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ADDRESS OF JOHN PAUL II
TO THE 18th INTERNATIONAL CONGRESS
OF THE TRANSPLANTATION SOCIETY
Tuesday 29 August 2000
Distinguished Ladies and Gentlemen,
1. I am happy to greet all of you at this International Congress, which has
brought you together for a reflection on the complex and delicate theme of
transplants. I thank Professor Raffaello Cortesini and Professor Oscar
Salvatierra for their kind words, and I extend a special greeting to the Italian
Authorities present.
To all of you I express my gratitude for your kind invitation to take part in
this meeting and I very much appreciate the serious consideration you are giving
to the moral teaching of the Church. With respect for science and being
attentive above all to the law of God, the Church has no other aim but the
integral good of the human person.
Transplants are a great step forward in science's service of man, and not a few
people today owe their lives to an organ transplant. Increasingly, the technique
of transplants has proven to be a valid means of attaining the primary goal of
all medicine - the service of human life. That is why in the Encyclical Letter
Evangelium Vitae I suggested that one way of nurturing a genuine culture of life
"is the donation of organs, performed in an ethically acceptable manner, with a
view to offering a chance of health and even of life itself to the sick who
sometimes have no other hope" (No. 86).
2.As with all human advancement, this particular field of medical science, for
all the hope of health and life it offers to many, also presents certain
critical issues that need to be examined in the light of a discerning
anthropological and ethical reflection.
In this area of medical science too the fundamental criterion must be the
defence and promotion of the integral good of the human person, in keeping with
that unique dignity which is ours by virtue of our humanity. Consequently, it is
evident that every medical procedure performed on the human person is subject to
limits: not just the limits of what it is technically possible, but also limits
determined by respect for human nature itself, understood in its fullness: "what
is technically possible is not for that reason alone morally admissible"
(Congregation for the Doctrine of the Faith, Donum Vitae, 4).
3. It must first be emphasized, as I observed on another occasion, that every
organ transplant has its source in a decision of great ethical value: "the
decision to offer without reward a part of one's own body for the health and
well-being of another person" (Address to the Participants in a Congress on
Organ Transplants, 20 June 1991, No. 3). Here precisely lies the nobility of the
gesture, a gesture which is a genuine act of love. It is not just a matter of
giving away something that belongs to us but of giving something of ourselves,
for "by virtue of its substantial union with a spiritual soul, the human body
cannot be considered as a mere complex of tissues, organs and functions . . .
rather it is a constitutive part of the person who manifests and expresses
himself through it" (Congregation for the Doctrine of the Faith, Donum Vitae,
3).
Accordingly, any procedure which tends to commercialize human organs or to
consider them as items of exchange or trade must be considered morally
unacceptable, because to use the body as an "object" is to violate the dignity
of the human person.
This first point has an immediate consequence of great ethical import: the need
for informed consent. The human "authenticity" of such a decisive gesture
requires that individuals be properly informed about the processes involved, in
order to be in a position to consent or decline in a free and conscientious
manner. The consent of relatives has its own ethical validity in the absence of
a decision on the part of the donor. Naturally, an analogous consent should be
given by the recipients of donated organs.
4. Acknowledgement of the unique dignity of the human person has a further
underlying consequence: vital organs which occur singly in the body can be
removed only after death, that is from the body of someone who is certainly
dead. This requirement is self-evident, since to act otherwise would mean
intentionally to cause the death of the donor in disposing of his organs. This
gives rise to one of the most debated issues in contemporary bioethics, as well
as to serious concerns in the minds of ordinary people. I refer to the problem
of ascertaining the fact of death. When can a person be considered dead with
complete certainty?
In this regard, it is helpful to recall that the death of the person is a single
event, consisting in the total disintegration of that unitary and integrated
whole that is the personal self. It results from the separation of the
life-principle (or soul) from the corporal reality of the person. The death of
the person, understood in this primary sense, is an event which no scientific
technique or empirical method can identify directly.
Yet human experience shows that once death occurs certain biological signs
inevitably follow, which medicine has learnt to recognize with increasing
precision. In this sense, the "criteria" for ascertaining death used by medicine
today should not be understood as the technical-scientific determination of the
exact moment of a person's death, but as a scientifically secure means of
identifying the biological signs that a person has indeed died.
5. It is a well-known fact that for some time certain scientific approaches to
ascertaining death have shifted the emphasis from the traditional
cardio-respiratory signs to the so-called "neurological" criterion.
Specifically, this consists in establishing, according to clearly determined
parameters commonly held by the international scientific community, the complete
and irreversible cessation of all brain activity (in the cerebrum, cerebellum
and brain stem). This is then considered the sign that the individual organism
has lost its integrative capacity.
With regard to the parameters used today for ascertaining death - whether the
"encephalic" signs or the more traditional cardio-respiratory signs - the Church
does not make technical decisions. She limits herself to the Gospel duty of
comparing the data offered by medical science with the Christian understanding
of the unity of the person, bringing out the similarities and the possible
conflicts capable of endangering respect for human dignity.
Here it can be said that the criterion adopted in more recent times for
ascertaining the fact of death, namely the complete and irreversible cessation
of all brain activity, if rigorously applied, does not seem to conflict with the
essential elements of a sound anthropology. Therefore a health-worker
professionally responsible for ascertaining death can use these criteria in each
individual case as the basis for arriving at that degree of assurance in ethical
judgement which moral teaching describes as "moral certainty". This moral
certainty is considered the necessary and sufficient basis for an ethically
correct course of action. Only where such certainty exists, and where informed
consent has already been given by the donor or the donor's legitimate
representatives, is it morally right to initiate the technical procedures
required for the removal of organs for transplant.
6. Another question of great ethical significance is that of the allocation of
donated organs through waiting-lists and the assignment of priorities. Despite
efforts to promote the practice of organ-donation, the resources available in
many countries are currently insufficient to meet medical needs. Hence there is
a need to compile waiting-lists for transplants on the basis of clear and
properly reasoned criteria.
From the moral standpoint, an obvious principle of justice requires that the
criteria for assigning donated organs should in no way be "discriminatory" (i.e.
based on age, sex, race, religion, social standing, etc.) or "utilitarian" (i.e.
based on work capacity, social usefulness, etc.). Instead, in determining who
should have precedence in receiving an organ, judgements should be made on the
basis of immunological and clinical factors. Any other criterion would prove
wholly arbitrary and subjective, and would fail to recognize the intrinsic value
of each human person as such, a value that is independent of any external
circumstances.
7. A final issue concerns a possible alternative solution to the problem of
finding human organs for transplantion, something still very much in the
experimental stage, namely xenotransplants, that is, organ transplants from
other animal species.
It is not my intention to explore in detail the problems connected with this
form of intervention. I would merely recall that already in 1956 Pope Pius XII
raised the question of their legitimacy. He did so when commenting on the
scientific possibility, then being presaged, of transplanting animal corneas to
humans. His response is still enlightening for us today: in principle, he
stated, for a xenotransplant to be licit, the transplanted organ must not impair
the integrity of the psychological or genetic identity of the person receiving
it; and there must also be a proven biological possibility that the transplant
will be successful and will not expose the recipient to inordinate risk (cf.
Address to the Italian Association of Cornea Donors and to Clinical Oculists and
Legal Medical Practitioners, 14 May 1956).
8. In concluding, I express the hope that, thanks to the work of so many
generous and highly-trained people, scientific and technological research in the
field of transplants will continue to progress, and extend to experimentation
with new therapies which can replace organ transplants, as some recent
developments in prosthetics seem to promise. In any event, methods that fail to
respect the dignity and value of the person must always be avoided. I am
thinking in particular of attempts at human cloning with a view to obtaining
organs for transplants: these techniques, insofar as they involve the
manipulation and destruction of human embryos, are not morally acceptable, even
when their proposed goal is good in itself. Science itself points to other forms
of therapeutic intervention which would not involve cloning or the use of
embryonic cells, but rather would make use of stem cells taken from adults. This
is the direction that research must follow if it wishes to respect the dignity
of each and every human being, even at the embryonic stage.
In addressing these varied issues, the contribution of philosophers and
theologians is important. Their careful and competent reflection on the ethical
problems associated with transplant therapy can help to clarify the criteria for
assessing what kinds of transplants are morally acceptable and under what
conditions, especially with regard to the protection of each individual's
personal identity.
I am confident that social, political and educational leaders will renew their
commitment to fostering a genuine culture of generosity and solidarity. There is
a need to instil in people's hearts, especially in the hearts of the young, a
genuine and deep appreciation of the need for brotherly love, a love that can
find expression in the decision to become an organ donor.
May the Lord sustain each one of you in your work, and guide you in the service
of authentic human progress. I accompany this wish with my Blessing.
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