Summary and Reflections on DIGNITAS PERSONAE

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william_e_may.jpgSeptember 8, 2008 is the official date of a new doctrinal document prepared by the Congregation for the Doctrine of the Faith (CDF) and approved by Pope Benedict XVI on bioethical issues.  It is a sequel to the CDF’s February 1987 doctrinal Instruction on Respect for Human Life in Its Origins and on the Dignity of Procreation (Latin title Donum vitae). Dignitas Personae (henceforth DP), formally released for publication on December 12, 2008, is of a doctrinal nature and falls within the category of documents that "participate in the ordinary Magisterium of the successor of Peter" (see Instruction Donum veritatis, no.18), and is to be received by Catholics "with the religious assent of their spirit" (DP, no. 37).

Dignitas Personae contains 36 numbered sections divided into Introduction (nos. 1-3); First Part: Anthropological, Theological, and Ethical Aspects of Human Life and Procreation (nos. 4-10); Second Part: New Problems Concerning Procreation (nos. 11-23); Third Part: New Treatments which Involve the Manipulation of the Embryo or the Human Genetic Patrimony (nos. 23-35); Conclusion (no. 36). The Second Part, after introductory number 11, is subdivided into Techniques for Assisting Infertility (nos. 12-16); Intracytoplasmic sperm injection (ICSI) (no. 17); Freezing embryos (nos. 18-19); The freezing of oocytes (no. 20); The reduction of embryos (no. 21); Preimplantation diagnosis (no. 22): New forms of interception and contragestation (no. 23). The Third Part, after introductory number 24, contains Gene therapy (nos. 24-27); Human Cloning (nos. 28-30); The therapeutic use of stem cells (nos. 31-32); Attempts at hybridization (nos. 33); The use of human “biological material” of illicit origin (nos. 34-35).

The Introduction clearly expresses the document’s purpose. A major purpose is to bring Donum vitae (1987) up to date by taking into account and evaluating new biomedical technologies that have raised new problems in the critical area of human life and the family and to examine “some issues that were treated earlier, but are in need of additional clarification” (no. 1). A subsidiary purpose is to show how Catholic teaching, based on both reason and faith, seeks to present an integral vision of man and his vocation and to offer encouragement and support for a culture that considers science an invaluable service to the integral good of the life and dignity of every human being (no. 3).

1.The First Part sets forth (nos. 4-6) two fundamental principles governing the bioethical issues with which DP is concerned. The basic criterion is this: "The human being is to be respected and treated as a person from the moment of conception; and therefore from that same moment his rights as a person must be recognized, among which in the first place is the inviolable right of every innocent human being to life" (no. 4, citing Donum vitae, 1,1). The second fundamental principle declares: "The origin of human life has its authentic context in marriage and in the family, where it is generated through an act which expresses the reciprocal love between a man and a woman. Procreation which is truly responsible vis-à-vis the child to be born must be the ‘fruit of marriage’" (no. 6; the internal citation is from Donum vitae, II, A, 1).

Although Donum vitae did not define the embryo as a person, it nonetheless indicated, DP declares, “an intrinsic connection between the ontological dimension and the specific value of every human life.” Thus it holds that ”the reality of the human being for the entire span of life, both before and after birth, does not allow us to posit either a change in nature or a gradation in moral value, since it possesses full anthropological and ethical status. The human embryo has, therefore, from the very beginning, the dignity proper to a person” (no. 5).

The natural law known through human reason is “the source that inspires the relationship between the spouses in their responsibility for begetting new children” (no. 6), but it is “only in the mystery of the Word Incarnate [that] the mystery of man truly become clear” (no. 7). This enables us (no. 8) to understand that there can be no contradiction between affirming the dignity of human life and affirming its sacredness: “These two dimensions of life, the natural and the supernatural, allow us to understand better the sense in which the acts that permit a new human being to come into existence, in which a man and a woman give themselves to each other, are a reflection of Trinitarian love” (no. 9).

Finally, the First Part emphasizes that in expressing ethical judgments on new developments in medical research “The Church…does not intervene in the area proper to medical science itself, but rather calls everyone to ethical and social responsibility for their actions,” reminding all that “the ethical value of biomedical science is gauged in reference to both the unconditional respect owed to every human being at every moment of his or her existence, and the defense of the specific character of the personal act which transmits life.” (no. 9).

2.The Second Part, after a brief introductory number (no. 11), first takes up Techniques for Assisting Infertility. No. 12 identifies 3 fundamental goods that must be respected in treating infertility: “a) the right to life and to physical integrity of every human being from conception to natural death; b) the unity of marriage, which means reciprocal respect for the right within marriage to become a father or mother only together with the other spouse; c) the specifically human values of sexuality which require ‘that the procreation of a human person be brought about as the fruit of the conjugal act specific to the love between spouses’" (internal citation from Donum vitae, II, B, 4). No. 13 recapitulates the teaching of Donum vitae by declaring: “all techniques of heterologous artificial fertilization, as well as those techniques of homologous artificial fertilization which substitute for the conjugal act, are to be excluded. On the other hand, techniques which act as an aid to the conjugal act and its fertility are permitted.” No. 13 approves techniques aimed at removing obstacles to natural fertilization, such as hormonal treatments, surgery to unblock fallopian tubes, etc., and encourages adoption and research to prevent infertility.  Nos. 14 and 15 focus on in vitro fertilization and the deliberate destruction of human embryos. Donum vitae had taken these acts up and condemned them, and, as DP points out, “subsequent experience has shown…that all techniques of in vitro fertilization proceed as if the human embryo were simply a mass of cells to be used, selected and discarded” (no. 14). No. 16 sums up Church’s teaching: “The Church…holds that it is ethically unacceptable to dissociate procreation from the integrally personal context of the conjugal act: human procreation is a personal act of a husband and wife, which is not capable of substitution. The blithe acceptance of the enormous number of abortions involved in the process of in vitro fertilization vividly illustrates how the replacement of the conjugal act by a technical procedure — in addition to being in contradiction with the respect that is due to procreation as something that cannot be reduced to mere reproduction – leads to a weakening of the respect owed to every human being.” While the desire for a child is legitimate, this desire “cannot justify the ‘production’ of offspring, just as the desire not to have a child cannot justify the abandonment or destruction of a child once he or she has been conceived. In reality, it seems that some researchers, lacking any ethical point of reference and aware of the possibilities inherent in technological progress, surrender to the logic of purely subjective desires.” Confronted with this reality, “‘The Magisterium of the Church has constantly proclaimed the sacred and inviolable character of every human life from its conception until its natural end’” (the internal citation is from Benedict XVI, Address to the General Assembly of the Pontifical Academy for Life and International Congress on "The Human Embryo in the Pre-implantation Phase," 27 February 2006).”

No. 17 is devoted to Intracytoplasmic sperm injection (ICSI), a more recently developed method of artificial fertilization. This procedure, as footnote 32 explains, “is similar in almost every respect to other forms of in vitro fertilization with the difference that in [it] fertilization in the test tube does not take place on its own, but rather by means of the injection into the oocyte of a single sperm, selected earlier, or by the injection of immature germ cells taken from the man.” Like in vitro fertilization, it is intrinsically evil because it causes “a complete separation between procreation and the conjugal act.”

Nos. 18 and 19 deal with the issues involved in Freezing embryos.  No. 18 describes the procedure and the problems it raises. It is used to avoid repeatedly removing the woman’s oocytes from her body by hyperfertilizing the woman and simultaneously extracting many oocytes, fertilizing them and cryopreserving the human embryos so produced and storing them for “retrieval” later if someone wishes to use them (the late Jerome Lejeune rightly described the procedure as putting embryonic human persons into “concentration cans”). DP teaches judges cryopreservation “incompatible with the respect owed to human embryos,” exposing them to the serious risk of death or physical harm, depriving them at least temporarily of maternal reception and gestation, and placing them in a situation in which they are susceptible to further offense and manipulation. Moreover, No. 18 continues, “The majority of embryos that are not used remain ‘orphans.’ Their parents do not ask for them and at times all trace of the parents is lost.”This raises the question, “what to do with the large number of frozen and abandoned embryos?”

No. 19 takes up this issue, definitively repudiating as intrinsically immoral proposals to use these embryos for research or for the treatment of disease. Such proposals “are obviously unacceptable because they treat the embryos as mere ‘biological material’ and result in their destruction.” Similarly the proposal that these embryos “could be put at the disposal of infertile couples as a treatment for infertility is not ethically acceptable for the same reasons which make artificial heterologous procreation illicit as well as any form of surrogate motherhood; this practice would also lead to other problems of a medical, psychological and legal nature.”

No. 19 then devotes two brief sentences to an issue on which Catholic theologians loyal to the Magisterium have been divided. It describes the issue as follows: “It has also been proposed, solely in order to allow human beings to be born who are otherwise condemned to destruction, that there could be a form of ‘prenatal adoption.’”  The following sentence reads as follows: “This proposal, praiseworthy with regard to the intention of respecting and defending human life, presents however various problems not dissimilar to those mentioned above.”

Does this passage definitively reject the proposal concerning the “prenatal adoption” of frozen and orphaned embryos? There is a dispute among those who have read the document on this issue. Some scholars think that the CDF has definitely concluded that adopting frozen embryos prenatally is not morally licit. But others, and I am among them, think that a close reading of this sentence and the context in which it appears makes it clear that it was not the intention of the CDF to make a definitive judgment on this disputed question but that it left the issue open to further debate by Catholic theologians. The “various problems not dissimilar to those mentioned above” in this sentence refers to “other problems of a medical, psychological, and legal nature” (emphasis added) noted in the paragraph rejecting using these embryos as a treatment for fertility, not to any moral problem.

Frequently, when people engage in intrinsically immoral acts, various medical, psychological, and/or legal factors that are not in themselves moral determinants add to the immorality of their immoral acts, while very similar factors, prudently dealt with, do not cause people’s morally acceptable acts to become immoral. Therefore, DP’s statement that embryo adoption presents problems not dissimilar to those involved in the immoral practice treated in the preceding paragraph is reasonably interpreted as warning those engaging in embryo adoption to attend to all relevant medical, psychological, and legal problems and to exercise prudence in dealing with them.

That paragraph of No. 19 also rejected any form of surrogate motherhood, which it defines, referring to the definition found in Donum vitae II, A, 3 (see footnote 38), a definition that supporters of embryo prenatal adoption completely accept (on this see the essays by Germain Grisez, William E. May, Christian Brugger and others in Human Embryo Adoption: Biotechnology, Marriage, and The Right to Life, eds. Thomas V. Berg, L.C. and Edward J. Furton. Philadelphia and Thornton, NY: National Catholic Bioethics Center and The Westchester Institute for Ethics & the Human Person, 2006).

The final paragraph of No. 19 declares: “All things considered, it needs to be recognized that the thousands of abandoned embryos represent a situation of injustice which in fact cannot be resolved.” This is definitely true. Someone, however, might argue that this sentence implies that embryo adoption is morally wrong and for that reason its practice cannot resolve the injustice that has been done to abandoned embryos.  That argument would be fallacious. Even if the practice of embryo adoption were so widely accepted by upright people that no abandoned embryo was left to die, all of those embryos would have suffered an injustice not rectified by the upright people who came to their rescue, just as injustices to other victims of wrongdoing are not rectified by the efforts of upright third parties to prevent or mitigate the injuries done by wrongdoers.

No. 20 considers The freezing of oocytes and declares: “cryopreservation of oocytes for the purpose of being used in artificial procreation is to be considered morally unacceptable.” No. 21 takes up The reduction of embryos, a procedure in which embryos or fetuses in the womb are directly exterminated and judges this “an intentional selective abortion” and always constituting “a grave moral disorder.” Appealing to the good that could be achieved by doing so is of no avail insofar as “It is never permitted to do something which is intrinsically illicit, not even in view of a good result: the end does not justify the means.” Preimplantation diagnosis is the subject of no.21. It is done to make sure “that only embryos free from defects or having the desired sex or other particular qualities are transferred.” It is directed to the destruction of human embryos judged defective or undesirable for other reasons, treats the human embryo as mere biological material and is a terrible affront to human dignity. No. 23 (the final number of the Second Part) focuses on New forms of interception and contragestation. “Interceptive methods”  interfere with human embryos prior to implantation in order to prevent their birth, while “contragestative” methods eliminate, i.e., kill, them after implantatation in order to achieve the same purpose. Both are forms of intentional abortion and always gravely immoral.

The Second Part leaves untouched the question debated by Catholic moral theologians regarding the procedure known as “gamete intrafallopian tube transfer” (GIFT). Some judge it an immoral substitute for the conjugal act; others consider it a legitimate way of aiding the conjugal act to achieve its procreative meaning. The issue thus remains one open to legitimate debate.

3. The Third Part, after its introductory paragraph, takes up new treatments involving the manipulation of the human embryo or the humane genome patrimony. Nos. 24-27 coneern Gene therapy, i.e., techniques of genetic engineering applied to human beings for therapeutic purposes. There are two broad types: somatic cell gene therapy and germ line cell therapy. The first aims at eliminating or reducing genetic defects by manipulating a person’s somatic or body cells, i.e., cells other than the reproductive cells. It affects only one individual person. Germ line cell therapy aims at correcting genetic defects present in germ line cells with the purpose of transmitting the therapeutic effects to the offspring of the individual. Both methods of gene therapy can be undertaken on a fetus before his or her birth as gene therapy in the uterus or after birth on a child or adult (nos. 24-25). The CDF judges that “[P]rocedures used on somatic cells for strictly therapeutic purposes are in principle morally licit,” but since gene therapy can involve significant risks for the patient, “the ethical principle must be observed according to which…it is necessary to establish beforehand that the person being treated will not be exposed to risks to his health or physical integrity which are excessive or disproportionate to the gravity of the pathology for which a cure is sought. The informed consent of the patient or his legitimate representative is also required.” The “moral evaluation of germ line cell therapy is different. Whatever genetic modifications are effected on the germ cells of a person will be transmitted to any potential offspring. Because the risks connected to any genetic manipulation are considerable and as yet not fully controllable, in the present state of research, it is not morally permissible to act in a way that may cause possible harm to the resulting progeny….in its current state, germ line cell therapy in all its forms is morally illicit” (no. 26). No. 27 rejects use of genetic engineering for purposes other than therapeutic,  e.g., to manipulate human genes for improving the genetic pool. DP claims that “Apart from technical difficulties and the real and potential risks involved, such manipulation would promote a eugenic mentality and would lead to indirect social stigma with regard to people who lack certain qualities, while privileging qualities that happen to be appreciated by a certain culture or society; such qualities do not constitute what is specifically human” (no. 27). Moreover, the attempt “to create a new type of human being” embodies “an ideological element in which man tries to take the place of his Creator” (no. 27).

No. 28 deals with human cloning. i.e., the asexual or agametic “reproduction” of the entire human organism in order to produce one or more "copies" which, from a genetic perspective, are substantially identical to the single original. It has two purposes: reproduction, to obtain the birth of a new human being, and medical therapy or research (no. 28). Reproductive cloning is gravely immoral; it imposes on “the resulting individual a predetermined genetic identity, subjecting him…to a form of biological slavery….The fact that someone would arrogate to himself the right to determine arbitrarily the genetic characteristics of another person represents a grave offence to the dignity of that person as well as to the fundamental equality of all people” (no. 29). “[S]o-called therapeutic cloning is even more serious. To create embryos with the intention of destroying them, even with the intention of helping the sick, is completely incompatible with human dignity, because it makes the existence of a human being at the embryonic stage nothing more than a means to be used and destroyed. It is gravely immoral to sacrifice a human life for therapeutic ends” (no. 30).

The final paragraph of no. 30 touches on the creation of stem cells without bringing into being any human individual who could be the victim of injustice—an issue more fully considered later in no. 32. No. 30 points out that ethical objections to therapeutic cloning and the use of human embryos formed in vitro have led to proposed new techniques presented as capable of producing embryonic-type stem cells without involving the destruction of true human embryos. Footnote 49 names some of these new techniques: “human parthenogenesis, altered nuclear transfer (ANT) and oocyte assisted reprogramming (OAR).” No. 30 then declares: “These proposals have been met with questions of both a scientific and an ethical nature regarding above all the ontological status of the ‘product’ obtained in this way. Until these doubts have been clarified, the statement of the Encyclical Evangelium vitae needs to be kept in mind: ‘what is at stake is so important that, from the standpoint of moral obligation, the mere probability that a human person is involved would suffice to justify an absolutely clear prohibition of any intervention aimed at killing a human embryo.’" DP neither condemns ANT and OAR, which many faithful Catholic theologians have proposed as morally legitimate and others opposed, as intrinsically evil nor affirms the opinion of those who think that the entity brought into being by those processes is a human being. Instead, it observes that questions have been raised about the status of the results of those processes and recalls previous teaching of the sound prudential norm that those dealing with what might be a human being cannot rightly treat that entity as other than a human being unless they are certain beyond reasonable doubt that it is not a human being. But here too there are some scholars who think that DP rejects ANT and OAR.

The discussion of cloning leads DP to reflect on the therapeuetic use of stem cells in nos. 31-32. No. 31 identifies stem cells, their sources, and the proven therapeutic value of adult stem cells. “Stem cells are undifferentiated cells with…a) the prolonged capability of multiplying themselves while maintaining the undifferentiated state; b) the capability of producing transitory progenitor cells from which fully differentiated cells descend, for example, nerve cells, muscle cells and blood cells. Among the sources for human stem cells…identified thus far are: the embryo in the first stages of its existence, the fetus, blood from the umbilical cord and various tissues from adult humans (bone marrow, umbilical cord, brain, mesenchyme from various organs, etc.) and amniotic fluid.” At first it was thought that only embryonic stem cells had significant capabilities of multiplication and differentiation but studies proved that adult stem cells are very versatile; in fact scientific studies and experiments have proved that their use has had far more positive results than embryonic stem cells.

No. 32 offers an ethical evaluation of the use of stem cells, emphasizing that “it is necessary to consider the methods of obtaining stem cells as well as the risks connected with their clinical and experimental use.… Methods which do not cause serious harm to the subject from whom the stem cells are taken are to be considered licit. This is generally the case when tissues are taken from: a) an adult organism; b) the blood of the umbilical cord at the time of birth; c) fetuses who have died of natural causes. The obtaining of stem cells from a living human embryo, on the other hand, invariably causes the death of the embryo and is consequently gravely illicit…The use of embryonic stem cells or differentiated cells derived from them – even when these are provided by other researchers through the destruction of embryos or when such cells are commercially available – presents serious problems from the standpoint of cooperation in evil and scandal. There are no moral objections to the clinical use of stem cells that have been obtained licitly; however, the common criteria of medical ethics need to be respected…. Research initiatives involving the use of adult stem cells, since they do not present ethical problems, should be encouraged and supported’” (no. 32).

No. 33 considers Attempts at hybridization, i.e., using animal oocytes to reprogram the nuclei of human somatic cells in order to obtain embryonic stem cells from embryos produced without having to use human oocytes. Procedures of this kind are a grave offense against human dignity because of the mixing of human and animal genetic elements that can disrupt man’s specific identity. Moreover, the possible use of stem cells taken from these embryos may also involve additional and as yet unknown health risks because of the presence of animal genetic material in their cytoplasm. “To consciously expose a human being to such risks is morally and ethically unacceptable.”

In nos. 34-35 DP addresses The use of human “biological material” of illicit origin. No. 34 identifies the problem: cooperation in evil and giving scandal insofar as cell lines originally obtained by illicit interventions against human life and integrity are at times used for scientific research or the production of vaccines and other products. Some general principles must be given to help people form their consciences rightly. Citing John Paul II’s Evangelium Vitae, no. 34 reminds all that the use of human embryos/fetuses as objects of experimentation “‘constitutes a crime against their dignity as human beings who have a right to the same respect owed to a child once born, just as to every person’" (Evangelium Vitae, 63); thus “these forms of experimentation always constitute a grave moral disorder” (cf. ibid, 62).

No. 35 notes that a different situation exists when researchers use “biological material” of illicit origin produced apart from their research center or commercially obtained. It likewise notes that Donum vitae articulated the principle to be followed; "The corpses of human embryos and fetuses…,deliberately aborted or not, must be respected just as the remains of other human beings.  In particular, they cannot be subjected to mutilation or to autopsies if their death has not yet been verified and without the consent of the parents or of the mother. Furthermore, the moral requirements must be safeguarded that there be no complicity in deliberate abortion and that the risk of scandal be avoided" (I,4). DP then considers “the criterion of independence” proposed by some. According to it the use of "biological material" of illicit origin would be ethically permissible provided there is a clear separation between those who produce, freeze, and cause the death of embryos and researchers involved in scientific experimentation. DP expresses caution here, arguing that of itself this criterion might not be sufficient “to avoid a contradiction in the attitude of the person who says that he does not approve of the injustice perpetrated by others, but at the same time accepts for his own work the ‘biological material’ which the others have obtained by means of that injustice. When the illicit action is endorsed by the laws which regulate healthcare and scientific research, it is necessary to distance oneself from the evil aspects of that system in order not to give the impression of a certain toleration or tacit acceptance of actions which are gravely unjust. Any appearance of acceptance would in fact contribute to the growing indifference to, if not the approval of, such actions in certain medical and political circles.” In fact, “there is a duty to refuse to use such ‘biological material’ even when there is no close connection between the researcher and the actions of those who performed the artificial fertilization or the abortion, or when there was no prior agreement with the centers in which the artificial fertilization took place. This duty springs from the necessity to remove oneself, within the area of one’s own research, from a gravely unjust legal situation and to affirm with clarity the value of human life. Therefore, the above-mentioned criterion of independence is necessary, but may be ethically insufficient.”

But “within this general picture there exist differing degrees of responsibility. Grave reasons may be morally proportionate to justify the use of such ‘biological material.’ Thus, for example, danger to the health of children could permit parents to use a vaccine which was developed using cell lines of illicit origin, while keeping in mind that everyone has the duty to make known their disagreement and to ask that their healthcare system make other types of vaccines available. Moreover, in organizations where cell lines of illicit origin are being utilized, the responsibility of those who make the decision to use them is not the same as that of those who have no voice in such a decision.”

The Conclusion (nos.36 and 37 is in essence a reasoned and reasonable apologia for the purpose and spirit of the Magisterium’s analysis and evaluation of contemporary developments in biomedicine affecting human persons and the institution of marriage. The entire matter is summarized this way: “In virtue of the Church’s doctrinal and pastoral mission, the Congregation for the Doctrine of the Faith has felt obliged to reiterate both the dignity and the fundamental and inalienable rights of every human being, including those in the initial stages of their existence, and to state explicitly the need for protection and respect which this dignity requires of everyone. The fulfillment of this duty implies courageous opposition to all those practices which result in grave and unjust discrimination against unborn human beings, who have the dignity of a person, created like others in the image of God. Behind every "no " in the difficult task of discerning between good and evil, there shines a great "yes" to the recognition of the dignity and inalienable value of every single and unique human being called into existence” (no. 37). DP ends by saying: “The Christian faithful will commit themselves to the energetic promotion of a new culture of life by receiving the contents of this Instruction with the religiousassent of their spirit, knowing that God always gives the grace necessary to observe his commandments and that, in every human being, above all in the least among us, one meets Christ himself (cf. Mt 25:40). In addition, all persons of good will, in particular physicians and researchers open to dialogue and desirous of knowing what is true, will understand and agree with these principles and judgments, which seek to safeguard the vulnerable condition of human beings in the first stages of life and to promote a more human civilization.”

Final word. As noted, different scholars have given different and opposing interpretations to some issues taken up the document, e.g. the moral liceity of prenatally adopting frozen and abandoned embryos and ANT and OAR as means of securing pluripotent stem cells without killing human embryos. Undoubtedly these and other debates interpretations will be brought to the attention of the CDF so that its teaching on these  and similar issues will be clearly understood.

(c) Culture of Life Foundation, 2009. Reproduction granted with attribution required.