Instruction Dignitas Personæ on Selected Bioethical Issues
Foundation: Congregation for the Doctrine of the Faith.
source : Holy See.
language original: Latin.
Copyright the Latin original: No.
English translation: Holy See.
Copyright of the Spanish translation: No.
Date: 12 December 2008.
Checked on 23 August 2018.
Full text (PDF 222K)
Synthesis of the Instruction Dignitas Personæ on some bioethical issues
Objective
In recent years, biomedical sciences have advanced considerably. These advances have opened up new therapeutic perspectives but have also raised serious questions which were not explicitly addressed in the Instruction Donum vitæ (22 February 1987). The new Instruction, dated 8 September 2008, the Feast of the Nativity of the Virgin Mary, is intended to respond to some new questions in the field of bioethics, which are raising hopes but also perplexities in ever wider sectors of society. In this sense, it "seeks to promote the training of consciences" (n. 10) and to encourage a biomedical research respectful of the dignity of every human being and of procreation.
Title
The Instruction begins with the words Dignitas personæ - the dignity of the person, which must be recognised for every human being, from conception to natural death. This fundamental principle "expresses a great 'yes' to human life", which "must occupy a central place in ethical reflection on biomedical research " (n. 1).
Value
It is an "Instruction of a doctrinal nature" (n. 1), issued by the Congregation for the Doctrine of the Faith and expressly approved by the Holy Father Benedict XVI. The Instruction, therefore, belongs to the documents that "participate in the ordinary magisterium of the Supreme Pontiff" (Instruction Donum veritatis, n. 18), which must be accepted by the faithful "with religious assent" (Instruction Dignitas personæ, n. 37).
Preparation
For several years the Congregation for the Doctrine of the Faith has been studying new biomedical questions for the purpose of update the Instruction Donum vitæ. In examining these new questions "the relevant scientific aspects have always been taken into account, taking advantage of the programs of study carried out by the Pontifical Academy for Life and the contributions of a large issue of experts, in order to compare them with the principles of Christian anthropology. The Encyclicals Veritatis splendor and Evangelium vitæ of John Paul II, as well as other interventions of the Magisterium, offer clear indications as to the method and content for the examination of the problems under consideration" (n. 2).
Addressees
The Instruction "is addressed to the Christian faithful and to all who seek the truth" (n. 3). When the Church proposes principles and moral evaluations for the biomedical research on human life, "she makes use of reason and faith, thus contributing to the elaboration of an integral vision of man and his vocation, capable of welcoming all the good that emerges from human works and from cultural and religious traditions, which often show great reverence for life" (n. 3).
Structure
The Instruction "comprises three parts: the first recalls some anthropological, theological and ethical aspects of fundamental importance; the second deals with new problems concerning procreation; the third part examines some new therapeutic proposals involving the manipulation of the embryo or of the human genetic patrimony" (n. 3).
Part One: Anthropological, Theological and Ethical Aspects of Human Life and Procreation
The two fundamental principles
"The human being must be respected and treated as a person from the moment of conception and, therefore, from that very moment, the rights of the person must be recognized, especially the inviolable right of every innocent human being to life" (n. 4). "The origin of human life... has its authentic context in marriage and the family, where it is generated through an act which expresses the reciprocal love between man and woman. A procreation which is truly manager for the one to be born is the fruit of marriage" (n. 6).
Faith and human dignity
"The Church is convinced that faith not only accepts and respects what is human, but also purifies, elevates and perfects it" (n. 7). God has created all human beings in his image; in his incarnate Son he has fully revealed the mystery of man; the Son makes it possible for us to become children of God. "From the combination of these two dimensions, the human and the divine, we can better understand the inviolable value of man: he possesses an eternal vocation and is called to share in the Trinitarian love of the living God" (n. 8).
Faith and married life
"The natural and supernatural dimensions of human life also make it possible to understand better in what sense the acts which give human beings existence, in which man and woman give themselves mutually to each other, are a reflection of Trinitarian love. God, who is love and life, has inscribed in man and woman the call to a special participation in his mystery of communion staff and in his work as Creator and Father... The Holy Spirit infused in the sacramental celebration offers Christian spouses the gift of a new communion of love, which is a living and real image of the unique unity which makes the Church the indivisible Mystical Body of the Lord Jesus" (n. 9).
Ecclesiastical Magisterium and the autonomy of science
"In judging from an ethical point of view certain results of recent medical research on man and his origins, the Church does not intervene in the field of medical science as such, but invites those concerned to act with ethical and social responsibility. She reminds them that the ethical value of biomedical science is measured at reference letter both in terms of the unconditional respect due to every human being, at every moment of his or her existence, and in terms of the protection of the specificity of the personal acts which transmit life" (n. 10).
Part Two: New issues relating to procreation
attendance fertility techniques
Techniques to overcome infertility include the following:
techniques of heterologous artificial fertilisation" (n. 12): "techniques designed to obtain artificially a human conception from gametes from at least one donor other than the spouses united in marriage" (grade 22); "techniques of homologous artificial fertilisation" (n. 12): "techniques designed to obtain artificially a human conception from the gametes of two spouses united in marriage" ( 23); "techniques which take the form of an artificial fertilisation of the gametes of at least one donor other than the spouses united in marriage" ( 22). 12): "techniques aimed at achieving human conception from the gametes of two spouses united in marriage" (grade 23); "techniques which are configured as a financial aid to the conjugal act and its fertility" (n. 12); "interventions which aim to remove the obstacles which impede natural fertility" (n. 13); "the procedure of adoption" (n. 13). In this regard, all techniques are licit which respect "the right to life and physical integrity of every human being", "the unity of marriage, which implies reciprocal respect for the right of the spouses to become father and mother only through each other" and "the specifically human values of sexuality, which "require that the procreation of a human person be desired as the fruit of the specific conjugal act of love between the spouses" (n. 12).
Techniques which take the form of a financial aid to the conjugal act and its fertility are "admissible... The medical act is respectful of the dignity of persons when it is aimed at assisting the conjugal act, either to facilitate its accomplishment or to enable the act normally performed to achieve its end" (n. 12). "Interventions aimed at removing obstacles to natural fertility are certainly licit" (n. 13). "The adoption of the many orphaned children should be encouraged, promote and facilitated... procedure ". It is important to stimulate "research and investment in the prevention of sterility" (n. 13).
In vitro fertilisation and voluntary embryo disposal
The experience of recent years has shown that in the context of in vitro fertilisation techniques "the issue of embryos sacrificed is very high" (n. 14): over 80% in the most important centres (cf. grade 27). "The defective embryos, produced in vitro, are directly discarded"; many couples "resort to artificial procreation techniques with the sole goal of being able to make a selection Genetics of their children"; among the embryos produced in vitro "a certain issue is transferred to the womb, while the others are frozen"; the technique of multiple transfer, that is "of a issue greater number of embryos than the desired child, foreseeing that some are lost ....leads in fact to a purely instrumental attention of the embryos" (n. 15).
"The passive acceptance of the very high rate of losses (abortions) produced by in vitro fertilisation techniques eloquently demonstrates that the substitution of the conjugal act with a technical procedure ... contributes to weakening the awareness of the respect due to each human being. On the contrary, the awareness of such respect is favoured by the intimacy of the spouses animated by conjugal love... In the face of the instrumentalisation of the human being in the embryonic stage, it must be repeated that the love of God makes no difference between the newly conceived, even in the womb of his mother, and the child or the young or the mature man or the old man. For this reason the Magisterium of the Church has constantly proclaimed the sacred and inviolable character of every human life, from conception to its natural end" (n. 16).
Intracytoplasmic Sperm Injection (ICSI)
It is a variant of in vitro fertilisation, in which "fertilisation does not occur spontaneously in the test tube, but through the injection into the cytoplasm of the egg cell of a single previously selected spermatozoon, and sometimes through the injection of immature elements of the male germ line" (grade 32).
This technique is morally illicit: "it implies a complete dissociation between procreation and the conjugal act", "it is carried out outside the body of the spouses by means of gestures of third parties, whose skill and technical activity determines the success of the intervention; it entrusts the life and identity of the embryo to the power of doctors and biologists, and establishes a domination of the technique over the origin and destiny of the human person" (n. 17).
Embryo freezing
"In order not to repeat the retrieval of the woman's eggs, a single multiple retrieval is carried out, followed by cryopreservation of a significant proportion of the embryos produced in vitro. This is done in anticipation of the possibility of a second cycle treatment, in case the first treatment fails, or because the parents might want another pregnancy" (n. 18). Freezing or cryopreservation in relation to embryos "is a cooling procedure at very low temperatures to allow a long conservation" (grade 35).
"Cryopreservation is incompatible with the respect due to human embryos: it presupposes their production in vitro; it exposes them to serious risks of death or damage to their physical integrity, since a high percentage do not survive the procedure freezing and thawing process; it deprives them at least temporarily of maternal reception and gestation; it places them in a status susceptible to further offences and manipulations" (n. 18). As regards the large issue of frozen embryos already in existence, what to do with them? In this respect, all the proposals put forward (using them for research or for therapeutic uses; thawing them and, without activating them, using them for research as if they were simple corpses; making them available to infertile couples, as "infertility therapy"; proceeding to a form of "prenatal adoption") pose different types of problems. "On final, it is necessary to note that the thousands of embryos in a state of withdrawal determine a status of injustice which is in fact irreparable. This is why John Paul II appealed to the conscience of those responsible in the scientific world, and in particular to doctors, to stop the production of human embryos, bearing in mind that there is no morally licit solution in sight for the human destiny of the thousands and thousands of "frozen" embryos, which are and always will remain holders of essential rights and which must therefore be legally protected as human persons" (n. 19).
Egg freezing
"In order to avoid the serious ethical problems raised by the cryopreservation of embryos, in the field of in vitro fertilisation techniques, proposal has been proposed to freeze the ova" (n. 20).
In this respect, the cryopreservation of ova, which in itself is not immoral and is situated in other contexts which are not considered here, "is morally unacceptable for the process of artificial procreation" (n. 20).
Embryonic reduction
"Some techniques used in artificial procreation, especially the transfer of several embryos into the womb, have led to a significant increase in the percentage of multiple pregnancies. Because of this, the so-called embryo reduction has been devised, which consists of an intervention to reduce the issue number of embryos or foetuses present in the womb by the direct suppression of some of them" (n. 21).
"From the ethical point of view, embryo reduction is an intentional selective abortion. It is, in effect, a deliberate and direct elimination of one or more innocent human beings in the initial phase of their existence, and as such always constitutes a grave moral disorder" (n. 21).
Pre-implantation diagnosis
"Preimplantation diagnosis is a form of prenatal diagnosis, linked to artificial fertilisation techniques, which provides for the genetic diagnosis of embryos formed in vitro, prior to their transfer to the mother's womb. It is carried out in order to be sure of transferring to the mother only embryos without defects or with a specific sex or with certain particular qualities" (n. 22).
Unlike "other types of prenatal diagnosis... pre-implantation diagnosis... is usually followed by the elimination of the embryo that has been designated as "suspected" of having genetic or chromosomal defects, or of being of an undesirable sex or of having undesirable qualities. Preimplantation diagnosis... is in fact ordered to a qualitative selection with the consequent destruction of embryos, which is configured as an early abortive internship ... By treating the human embryo as simple "material of laboratory", an alteration and a discrimination is also produced with regard to the very concept of human dignity... Such discrimination is immoral and should be considered juridically unacceptable" (n. 22).
New forms of interception and counteraction
There are technical means that act after fertilisation, once the embryo has been formed.
"These techniques are interceptive when they intercept the embryo before its nesting in the maternal uterus" (n. 23), for example, through the "spiral... and the so-called "morning after pill"" (n. 42). (grade 42). They are "contragestative when they cause the elimination of the embryo as soon as it is implanted" (n. 23), for example through "the RU 486 pill" (grade 43). Although it is true that interceptives do not cause an abortion every time they are used, because fertilisation does not always occur after sexual intercourse, it should be noted "that the intention to abort is generally present in the person who wants to prevent the implantation of an embryo if it has been conceived and who, therefore, asks for or prescribes interceptive drugs. In the case of contragestation "it is a matter of the abortion of a barely nested embryo... The use of the means of interception and contragestation is part of the sin of abortion and is gravely immoral" (n. 23).
Part Three: New therapeutic proposals involving manipulation of the embryo or the human genetic heritage
Gene therapy
goal Gene therapy means "the application to humans of engineering techniques Genetics for therapeutic purposes, i.e. for the purpose of curing diseases of genetic origin" (n. 25).
Somatic gene therapy "aims to eliminate or reduce genetic defects present at the level of somatic cells" (n. 25). Germline gene therapy "aims instead to correct genetic defects present in germline cells, so that the therapeutic effects achieved on the subject are transmitted to their eventual offspring" (n. 25). From an ethical point of view, the following must be borne in mind:
As regards somatic gene therapy interventions, these "are, in principle, morally licit... Since gene therapy can entail significant risks for the patient, it is necessary to observe the general deontological principle according to which, in order to carry out a therapeutic intervention, it is necessary to ensure beforehand that the treated subject is not exposed to risks to his health or physical integrity that are excessive or disproportionate to the seriousness of the pathology to be cured. It is also required that the patient, previously informed, gives his consent, or that a legitimate representative does so" (n. 26).
As far as germline gene therapy is concerned, "the risks associated with each manipulation Genetics are significant and still not very controllable, in the current state of the art of research, it is not morally permissible to act in such a way that the resulting potential damage can be passed on to offspring" (n. 26).
As regards the hypothesis of the application of engineering Genetics with the alleged aim of improving and enhancing the endowment Genetics, such manipulations favour "a eugenic mentality and indirectly introduce a social stigma on those who do not possess particular endowments, while emphasising other qualities that are appreciated by certain cultures and societies, without constituting in themselves what is specifically human. This contrasts with the fundamental truth of the equality of all human beings, which is translated into the principle of justice, and the violation of which, in the long run, threatens peaceful coexistence among men... Finally, it should be noted that in the attempt to create a new subject of man, an ideological question is easily discernible: man seeks to substitute himself for the Creator" (n. 27).
Human cloning
Human cloning means "the asexual and agamic reproduction of the whole human organism, with the aim of producing one or more "copies" substantially identical, from the genetic point of view, to the single parent" (n. 28). "There are two proposed techniques for human cloning: twin fission and nuclear transfer. Twin fission consists of the artificial separation of individual cells or groups of cells from the embryo, in the early stages of development, and their subsequent transfer to the uterus, in order to obtain artificially identical embryos. Nucleus transfer, or cloning proper, consists in the introduction of a nucleus extracted from an embryonic or somatic cell into an ovum previously deprived of its nucleus, followed by the activation of this ovum which should therefore develop into an embryo" (grade 47). "Cloning is proposed for two fundamental purposes: reproductive, i.e. to obtain the birth of a cloned child, and therapeutic or research" (n. 28).
Human cloning is "intrinsically illicit because... it is intended to give rise to a new human being without any connection with the act of reciprocal donation between two spouses and, more radically, without any link to sexuality. Such a circumstance gives rise to abuses and manipulations seriously prejudicial to human dignity" (n. 28).
As far as reproductive chlorination is concerned, "a preordained genetic heritage would be imposed on the cloned subject, subjecting him in fact to a form of biological slavery from which it would be difficult for him to free himself. For one person to arrogate to himself the right to arbitrarily determine the genetic characteristics of another person is a grave offence to the dignity of the latter and to the fundamental equality of mankind... Each of us finds in the other a human being who owes his existence and his personal characteristics to the love of God, of which only the love between spouses constitutes a mediation in conformity with the plan of our Creator and Heavenly Father" (n. 29). purpose With regard to therapeutic cloning, it is necessary to specify that "to produce embryos with the aim of destroying them, even if only to help the sick, is totally incompatible with human dignity, because it reduces the existence of a human being, even in the embryonic state, to the status of an instrument to be used and destroyed. It is gravely immoral to sacrifice a human life for therapeutic purposes" (n. 30).
The therapeutic use of stem cells
"Stem cells or stem cells are undifferentiated cells that possess two fundamental characteristics: a) the prolonged capacity to multiply without differentiating; b) the capacity to give rise to transit progenitor cells, from which highly differentiated cells, e.g. nerve, muscle or blood cells, descend. Since the experimental verification that stem cells transplanted into damaged tissue tend to favour cell repopulation and tissue regeneration, new perspectives for regenerative medicine have opened up, which have aroused great interest among researchers worldwide" (n. 31).
For the ethical evaluation , the methods of stem cell collection must be considered first and foremost.
"Methods that do not cause serious harm to the subject from whom they are taken are to be considered lawful. This condition is generally verified in the case of: a) extraction of cells from tissues of an adult organism; b) from the blood of the umbilical cord at the moment of birth; c) from the tissues of foetuses that have died a natural death" (n. 32). "The extraction of stem cells from the living human embryo inevitably causes its destruction and is therefore gravely illicit... In this case "the research... is not truly at the service of humanity, since it implies the suppression of human lives which have the same dignity as other human individuals and researchers" (n. 32). "The use of embryonic stem cells or differentiated cells derived from them, which may have been provided by other researchers through the suppression of embryos or which are commercially available, raises serious problems from the point of view of cooperation with evil and scandal" (n. 32). It should be noted, however, that many programs of study tend to recognise more positive results for adult stem cells than for embryonic stem cells.
Attempts at hybridisation
"Recently, animal eggs have been used for the reprogramming of human somatic cell nuclei... in order to extract embryonic stem cells from the resulting embryos, without having to resort to the use of human eggs" (n. 33).
"From an ethical point of view, such procedures constitute an offence to the dignity of the human being, due to the mixture of human and animal genetic elements capable of altering the specific identity of man" (n. 33).
The use of human "biological material" of illicit origin
For scientific research and the development of various products, embryos or cell lines are sometimes used, which are the result of illicit interventions against the life or physical integrity of the human being.
In relation to experimentation on embryos, this "constitutes a crime in consideration of their dignity as human beings, who are entitled to the same respect due to the child already born and to every person". These forms of experimentation always constitute a grave moral disorder" (n. 34). Regarding the use by researchers of "biological material" of illicit origin, which has been produced outside their centres of research, or which is in trade, "the moral requirement that there be no complicity in the voluntary abortion, and that the danger of scandal be avoided, must also be safeguarded. In this sense, the criterion of independence formulated by some ethics committees, according to which the use of "biological material" of illicit origin would be ethically licit, provided that there is a clear separation between those who produce, freeze and kill the embryos, and the researchers who carry out the scientific experimentation, is insufficient". It must be specified that "the duty to reject "biological material" derives from the obligation to separate oneself, in the exercise of one's activity from research, from a gravely unjust legislative framework and to clearly affirm the value of human life... For this reason, the aforementioned criterion of independence is necessary, but it may be ethically insufficient" (n. 35). "Of course, within this general framework there are different Degrees of responsibility. Reasons of particular gravity could be morally proportionate enough to justify the use of such "biological material". Thus, for example, the danger to the health of children could authorise their parents to use a vaccine made with cell lines of illicit origin, leaving them with the duty to express their disagreement and to request that health systems make other types of vaccines available. On the other hand, we must bear in mind that in companies using cell lines of illicit origin, the responsibility of those who decide on the direction of production is not identical to that of those who do not have the power to decide" (n. 35).