Responsibility for the biological integrity of human beings

81. Modern technology, along with the latest developments in biochemistry and molecular biology, continues to provide contemporary medicine with new diagnostic and therapeutic possibilities. These techniques not only offer new and more effective treatments for disease, however, but also the potential to alter man himself. The availability and feasibility of these technologies lend new urgency to the question, how far is man allowed to remake himself? The exercise of a responsible stewardship in the area of bioethics requires profound moral reflection on a range of technologies that can affect the biological integrity of human beings. Here, we can offer only some brief indications of the specific moral challenges posed by the new technologies and some of the principles which must be applied if we are to exercise a responsible stewardship over the biological integrity of human beings created in the image of God.

82. The right fully to dispose of the body would imply that the person may use the body as a means to an end he himself has chosen: i.e., that he may replace its parts, modify or terminate it. In other words, a person could determine the finality or teleological value of the body. A right to dispose of something extends only to objects with a merely instrumental value, but not to objects which are good in themselves, i.e., ends in themselves. The human person, being created in the image of God, is himself such a good. The question, especially as it arises in bioethics, is whether this also applies to the various levels that can be distinguished in the human person: the biological-somatic, the emotional and the spiritual levels.

83. Everyday clinical practice generally accepts a limited form of disposing of the body and certain mental functions in order to preserve life, as for example in the case of the amputation of limbs or the removal of organs. Such practice is permitted by the principle of totality and integrity (also known as the therapeutic principle). The meaning of this principle is that the human person develops, cares for, and preserves all his physical and mental functions in such a way that (1) lower functions are never sacrificed except for the better functioning of the total person, and even then with an effort to compensate for what is being sacrificed; and (2) the fundamental faculties which essentially belong to being human are never sacrificed, except when necessary to save life.

84. The various organs and limbs together constituting a physical unity are, as integral parts, completely absorbed in the body and subordinate to it. But lower values cannot simply be sacrificed for the sake of higher ones: these values together constitute an organic unity and are mutually dependent. Because the body, as an intrinsic part of the human person, is good in itself, fundamental human faculties can only be sacrificed to preserve life. After all, life is a fundamental good that involves the whole of the human person. Without the fundamental good of life, the values – like freedom—that are in themselves higher than life itself also expire. Given that man was also created in God’s image in his bodiliness, he has no right of full disposal of his own biological nature. God himself and the being created in his image cannot be the object of arbitrary human action.

85. For the application of the principle of totality and integrity, the following conditions must be met: (1) there must be a question of an intervention in the part of the body that is either affected or is the direct cause of the life-threatening situation; (2) there can be no other alternatives for preserving life; (3) there is a proportionate chance of success in comparison with drawbacks; and (4) the patient must give assent to the intervention. The unintended drawbacks and side-effects of the intervention can be justified on the basis of the principle of double effect.

86. Some have attempted to interpret this hierarchy of values to permit the sacrifice of lower functions, like the procreative capacity, for the sake of higher values, like preserving mental health and improving relationships with others. However, the reproductive faculty is here sacrificed in order to preserve elements that may be essential to the person as a functioning totality but are not essential to the person as a living totality. In fact, the person as a functioning totality is actually violated by the loss of the reproductive faculty, and at a moment when the threat to his mental health is not imminent and could be averted in another way. Furthermore, this interpretation of the principle of totality suggests the possibility of sacrificing a part of the body for the sake of social interests. On the basis of the same reasoning, sterilization for eugenic reasons could be justified on the basis of the interest of the state.

87. Human life is the fruit of conjugal love – the mutual, total, definitive, and exclusive gift of man and woman to one another – reflecting the mutual gift in love between the three Divine Persons which becomes fruitful in creation, and the gift of Christ to his Church which becomes fruitful in the rebirth of man. The fact that a total gift of man concerns both his spirit and his body is the basis for the inseparability of the two meanings of the conjugal act which is (1) the authentic expression of conjugal love on the physical level and (2) comes to completion through procreation during the woman’s fertile phase (Humanae vitae, 12; Familiaris consortio, 32).

88. The mutual gift of man and woman to one another on the level of sexual intimacy is rendered incomplete through contraception or sterilization. Furthermore, if a technique is used that does not assist the conjugal act in attaining its goal, but replaces it, and the conception is then effected through the intervention of a third party, then the child does not originate from the conjugal act which is the authentic expression of the mutual gift of the parents.

89. In the case of cloning – the production of genetically identical individuals by means of cleaving of embryos or nuclear transplantation – the child is produced asexually and is in no way to be regarded as the fruit of a mutual gift of love. Cloning, certainly if it involves the production of a large number of people from one person, entails an infringement of the identity of the person. Human community, which as we have seen is also to be conceived as an image of the triune God, expresses in its variety something of the relations of the three divine Persons in their uniqueness which, through being of the same nature, marks their mutual differences.

90. Germ line genetic engineering with a therapeutic goal in man would in itself be acceptable were it not for the fact that is it is hard to imagine how this could be achieved without disproportionate risks especially in the first experimental stage, such as the huge loss of embryos and the incidence of mishaps, and without the use of reproductive techniques. A possible alternative would be the use of gene therapy in the stem cells that produce a man’s sperm, whereby he can beget healthy offspring with his own seed by means of the conjugal act.

91. Enhancement genetic engineering aims at improving certain specific characteristics. The idea of man as “co-creator” with God could be used to try to justify the management of human evolution by means of such genetic engineering. But this would imply that man has full right of disposal over his own biological nature. Changing the genetic identity of man as a human person through the production of an infrahuman being is radically immoral. The use of genetic modification to yield a superhuman or being with essentially new spiritual faculties is unthinkable, given that the spiritual life principle of man – forming the matter into the body of the human person – is not a product of human hands and is not subject to genetic engineering. The uniqueness of each human person, in part constituted by his biogenetic characteristics and developed through nurture and growth, belongs intrinsically to him and cannot be instrumentalized in order to improve some of these characteristics. A man can only truly improve by realizing more fully the image of God in him by uniting himself to Christ and in imitation of him. Such modifications would in any case violate the freedom of future persons who had no part in decisions that determine his bodily structure and characteristics in a significant and possibly irreversible way. Gene therapy, directed to the alleviation of congenital conditions like Down's syndrome, would certainly affect the identity of the person involved with regard to his appearance and mental gifts, but this modification would help the individual to give full expression to his real identity which is blocked by a defective gene.

92. Therapeutic interventions serve to restore the physical, mental and spiritual functions, placing the person at the center and fully respecting the finality of the various levels in man in relation to those of the person. Possessing a therapeutic character, medicine that serves man and his body as ends in themselves respects the image of God in both. According to the principle of proportionality, extraordinary life-prolonging therapies must be used when there is a just proportion between the positive results that attend these therapies and possible damage to the patient himself. Therapy may be abandoned, even if death is thereby hastened, when this proportion is absent. A hastening of death in palliative therapy by the administration of analgesics is an indirect effect which, like all side-effects in medicine, can come under the principle of double effect, provided that the dosage is geared to the suppression of painful symptoms and not to the active termination of life.

93. Disposing of death is I n reality the most radical way of disposing of life. In assisted suicide, direct euthanasia, and direct abortion - however tragic and complex personal situations may be - physical life is sacrificed for a self-selected finality. In the same category is the instrumentalization of the embryo through non-therapeutic experimentation on embryos, as well as by pre-implantation diagnostics.

94. Our ontological status as creatures made in the image of God imposes certain limits on our ability to dispose of ourselves. The sovereignty we enjoy is not an unlimited one: we exercise a certain participated sovereignty over the created world and, in the end, we must render an account of our stewardship to the Lord of the Universe. Man is created in the image of God, but he is not God himself.

 

CONCLUSION

95. Throughout these reflections, the theme of the imago Dei has demonstrated its systematic power in clarifying many truths of the Christian faith. It helps us to present a relational - and indeed personal - conception of human beings. It is precisely this relationship with God which defines human beings and founds their relationships with other creatures. Nonetheless, as we have seen, the mystery of the human is made fully clear only in the light of Christ who is the perfect image of the Father and who introduces us, through the Holy Spirit, to a participation in the mystery of the triune God. It is within this communion of love that the mystery of all being, as embraced by God, finds its fullest meaning. At one and the same time grand and humble, this conception of human being as the image of God constitutes a charter for human relations with the created world and a basis upon which to assess the legitimacy of scientific and technical progress that has a direct impact on human life and the environment. In these areas, just as human persons are called to give witness to their participation in the divine creativity, they are also required to acknowledge their position as creatures to whom God has confided a precious responsibility for the stewardship of the physical universe.

* Preliminary Note

The theme of “man created in the image of God” was submitted for study to the International Theological Commission. The preparation of this study was entrusted to a subcommission whose members included: Very Rev. J. Augustine Di Noia, O.P., Most Reverend Jean-Louis Bruguès, Msgr. Anton Strukelj, Rev. Tanios Bou Mansour, O.L.M., Rev. Adolpe Gesché, Most Reverend Willem Jacobus Eijk, Rev. Fadel Sidarouss, S.J., and Rev. Shun ichi Takayanagi, S.J.

As the text developed, it was discussed at numerous meetings of the subcommission and several plenary sessions of the International Theological Commission held at Rome during the period 2000-2002. The present text was approved in forma specifica, by the written ballots of the International Theological Commission. It was then submitted to Joseph Cardinal Ratzinger, the President of the Commission, who has give his permission for its publication.

 

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