate ethical
In moral evaluation a distinction must
be made between strictly therapeutic manipulation,
which aims to cure illnesses caused by genetic or
chromosome anomalies (genetic therapy), from
manipulation altering the human genetic patrimony. A
curative intervention, which is also called "genetic
surgery," "will be considered desirable in
principle. provided its purpose is the real
promotion of the personal well-being of the
individual, without damaging his integrity or
worsening his condition of life."
13. On the other hand, interventions which are
not directly curative, the purpose of which is "the
production of human beings selected according to sex
or other predetermined qualities," which change the
genotype of the individual and of the human species,
"are contrary to the personal dignity of the human
being, to his integrity and to his identity.
Therefore they can be in no way justified on the
pretext that they will produce some beneficial
results for humanity in the future,"
"no social or scientific usefulness and no
ideological purpose could ever justify an
intervention on the human genome unless it be
therapeutic, that is its finality must be the
natural development of the human being."
14. In any case, this type of intervention
"should not prejudice the beginnings of human life,
that is, procreation linked to not only the
biological but also the spiritual union of the
parents, united in the bond of matrimony."
The negative ethical evaluations outlined here apply
to all genetic manipulatory interventions concerned
with embryos. On the other hand there are no moral
objections to the manipulation of human body cells
for curative purposes and the manipulation of animal
or vegetable cells for pharmaceutical purposes.
15. "Without intending to underestimate the other
ends of marriage, it must be said that true married
love and the whole structure of family life which
results from it is directed to disposing the spouses
to cooperate valiantly with the love of the Creator
and Savior, who through them will increase and
enrich his family from day to day."
"When a new person is born of the conjugal union of
the two, he brings with him into the world a
particular image and likeness of God himself: the
genealogy of the person is inscribed in the very
biology of generation. In affirming that the
spouses, as parents, cooperate with God the Creator
in conceiving and giving birth to a new human being,
we are not speaking merely with reference to the
laws of biology.... Begetting is the continuation of
"Those are considered to exercise responsible
parenthood who prudently and generously decide to
have a large family, or who, for serious reasons and
with due respect for the moral law, choose to have
no more children for the time being or even for an
In the latter case there is the problem of birth
16. In evaluating behavior with regard to this
control, the moral judgment "does not depend solely
on good intentions and on the evaluation of motives;
it is determined by objective criteria, criteria
drawn from the dignity of the human person and human
It is a question of the dignity of the man and the
woman and of their most intimate relationship.
Respect for this dignity shows the truth of their
With regard to the marriage act, this expresses
"the indissoluble bond between the two meanings of
the act: the unitive meaning and the procreative
In fact, the acts by which the partners fully
express themselves and which intensify their union
are the same ones that generate life and vice-versa.
Love which uses "body language" to express itself
is at once unitive and procreative: "it clearly
implies both spousal and parental significance."
This bond is intrinsic to the marriage act: "man
may not break it on his own initiative," without
denying the dignity proper to the person and "the
inner truth of married love."
17. Therefore, while it is lawful, for grave
reasons, to take advantage of a knowledge of the
woman's fertility and forego the use of marriage in
the fertile periods, recourse to contraceptive
practice is illicit.
Natural methods imply a marriage act which, on
the one hand does not result in a new life and
which, on the other hand, is still intrinsically
"It is precisely this respect which makes
legitimate, at the service of responsible
procreation, the use of natural methods of
regulating fertility. From the scientific point of
view, these methods are becoming more and more
accurate and make it possible in practice to make
choices in harmony with moral values."
Artificial means contradict "the nature of the
man and the woman and of their most intimate
Here sexual union is separated from procreation: the
act is deprived of its natural openness to life.
"Thus the original import of human sexuality is
distorted and falsified, and the two meanings,
unitive and procreative, inherent in the very nature
of the conjugal act, are artificially separated: in
this way the marriage union is betrayed and its
fruitfulness is subjected to the caprice of the
This occurs in "every action which, either in
anticipation of the conjugal act, or in its
accomplishment, or in the development of its natural
consequences, proposes, whether as an end or as a
means, to render procreation impossible."
18. Here, then, is "the difference, both
anthropological and moral, between contraception and
recourse to the rhythm of the cycle."
"It is not a distinction simply of techniques or
methods, where the decisive element would be the
artificial or natural character of the procedure. "
It is a difference involving "two irreconcilable
concepts of the human person and of human
The "difference," then, must be recognized and
illustrated: "The ultimate reason for every natural
method is not just its effectiveness or biological
reliability, but its consistency with the Christian
vision of sexuality as expressive of married love.""It
is frequently asserted that contraception, if made
safe and available to all, is the most effective
remedy against abortion.... When looked at
carefully, this objection is clearly unfounded....
Indeed, the pro-abortion culture is especially
strong precisely where the Church's teaching on
contraception is rejected."
19. Rather than directions for use, natural
methods are in keeping with the meaning of conjugal
love, which gives direction to the life of the
couple: "The choice of the natural rhythms involves
accepting the cycle of the person, that is the
woman, and thereby accepting dialogue, reciprocal
respect, shared responsibility and self-control....
In this context...conjugal communion is enriched
with those values of tenderness and affection which
constitute the inner soul of human sexuality, in its
physical dimension also."
20. Health care workers can contribute, when
opportunities occur in their field, towards an
acceptance of this human and Christian concept of
sexuality by making available to married people, and
even before that to young people, the required
information for responsible behavior, respectful of
the special dignity of human sexuality.
This is why the Church appeals to their
"responsibility" in "effectively helping couples to
live their love with respect for the structures and
finalities of the conjugal act which expresses that
21. The application to humans of biotechnology
learned from animal fertilization has made possible
various interventions in human procreation, giving
rise to serious questions of moral lawfulness. "The
various <techniques of artificial reproduction>,
which would seem to be at the service of life and
which are frequently used with this intention,
actually open the door to new threats against life."
The evaluative ethical criterion must take
account of the originality of human procreation,
which "derives from the originality itself of the
"Nature itself dictates that the transmission of
human life be a personal and conscious act and, as
such, subject to the most holy laws of God:
immutable and inviolable laws which must be
acknowledged and observed."
This personal act is the intimate union of the love
of the spouses who, in giving themselves completely
to each other, give life. It is a single,
indivisible act, at once unitive and procreative,
conjugal and parental.
This act-"an expression of the reciprocal gift
which, in the words of Scripture, brings about a
union 'in one flesh"'-is
the source of life.
22. Humans are not at liberty to be ignorant of
and to ignore the meanings and values intrinsic to
human life from its very beginning. "And therefore
means cannot be used nor laws followed which may be
licit in the transmission of animal or vegetable
The dignity of the human person demands that it come
into being as a gift of God and as the fruit of the
conjugal act, which is proper and specific to the
unitive and procreative love between the spouses, an
act which of its very nature is irreplaceable.
Every means and medical intervention, in the
field of procreation, must always be by way of
assistance and never substitution of the marriage
act. In fact, "the doctor is at the service of
people and human procreation: he has no authority to
do as he wills with them or to make decisions about
them. Medical intervention respects the dignity of
the persons when it aims at helping the marriage
act.... On the contrary, sometimes medical
intervention replaces the conjugal act.... In this
case, the medical action is not, as it should be, at
the service of the marriage union, but it
appropriates the procreative function and thus is
contrary to the dignity and inalienable rights of
the spouses and of the expected child."
23. "The use of such artificial means is not
necessarily forbidden if their function is merely to
facilitate the natural act, or to ensure that a
normally performed act reaches its proper end."This
is homologous artificial insemination, that is,
within matrimony with the semen of the partner, when
this is obtained through a normal marriage act.
24. But homologous FIVET (Fertilization in vitro
with embryo transfer) is illicit because conception
is not the result of a conjugal act-"the fruit of
the conjugal act specific to the love between the
outside it: in vitro through techniques which
determine the conditions and decide the effect.This
is not in accord with the logic of "donation,"
proper to human procreation, but "production" and
"dominion," proper to things and effects. In this
case the child is not born as a "gift" of love, but
as a laboratory "product."
Of itself, FIVET "separates the acts which are
destined for human procreation in the conjugal act,"
an act which is "indissolubly corporeal and
spiritual." Fertilization takes place outside the
bodies of the spouses. It is not "actually effected
nor positively willed as an expression of and fruit
of the specific act of conjugal union," but as a
"result" of a technical intervention."[Man]
no longer considers life as a splendid gift of God,
something 'sacred' entrusted to his responsibility
and thus also to his loving care and 'veneration.'
Life itself becomes a mere 'thing,' which man claims
as his exclusive property, completely subject to his
control and manipulation."
25. The desire for a child, sincere and intense
though it be, by the spouses, does not legitimize
recourse to techniques which are contrary to the
truth of human procreation and to the dignity of the
new human being.
The desire for a child gives no right to have a
child. The latter is a person, with the dignity of a
"subject." As such, it cannot be desired as an
"object." The fact is that the child is a subject of
rights: the child has the right to be conceived only
with full respect for its personhood.
26. Besides these intrinsic reasons of the
dignity of the person and its conception, homologous
FIVET is also morally inadmissible because of the
circumstances and consequences of its present-day
In fact, it is effected at the cost of numerous
embryonal losses, which are procured abortions. It
could also involve congealment, which means
suspension of life, of the so-called "spare"
embryos, and often even their destruction.
Unacceptable is "post mortem" insemination, that
is, with semen, given during his lifetime, by the
These are aggravating factors in a technical
procedure already morally illicit in itself, and
which remains such even without these factors.
27. Heterologous techniques are "burdened" with
the "ethical negativity" of conception outside of
marriage. Recourse to gametes of people other than
the spouses is contrary to the unity of marriage and
the fidelity of the spouses, and it harms the right
of the child to be conceived and born in and from a
marriage. "Procreation then...expresses a desire, or
indeed the intention, to have a child 'at all
costs,' and not because it signifies the complete
acceptance of the other and therefore an openness to
the richness of life which the child represents."
These techniques, in fact, ignore the common and
unitary vocation of the partners to paternity and
maternity-to "become father and mother only through
one another"-and they cause "a rupture between
genetic parenthood, gestational parenthood and
educational responsibility," which, from the family,
has repercussions in society.
A further reason for unlawfulness is the
commercialization and eugenic selection of the
28. For the same reasons, aggravated by the
absence of the marriage bond, artificial
insemination of the unmarried and cohabitants is
29. Equally contrary to the dignity of the woman,
to the unity of marriage and to the dignity of the
procreation of a human person is "surrogate"
To implant in a woman's womb an embryo which is
genetically foreign to her or just to fertilize her
with the condition that she hand over the newly born
child to a client means separating gestation from
maternity, reducing it to an incubation which does
not respect the dignity and right of the child to be
"conceived, borne in the womb, brought to birth and
educated by its own parents."
30. The verdict of moral unlawfulness obviously
concerns the ways by which human fertilization takes
place, not the fruit of these techniques, which is
always a human being, to be welcomed as a gift of
God's goodness and nurtured with love.
31. Artificial insemination techniques nowadays
could open the way to attempts or projects of
fertilization between human and animal gametes, to
gestation of human embryos in animal or artificial
wombs, of sexless reproduction of human beings
through twinning fission, cloning, parthenogenesis.
Such procedures are contrary to the human dignity
of the embryo and of procreation, and thus they are
to be considered morally reprehensible.
32. Medicine directed to the integral good of the
person cannot prescind from the ethical principles
governing human procreation.
Hence the "urgent appeal" to doctors and
researchers to give "an exemplary witness of the
respect due to the human embryo and to the dignity
33. Medical service to life accompanies the life
of the person throughout their whole life-span. It
is protection, promotion and care of health, that
is, of the integrity and psycho-physical well-being
of the person, in whom life "is enfleshed."
It is a service based on the dignity of the human
person and on the right to life, and it is expressed
not only in prevention, treatment and rehabilitation
but also in an holistic promotion of the person's
34. This responsibility commits the health care
worker to a service to life extending "from its very
beginning to its natural end," that is, "from the
moment of conception to death."