Medical ethics and natural law 1
Antonio Pardo.
Published in Portuguese: A deontologia médica e a lei natural. In: Miguel Cabral, Pedro Afonso, eds. Reflexões sobre Ética Médica. Parede: Principia; 2019. pp. 29-48.
available at https://www.principia.pt /livro/reflexoes-sobre-etica-medica/
"The doctor's duty is taught, most of the time and above all, by medicine itself. It is also taught by medical ethics, which itself stems from the nature of the relationship of trust between doctor and patient.
Robert Spaemann2
V. The duties that follow the vocation
VII. Conclusion
In order to develop this topic, it is first necessary to clarify the concept of natural law. Only then will we be in a position to analyse the professional activity of the doctor and the intrinsic requirements of this activity that derive more immediately from this natural law. Given the breadth of this topic, the text will limit itself to setting out the basic issues, following a thread of argument that covers the most relevant aspects in an orderly fashion.
The concept of natural law is a classic one in Philosophy. We could make a very basic description of its content by saying that it is the rule of operation that corresponds to a certain thing subject .
By rule I mean the internal regularity which directs action in a certain direction. It is very evident in living beings, which have marked tendencies and very specific objectives, determined by instincts; thus, it can be taken as a rudimentary example that, in order to feed themselves, cats tend towards mice and cows towards grass. In science, too, we are very used to these internal regularities, which we call scientific laws: positive and negative charges attract each other, the law of gravity causes bodies to fall, and so on. These regular behaviours and tendencies are manifestations of what is classically called "nature".
Today, although this word is used, its meaning is quite different3. For the classics, the nature of something is its mode of being insofar as it is the principle of its own operations, that is, insofar as it is something active, with a dynamism that proceeds from itself; thus, with the rudimentary example seen earlier, the cat-like nature is what drives cats to hunt mice. Nowadays, modern science has made nature to mean the material world insofar as it is not modified or altered by technology. As can be seen, while the classical concept points to the way things act, the present one is more concerned with the description of their materiality, as it is before man's intervention.
Therefore, to call something "natural" today has a purely factual connotation: it is materially so. Following rigorous logic, one cannot move from natural factual descriptions to statements indicating trends; the statements of the classics have no support in the description of reality made by modern science.
This change of perspective in modern science also applies to man: if the description of reality is purely factual, one cannot speak of tendencies in man. In man, these tendencies require a free decision in order to become actions. Thus, the concept of nature in its classical sense was directly connected with ethics. But in a science that does not see the tendencies of reality, this intrinsic connection disappears.
Hence it follows that today the natural human being is rejected as source of duty or morality: the natural human being is simply, in this current view, a description of what man is like physically or what he does in fact. And, in good logic, from factual descriptions it is not possible to move on to affirmations that indicate a duty to be, that is, a suitable or unsuitable orientation of human action. This is what is called the naturalistic fallacy: the passage from descriptive statements to normative statements.
The other word whose meaning we need to clarify is "law". We have mentioned that we usually call laws the regularities which science discovers in nature. They are discovered by intelligence when examining reality. They are a description of the way a certain being acts. Science and observation encounter their regularities and formalise them by affirming that these realities always behave in this way. The word "law", in this scientific context, has a purely descriptive connotation of how reality behaves.
Man is also part of nature and can be studied from a scientific point of view, but also from a classical point of view. According to the former, regularities are discovered and studied by science. According to the second, internal tendencies are discovered that point to appropriate behaviour, and which are the backbone of human ethical behaviour. The result of this second mode of study discovers man's natural ethical imperatives, which are properly called "natural law". However, in the face of this assertion, the modern view, blind to natural tendencies, protests and concludes that this is the naturalistic fallacy we have just seen: no ethical consequences can be drawn from the study of the (merely factual) nature of man (and from this point of view, it is right).
In addition to this reductionist view of reality that current science has of reality, there is also the meaning attributed to the word "law" in the political sphere: something that is commanded to be done in a certain way, because the authority has decided to do so. The word "law" thus takes on a pejorative meaning of the imposition of someone else's will, something that must be carried out, even if it does not please. The terminology "natural law" was born in a theological context; behind this law, God was seen as the author of nature; in this context, the feeling that God is a dictator who imposes something is given4 , and natural law ends up looking like an instrument of Christianity to impose its beliefs. For the classics, however, there was no such negative connotation: law is rational organisation.
To avoid these misunderstandings, we will reduce the use of the expression "natural law", although, properly understood, it has no problems. Instead, we will describe the human realities of health care, showing their regularities and trying to highlight the most humane or appropriate behaviours, which correspond to what the classics understood by this expression.
The study of man goes back to the beginnings of history. And those first analyses, decanted by time, conclude something elementary: human life is only possible in society. Not so much because of the practicality of dividing work to facilitate survival or well-being, but because human fulfilment is not possible without financial aid and mutual influence. Following Aristotle, man first lived with other men to solve the necessities of life; now, we live together to live well5. With this "living well" he points to a classical concept at Philosophy: the fulfilled life, realised from the human point of view. This idea dates back to the 4th century B.C.: it can be seen that not so many things are necessary to satisfy the basic biological needs of man.
It is easy to see that human interaction is necessary for the human being to achieve the good life. Thus, human relationships are indispensable for the humanisation of human life during growth in the family (if this interaction does not occur, we have the clinical cases of "wild children", who do not develop in a human way, cannot speak, etc.); for the Education and the acquisition of culture, which allows all further enrichment; for the human interactions that allow growth as a person; all these are manifestations of the basic importance of the social for a full human life.
The classics analysed the possible motives for human relationships, and basically distinguished three: those that occur for pleasure (enjoying a film or a meal together), for utility (commercial activity, in which buyer and seller benefit mutually, is paradigmatic) and those that occur for what today we would call altruistic purposes: those that do not expect a benefit in return; classically, they were called for love of friendship. This division is somewhat artificial: they are always mixed to a greater or lesser extent. Enjoying an activity together opens the way to a benevolent attention with playmates or other playful activities. The same applies to commercial activity.
But the bond of love and friendship is essential for human relationships to bear the fruit of the "good life" we have mentioned. Just look at the free submission of a mother to her children, of a teacher to his pupils... It is very clear when we see service activities which, in the popular expression, "I wouldn't do it for all the gold in the world": indeed, they are not paid for with gold, indeed, they are free of charge. But, without this free submission , there would be no society. Again, following Aristotle: friendship holds cities together6 , i.e. the political society he knew, the polis; life in common is only possible if we take care of each other in a benevolent way.
The good life, the end to which human activity aims, is difficult to achieve7. As mentioned above, it requires the financial aid of others in conjunction with human freedom. The financial aid of others comes to us through upbringing, language, Education, advice, the orientation of laws, the rules of civility, religious and political beliefs, etc., which shape a person's way of life when they are lived in a peculiar way by each individual through the exercise of his freedom (social conditioning factors are not strict determinants of our actions). But it also comes to us in the form of help Materials, which is essential for us to be able to develop as people: food, clothing, housing, are hardly feasible for man alone. He needs others to obtain them.
The gratuitous component, which we have called the love of friendship, is evident in the help not Materials . But this benevolent love also exists when it comes to facilitating the things Materials necessary for the good life: as we have seen, one cannot really isolate a motive of social relations.
The financial aid for health is one of the aids Materials that we men lend each other with benevolent love especially clear. exchange When someone is ill, their relationship with the person who financial aid helps them in their illness is not one of enjoyment (one of the reasons for the union between people), nor is it one of benefiting the person who cares for them financial aid (from this point of view, they will always receive more than the caregiver, the relationship is unbalanced). The relationship of a caregiver with a sick person is typically one of benevolence on the part of the caregiver and dependence on the part of the patient, who materially receives more than he/she gives.
This relationship occurs spontaneously, without the need for scientific knowledge or specialization : the mother who brings a hot broth to her child with fever is a good sample. But it is obvious that these basic aids (food, bed, tucking in) do not lead to the recovery of the fullness of Schools of the sick person unless the morbid process is mild or tends to end by itself. Since classical antiquity, the causes of illness have been sought and the most appropriate remedies have been applied. This is scientific medicine.
Medical activity aims to bring the sick person back to health. The definition of this term in vogue, provided more than half a century ago by the World Health Organisation, is very misguided, and is source of many erroneous approaches to health care8 . This definition equates health with well-being. Obviously, this is not true: there are states of discomfort that do not imply illness (tiredness from sport, sadness at losing a loved one), and states of well-being that are calling for urgent medical intervention (drug overdose, death by frostbite), among other insurmountable difficulties that could be adduced.
Health, following the classics, is the bodily and psychological state that allows us to continue living. Living, in this definition, refers not only to the merely biological, but to the whole complex of activities that make up human life. To live for some is to be a lawyer, for others a farmer, and so on. Every human life has its peculiarities, which cannot be reduced to the animal aspect of man. And each way of living has its own peculiar organic needs in order to be able to perform adequately. For example, the body of a professional footballer has to perform much better than that of a sedentary office worker.
But, independently of this aspect (health is something peculiar to each person, as it depends on what they do and how they live), health is also necessary in order to achieve human fulfilment. The classics expressed this perfection of the good life in life according to virtue. However, in order to be able to perform virtuous acts, in many cases a certain Degree of physical and psychological integrity, or health, in a word, is necessary. This is necessary in order to be able to perform the free acts that lead to the maturation of virtue. Therefore, the financial aid for health, which is part of human sociability, is a necessary element for the attainment of the good life, which is the goal of human life in common and, in general, of human life in general.
In this sense, it is indicative that medicine is usually considered a free or liberal profession. For the classics, necessary professions were those that were linked to necessary aspects of human life, which cannot be otherwise, and can only be carried out in a fixed way, usually through physical labour (today largely replaced by machines). Thus, one cannot freely decide to stop eating and supplying food: for this reason, agriculture is tied to necessity (even if it can be developed in various ways). However, in matters of law, for example, we can organise things in different ways, all of them just: comparing just laws in different countries gives an idea of the freedom of jurists; it is not a necessary activity, but a free one9.
Medicine is free in the sense that it is not tied to a single way of doing things. Medical techniques have changed a great deal over time, but there has always been a degree of discretion on the part of the doctor when it comes to treatment, partly for technical reasons (just as agricultural techniques can change), partly because the end of his professional activity is not a body to be fixed, as if it were a broken mechanism, but the life of a person with its unique peculiarities (the footballer and the sedentary office worker require very different aids for their lives). And as these peculiarities are enormously variable, medical advice is equally variable (just as various just legal solutions are valid).
To put it another way: medicine does not cure or fix the body of the sick person. It can, but not always, and that is only a means. Its goal is to change the way people live. From being tied to what their biology decides and limits with the illness, the sick can, with the medical financial aid , recover their health, different from recovering their physical integrity; thus, an analgesic can change an afternoon in bed with a headache into a time of reading or studying. With this medical financial aid , the patient is no longer tied to biological necessity, and can freely decide what to do, and shape his or her life in his or her own way, staff, peculiar. Medicine allows free ways of living. It thus joins the jurists (who create ways of living in society with laws), philosophers (who create ways of living in society with their ideas), artists, architects, engineers, etc., etc., etc.
Health activity is, in short, helping people to live. And for humans, living is human life, not just biology: it is caring for children, doing sport, cooking, going on holiday, working in a factory, and everything else we can think of. Medicine, with its work, contributes to all these ways of living and acting, which would not be possible without it when illness strikes. And, in this medical action, it is necessary to keep in mind the idea that these ways of living possible with its technique are different ways to reach the perfection of the good life, of life according to virtue.
We all have to help others in society. However, the spectrum of help that can be given is infinite. And, obviously, we are not all obliged to do everything for others. The sieve of these possible activities is given by proximity (I cannot help an old woman in Bangkok to cross the street because I am not there), and by vocation10 , which I will explain below.
Among the various activities that we can develop, we men discover one that, so to speak, fills us especially, touches us and leads us to think that "it is our thing". It appears in very variable circumstances; from the child who already sees what he wants from his life very early on, to the person who, after having studied a degree program, realises that the techniques he has acquired challenge him as a person, and place him before a dilemma that will determine his life goals from then on, depending on the answer he gives. In any case, it is a finding, a finding, which asks for a response of vital commitment. While other activities have passed through our lives or our knowledge with no special importance, the call of a professional vocation challenges us.
It would take us too far to examine why this call is perceived and its profound nature. But, in any case, it is clear that it does not leave one indifferent and calls for a response. A person's path after appreciating that call may be rejection (usually because he or she finds it too demanding, tiring, or other reasons), or unconditional acceptance. In the first case, in a more or less pronounced way, vital failure will be experienced: after all, this perceived vocation was the goal in life, the perfect way to reach the human perfection of the good life for that person11.
The second case, the interior acceptance of the vocational call, supposes a commitment staff to that profession. This inner commitment is manifested externally. In classical antiquity, the way to manifest it was the oath. The reason for its employment is the following: at that time, the teaching of Medicine was done by following a master (who, by the way, taught much more than technical matters: he also transmitted a way of doing, with its professional virtues and good human habits); when the master considered the disciple adequately prepared, the latter publicly manifested his inner commitment to the profession and its demands.
As the capacity of expert evidence was very limited in antiquity, it was common to use resource as a way of settling disputes in court (an issue that survives today in the Anglo-Saxon crime of perjury, which serves more to shore up the administration of justice than to show respect for God). The oath was the strongest way to make a statement. Given the importance of the professional goal of medicine (the financial aid to people's health) and its nature (it implies a vital commitment of the doctor to his vocation), from that time onwards it was manifested as an oath, the Hippocratic Oath.
In it, the doctor's commitment to the profession is expressed, not in a generic way, but in detail, with its basic requirements of conduct. This gives rise to very specific duties that people who do not have this vocation do not experience. This does not happen because medicine provides a somehow superfluous financial aid . It is, rather, that the vocation accepted sample its intrinsic duties to the person who has accepted it. For him, in particular, not providing professional financial aid to others would constitute a moral wrong, whereas for others without such a vocation, it would not. Not to mention that his fulfilment as a person depends, henceforth, on his fulfilment of his professional duties.
Using the classical terminology , nowadays so little in vogue and, as we mentioned, so badly understood, the natural law of helping others takes the form, for each person, of following the accepted professional commitment and its intrinsic duties. Obviously, this does not imply following professional guidelines like an automaton: duties must be fulfilled according to the virtue of prudence, which leads us to choose the most appropriate decisions according to the circumstances. The professional vocation does not extinguish the normal path of perfection staff (the proper exercise of freedom), but channels it through professional duties, which thus acquire a primordial importance in life staff.
V. The duties that follow the vocation 
A detailed enumeration of the physician's professional duties would be lengthy. Moreover, such a list would be subject to the circumstances of the moment: not every duty requires action here and now. The dosage of the correct actions within the professional duties corresponds to the virtue of prudence, which provides guidance on the most appropriate action at any given moment. Ethical and deontological codes are a good compilation of these general duties, drawn up by doctors who are recognised as prudent by their colleagues. Their role, like that of any other rule, is to guide action by showing the duty, albeit in a generic way. Only a few very specific, negative rules, very few, can arrogate to themselves the privilege of always having to be complied with without exception. The Hippocratic oath itself contains some of them, such as the prohibition to administer poison, even if the patient asks for it.
However, it is worth describing two basic ideas behind these duties, which are their manifestation and their root respectively. Specifically, these are the need for the technical skill , and the importance of attention to the individual. Let us look at them in some detail.
As mentioned above, professionally helping a sick person back to health cannot be limited to providing maternity care. Since the birth of scientific medicine, with the Hippocratic idea of searching for the natural causes of illness and remedying them, specialised knowledge has been necessary in order to bring health to the sick. From this stems the duty to know, which can only be achieved through constant and regulated study to keep knowledge up to date; it is also necessary to acquire and maintain the necessary practical skills to be able to intervene on the human body and repair injuries, if necessary, each doctor according to the requirements of his or her specialization program. It is not uncommon to observe colleagues who remain stagnant, and do not review recent bibliography to enable them to update practices that may have been good at the time, but are less effective or even harmful according to current knowledge. This technical skill is the manifestation of having taken their professional duties seriously.
Attention to the individual is at the root of appropriate professional action. In fact, the financial aid to the sick person, to the patient that concerns us at that moment, is the concretisation of the general duty of financial aid to those around us, which goes with man's way of being. It is very different from the consideration of work as a merely technical task, which is carried out for emoluments that are received, and which does not affect us beyond the schedule of work. This is inhuman, however widespread it may be, or even if it is agreement with the legal rule : this, by definition, cannot go to the core of the acceptance of the vocation and the subsequent commitment staff , with its attached duties.
However, if the root of professional duties is care for the individual, our professional action must vary with as much elasticity as people's lives are varied. Let us not forget that the goal of medicine, health, is a means to life staff, which takes on an infinite variety of manifestations. For this reason, a new series of considerations arise, which are essential for good professional practice.
Thus, in the different medical specialties, for the appropriate treatment or approach of different morbid processes, there are often standardised protocols for action. They may take the form of flow charts with questions and different courses of action depending on the answers, or they may simply be a list of rules for approach of the problem, etc. These protocols, drawn up by experts at subject, are a great financial aid for daily professional practice, as they often allow problems to be approached appropriately without excessive effort.
However, they also have a serious problem: by coming as a closed set, they make us lose sight of the rest of the reality of the patient and his or her illness. In a way, the protocols equate all patients with the same diagnosis. But if health is something different for everyone, each patient's illness is different, and entails different limitations to his or her life. The temptation for the doctor is therefore to apply the protocol, without taking into account these personal peculiarities. Basically, it is a certain laziness to reason with the problems of the individual patient. The result is often technically good, from the partial point of view of health as a technique to fix a broken body, but from the human point of view it is deficient: it does not take into account the peculiarities of the person's life.
This opens up a whole new area of training for doctors. Going with the technical issues first, even if it is sometimes complex, is always proportionally simple when compared to the need to know the peculiarities of the patient, his or her way of being. The patient has a human problem, he cannot live. This is not something technical, however much attempts have been made to formalise it, with expressions such as "bio-psycho-social" and others of a similar nature: reality is always broader than any formal framework designed to order and protocolise its richness.
This implies the need for the doctor to be humanely close, to have a attention in which he listens a lot, trying to understand the patient and his peculiarities. The doctor must be rich in humanity. This cannot be formalised. One can receive some basic lessons in civility, but then life always brings more.
The term empathy is quite fashionable to denote the human sympathy of the doctor towards his patients. But the relationship with the patient, although it requires feeling, especially compassion, cannot be reduced to the emotional speech that we call empathy12 . This has become a much-used term to express something that is intuited, but rarely clarified. The human relationship with the patient involves more.
To try to refine it somewhat, we could say that it is a manifestation of an inner attitude of benevolence towards the patient, which manifests itself in the form of courtesy, concern for his or her problems, availability to help him or her. The "Materials" forms of such an attitude are as variable as the regions of the world and their idiosyncrasies. What in some quarters is seen as rudeness, in others may appear to be excessive gentleness, almost a gentleness at attention, and the patient may be inwardly desirous of a more expeditious conversation... which another patient may find extremely harsh. My memory goes to a doctor, a very good clinician, who treated me on occasions, and who was shunned by his patients because of the rewarding nature of his detailed and painstaking dedication.
As can be seen, this question is very difficult to outline, if by this we mean the attempt to formalise some of the issues that need to be taken into account in the attention with the patient. There is no doubt that some things can be said to structure the attention with the patient: ways of saying that should be avoided (such as always talking to the cancer patient about his status as a battle), advice that is always useful (when entering the hospital room, introduce yourself by saying your name), etc. But, in the end, we have a problem similar to that of virtue: the right attitude towards the patient cannot be reduced to a list of rules. It is something that comes from within the doctor, it cannot be result from a technical apprenticeship, like an actor playing a role. It either comes from within, or it is grade from the outside that there is no such benevolent and caring attitude towards the patient.
With the human attention towards the patient it is as with virtue in another respect: it matures over time. A helpful attitude in a junior doctor will never have the same characteristics as that of a doctor who has been practising for years. The former has all the goodwill in the world, but lacks habits that he must gradually develop. The latter takes care of his patients in a caring manner without even thinking about it, it comes naturally to him. This is the logical maturation of the human attention over the years, thanks to a daily commitment to his work. This maturing does not imply a change of temperament: one can be energetic or shy, and remain so over time; what changes is the inner enrichment, the growth in virtue, which produces the best attention and the best dedication to patients.
To sum it up, the doctor must have, in addition to skill technique, the capacity of human attention necessary to be able to maintain a friendly relationship with the patient: this is the necessary basis for being able to help him with his problems. And that basis depends on the right inner attitude towards the patient, cultivated with perseverance.
The need to be able to maintain a proper human attention implies other duties: the human training , so as not to be an uneducated person with good will. This includes reading good literature, a certain humanistic training (there are history books or biographies that can make the hours pass by without noticing while giving lessons in humanity), good cinema (as opposed to thrillers devoid of human content, which are only seen as a distraction), painting, music, and a long etcetera that can never be neglected.
In the development of this chapter, many questions have been raised concerning the interior response, the interior attitude, etc.: the commitment to make right decisions, the surrendered acceptance of the vocational call, the interior commitment to care for all the sick. To more than one person it may seem that such a business is unfeasible, superhuman. It is one thing to consider this submission on an occasional basis or during the schedule of work, but it is quite another to make it a permanent attitude of life. In fact, the demands of the correct human attention , for example, imply not abandoning these ways of behaving when not treating patients; otherwise, the benevolent habit is weakened, because the doctor's way of being is the same inside and outside the enquiry: being a good person towards the patient also implies being a good person towards all people, without neglecting the responsibilities towards those closest to him (the family, if one has one). Thus, the ethical challenge of a humane attention , appropriate to the patient, is sample as a very high level requirement.
There are many doctors who consider this too high an ideal. Perhaps not in a theoretical or conscious way, but in a practical way: fatigue takes its toll, painstaking care becomes hard, and they give in. They are good people, they care about their patients in a reasonable way, but there are always some leftovers in their behaviour that could be significantly improved: giving in to laziness when it comes to looking for a bibliographic reference letter on an issue that concerns the patient we are treating, a rude response to a patient who gets a bit tiresome about something, and many more things that any professional could list.
There is a passage in Aristotle's Nicomachean Ethics that is very illuminating in this respect. It appears after he has described the vices and virtues (a description of B vividness, which seems to be made today by observing our contemporaries). At that point, after having dealt with human growth with virtue and its degradation with vice, he observes that, although it is normal to find people with a mixture of both in different proportions, one occasionally finds people who are exceptionally good, a characteristic that cannot be related to social or educational factors worthy of accredited specialization. The explanation he gives is that such people are favoured by some divine cause13 . It is an intuition which, in his view, must be taken very seriously.
Centuries later, Christianity gave this idea a new lease of life. Man is not capable of doing good by his own strength, why is this so, and what is the remedy to achieve it? The Christian answer to these questions is the doctrine of original sin and redemption.
The usual formulation of original sin can cause some confusion, since it uses the word "sin" in a different way from sin staff. Indeed, sin is usually understood as an evil action, derived from the free will and therefore manager and guilty. Original sin, however, does not fall under this description. The Christian approach points out that it is a sin staff in our first parents, which is passed on to our descendants "by propagation, not by imitation "14: it does not affect all men by an ethically incorrect act staff of each one.
Perhaps it is best understood by the following description: our first parents had received as an undeserved gift the participation in the divine nature, or, as it is also called, sanctifying grace, which made them capable of the divine life already in this life, a life that would be consummated in the eternal life of union with God in heaven. When they sinned, they lost this gift. Whoever has property, and loses it through his fault, is left without it, for himself and for his offspring, who will not be able to inherit it. Similarly, by losing God's gifts, his offspring (the rest of mankind) are also left without those gifts. The human race is left with its nature left to itself. From this status no acts can follow that merit supernatural reward, although acts can be done that degrade man to a level below what his nature demands,15 which is very often the case.
In order to bring us out of this status, which was not what God wanted for man, the Father, having compassion for mankind's wandering, sent his Son to redeem us16. By his life and death on the Cross he restored us to friendship with God in him, so that we can once again live supernatural life in ourselves.
This supernatural life not only enables us to obtain the supernatural reward of heaven (full communion with God), but also to do the good that we would have done if we had retained the gift of supernature. In other words, participation in the life of Christ, which begins with baptism, not only gives supernatural life, but also heals the wounds left in our nature by original sin. However, this healing is not automatic, but requires our effort: we continue to feel tensions towards wrongdoing17 , against which we have to fight. Without this active civil service examination , neither the fullness of the supernatural life, holiness, nor the fullness of human life, the good life in the expression of the classics, is achieved.
Is it possible, therefore, to fulfil the demands of the professional vocation to medicine without the financial aid of the grace that comes to us through baptism (which incorporates us into Christ)? It may seem so, since we see people who, without being baptised Christians, are that subject of people who, according to Aristotle, are favoured by a divine cause. However, the Church affirms that these people also share in the redemption wrought by Christ, even if it has not come to them through the ordinary channel of baptism: God's grace is not tied to the means Materials that He has provided as the normal way of obtaining it, and He can graciously bestow it on whomever He wishes. In any case, the ordinary way is clearly preferable and more secure, among other things because it is linked to a Christian cultural context (the community in which baptism takes place), which transmits, together with the sacramental sign, the training and the example necessary for this divine germ to mature.
VII. Conclusion
Natural law is the formulation of the right order of human conduct, of what is most suitable for man. In medicine, this right order is the application of the natural obligation that every human being has to care for and serve those around him. This basic sociability is given concrete form through the professional vocation, which indicates duties towards others that do not apply to everyone: professional duties. These derive from the commitment staff to the vocation, which is manifested externally in the Hippocratic Oath (in classical times) and, today, in the acceptance of and fidelity to professional duties. These duties can be summarised in two basic points: technical skill and benevolent human attention that attends to each individual person in a specific way, looking at his or her personal peculiarities. Fulfilling these duties is greatly facilitated by divine grace, which is usually received in Christian baptism.
(1) I am grateful to Dr. Echarte for his critical review of the original and his kind suggestions for improvement.
(2) Spaemann R. Ethics: Fundamental questions. Pamplona: Eunsa; 1987. p. 103.
(3) For a summary of the following ideas, see International Theological Commission. In Search of a Universal Ethic: A New Perspective on Natural Law (20 May 2009), n. 10. available at http://www.vatican.va/roman_curia/congregations/cfaith/cti_documents/rc_con_cfaith_doc_20090520_legge-naturale_sp.html Accessed 12 February 2019.
(4) A question that also arises from interpreting natural law in a legalistic way. Cf. Cruz A. Natural law and Philosophy internship . The presence of a theological concept in the moral knowledge . lecture in the XLIV Philosophical Meetings. Pamplona, 27-29 March 2006. summary de las Reuniones available at https://es.scribd.com/document/94856885/report Accessed 12 February 2019.
(5) Aristotle. Politica. Madrid: Aguilar; 1977, 1252b (book I, chapter 1, p. 1412).
(6) Aristotle. Op. cit., 1262b (book II, chapter 8, p. 1430).
(7) Cf. for the following Abbà G. Happiness, good life and virtue. Barcelona: Ediciones Internacionales Universitarias; 1992.
(8) Some of the ideas of this section are further developed in Pardo A. ¿Qué es la salud? Journal of Medicine of the University of Navarra. 1997; 41(2): 4-9. available at https://www.academia.edu/7150548/_Qué_es_la_salud Accessed February 12, 2019.
(9) Hannah Arendt recovers this classic distinction and masterfully explains it by distinguishing labour and action in Arendt H. La condición humana. Barcelona: Seix Barral; 1974.
(10) For this question, see Pardo A. Los intereses de la class médica. Revista de Medicina de la Universidad de Navarra. 2009; 53(3): 17-19. available at https://www.academia.edu/36217205/Los_intereses_de_la_clase_médica Accessed February 12, 2019.
(11) I leave aside psychological issues (compliant personalities who think they have to do everything they see, poor mentalities that do not fully grasp what life asks of them and pass through it with no pain or glory more than anything else, etc.).
(12) Cf. Edith Stein. On the problem of empathy. Madrid: Trotta; 2004.
(13) Aristotle. Nicomachean Ethics. Madrid: Aguilar; 1977 (book X, chapter 9, p. 1307, BK 1179b).
(14) "We maintain, therefore, following the Council of Trent, that original sin is transmitted, together with human nature, 'by propagation, not by imitation' and that 'it is found as proper to each one'": Catechism of the Catholic Church, 419.
(15) "Natura sibi relicta": Thomas Aquinas, Quodlibet V, q. 1, a. 2, c. available at http://www.corpusthomisticum.org/q05.html Accessed 11 February 2019.
(16) "Christ, our Lord, [...], having compassion on mankind's wanderings, wished to be born of the Virgin; suffering the cross, he freed us from eternal death, and, rising from the dead, he gave us eternal life": Roman Missal, Preface II Sunday in Ordinary Time.
(17) "For to will is within my power, but to do good is within my power, but to do evil is not. For I do not do the good I want to do, but the evil I do not want to do": Romans 7, 18-19.