Sanctity of life and the medical profession. From humanae vitae to Laudato si’

The almost fifty years that separate Humanae Vitae (“HV”) (1968) and Laudato Si’ (“LS”) (2015) have seen great changes take place in the planet’s structure, and great transformations in the balance among different cultures.  The dynamics of globalization have led to much sharper confrontations among human groups that are characterized by their different cultures, which already had seen considerable internal evolution.  However, the issues concerning human life and the specific issues dealt with by HumanaeVitae have not lost their relevance.

         From the sense of generation to the “sacredness” of life

In the framework of the many theological, and especially theological-moral, questions that in these past fifty years have been raised about Humanae Vitae, I would first like to consider what I believe to be the most important affirmation in this Encyclical, its wisest and most valuable theological and anthropological legacy, namely, the “unbreakable bond” (HV 12) between marital unity and the passing on of life.  The phrase has its origin in the earlier Section 9 of the document where Paul VI lists the four principal “characteristics” and requirements of marital love: 1) It is “thoroughly human,” that is, both sensual and spiritual.  2) It is “total”; it is “a special form of personal friendship” where husband and wife share everything generously and love each other for the other’s sake and not for personal gain.  3) It is “faithful and exclusive until death.” 4)  Lastly, it is “fruitful.”  With this last characteristic, Paul VI reconciled the age-old question of the relationship between the purposes of marriage:  the “primary” end (the prolis generatio et educatio) and the “secondary” end (mutuum adiutorium e remedium concupiscentiae).  Pope Paulaffirms that it is equally ordered to the personal communion between husband and wife and to the bringing forth of new lives.  This seems to me the first, essential, “conquest” of the encyclical of Paul VI—a prophetic lesson in human wisdom, which we can not and must not forget.

We have to remember that in the late 60s the Pope foresaw a difficulty and an objection that at that time was barely perceived, but that today has doubtless become radicalized and even extremely so—namely, the separation between marital love and the passing on of life.  In today’s culture, both in individual lives and in the media, sex is viewed ambiguously.  On the one hand, it is considered indispensable for happiness.  On the other hand, it seems unable to provide the deep satisfaction that individuals hope to derive from it.  Seeing this, we have to ask ourselves whether this ambiguity is not the result of an incomplete understanding of the relationship between sexuality and the other dimensions of humanity and of relationships.

Another aspect of this ambiguity is that we are no longer sure that a child  has any right to be brought into the world within a loving relationship between a man and a woman, or even within a relationship that is stable and socially established and recognized—a family.  Here we touch something central to the Christian faith.  The reality of generation introduces us into the mystery of our Trinitarian God, Himself, in which the generation by the Father has its counterpart in the being generated that is proper to the Son, and the bond between Father and Son results in the being they share in and with the Spirit.  Thus revelation shows that the love that leads to happiness cannot be lived except by “making” the other in a circle of life that is accessible to the human creature, and in which he or she can participate responsibly.  The entry of God into the passing on of human life with His Incarnation (in the womb of a Woman) opens up a vision which, incorporating history, with all its contradictions, through a structure of agape, arrives at the Resurrection.

Only in this broader framework can we understand what is meant by the “sacredness” of life.  Only within the framework of our supernatural calling can we understand the greatness and the preciousness of human life, earthly as well as eternal, as St. John Paul II writes Section 2 of his Encyclical Letter, Evangelium Vitae, where he points out that “… it is precisely this supernatural calling which highlights the incomplete character of each individual’s earthly life.  After all, life on earth is not an “ultimate” but a “penultimate” reality; even so, it remains a sacred reality entrusted to us, to be preserved with a sense of responsibility and brought to perfection in love and in the gift of ourselves to God and to our brothers and sisters.”   Each one of us is therefore called to live his or her life as a gift, close to God and our brothers and sisters.  In Section 47 of the Encyclical, the Pope writes: “…the life of the body in its earthly state is not an absolute good for the believer, especially as he may be asked to give up his life for a greater good.  As Jesus says: ‘Whoever would save his life will lose it; and whoever loses his life for my sake and the gospel’s will save it.’ (Mk 8:35). The New Testament gives many different examples of this…John the Baptist, precursor of the Savior testifies that earthly existence is not an absolute good; what is more important is remaining faithful to the word of the Lord even at the risk of one’s life (cf. Mk 6:17-29). Stephen, losing his earthly life because of his faithful witness to the Lord’s Resurrection, follows in the Master’s footsteps and meets those who are stoning him with words of forgiveness (cf. Acts 7:59-60), thus becoming the first of a countless host of martyrs whom the Church has venerated since the very beginning.  No one, however, can arbitrarily choose whether to live or die; the absolute master of such a decision is the Creator alone, in whom ‘we live and move and have our being.’” (Acts 17:28)

From Humanae Vitae to Laudato Si’.

The question of the passing on of life is a kind of crossroads, a meeting place not only of the lives of individuals and families but also of all of society.  The connection that Blessed Paul VI himself made between Humanae Vitae and Populorum Progressio lets us  take a further step toward Laudato Si’. We realize that the entire planet, even allowing for significant differences on the different continents, is aging.  And those societies that have fewer children appear more affected by a decline that is not only material but also spiritual.  Laudato Si’ highlights how the land is not ungenerous, but rather that our stewardship of it is not fair.  Human groupings are strongly tempted to focus on their own interests, culturally inclined as they are to reproduce themselves as individuals rather than to build communities.  If self-fulfillment is emphasized, sterility increases.   Laudato Si’ shows us how, if we allow ourselves to be enlightened by the generative mystery of God who reveals Himself  in the reality of the Son made man in Mary’s womb, the Church is called to restore confidence to a world that struggles to pass on the meaning of “coming into the world.”  But it also offers other insights that invite us to understand human life as we live it in our common home, respecting the notion of integral ecology.  This integrated perspective helps us see the interconnectedness of various aspects of life that we often look at separately and thus limit the horizons of our thinking.  Integral ecology allows us to develop a clearer and more convincing (and perhaps even more shareable) understanding of some groups that we are committed to as we defend and promote human life at every stage, especially those that are weaker and more threatened.

I would now like to offer some brief reflections on the meaning of “dignity of the person,” the subject of your meeting this morning.  We know that the notion of dignity is in one that is important to everyone.  In general, reference is made to the Preamble of the Declaration of Human Rights and of the Citizen of 1948, which states: “the recognition of the inherent dignity of all members of the human family and their equal and inalienable rights constitutes the foundation of freedom, justice and peace in the world.”  And Article 1 reaffirms: “All human beings are born free and equal in dignity and rights.”  It is also repeatedly invoked in the UNESCO Universal Declaration on Bioethics and Human Rights (2005).  The notion of dignity, however, remains imprecise, and is not able to furnish definitive interpretations of individual situations, especially in the area of bioethics.  The diversity of interpretations also stems from the diversity of cultural horizons.  These can be grouped in the West into three main currents:  the Judeo-Christian tradition, Kantian-inspired ethics, and the  more  recent  anthropology of (late) modernity.

  1. The Judeo-Christian Tradition.   Although the Judeo-Christian tradition has known different emphases and nuances over the centuries and has reacted to varying cultural contexts, it has shown remarkable consistency about the central elements of dignity.  As emphasized by the Second Vatican Council  (in particular Gaudium et Spes, Sections 12-22), the Christian vision of dignity is based on the biblical witness, amply confirmed by patristic tradition, according to which man is created “in the image and likeness of God.”  Although sin disfigures this image, it is restored by the grace and the salvation that Jesus Christ offers to humanity.  This applies to every man and every woman.  In this sense, dignity is another name for each of us being a child of God.  Dignity does not depend on factors such as behavior or the particular abilities of an individual, but only on the fact of being children of God, created in his image and likeness.  To this, Jesus adds that the poor—those who are cast aside because they have no dignity—represent God on earth.  They are his sacrament.

The Kantian Change of Direction.  In his Groundwork of the Metaphysic of Morals, at  the  end  of its  Second Formulation,  Kant  presented a proposition that was to have a huge following in Western civilization.  He states that the condition that makes something an end in itself, and to which it is impossible to attribute a price, is dignity, which is intrinsic to the person. Dignity cannot be given an economic value. It has no graduations, nor is it divisible.  Everyone must be accorded the same dignity, and likewise must recognize it in others.  Kant bases this dignity on the moral law that everyone finds within himself.  In a certain sense, therefore, he “secularizes”  what  in the  Christian tradition is  dependent  on man’s relationship with God.  In that context, we can see that the Constitution Gaudium et Spes, speaking in Section 16 about the conscience as a place where mankind finds a law which it does not impose upon itself, but rather is written by God,  forges  a solid bond between the Christian and  the  Kantian perspectives.

  1. Modernity. We are seeing today the emergence of both subjectivity and relationality—dignity being linked to both the judgment of others and to one’s own belief about him or herself.  We therefore speak now about the perception of one’s own dignity rather than about its ontological dimension, which, obviously, must not be lost.  In Aristotelian terms, it can be said that dignity that is not recognized by others is potential and not yet actual.  That’s why a believing doctor’s friendly face is an important encouragement for patients who needs a little comfort and a little less anxiety when faced with doubts about their dignity because of their weakness and dependency.  It is essential to support positive interaction between doctors and patients, especially in highly debilitating circumstances or when death is imminent.  For me, this kind of relationality is essential to dignity.

The three aspects of dignity.

There are three different lines of though underlying the notion of dignity, and they furnish valuable insights into the meaning of the term.  I welcome the words of a secular French philosopher, Luc Ferry, who says:  “…the very idea that a human being can ‘lose his dignity’ because he has become weak, sick, old and therefore in a situation of dependency it is an intolerable idea on an ethical level, and is redolent of the deathly policies of the 1930s.”  And the observations of an Italian writer, Lucio Magris, an attentive scholar of contemporary culture, on the question of dignity in the context of euthanasia offer food for thought:  “Proposed in the name of mercy and human dignity, euthanasia can easily become a shameful, even if unwitting, societal cleansing—an exercise of the arbitrariness of those who, in the name of the quality of life, affirm that below a certain level, life is no longer worthy of being lived, and who give themselves the right to establish the level that authorizes the elimination of those who do not possess that level.  Doubtless, for many of the millions of frighteningly malnourished children who, even in their scandalous circumstances, are often abused psychologically and physically, death would be a lesser evil than the terrible life that awaits them, but it is doubtful that this authorizes their elimination.”

There is a wise and but somber text from the Second Vatican Council that is worth reading and  that will encourage each of us to consider “the other” as another “self”:   “Whatever is opposed to life itself, such as any type of murder, genocide, abortion, euthanasia, or willful self-destruction, whatever violates the integrity of the human person, such as mutilation, torments inflicted on body or mind, attempts to coerce the will itself; whatever insults human dignity, such as subhuman living conditions, arbitrary imprisonment, deportation, slavery, prostitution, the selling of women and children; as well as disgraceful working conditions, where people are treated as mere instruments of gain rather than as free and responsible persons; all these things and others like them are infamies indeed. They poison human society, and they do more harm to those who practice them than to those who suffer from the injury. Moreover, they are a supreme dishonor to the Creator”. (Gaudium et Spes, 27).

I do not believe there is any question that each person should live and die in a dignified manner.  I was moved by the words of a ninety-year-old lady who told me what death with dignity meant for her:  “I would like a peaceful death, in my bed, not at the hospital.  I would like to have a clear conscience and be at peace with God and everyone I know.  I would like people around me to say me a word of love, to give me the strength to die, to caress me with loving and tender gestures. to let me slip into death without forcing me to eat, if I don’t want to.  I want to feel life around me, children running, people talking; and if I suffer, I want someone give me what helps me not to suffer.  For me, this is death with dignity.”  Of course, this kind of death is not something you can legislate.  Really, talking about dignity in dying means promoting a new culture of life and relationships.  Dignity is not putting a lethal drug on the night table of someone who is dying; it is not a heart-stopping injection, or a deadly drink, even if the patient requests it.  And it is certainly not dignity to ignore the ocean of loneliness and confusion of those who think life is no longer worth living.  Such indifference is the bitter confirmation of what torments the dying: to no longer be worth anything to anyone.  The Catholic doctor—at least—stays at the bedside and is close to the dying, tries to heal if possible, but never stops caring.  This is what Jesus did and this is why in the ancient Church he was called “the Healer.”

Dear friends, true dignity is what the frail, sick person feels when he or she is treated with sensitivity,  touch, attention and affectionate, generous accompaniment.  Dignity is being recognized as a person, in every condition and situation.  Closeness, physical contact—holding hands, a kind word, a caress on the cheek at the last moments of earthly life—confirm to the dying their great dignity and to those who remain they offer a lesson about the meaning of life when life is slipping away.  That is why we should oppose the shameful deaths of the millions who die from famine, war, medical neglect, and so on.  Pope Francis writes in his most recent Apostolic Exhortation, Gaudete et Exultate: “Our defense of the innocent unborn, for example, needs to be clear, firm and passionate, for at stake is the dignity of a human life, which is always sacred and demands love for each person, regardless of his or her stage of development. Equally sacred, however, are the lives of the poor, those already born, the destitute, the abandoned and the underprivileged, the vulnerable infirm and elderly exposed to covert euthanasia, the victims of human trafficking, new forms of slavery, and every form of rejection.”  It would seem to me very opportune to encourage cultural initiatives—like this Conference—together with legislative proposals, that ensure for everyone a dignified healthy life and appropriate health care.  In a short essay written by Evangelical Church Christians and Roman Catholics in Germany, and published by Bernhard Vogel under the title “Focus on the Dignity of the Human Being,” it is stated clearly that  “dignity is the demanding of respect.”  But perhaps rather than “demand” the term “right” should be used.  And then the phrase would be:  “Dignity is the right to be respected.”

(Congresso Mondiale dei Medici Cattolici a Zagabria)