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ADDRESS OF JOHN PAUL II Tuesday 29 August 2000
Distinguished Ladies and Gentlemen,
1. I am happy to greet all of you at
this International Congress, which has brought you together for a reflection
on the complex and delicate theme of transplants.
I thank Professor Raffaello Cortesini and Professor Oscar Salvatierra
for their kind words, and I extend a special greeting to the Italian
Authorities present.
To all of you I express my gratitude for your kind invitation to take
part in this meeting and I very much appreciate the serious consideration you
are giving to the moral teaching of the Church. With respect for science and
being attentive above all to the law of God, the Church has no other aim but
the integral good of the human person.
Transplants are a great step forward in science's service of man,
and not a few people today owe their lives to an organ transplant.
Increasingly, the technique of transplants has proven to be a valid means of
attaining the primary goal of all medicine - the service of human life. That is why in the Encyclical Letter Evangelium
Vitae I suggested that one way of nurturing a genuine culture of life "is the donation of
organs, performed in an ethically acceptable manner, with a view to offering a
chance of health and even of life itself to the sick who sometimes have no
other hope" (No. 86).
2.As with all human advancement,
this particular field of medical science, for all the hope of health and life
it offers to many, also presents certain critical issues that need to
be examined in the light of a discerning anthropological and ethical
reflection.
In this area of medical science too the fundamental criterion must be the
defence and promotion of the integral good of the human person, in keeping
with that unique dignity which is ours by virtue of our humanity.
Consequently, it is evident that every medical procedure performed on the
human person is subject to limits: not just the limits of what it is
technically possible, but also limits determined by respect for human nature
itself, understood in its fullness: "what is
technically possible is not for that reason alone morally admissible" (Congregation for
the Doctrine of the Faith, Donum Vitae, 4).
3. It must first be emphasized, as I observed on another occasion, that
every organ transplant has its source in a decision of great ethical value: "the decision to
offer without reward a part of one's own body for the health and well-being of another person" (Address to
the Participants in a Congress on Organ Transplants, 20 June 1991, No. 3).
Here precisely lies the nobility of the gesture, a gesture which is a
genuine act of love. It is not just a matter of giving away something that
belongs to us but of giving something of ourselves, for "by virtue of its
substantial union with a spiritual soul, the human body cannot be considered
as a mere complex of tissues, organs and functions . . . rather it is a
constitutive part of the person who manifests and expresses himself through it" (Congregation for
the Doctrine of the Faith, Donum Vitae, 3).
Accordingly, any procedure which tends to commercialize human organs or
to consider them as items of exchange or trade must be considered morally
unacceptable, because to use the body as an "object" is to violate the
dignity of the human person.
This first point has an immediate consequence of great ethical import: the
need for informed consent. The
human "authenticity" of such a
decisive gesture requires that individuals be properly informed about the
processes involved, in order to be in a position to consent or decline in a
free and conscientious manner. The consent of relatives has its own ethical
validity in the absence of a decision on the part of the donor. Naturally, an
analogous consent should be given by the recipients of donated organs.
4. Acknowledgement of the unique dignity of the human person has a
further underlying consequence: vital organs which occur singly in the body
can be removed only after death, that is from the body of someone who is
certainly dead. This requirement
is self-evident, since to act otherwise would mean intentionally to cause the
death of the donor in disposing of his organs. This gives rise to one of the
most debated issues in contemporary bioethics, as well as to serious concerns
in the minds of ordinary people. I refer to the problem of ascertaining the
fact of death. When can a person be considered dead with complete
certainty?
In this regard, it is helpful to recall that the death of the person
is a single event, consisting in the total disintegration of that unitary and
integrated whole that is the personal self. It results from the separation of
the life-principle (or soul) from the corporal reality of the person. The
death of the person, understood in this primary sense, is an event which no
scientific technique or empirical method can identify directly.
Yet human experience shows that once death occurs certain biological
signs inevitably follow, which medicine has learnt to recognize with
increasing precision. In this sense, the "criteria" for ascertaining
death used by medicine today should not be understood as the
technical-scientific determination of the exact moment of a person's death, but as a
scientifically secure means of identifying the biological signs that a
person has indeed died.
5. It is a well-known fact that for
some time certain scientific approaches to ascertaining death have shifted the
emphasis from the traditional cardio-respiratory signs to the so-called "neurological" criterion.
Specifically, this consists in establishing, according to clearly
determined parameters commonly held by the international scientific community,
the complete and irreversible cessation of all brain activity (in the
cerebrum, cerebellum and brain stem). This is then considered the sign that
the individual organism has lost its integrative capacity.
With regard to the parameters used today for ascertaining death -
whether the "encephalic" signs or the more
traditional cardio-respiratory signs - the Church does not make technical decisions. She limits herself to the
Gospel duty of comparing the data offered by medical science with the
Christian understanding of the unity of the person, bringing out the
similarities and the possible conflicts capable of endangering respect for
human dignity.
Here it can be said that the criterion adopted in more recent times for
ascertaining the fact of death, namely the complete and irreversible
cessation of all brain activity, if rigorously applied, does not seem to
conflict with the essential elements of a sound anthropology. Therefore a
health-worker professionally responsible for ascertaining death can use these
criteria in each individual case as the basis for arriving at that degree of
assurance in ethical judgement which moral teaching describes as "moral certainty". This moral
certainty is considered the necessary and sufficient basis for an ethically
correct course of action. Only
where such certainty exists, and where informed consent has already been given
by the donor or the donor's legitimate
representatives, is it morally right to initiate the technical procedures
required for the removal of organs for transplant.
6. Another question of great ethical significance is that of the
allocation of donated organs through waiting-lists and the assignment of
priorities. Despite efforts to promote the practice of organ-donation, the
resources available in many countries are currently insufficient to meet
medical needs. Hence there is a
need to compile waiting-lists for transplants on the basis of clear and
properly reasoned criteria.
From the moral standpoint, an obvious principle of justice requires that
the criteria for assigning donated organs should in no way be "discriminatory" (i.e. based on
age, sex, race, religion, social standing, etc.) or "utilitarian" (i.e.
based on work capacity, social usefulness, etc.).
Instead, in determining who should have precedence in receiving an
organ, judgements should be made on the basis of immunological and clinical
factors. Any other
criterion would prove wholly arbitrary and subjective, and would fail to
recognize the intrinsic value of each human person as such, a value that is
independent of any external circumstances.
7. A final issue concerns a possible alternative solution to the problem
of finding human organs for transplantion, something still very much in the
experimental stage, namely xenotransplants, that is, organ transplants
from other animal species.
It is not my intention to explore in detail the problems connected with
this form of intervention. I would merely recall that already in 1956 Pope
Pius XII raised the question of their legitimacy. He did so when commenting on
the scientific possibility, then being presaged, of transplanting animal
corneas to humans. His response
is still enlightening for us today: in principle, he stated, for a xenotransplant
to be licit, the transplanted organ must not impair the integrity of the
psychological or genetic identity of the person receiving it; and there must
also be a proven biological possibility that the transplant will be successful
and will not expose the recipient to inordinate risk (cf. Address to the
Italian Association of Cornea Donors and to Clinical Oculists and Legal
Medical Practitioners, 14 May 1956).
8. In concluding, I express the hope that, thanks to the work of so many
generous and highly-trained people, scientific and technological research in
the field of transplants will continue to progress, and extend to experimentation
with new therapies which can replace organ transplants, as some recent
developments in prosthetics seem to promise.
In any event, methods that fail to respect the dignity and value of the
person must always be avoided. I
am thinking in particular of attempts at human cloning with a view to
obtaining organs for transplants: these techniques, insofar as they involve
the manipulation and destruction of human embryos, are not morally acceptable,
even when their proposed goal is good in itself. Science itself points to
other forms of therapeutic intervention which would not involve cloning
or the use of embryonic cells, but rather would make use of stem cells taken
from adults. This is the direction that research must follow if it wishes to
respect the dignity of each and every human being, even at the embryonic
stage.
In addressing these varied issues, the contribution of philosophers
and theologians is important. Their careful and competent reflection on
the ethical problems associated with transplant therapy can help to clarify
the criteria for assessing what kinds of transplants are morally acceptable
and under what conditions, especially with regard to the protection of each
individual's personal
identity.
I am confident that social, political and educational leaders will renew
their commitment to fostering a genuine culture of generosity and solidarity.
There is a need to instil in people's hearts,
especially in the hearts of the young, a genuine and deep appreciation of the
need for brotherly love, a love that can find expression in the decision to
become an organ donor. May the Lord sustain each one of you in your work, and guide you in the service of authentic human progress. I accompany this wish with my Blessing.
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