by the Congregation of the Doctrine of the Faith
June 20, 2008
1. The dignity of a
person must be recognized in every human being from conception to natural
death. This fundamental principle expresses a great “yes” to human life
and must be at the center of ethical reflection on biomedical research, which
has an ever greater importance in today’s world. The Church’s Magisterium has
frequently intervened to clarify and resolve moral questions in this area. The
Instruction Donum Vitae was particularly significant.[i] And now, twenty years after its publication,
it is appropriate to bring it up to date.
The teaching of Donum Vitae remains completely valid,
both with regard to the principles on which it is based and the moral
evaluations which it expresses. However,
new biomedical technologies which have been introduced in the critical area of
human life and the family have given rise to further questions, in particular
in the field of research on human embryos, the use of stem cells for
therapeutic purposes, as well as in other areas of experimental medicine. These
new questions require answers. The pace of scientific developments in this area
and the publicity they have received have raised expectations and concerns in
large sectors of public opinion. Legislative assemblies have been asked to make
decisions on these questions in order to regulate them by law; at times, wider
popular consultation has also taken place.
These developments have led the Congregation for
the Doctrine of the Faith to prepare a new doctrinal Instruction which
addresses some recent questions in the light of the criteria expressed in the
Instruction Donum Vitae and which also examines some issues that were
treated earlier, but are in need of additional clarification.
2. In undertaking this
study, the Congregation for the Doctrine of the Faith has benefited from the
analysis of the Pontifical
Academy for Life and has
consulted numerous experts with regard to the scientific aspects of these
questions, in order to address them with the principles of Christian
anthropology. The Encyclicals Veritatis Splendor[ii] and Evangelium
Vitae[iii] of John Paul II, as well
as other interventions of the Magisterium, offer clear indications with regard
to both the method and the content of the examination of the problems under
consideration.
In the current multifaceted philosophical and
scientific context, a considerable number of scientists and philosophers, in
the spirit of the Hippocratic Oath, see in medical science a service to
human fragility aimed at the cure of disease, the relief of suffering and the
equitable extension of necessary care to all people. At the same time, however,
there are also persons in the world of philosophy and science who view advances
in biomedical technology from an essentially eugenic perspective.
3.
In presenting principles and moral evaluations regarding biomedical research on
human life, the Catholic Church draws upon the light both of reason and of
faith and seeks to set forth an integral vision of man and his vocation,
capable of incorporating everything that is good in human activity, as well as
in various cultural and religious traditions which not infrequently demonstrate
a great reverence for life.
The Magisterium also seeks to offer a word of
support and encouragement for the perspective on culture which considers science
an invaluable service to the integral good of the life and dignity of every
human being. The Church therefore views scientific research with hope and
desires that many Christians will dedicate themselves to the progress of
biomedicine and will bear witness to their faith in this field. She hopes
moreover that the results of such research may also be made available in areas
of the world that are poor and afflicted by disease, so that those who are most
in need will receive humanitarian assistance. Finally, the Church seeks to draw
near to every human being who is suffering, whether in body or in spirit, in
order to bring not only comfort, but also light and hope. These give meaning to
moments of sickness and to the experience of death, which indeed are part of
human life and are present in the story of every person, opening that story to
the mystery of the Resurrection. Truly, the gaze of the Church is full of trust
because “Life will triumph: this is a sure hope for us. Yes, life will
triumph because truth, goodness, joy and true progress are on the side of life.
God, who loves life and gives it generously, is on the side of life.”[iv]
The present Instruction is addressed to the
Catholic faithful and to all who seek the truth.[v] It has three parts:
the first recalls some anthropological, theological and ethical elements of
fundamental importance; the second addresses new problems regarding
procreation; the third examines new procedures involving the manipulation of
embryos and the human genetic patrimony.
4. In recent decades,
medical science has made significant strides in understanding human life in its
initial stages. Human biological structures and the process of human generation
are better known. These developments are certainly positive and worthy of
support when they serve to overcome or correct pathologies and succeed in
re-establishing the normal functioning of human procreation. On the other hand,
they are negative and cannot be utilized when they involve the destruction of
human beings or when they employ means which contradict the dignity of the
person or when they are used for purposes contrary to the integral good of man.
The body of a human being, from the very first
stages of its existence, can never be reduced merely to a group of
cells. The embryonic human body develops progressively according to a
well-defined program with its proper finality, as is apparent in the birth of
every baby.
It is appropriate to recall the fundamental
ethical criterion expressed in the Instruction Donum
Vitae in
order to evaluate all moral questions which relate to procedures involving the
human embryo: “Thus the fruit of human generation, from the first moment of its
existence, that is to say, from the moment the zygote has formed, demands the
unconditional respect that is morally due to the human being in his bodily and
spiritual totality. 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.”[vi]
5. This ethical principle,
which reason is capable of recognizing as true and in conformity with the
natural moral law, should be the basis for all legislation in this area.[vii] In fact, it
presupposes a truth of an ontological character, as Donum
Vitae demonstrated
from solid scientific evidence, regarding the continuity in development of a
human being.
If Donum Vitae, in order to avoid a
statement of an explicitly philosophical nature, did not define the embryo as a
person, it nonetheless did indicate that there is an intrinsic connection
between the ontological dimension and the specific value of every human life.
Although the presence of the spiritual soul cannot be observed experimentally,
the conclusions of science regarding the human embryo give “a valuable
indication for discerning by the use of reason a personal presence at the
moment of the first appearance of a human life: how could a human individual
not be a human person?”[viii] Indeed, 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.
6. Respect for that dignity
is owed to every human being because each one carries in an indelible way his
own dignity and value. 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.”[ix]
Marriage, present in all times and in all
cultures, “is in reality something wisely and providently instituted by God the
Creator with a view to carrying out his loving plan in human beings. Thus,
husband and wife, through the reciprocal gift of themselves to the other –
something which is proper and exclusive to them – bring about that communion of
persons by which they perfect each other, so as to cooperate with God in the
procreation and raising of new lives.”[x] In the fruitfulness
of married love, man and woman “make it clear that at the origin of their
spousal life there is a genuine ‘yes’, which is pronounced and truly lived in
reciprocity, remaining ever open to life... Natural law, which is at the root
of the recognition of true equality between persons and peoples, deserves to be
recognized as the source that inspires the relationship between the spouses in
their responsibility for begetting new children. The transmission of life is
inscribed in nature and its laws stand as an unwritten norm to which all must
refer.”[xi]
7. It is the Church’s
conviction that what is human is not only received and respected by faith,
but is also purified, elevated and perfected. God, after having created man in
his image and likeness (cf. Genesis
1:26), described his creature as “very good” (Genesis 1:31), so as to be assumed later in the Son (cf. John 1:14). In the mystery of the
Incarnation, the Son of God confirmed the dignity of the body and soul which
constitute the human being. Christ did not disdain human bodiliness, but
instead fully disclosed its meaning and value: “In reality, it is only in the
mystery of the incarnate Word that the mystery of man truly becomes clear.”[xii]
By becoming one of us, the Son makes it possible
for us to become “sons of God” (John
1:12), “sharers in the divine nature” (2
Peter 1:4). This new dimension does not conflict with the
dignity of the creature which everyone can recognize by the use of reason, but
elevates it into a wider horizon of life which is proper to God, giving us the
ability to reflect more profoundly on human life and on the acts by which it is
brought into existence.[xiii]
The respect for the individual human being, which
reason requires, is further enhanced and strengthened in the light of these
truths of faith: thus, we see that there is no contradiction between the
affirmation of the dignity and the affirmation of the sacredness of human life.
“The different ways in which God, acting in history, cares for the world and
for mankind are not mutually exclusive; on the contrary, they support each
other and intersect. They have their origin and goal in the eternal, wise
and loving counsel whereby God predestines men and women ‘to be conformed to
the image of his Son’ (Romans 8:29).”[xiv]
8. By taking the
interrelationship of these two dimensions, the human and the divine, as
the starting point, one understands better why it is that man has unassailable
value: he possesses an eternal vocation and is called to share in the
trinitarian love of the living God.
This value belongs to all without
distinction. By virtue of the simple fact of existing, every human being
must be fully respected. The introduction of discrimination with regard to
human dignity based on biological, psychological, or educational development,
or based on health-related criteria, must be excluded. At every stage of
his existence, man, created in the image and likeness of God, reflects “the
face of his Only-begotten Son… This boundless and almost incomprehensible love
of God for the human being reveals the degree to which the human person
deserves to be loved in himself, independently of any other consideration –
intelligence, beauty, health, youth, integrity, and so forth. In short, human
life is always a good, for it ‘is a manifestation of God in the world, a
sign of his presence, a trace of his glory’ (Evangelium
Vitae, 34).”[xv]
9. 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. “God, who is love and life, has inscribed in man and
woman the vocation to share in a special way in his mystery of personal communion
and in his work as Creator and Father.”[xvi]
Christian marriage is rooted “in the natural
complementarity that exists between man and woman, and is nurtured through the
personal willingness of the spouses to share their entire life-project, what
they have and what they are: for this reason such communion is the fruit and
the sign of a profoundly human need. But in Christ the Lord, God takes up this
human need, confirms it, purifies it and elevates it, leading it to perfection
through the sacrament of matrimony: the Holy Spirit who is poured out in the
sacramental celebration offers Christian couples the gift of a new communion of
love that is the living and real image of that unique unity which makes of the
Church the indivisible Mystical Body of the Lord Jesus.”[xvii]
10. The Church, by expressing
an ethical judgment on some developments of recent medical research concerning
man and his beginnings, does not intervene in the area proper to medical
science itself, but rather calls everyone to ethical and social responsibility
for their actions. She reminds them 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. The
intervention of the Magisterium falls within its mission of contributing to
the formation of conscience, by authentically teaching the truth which is
Christ and at the same time by declaring and confirming authoritatively the
principles of the moral order which spring from human nature itself.[xviii]
11. In light of the
principles recalled above, certain questions regarding procreation which have
emerged and have become more clear in the years since the publication of Donum Vitae can now be examined.
12. With regard to the treatment
of infertility, new medical techniques must respect three fundamental
goods: 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;[xix] 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.”[xx]
Techniques which assist procreation “are not to be rejected on the grounds that
they are artificial. As such, they bear witness to the possibilities of the art
of medicine. But they must be given a moral evaluation in reference to the
dignity of the human person, who is called to realize his vocation from God to
the gift of love and the gift of life.”[xxi]
In light of this principle, all techniques of
heterologous artificial fertilization,[xxii] as well as those
techniques of homologous artificial fertilization[xxiii] 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. The
Instruction Donum Vitae states: “The doctor is at the service of
persons and of human procreation. He does not have the authority to dispose of
them or to decide their fate. A medical intervention respects the dignity
of persons when it seeks to assist the conjugal act either in order to
facilitate its performance or in order to enable it to achieve its objective
once it has been normally performed.”[xxiv] And, with regard
to homologous artificial insemination, it states: “Homologous artificial
insemination within marriage cannot be admitted except for those cases in which
the technical means is not a substitute for the conjugal act, but serves to
facilitate and to help so that the act attains its natural purpose.”[xxv]
13. Certainly,
techniques aimed at removing obstacles to natural fertilization, as for
example, hormonal treatments for infertility, surgery for endometriosis,
unblocking of fallopian tubes or their surgical repair, are licit. All
these techniques may be considered authentic treatments because, once
the problem causing the infertility has been resolved, the married couple is
able to engage in conjugal acts resulting in procreation, without the
physician’s action directly interfering in that act itself. None of these
treatments replaces the conjugal act, which alone is worthy of truly
responsible procreation.
In order to come to the aid of the many infertile
couples who want to have children, adoption should be encouraged,
promoted and facilitated by appropriate legislation so that the many children
who lack parents may receive a home that will contribute to their human
development. In addition, research and investment directed at the prevention
of sterility deserve encouragement.
14. The fact that the
process of in vitro fertilization very frequently involves the
deliberate destruction of embryos was already noted in the Instruction Donum
Vitae.[xxvi] There were some
who maintained that this was due to techniques which were still somewhat
imperfect. Subsequent experience has shown, however, 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.
It is true that approximately a third of women who
have recourse to artificial procreation succeed in having a baby. It
should be recognized, however, that given the proportion between the total
number of embryos produced and those eventually born, the number of embryos
sacrificed is extremely high.[xxvii]
These losses are accepted by the practitioners of in vitro fertilization
as the price to be paid for positive results. In reality, it is deeply
disturbing that research in this area aims principally at obtaining better
results in terms of the percentage of babies born to women who begin the
process, but does not manifest a concrete interest in the right to life of each
individual embryo.
15. It is often objected that
the loss of embryos is, in the majority of cases, unintentional or that it
happens truly against the will of the parents and physicians. They say
that it is a question of risks which are not all that different from those in
natural procreation; to seek to generate new life without running any risks
would in practice mean doing nothing to transmit it. It is true that not all
the losses of embryos in the process of in vitro fertilization have the
same relationship to the will of those involved in the procedure. But it
is also true that in many cases the abandonment, destruction and loss of
embryos are foreseen and willed.
Embryos produced in vitro which have
defects are directly discarded. Cases are becoming ever more prevalent in
which couples who have no fertility problems are using artificial means of
procreation in order to engage in genetic selection of their offspring. In many
countries, it is now common to stimulate ovulation so as to obtain a large
number of oocytes which are then fertilized. Of these, some are transferred
into the woman’s uterus, while the others are frozen for future use. The reason
for multiple transfer is to increase the probability that at least one embryo
will implant in the uterus. In this technique, therefore, the number of
embryos transferred is greater than the single child desired, in the
expectation that some embryos will be lost and multiple pregnancy may not
occur. In this way, the practice of multiple embryo transfer implies a
purely utilitarian treatment of embryos. One is struck by the fact
that, in any other area of medicine, ordinary professional ethics and the
healthcare authorities themselves would never allow a medical procedure which
involved such a high number of failures and fatalities. In fact,
techniques of in vitro fertilization are accepted based on the
presupposition that the individual embryo is not deserving of full respect in
the presence of the competing desire for offspring which must be satisfied.
This sad reality, which often goes unmentioned, is
truly deplorable: the “various techniques of artificial reproduction, which
would seem to be at the service of life and which are frequently used with this
intention, actually open the door to new threats against life.”[xxviii]
16. The Church moreover holds
that it is ethically unacceptable to dissociate procreation from the
integrally personal context of the conjugal act:[xxix] 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. Recognition of such respect is, on
the other hand, promoted by the intimacy of husband and wife nourished by
married love.
The Church recognizes the legitimacy of the desire
for a child and understands the suffering of couples struggling with problems
of fertility. Such a desire, however, should not override the dignity of every
human life to the point of absolute supremacy. The desire for a child 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[xxx] and to economic
pressures which are so strong in this area. In the face of this manipulation of
the human being in his or her embryonic state, it needs to be repeated that
“God’s love does not differentiate between the newly conceived infant still in
his or her mother’s womb and the child or young person, or the adult and the
elderly person. God does not distinguish between them because he sees an
impression of his own image and likeness (Gen 1:26) in each one…
Therefore, the Magisterium of the Church has constantly proclaimed the sacred
and inviolable character of every human life from its conception until its
natural end.”[xxxi]
17. Among the recent
techniques of artificial fertilization which have gradually assumed a particular
importance is intracytoplasmic sperm injection.[xxxii]
This technique is used with increasing frequency given its effectiveness in
overcoming various forms of male infertility.[xxxiii]
Just as in general with in vitro
fertilization, of which it is a variety, ICSI is intrinsically illicit:
it causes a complete separation between procreation and the conjugal act. Indeed
ICSI takes place “outside the bodies of the couple through actions of third
parties whose competence and technical activity determine the success of the
procedure. Such fertilization entrusts the life and identity of the embryo
into the power of doctors and biologists and establishes the domination of
technology over the origin and destiny of the human person. Such a
relationship of domination is in itself contrary to the dignity and equality
that must be common to parents and children. Conception in vitro is the
result of the technical action which presides over fertilization. Such
fertilization is neither in fact achieved nor positively willed as the
expression and fruit of a specific act of the conjugal union.”[xxxiv]
18. One of the methods for
improving the chances of success in techniques of in vitro fertilization
is the multiplication of attempts. In order to avoid repeatedly taking
oocytes from the woman’s body, the process involves a single intervention in
which multiple oocytes are taken, followed by cryopreservation of a
considerable number of the embryos conceived in vitro.[xxxv] In this way,
should the initial attempt at achieving pregnancy not succeed, the procedure
can be repeated or additional pregnancies attempted at a later date. In some
cases, even the embryos used in the first transfer are frozen because the
hormonal ovarian stimulation used to obtain the oocytes has certain effects
which lead physicians to wait until the woman’s physiological conditions have
returned to normal before attempting to transfer an embryo into her womb.
Cryopreservation is incompatible with the
respect owed to human embryos; it presupposes their production in vitro;
it exposes them to the serious risk of death or physical harm, since a high
percentage does not survive the process of freezing and thawing; it deprives
them at least temporarily of maternal reception and gestation; it places them
in a situation in which they are susceptible to further offense and
manipulation.[xxxvi]
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 is why there are thousands upon thousands of frozen
embryos in almost all countries where in vitro fertilization takes
place.
19. With regard to the large
number of frozen embryos already in existence the question becomes: what
to do with them? Some of those who pose this question do not grasp its
ethical nature, motivated as they are by laws in some countries that require
cryopreservation centers to empty their storage tanks
periodically. Others, however, are aware that a grave injustice has been
perpetrated and wonder how best to respond to the duty of resolving it.
Proposals to use these embryos for research or
for the treatment of disease are obviously unacceptable because they treat
the embryos as mere “biological material” and result in their destruction. The
proposal to thaw such embryos without reactivating them and use them for
research, as if they were normal cadavers, is also unacceptable.[xxxvii]
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;[xxxviii] this practice would
also lead to other problems of a medical, psychological and legal nature.
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.” This proposal,
praiseworthy with regard to the intention of respecting and defending human
life, presents however various problems not dissimilar to those mentioned
above.
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. Therefore John Paul II made an “appeal to
the conscience of the world’s scientific authorities and in particular to
doctors, that the production of human embryos be halted, taking into account
that there seems to be no morally licit solution regarding the human destiny of
the thousands and thousands of ‘frozen’ embryos which are and remain the
subjects of essential rights and should therefore be protected by law as human
persons.”[xxxix]
The
Freezing of Oocytes
20. In order avoid the
serious ethical problems posed by the freezing of embryos, the freezing of
oocytes has also been advanced in the area of techniques of in vitro
fertilization.[xl]
Once a sufficient number of oocytes has been obtained for a series of attempts
at artificial procreation, only those which are to be transferred into the
mother’s body are fertilized while the others are frozen for future
fertilization and transfer should the initial attempts not succeed.
In this regard it needs to be stated that cryopreservation
of oocytes for the purpose of being used in artificial procreation is to be
considered morally unacceptable.
21. Some techniques used in
artificial procreation, above all the transfer of multiple embryos into the
mother’s womb, have caused a significant increase in the frequency of multiple
pregnancy. This situation gives rise in turn to the practice of so-called
embryo reduction, a procedure in which embryos or fetuses in the womb are
directly exterminated. The decision to eliminate human lives, given that it was
a human life that was desired in the first place, represents a contradiction
that can often lead to suffering and feelings of guilt lasting for years.
From the ethical point of view, embryo
reduction is an intentional selective abortion. It is in fact the
deliberate and direct elimination of one or more innocent human beings in the
initial phase of their existence and as such it always constitutes a grave
moral disorder.[xli]
The ethical justifications proposed for embryo
reduction are often based on analogies with natural disasters or emergency situations
in which, despite the best intentions of all involved, it is not possible to
save everyone. Such analogies cannot in any way be the basis for an action
which is directly abortive. At other times, moral principles are invoked,
such as those of the lesser evil or double effect, which are likewise
inapplicable in this case. 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.
22. Preimplantation diagnosis
is a form of prenatal diagnosis connected with techniques of artificial
fertilization in which embryos formed in vitro undergo genetic diagnosis
before being transferred into a woman’s womb. Such diagnosis is done in
order to ensure that only embryos free from defects or having the desired
sex or other particular qualities are transferred.
Unlike other forms of prenatal diagnosis, in which
the diagnostic phase is clearly separated from any possible later elimination
and which provide therefore a period in which a couple would be free to accept
a child with medical problems, in this case, the diagnosis before implantation
is immediately followed by the elimination of an embryo suspected of having
genetic or chromosomal defects, or not having the sex desired, or having other
qualities that are not wanted. Preimplantation diagnosis – connected as it
is with artificial fertilization, which is itself always intrinsically illicit
– is directed toward the qualitative selection and consequent destruction of
embryos, which constitutes an act of abortion. Preimplantation
diagnosis is therefore the expression of a eugenic mentality that
“accepts selective abortion in order to prevent the birth of children affected
by various types of anomalies. Such an attitude is shameful and utterly
reprehensible, since it presumes to measure the value of a human life only
within the parameters of ‘normality’ and physical well-being, thus opening the
way to legitimizing infanticide and euthanasia as well.”[xlii]
By treating the human embryo as mere “laboratory
material”, the concept itself of human dignity is also subjected to
alteration and discrimination. Dignity belongs equally to every single
human being, irrespective of his parents’ desires, his social condition, educational
formation or level of physical development. If at other times in history,
while the concept and requirements of human dignity were accepted in general,
discrimination was practiced on the basis of race, religion or social
condition, today there is a no less serious and unjust form of discrimination
which leads to the non-recognition of the ethical and legal status of human
beings suffering from serious diseases or disabilities. It is forgotten that
sick and disabled people are not some separate category of humanity; in fact,
sickness and disability are part of the human condition and affect every
individual, even when there is no direct experience of it. Such
discrimination is immoral and must therefore be considered legally
unacceptable, just as there is a duty to eliminate cultural, economic and
social barriers which undermine the full recognition and protection of disabled
or ill people.
23. Alongside methods of
preventing pregnancy which are, properly speaking, contraceptive, that is,
which prevent conception following from a sexual act, there are other technical
means which act after fertilization, when the embryo is already constituted,
either before or after implantation in the uterine wall. Such methods are interceptive
if they interfere with the embryo before implantation and contragestative
if they cause the elimination of the embryo once implanted.
In order to promote wider use of interceptive
methods,[xliii] it is sometimes stated
that the way in which they function is not sufficiently understood. It is
true that there is not always complete knowledge of the way that different
pharmaceuticals operate, but scientific studies indicate that the effect of
inhibiting implantation is certainly present, even if this does not mean
that such interceptives cause an abortion every time they are used, also
because conception does not occur after every act of sexual
intercourse. It must be noted, however, that anyone who seeks to prevent
the implantation of an embryo which may possibly have been conceived and who
therefore either requests or prescribes such a pharmaceutical, generally
intends abortion.
When there is a delay in menstruation, a
contragestative is used,[xliv] usually one or two
weeks after the non-occurrence of the monthly period. The stated aim is to
re-establish menstruation, but what takes place in reality is the abortion
of an embryo which has just implanted.
As is known, abortion is “the deliberate and
direct killing, by whatever means it is carried out, of a human being in the
initial phase of his or her existence, extending from conception to birth.”[xlv] Therefore, the use
of means of interception and contragestation fall within the sin of abortion
and are gravely immoral. Furthermore, when there is certainty that an
abortion has resulted, there are serious penalties in canon law.[xlvi]
24. Knowledge
acquired in recent years has opened new perspectives for both regenerative
medicine and for the treatment of genetically based diseases. In
particular, research on embryonic stem cells and its possible future
uses have prompted great interest, even though up to now such research has not
produced effective results, as distinct from research on adult stem cells.
Because some maintain that the possible medical advances which might result
from research on embryonic stem cells could justify various forms of
manipulation and destruction of human embryos, a whole range of questions has
emerged in the area of gene therapy, from cloning to the use of stem cells,
which call for attentive moral discernment.
25. Gene
therapy commonly refers to techniques of genetic engineering applied to
human beings for therapeutic purposes, that is to say, with the aim of curing
genetically based diseases, although recently gene therapy has been attempted
for diseases which are not inherited, for cancer in particular.
In theory, it is possible to use gene
therapy on two levels: somatic cell gene therapy and germ line cell
therapy. Somatic cell gene therapy seeks to eliminate or reduce
genetic defects on the level of somatic cells, that is, cells other than the
reproductive cells, but which make up the tissue and organs of the body. It
involves procedures aimed at certain individual cells with effects that are
limited to a single person. Germ line cell therapy aims instead at
correcting genetic defects present in germ line cells with the purpose of
transmitting the therapeutic effects to the offspring of the individual. Such
methods of gene therapy, whether somatic or germ line cell 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.
26. For a moral
evaluation the following distinctions need to be kept in mind. Procedures
used on somatic cells for strictly therapeutic purposes are in principle
morally licit. Such actions seek to restore the normal genetic
configuration of the patient or to counter damage caused by genetic anomalies
or those related to other pathologies. Given that gene therapy can involve
significant risks for the patient, the ethical principle must be observed
according to which, in order to proceed to a therapeutic intervention, 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 the hypothesis of gene therapy on the
embryo, it needs to be added that this only takes place in the context of in
vitro fertilization and thus runs up against all the ethical objections to
such procedures. For these reasons, therefore, it must be stated that, in its
current state, germ line cell therapy in all its forms is morally illicit.
27. The
question of using genetic engineering for purposes other than medical treatment
also calls for consideration. Some have imagined the possibility of
using techniques of genetic engineering to introduce alterations with the
presumed aim of improving and strengthening the gene pool. Some of these
proposals exhibit a certain dissatisfaction or even rejection of the value of
the human being as a finite creature and person. 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. This would be in contrast with the
fundamental truth of the equality of all human beings which is expressed in the
principle of justice, the violation of which, in the long run, would harm
peaceful coexistence among individuals. Furthermore, one wonders who would
be able to establish which modifications were to be held as positive and which
not, or what limits should be placed on individual requests for improvement
since it would be materially impossible to fulfill the wishes of every single
person. Any conceivable response to these questions would, however, derive
from arbitrary and questionable criteria. All of this leads to the
conclusion that the prospect of such an intervention would end sooner or later
by harming the common good, by favoring the will of some over the freedom of
others. Finally it must also be noted that in the attempt to create a
new type of human being one can recognize an ideological element in
which man tries to take the place of his Creator.
In stating the ethical negativity of
these kinds of interventions which imply an unjust domination of man over
man, the Church also recalls the need to return to an attitude of care for
people and of education in accepting human life in its concrete historical
finite nature.
28. Human cloning
refers to 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.[xlvii]
Cloning is proposed for two basic
purposes: reproduction, that is, in order to obtain the birth of a baby,
and medical therapy or research. In theory, reproductive cloning
would be able to satisfy certain specific desires, for example, control over
human evolution, selection of human beings with superior qualities,
pre-selection of the sex of a child to be born, production of a child who is
the “copy” of another, or production of a child for a couple whose infertility
cannot be treated in another way. Therapeutic cloning, on the other hand,
has been proposed as a way of producing embryonic stem cells with a
predetermined genetic patrimony in order to overcome the problem of immune
system rejection; this is therefore linked to the issue of the use of stem
cells.
Attempts at cloning have given rise to
genuine concern throughout the entire world. Various national and
international organizations have expressed negative judgments on human cloning
and it has been prohibited in the great majority of nations.
Human cloning is intrinsically illicit
in that, by taking the ethical negativity of techniques of artificial
fertilization to their extreme, it seeks to give rise to a new human being
without a connection to the act of reciprocal self-giving between the spouses
and, more radically, without any link to sexuality. This leads to
manipulation and abuses gravely injurious to human dignity.[xlviii]
29. If cloning
were to be done for reproduction, this would impose on the resulting
individual a predetermined genetic identity, subjecting him – as has been
stated – to a form of biological slavery, from which it would be
difficult to free himself. The fact that someone would arrogate to himself
the right to determine arbitrarily the genetic characteristics of another
person represents a grave offense to the dignity of that person as well as
to the fundamental equality of all people.
The originality of every person is a
consequence of the particular relationship that exists between God and a human
being from the first moment of his existence and carries with it the obligation
to respect the singularity and integrity of each person, even on the biological
and genetic levels. In the encounter with another person, we meet a human
being who owes his existence and his proper characteristics to the love of God,
and only the love of husband and wife constitutes a mediation of that love in
conformity with the plan of the Creator and heavenly Father.
30. From the
ethical point of view, so-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.
The ethical objections raised in many
quarters to therapeutic cloning and to the use of human embryos formed in
vitro have led some researchers to propose new techniques which are
presented as capable of producing stem cells of an embryonic type without
implying the destruction of true human embryos.[xlix] 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.”[l]
31. Stem cells
are undifferentiated cells with two basic characteristics: 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.
Once it was experimentally verified
that when stem cells are transplanted into damaged tissue they tend to promote
cell growth and the regeneration of the tissue, new prospects opened for
regenerative medicine, which have been the subject of great interest among
researchers throughout the world.
Among the sources for human stem cells
which have been 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 the outset, studies focused on embryonic
stem cells, because it was believed that only these had significant
capabilities of multiplication and differentiation. Numerous studies, however,
show that adult stem cells also have a certain versatility. Even if
these cells do not seem to have the same capacity for renewal or the same
plasticity as stem cells taken from embryos, advanced scientific studies and
experimentation indicate that these cells give more positive results than
embryonic stem cells. Therapeutic protocols in force today provide for the use
of adult stem cells and many lines of research have been launched, opening new
and promising possibilities.
32. With regard
to the ethical evaluation, it is necessary to consider the methods of
obtaining stem cells as well as the risks connected with their clinical
and experimental use.
In these methods, the origin of the
stem cells must be taken into consideration. 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: “research, in such cases,
irrespective of efficacious therapeutic results, is not truly at the service of
humanity. In fact, this research advances through the suppression of human
lives that are equal in dignity to the lives of other human individuals and to
the lives of the researchers themselves. History itself has condemned such
a science in the past and will condemn it in the future, not only because it
lacks the light of God but also because it lacks humanity.”[li]
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.[lii]
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. Such use should be
characterized by scientific rigor and prudence, by reducing to the bare minimum
any risks to the patient and by facilitating the interchange of information
among clinicians and full disclosure to the public at large.
Research initiatives involving the use
of adult stem cells, since they do not present ethical problems, should be encouraged
and supported.[liii]
33. Recently
animal oocytes have been used for reprogramming the nuclei of human somatic
cells ― this is generally called hybrid cloning ― in order to extract
embryonic stem cells from the resulting embryos without having to use human
oocytes.
From the ethical standpoint, such
procedures represent an offense against the dignity of human beings on account
of the admixture of human and animal genetic elements capable of disrupting
the specific identity of man. The possible use of the stem cells,
taken from these embryos, may also involve additional health risks, as yet
unknown, due to the presence of animal genetic material in their
cytoplasm. To consciously expose a human being to such risks is morally
and ethically unacceptable.
34. For
scientific research and for the production of vaccines or other products, cell
lines are at times used which are the result of an illicit intervention against
the life or physical integrity of a human being. The connection to the
unjust act may be either mediate or immediate, since it is generally a question
of cells which reproduce easily and abundantly. This “material” is
sometimes made available commercially or distributed freely to research centers
by governmental agencies having this function under the law. All of this gives
rise to various ethical problems with regard to cooperation in evil and with
regard to scandal. It is fitting therefore to formulate general
principles on the basis of which people of good conscience can evaluate and
resolve situations in which they may possibly be involved on account of their
professional activity.
It needs to be remembered above all
that the category of abortion “is to be applied also to the recent forms of intervention
on human embryos which, although carried out for purposes legitimate in
themselves, inevitably involve the killing of those embryos. This is the case
with experimentation on embryos, which is becoming increasingly
widespread in the field of biomedical research and is legally permitted in some
countries… [T]he use of human embryos or fetuses as an object 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.”[liv] These forms of
experimentation always constitute a grave moral disorder.[lv]
35. A different
situation is created when researchers use “biological material” of illicit
origin which has been produced apart from their research center or which has
been obtained commercially. The Instruction Donum Vitae formulated the
general principle which must be observed in these cases: “The corpses of human
embryos and fetuses, whether they have been 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.”[lvi]
In this regard, the criterion of
independence as it has been formulated by some ethics committees is not
sufficient. According to this criterion, the use of “biological
material” of illicit origin would be ethically permissible provided there is a
clear separation between those who, on the one hand, produce, freeze and cause
the death of embryos and, on the other, the researchers involved in scientific
experimentation. The criterion of independence is not 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.[lvii]
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.
At times, the objection is raised that
the above-mentioned considerations would mean that people of good conscience
involved in research would have the duty to oppose actively all the illicit
actions that take place in the field of medicine, thus excessively broadening
their ethical responsibility. In reality, the duty to avoid cooperation in evil
and scandal relates to their ordinary professional activities, which they must
pursue in a just manner and by means of which they must give witness to the
value of life by their opposition to gravely unjust laws. Therefore, it needs
to be stated that 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.
Of course, 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.
In the context of the urgent need to mobilize
consciences in favor of life, people in the field of healthcare need to be
reminded that “their responsibility today is greatly increased. Its deepest
inspiration and strongest support lie in the intrinsic and undeniable ethical
dimension of the health-care profession, something already recognized by the
ancient and still relevant Hippocratic Oath, which requires every doctor
to commit himself to absolute respect for human life and its sacredness.”[lviii]
36. There
are those who say that the moral teaching of the Church contains too many
prohibitions. In reality, however, her teaching is based on the recognition and
promotion of all the gifts which the Creator has bestowed on man: such as life,
knowledge, freedom and love. Particular appreciation is due not only to man’s
intellectual activities, but also to those which are practical, like work and
technological activities. By these, in fact, he participates in the
creative power of God and is called to transform creation by ordering its many
resources toward the dignity and wellbeing of all human beings and of the human
person in his entirety. In this way, man acts as the steward of the value
and intrinsic beauty of creation.
Human history shows, however, how man
has abused and can continue to abuse the power and capabilities which God has
entrusted to him, giving rise to various forms of unjust discrimination and
oppression of the weakest and most defenseless: the daily attacks on human
life; the existence of large regions of poverty where people are dying from
hunger and disease, excluded from the intellectual and practical resources
available in abundance in many countries; technological and industrial
development which is creating the real risk of a collapse of the ecosystem; the
use of scientific research in the areas of physics, chemistry and biology for
purposes of waging war; the many conflicts which still divide peoples and
cultures; these sadly are only some of the most obvious signs of how man can
make bad use of his abilities and become his own worst enemy by losing the
awareness of his lofty and specific vocation to collaborate in the creative
work of God.
At the same time, human history has
also shown real progress in the understanding and recognition of the value
and dignity of every person as the foundation of the rights and ethical
imperatives by which human society has been, and continues to be
structured. Precisely in the name of promoting human dignity, therefore,
practices and forms of behavior harmful to that dignity have been
prohibited. Thus, for example, there are legal and political – and not
just ethical – prohibitions of racism, slavery, unjust discrimination and
marginalization of women, children, and ill and disabled people. Such
prohibitions bear witness to the inalienable value and intrinsic dignity of
every human being and are a sign of genuine progress in human history. In
other words, the legitimacy of every prohibition is based on the need to
protect an authentic moral good.
37. If
initially human and social progress was characterized primarily by industrial
development and the production of consumer goods, today it is distinguished by
developments in information technologies, research in genetics, medicine and
biotechnologies for human benefit, which are areas of great importance for the
future of humanity, but in which there are also evident and unacceptable
abuses. “Just as a century ago it was the working classes which were oppressed
in their fundamental rights, and the Church courageously came to their defense
by proclaiming the sacrosanct rights of the worker as person, so now, when
another category of persons is being oppressed in the fundamental right to
life, the Church feels in duty bound to speak out with the same courage on
behalf of those who have no voice. Hers is always the evangelical cry in
defense of the world’s poor, those who are threatened and despised and whose
human rights are violated.”[lix]
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.
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 religious assent 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.
The Sovereign Pontiff Benedict XVI, in
the Audience granted to the undersigned Cardinal Prefect on 20 June 2008,
approved the present Instruction, adopted in the Ordinary Session of this
Congregation, and ordered its publication.
† William Cardinal Levada, Prefect
† Luis F. Ladaria, S.I., Titular
Archbishop of Thibica, Secretary
Congregation for the Doctrine of the Faith
Aim
In recent years, biomedical research has
made great strides, opening new possibilities for the treatment of disease, but
also giving rise to serious questions which had not been directly treated in
the Instruction Donum Vitae (22
February 1987). A new Instruction, which is dated 8 September 2008, the Feast
of the Nativity of the Blessed Virgin Mary, seeks to provide some responses to
these new bioethical questions, as these have been the focus of expectations
and concerns in large sectors of society. In this way, the Congregation for the
Doctrine of the Faith seeks both to contribute “to the formation of conscience”
(n. 10) and to encourage biomedical research respectful of the dignity of every
human being and of procreation.
Title
The Instruction opens with the words Dignitas Personae ― the dignity of a
person, which must be recognized in every human being from conception to
natural death. This fundamental principle expresses “a great ‘ yes’ to human
life and must be at the center of ethical reflection on biomedical research”
(n. 1).
Value
The document is an Instruction of a
doctrinal nature, published by the Congregation for the Doctrine of the Faith
and expressly approved by the Holy Father, Pope Benedict XVI. The Instruction
therefore falls within the category of documents that “participate in the
ordinary Magisterium of the successor of Peter” (Instruction Donum Veritatis, n.18), and is to be
received by Catholics “with the religious assent of their spirit” (Dignitas Personae, n. 37).
Preparation
For several years, the Congregation for
the Doctrine of the Faith has been studying new biomedical questions with a
view to updating the Instruction Donum
Vitae. In undertaking the
examination of such new questions, the Congregation for the Doctrine of the
Faith “has benefited from the analysis of the Pontifical Academy
for Life and has consulted numerous experts with regard to the scientific
aspects of these questions, in order to address them with the principles of
Christian anthropology. The Encyclicals Veritatis
Splendor and Evangelium Vitae of
John Paul II, as well as other interventions of the Magisterium, offer clear
indications with regard to both the method and the content of the examination
of the problems under consideration” (n. 2).
Intended Recipients of the Document
The Instruction is meant for “all who
seek the truth” (n. 3). Indeed, in presenting principles and moral evaluations
regarding biomedical research on human life, the Catholic Church “draws upon
the light both of reason and of faith and seeks to set forth an integral vision
of man and his vocation, capable of incorporating everything that is good in
human activity, as well as in various cultural and religious traditions which
not infrequently demonstrate a great reverence for life” (n. 3).
Structure
The Instruction has three parts: “the
first recalls some anthropological, theological and ethical elements of
fundamental importance; the second addresses new problems regarding procreation;
the third examines new procedures involving the manipulation of embryos and the
human genetic patrimony” (n. 3).
First Part: Anthropological,
Theological and
Ethical Aspects of Human Life and Procreation
The Two Fundamental Principles
“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”
(n. 4).
“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” (n. 6).
Faith and Human Dignity
“It is the Church’s
conviction that what is human is not only received and respected by faith, but
is also purified, elevated and perfected” (n. 7). God has created every human
being in his own image, and his Son has made it possible for us to become
children of God. “By taking the interrelationship of these two dimensions, the
human and the divine, as the starting point, one understands better why it is
that man has unassailable value: he possesses an eternal vocation and is called
to share in the trinitarian love of the living God” (n. 8.).
Faith and Married Life
“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. God, who is love and life, has inscribed in man and woman the
vocation to share in a special way in his mystery of personal communion and in
his work as Creator and Father… The Holy Spirit who is poured out in the
sacramental celebration offers Christian couples the gift of a new communion of
love that is the living and real image of that unique unity which makes of the
Church the indivisible Mystical Body of the Lord Jesus” (n. 9).
The Church’s Magisterium and the Legitimate
Autonomy of Science
“The Church, by expressing
an ethical judgment on some developments of recent medical research concerning
man and his beginnings, does not intervene in the area proper to medical
science itself, but rather calls everyone to ethical and social responsibility
for their actions. She reminds them 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” (n. 10).
Second Part:
New Problems Concerning Procreation
Techniques for Assisting Fertility
Among the procedures which respond to
problems of fertility are the following:
§ “techniques of
heterologous artificial fertilization” (n. 12): that is, “techniques used to
obtain a human conception artificially by the use of gametes coming from at
least one donor other than the spouses who are joined in marriage” (footnote
22).
§ “techniques of homologous
artificial fertilization” (n. 12): that is, “the technique used to obtain a
human conception using the gametes of the two spouses joined in marriage”
(footnote 23).
§ “techniques which act as
an aid to the conjugal act and its fertility” (n. 12).
§ “techniques aimed at
removing obstacles to natural fertilization” (n. 13).
§ “adoption” (n. 13).
Techniques are morally permissible if they
respect: “the right to life and to physical integrity of every human being”,
“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” and
“the specifically human values of sexuality” (n. 12), which require that the
procreation of a new human person come about as a result of the conjugal act
specific to the love between a husband and wife.
§ Therefore, “techniques
which act as an aid to the conjugal act and its fertility are permitted” (n.
12). In such procedures, the “medical intervention respects the dignity of
persons when it seeks to assist the conjugal act either in order to facilitate
its performance or in order to enable it to achieve its objective once it has
been normally performed” (n. 12).
§ “Certainly, techniques
aimed at removing obstacles to natural fertilization… are licit” (n. 13).
§ “Adoption should be
encouraged, promoted and facilitated so that the many children who lack parents
may receive a home… In addition, research and investment directed at the
prevention of sterility deserve encouragement (n. 13).
In Vitro Fertilization and the Deliberate Destruction of
Embryos
The experience of recent years has shown
that in all techniques of in vitro fertilization
“the number of embryos sacrificed is extremely high” (n. 14). Even in the most
technically advanced centers of artificial fertilization, the number is above
80% (cf. footnote 27). “Embryos produced in vitro which have defects are
directly discarded”; a increasing number of couples “are using artificial means
of procreation in order to engage in genetic selection of their offspring”; of
the embryos which are produced in vitro
“some are transferred into the woman’s uterus, while the others are frozen”;
the technique of multiple transfer in which “the number of embryos transferred
is greater than the single child desired, in the expectation that some embryos
will be lost… implies a purely utilitarian treatment of embryos” (n. 15).
“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…leads to a weakening of the respect owed to every human being. Recognition
of such respect is, on the other hand, promoted by the intimacy of husband and
wife nourished by married love… In the face of this manipulation of the human
being in his or her embryonic state, it needs to be repeated that God’s love
does not differentiate between the newly conceived infant still in his or her
mother’s womb and the child or young person, or the adult and the elderly
person. God does not distinguish between them because he sees an impression of
his own image and likeness.. Therefore, the Magisterium of the Church has
constantly proclaimed the sacred and inviolable character of every human life
from its conception until its natural end” (n. 16).
Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection is a
variety of in vitro procreation in
which fertilization in the test tube does not simply “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” (footnote 32).
This technique, which is morally illicit,
causes a complete separation between procreation and the conjugal act” (n. 17).
It takes place “outside the bodies of the couple through actions of third
parties whose competence and technical activity determine the success of the
procedure. Such fertilization entrusts the life and identity of the embryo into
the power of doctors and biologists and establishes the domination of
technology over the origin and destiny of the human person” (n. 17).
Freezing Embryos
“In order to avoid repeatedly taking
oocytes from the woman’s body, the process involves a single intervention in
which multiple oocytes are taken, followed by cryopreservation of a
considerable number of the embryos conceived in vitro. In this way, should the initial attempt at achieving
pregnancy not succeed, the procedure can be repeated or additional pregnancies
attempted at a later date” (n. 18). The freezing or cryopreservation of embryos
“refers to freezing them at extremely low temperatures, allowing long term
storage” (cf. footnote 35).
“Cryopreservation is incompatible with
the respect owed to human embryos; it presupposes their production in vitro; it exposes them to the serious
risk of death or physical harm, since a high percentage does not survive the
process of freezing and thawing; it deprives them at least temporarily of
maternal reception and gestation; it places them in a situation in which they
are susceptible to further offense and manipulation” (n. 18).
With regard to the large number of
frozen embryos already in existence the question becomes: what to do with them? All the answers that
have been proposed (use the embryos for research or for the treatment of
disease; thaw them without reactivating them and use them for research, as if
they were normal cadavers; put them at the disposal of infertile couples as a
“treatment for infertility”; allow a form of “prenatal adoption”) present real
problems of various kinds. It needs to be recognized “that the thousands of
abandoned embryos represent a situation of injustice which in fact cannot be
resolved. Therefore, John Paul II made an “appeal to the conscience of the
world’s scientific authorities and in particular to doctors, that the
production of human embryos be halted, taking into account that there seems to
be no morally licit solution regarding the human destiny of the thousands and
thousands of ‘frozen’ embryos which are and remain the subjects of essential
rights and should therefore be protected by law as human persons” (n. 19).
The Freezing of Oocytes
§ “In order avoid the
serious ethical problems posed by the freezing of embryos, the freezing of
oocytes has also been advanced in the area of techniques of in vitro
fertilization” (n. 20).
§ In this regard it needs to
be stated that while the cryopreservation of oocytes is not in itself immoral,
and is employed in other medical contexts which are not the subject of this
document, when it takes place “for the purpose of being used in artificial procreation”
it is “to be considered morally unacceptable” (n. 20).
The Reduction of Embryos
§ “Some techniques used in
artificial procreation, above all the transfer of multiple embryos into the
mother’s womb, have caused a significant increase in the frequency of multiple
pregnancy. This situation gives rise in turn to the practice of so-called
embryo reduction, a procedure in which embryos or fetuses in the womb are
directly exterminated” (n. 21).
§ “From the ethical point of
view, embryo reduction is an intentional selective abortion. It is in fact the
deliberate and direct elimination of one or more innocent human beings in the
initial phase of their existence and as such it always constitutes a grave
moral disorder” (n. 21).
Preimplantation Diagnosis
§ “Preimplantation diagnosis
is a form of prenatal diagnosis connected with techniques of artificial
fertilization in which embryos formed in vitro undergo genetic diagnosis before
being transferred into a woman’s womb. Such diagnosis is done in order to ensure
that only embryos free from defects or having the desired sex or other
particular qualities are transferred” (n. 22).
§ “Unlike other forms of
prenatal diagnosis…, diagnosis before implantation is immediately followed by
the elimination of an embryo suspected of having genetic or chromosomal
defects, or not having the sex desired, or having other qualities that are not
wanted. Preimplantation diagnosis…is
directed toward the qualitative selection and consequent destruction of
embryos, which constitutes an act of abortion... By treating the human embryo
as mere ‘laboratory material’, the concept itself of human dignity is also
subjected to alteration and discrimination…Such discrimination is immoral and
must therefore be considered legally unacceptable…” (n. 22).
New Forms of Interception and Contragestation
There are methods of
preventing pregnancy which act after fertilization, when the embryo is already
constituted.
“Such methods are
interceptive if they interfere with the embryo before implantation” (n. 23);
for example, the IUD (intrauterine device) and the so-called ‘morning-after
pills’ (footnote 42). They are “contragestative if they cause the elimination
of the embryo once implanted” (n. 23); for example, the pharmaceutical known
commercially as RU-486 (footnote 43). Even if such interceptives may not cause
an abortion every time they are used, also because conception does not occur
after every act of sexual intercourse, it must be noted, however, that “anyone
who seeks to prevent the implantation of an embryo which may possibly have been
conceived and who therefore either requests or prescribes such a
pharmaceutical, generally intends abortion”. In the case of contragestatives
“what takes place in reality is the abortion of an embryo which has just
implanted… the use of means of interception and contragestation fall within the
sin of abortion and are gravely immoral” (n. 23).
Third Part: New
Treatments which Involve the
Manipulation of the Embryo or the Human Genetic
Patrimony
Gene
Therapy
§ Gene therapy commonly
refers to “techniques of genetic engineering applied to human beings for
therapeutic purposes, that is to say, with the aim of curing genetically based
diseases” (n. 25).
§ Somatic cell gene therapy
“seeks to eliminate or reduce genetic defects on the level of somatic cells”
(n. 25).
§ 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” (n.
25).
From the ethical point of
view:
§ Procedures used on somatic
cells for strictly therapeutic purposes “are in principle morally licit…Given
that gene therapy can involve significant risks for the patient, the ethical
principle must be observed according to which, in order to proceed to a
therapeutic intervention, 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” (n. 26).
§ With regard to germ line
cell therapy, “the risks connected to any genetic manipulation are considerable
and as yet not fully controllable” and therefore “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” (n. 26).
§ With regard to the
possibility of using techniques of genetic engineering to introduce alterations
with the presumed aim of improving and strengthening the gene pool, it must be
observed that such interventions would promote a “eugenic mentality” and would
introduce an “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. This would be in contrast with the fundamental truth of the
equality of all human beings which is expressed in the principle of justice,
the violation of which, in the long run, would harm peaceful coexistence among
individuals… Finally it must also be noted that in the attempt to create a new
type of human being one can recognize an ideological element in which man tries
to take the place of his Creator” (n. 27).
Human Cloning
Human cloning refers to “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” (n. 28). The techniques which have been proposed for
accomplishing human cloning are artificial embryo twinning, which “consists in
the artificial separation of individual cells or groups of cells from the
embryo in the earliest stage of development… which are then transferred into
the uterus in order to obtain identical embryos in an artificial manner”
(footnote 47) and cell nuclear transfer, which “consists in introducing a
nucleus taken from an embryonic or somatic cell into an denucleated oocyte.
This is followed by stimulation of the oocyte so that it begins to develop as
an embryo” (footnote 47). Cloning is proposed for two basic purposes:
reproduction, that is, in order to obtain the birth of a baby, and medical therapy
or research.
Human cloning is “intrinsically illicit
in that…it seeks to give rise to a new human being without a connection to the
act of reciprocal self-giving between the spouses and, more radically, without
any link to sexuality. This leads to manipulation and abuses gravely injurious
to human dignity” (n. 28).
§ With regard to
reproductive cloning, “this would impose on the resulting individual a
predetermined genetic identity, subjecting him ― as has been stated ― to a form
of biological slavery, from which it would be difficult to free himself. 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… In the encounter with another
person, we meet a human being who owes his existence and his proper
characteristics to the love of God, and only the love of husband and wife
constitutes a mediation of that love in conformity with the plan of the Creator
and heavenly Father” (n. 29).
§ With regard to cloning for
medical therapy or research, it must be said that 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” (n. 30).
§ As an alternative to
therapeutic cloning some researchers have proposed new techniques which are
presented as capable of producing stem cells of an embryonic type without
implying the destruction of true human embryos, for example, by altered nuclear
transfer (ANT) or oocyte assisted reprogramming (OAR). Doubts still remain,
however, “regarding the ontological status of the ‘product’ obtained in this
way” (n. 30).
The Therapeutic Use of Stem Cells
"Stem cells are undifferentiated
cells with two basic characteristics: 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. Once it was experimentally verified that when stem cells are
transplanted into damaged tissue they tend to promote cell growth and the
regeneration of the tissue, new prospects opened for regenerative medicine,
which have been the subject of great interest among researchers throughout the
world” (n. 31).
For the ethical evaluation, it is
necessary above all to consider the methods of obtaining stem cells.
§ “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” (n. 32).
§ “The obtaining of stem
cells from a living human embryo…invariably causes the death of the embryo and
is consequently gravely illicit… In this case, research…is not truly at the
service of humanity. In fact, this research advances through the suppression of
human lives that are equal in dignity to the lives of other human individuals
and to the lives of the researchers themselves” (n. 32).
§ “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” (n. 32).
Numerous studies, however, have shown
that adult stem cells give more positive results than embryonic stem cells.
Attempts at Hybridization
§ “Recently animal oocytes
have been used for reprogramming the nuclei of human somatic cells… in order to
extract embryonic stem cells from the resulting embryos without having to use
human oocytes” (n. 33).
§ “From the ethical
standpoint, such procedures represent an offense against the dignity of human
beings on account of the admixture of human and animal genetic elements capable
of disrupting the specific identity of man” (n. 33).
The Use of Human “Biological Material” of Illicit
Origin
For scientific research and for the
production of vaccines or other products, cell lines are at times used which
are the result of an illicit intervention against the life or physical
integrity of a human being.
§
Experimentation
on human embryos “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. These forms of experimentation always constitute a grave moral
disorder” (n. 34).
§
With
regard to the use of “biological material” of illicit origin by researchers,
which has been produced apart from their research center or which has been
obtained commercially, the moral requirement “must be safeguarded that there be
no complicity in deliberate abortion and that the risk of scandal be avoided.
In this regard, the criterion of independence as it has been formulated by some
ethics committees is not sufficient. According to this criterion, the use of
‘biological material’ of illicit origin would be ethically permissible provided
there is a clear separation between those who, on the one hand, produce, freeze
and cause the death of embryos and, on the other, the researchers involved in
scientific experimentation”. It needs to be remembered that the “duty to refuse
to use such ‘biological material’ 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” (n. 35).
§
“Of
course, 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” (n. 35).
[i]
Congregation
for the Doctrine of the Faith, Instruction Donum Vitae [“On Respect for Human
Life at Its Origins and for the Dignity of Procreation”] (22 February 1987): AAS
80 (1988), 70-102.
[ii]
John
Paul II, Encyclical Letter Veritatis Splendor [“Regarding Certain Fundamental Questions
of the Church’s Moral Teaching”] (6 August 1993): AAS 85 (1993),
1133-1228.
[iii]
John
Paul II, Encyclical Letter Evangelium Vitae [“On the Value and Inviolability of Human
Life”] (25 March 1995): AAS 87 (1995), 401-522.
[iv]
John
Paul II, Address to the participants in the Seventh Assembly of the Pontifical
Academy of Life (3 March 2001), 3: AAS 93 (2001), 446.
[v]
Cf. John
Paul II, Encyclical Letter Fides et Ratio [“On the Relationship between Faith
and Reason”] (14 September 1998), 1: AAS 91 (1999), 5.
[vii]
Human
rights, as Pope Benedict XVI has recalled, and in particular the right to life
of every human being “are based on the natural law inscribed on human hearts
and present in different cultures and civilizations. Removing human rights
from this context would mean restricting their range and yielding to a
relativistic conception, according to which the meaning and interpretation of
rights could vary and their universality would be denied in the name of
different cultural, political, social and even religious outlooks. This
great variety of viewpoints must not be allowed to obscure the fact that not
only rights are universal, but so too is the human person, the subject of those
rights” (Address to the General Assembly of the United Nations [18 April 2008]:
AAS 100 [2008], 334).
[viii]
Congregation
for the Doctrine of the Faith, Instruction Donum Vitae, I, 1: AAS
80 (1988), 78-79.
[ix]
Congregation
for the Doctrine of the Faith, Instruction Donum Vitae, II, A, 1: AAS
80 (1988), 87.
[xi]
Benedict
XVI, Address to the Participants in the International Congress organized by the
Pontifical Lateran University on the 40th Anniversary of the
Encyclical Humanae
Vitae, 10 May 2008: L’Osservatore Romano, 11
May 2008, p. 1; cf. John XXIII, Encyclical Letter Mater et Magistra (15
May 1961), III: AAS 53 (1961), 447.
[xv]
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): AAS 98 (2006), 264.
[xvi]
Congregation
for the Doctrine of the Faith, Instruction Donum Vitae,
Introduction, 3: AAS 80 (1988), 75.
[xvii]
John
Paul II, Apostolic Exhortation Familiaris Consortio [“On the Role of the Christian Family in the Modern World”]
(22 September 1981), 19: AAS 74 (1982), 101-102.
[xix]
Cf.
Congregation for the Doctrine of the Faith, Instruction Donum Vitae, II, A, 1: AAS
80 (1988), 87.
[xx]
Cf.
Congregation for the Doctrine of the Faith, Instruction Donum Vitae, II, B, 2: AAS
80 (1988), 94.
[xxi]
Congregation
for the Doctrine of the Faith, Instruction Donum Vitae Introduction,
3: AAS 80 (1988), 75.
[xxii]
The term
heterologous artificial fertilization or procreation refers to
“techniques used to obtain a human conception artificially by the use of
gametes coming from at least one donor other than the spouses who are joined in
marriage” (Instruction Donum Vitae II: AAS 80 [1988], 86).
[xxiii]
The term
homologous artificial fertilization or procreation refers to “the
technique used to obtain a human conception using the gametes of the two
spouses joined in marriage” (Instruction Donum Vitae, II: AAS 80 [1988], 86).
[xxiv]
Congregation
for the Doctrine of the Faith, Instruction Donum Vitae, II, B, 7: AAS
80 (1988), 96; cf. Pius XII, Address to those taking part in the Fourth
International Congress of Catholic Doctors (29 September 1949): AAS 41
(1949), 560.
[xxv]
Congregation
for the Doctrine of the Faith, Instruction Donum Vitae, II, B, 6: AAS
80 (1988), 94.
[xxvi]
Cf.
Congregation for the Doctrine of the Faith, Instruction Donum Vitae, II: AAS 80
(1988), 86.
[xxvii]
Currently
the number of embryos sacrificed, even in the most technically advanced centers
of artificial fertilization, hovers above 80%.
[xxix]
Cf. Pius
XII, Address to the Second World Congress in Naples on human reproduction and
sterility (19 May 1956): AAS 48 (1956), 470; Paul VI, Encyclical Letter Humanae Vitae, 12: AAS 60 (1968), 488-489;
Congregation for the Doctrine of the Faith, Instruction Donum Vitae, II, B, 4-5: AAS
80 (1988), 90-94.
[xxx]
An increasing
number of persons, even those who are unmarried, are having recourse to
techniques of artificial reproduction in order to have a child. These
actions weaken the institution of marriage and cause babies to be born in
environments which are not conducive to their full human development.
[xxxi]
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): AAS 98 (2006), 264.
[xxxii]
Intracytoplasmic
sperm injection is similar in almost every respect to other forms of in vitro
fertilization with the difference that in this procedure 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.
[xxxiii]
There is
ongoing discussion among specialists regarding the health risks which this
method may pose for children conceived in this way.
[xxxiv]
Congregation
for the Doctrine of the Faith, Instruction Donum Vitae, II, B, 5: AAS
80 (1988), 93.
[xxxv]
Cryopreservation
of embryos refers to freezing them at extremely low temperatures, allowing long
term storage.
[xxxvi] Cf.
Congregation for the Doctrine of the Faith, Instruction Donum Vitae, I, 6: AAS
80 (1988), 84-85.
[xxxvii]
Cf.
numbers 34-35 below.
[xxxviii]
Cf.
Congregation for the Doctrine of the Faith, Instruction Donum Vitae, II, A, 1-3: AAS
80 (1988), 87-89.
[xxxix]
John
Paul II, Address to the participants in the Symposium on “Evangelium Vitae and Law” and
the Eleventh International Colloquium on Roman and Canon Law (24 May 1996), 6: AAS
88 (1996), 943-944.
[xl]
Cryopreservation
of oocytes is also indicated in other medical contexts which are not under
consideration here. The term oocyte refers to the female germ cell (gametocyte)
not penetrated by the spermatozoa.
[xli]
Cf.
Second Vatican Council, Pastoral Constitution Gaudium et Spes, n. 51;
John Paul II, Encyclical Letter Evangelium Vitae, 62: AAS 87 (1995),
472.
[xliii]
The
interceptive methods which are best known are the IUD (intrauterine device) and
the so-called “morning-after pills”.
[xliv]
The
principal means of contragestation are RU-486 (Mifepristone), synthetic
prostaglandins or Methotrexate.
[xlvi]
Cf. CIC,
can. 1398 and CCEO, can. 1450 § 2; cf. also CIC, can. 1323-1324. The
Pontifical Commission for the Authentic Interpretation of the Code of Canon Law
declared that the canonical concept of abortion is “the killing of the fetus in
whatever way or at whatever time from the moment of conception” (Response
of 23 May 1988: AAS 80 [1988], 1818).
[xlvii]
In the
current state of knowledge, the techniques which have been proposed for
accomplishing human cloning are two: artificial embryo twinning and cell
nuclear transfer. Artificial embryo twinning consists in the
artificial separation of individual cells or groups of cells from the embryo in
the earliest stage of development. These are then transferred into the
uterus in order to obtain identical embryos in an artificial manner. Cell
nuclear transfer, or cloning properly speaking, consists in introducing a
nucleus taken from an embryonic or somatic cell into a denucleated oocyte. This
is followed by stimulation of the oocyte so that it begins to develop as an
embryo.
[xlviii]
Cf.
Congregation for the Doctrine of the Faith, Instruction Donum Vitae, I, 6: AAS 80 (1988), 84; John
Paul II, Address to Members of the Diplomatic Corps accredited to the Holy See
(10 January 2005), 5: AAS 97 (2005), 153.
[xlix]
The new
techniques of this kind are, for example, the use of human parthenogenesis,
altered nuclear transfer (ANT) and oocyte assisted reprogramming (OAR).
[li]
Benedict
XVI, Address to the participants in the Symposium on the topic: “Stem Cells:
what is the future for therapy?” organized by the Pontifical Academy
for Life (16 September 2006): AAS 98 (2006), 694.
[lii]
Cf.
numbers 34-35 below.
[liii]
Cf.
Benedict XVI, Address to the participants in the Symposium on the topic: “Stem
Cells: what is the future for therapy?” organized by the Pontifical Academy
for Life (16 September 2006): AAS 98 (2006), 693-695.
[lvii]
Cf. John
Paul II, Encyclical Letter Evangelium Vitae, 73: AAS 87
(1995), 486: “Abortion and euthanasia are thus crimes which no human law can
claim to legitimize. There is no obligation in conscience to obey such laws;
instead there is a grave and clear obligation to oppose them by
conscientious objection”. The right of conscientious objection, as an
expression of the right to freedom of conscience, should be protected by law.
[lix] John Paul II,
Letter to all the Bishops on “The Gospel of Life” (19 May 1991): AAS 84
(1992), 319.
SOURCE: Human Life International
SOURCE: Human Life International
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