OBSTETRICIANS AND GYNAECOLOGISTS
Rome, June 17-20, 2001
Cardinal Dionigi Tettamanzi, Archbishop of Genoa
No problem can be tackled and solved but in the social and cultural context in which we are. This also applies, and in a very particular way, to the problem of human life.
Now we all know which is the actual social and cultural situation with regard to interventions on life. It can be synthetically described as follows: it is the situation in which "science and the practice of medicine risk losing sight of their inherent ethical dimension" and as a consequence health-care professionals "can be strongly tempted at times to become manipulators of life, or even agents of death" (Evangelium Vitae, 89).
As we can see, it is a situation that is radically changed with respect to the past on account of the scientific and technical innovations that apply to the birth of human life, especially in its beginnings.
The Holy Father reminded us of them in the speech he gave to the participants of this Congress, on June 18 2001: "The availability of contraceptive and abortive drugs, new threats to life in the laws of some countries, some of the uses of prenatal diagnosis, the spread of in vitro fertilization techniques, the consequent production of embryos to deal with sterility, but also their destination to scientific research, the use of embryonic stem cells for the development of tissues for transplants to cure degenerative diseases and projects of full or partial cloning, already done with animals; all of these have changed the situation radically ".
But in this modified situation we do not only find scientific and technological innovations, there is also and above all a very widespread and rooted cultural reality, possessing its own specific power that is decisive in view of making this radical change. Once again the Holy Father signals it with very simple words full of meaning: "Conception, pregnancy and childbirth are no longer understood as ways of cooperating with the Creator in the marvelous task of giving life to a new human being".
How to "look" at the beginning of human life?
It is for this that I ask the question, "How to look at human life, specifically at the beginning of human life?".
This question, so simple and even banal, is in truth crucial with regard to judgements and choices, that is to the way we consider life and we face the concrete problems life poses to everybody, specifically to obstetricians, gynaecologists and obstetric nurses. The way we look at life, intended as internal and spiritual attitude, determines external concrete behaviour. Therefore it also determines the answer we give to the problems of life itself.
The wish I address to myself and to all of you is precise and unequivocal: it is the wish to possess a deeply religious way of looking at life, God's way of looking at life.
The ancient Jewish praying man, the psalmist, speaks to us of this way of looking at life in a wonderful and moving way: "Lord, you have examined me and you know me...You know everything I do...When my bones were being formed, carefully put together in my mother's womb, when I was growing there in secret, you knew that I was there &emdash; you saw me before I was born. The days allotted to me had all been recorded in your book, before any of them ever began..." (Psalm 139).
This religious way of looking at life is part of the deep human experience of the couple, and in particular of the woman who becomes a mother. She can make the amazed and joyful cry of Eve, the mother of all living creatures, her own: "By the Lord's help I have acquired a son" (Genesis 4,1).
This same way of looking at life is possible also for scientific researchers and for those who work in the medical profession.
But we must immediately note that such a way of looking at life is not easy. It demands humility, wisdom and courage. These are three virtuous attitudes, three spiritual energies that are essential in order for this religious way of looking at human life to be realized in a cultural context that categorically refuses them. But without humility there is no access to truth, without wisdom one cannot reach the roots of reality, without courage it is not possible to be coherent with oneself and ready to sustain the clash with a society and a culture that do not acknowledge and that fight that way of looking at life.
In truth, daily experience convinces us that possessing and living that religious way of looking at human life is not easy at all. It takes little to cloud it: for example, the habit and haste marking our work, adding labour as well and at times disappointment, these also being realities that accompany our daily engagement. Above all this way of looking at life is somehow erased - or tends to be erased - by the dominant cultural pressure, especially on account of the twofold connotation characterizing culture today: that of a technology that ends up becoming an absolute, and that of an understanding of the "quality of life" that is defined by the absolute criteria of possession, of power, and of pleasure.
In a similar context, of daily profession and cultural pressure, it seems to me absolutely necessary to detect in this religious way of looking at the beginning of human life, on the one hand all of its human and rational richness, and on the other hand all of its power of concrete incidence on the scientifically and professionally demanding practice of the medical art and praxis.
The rationality/scientific quality of the religious way of looking at life
One might say (and this is the easy objection that can be raised) that the religious way of looking at human life is "poetic", therefore "sentimental". This may be, but it also true that poetry and sentiment are a significant medium to reach reality, the very heart of reality, and therefore the ultimate truth. Intuition, in fact, constitutes undoubtedly a great power to penetrate and interpret reality. Moreover, the same poetry and the same sentiment can meet and harmonize perfectly with the most lucid rationality, and hence with the most serious and objective scientific reflection, be it of philosophical-theological nature or be it positive.
Through this way of knowing - which I would call of "composite knowing " - our looking at the beginning of human life reaches its center, its focal point when it singles out in the living human being its proprium, that is to say its typical and specific element, his being "person". The dignity specific to man, to every man, always and everywhere, in every phase and condition of life, resides in his being "person".
When we say "person" according to an anthropological perspective not reductive nor impoverished, but integral and adequate - which we can know with the twofold light of human reason and divine revelation - we imply an extraordinary richness of contents. It will suffice here just to make a list of them, with the warning however not to deem them abstract principles, faraway and extraneous to the many concrete problems that the medical profession faces daily, but rather to understand them in their value of extreme concreteness for they constitute the necessary criteria that cannot be renounced of ethical reference for our behaviour towards others.
I am speaking of "ethical reference", whereby it is understood that ethics is not something which from the outside places itself above or imposes itself upon the human being, but rather it is something intrinsic - I would say "innate" - to the human being himself, once he is considered in his structure, in his dynamisms and his finalities, that is as being "ordered" to the values, to the Value, with an ordering which the human being - insofar he is rational and volitive - is called to assume consciously and freely, that is in the obedience to his conscience, which in turn is fidelity to one's being a person. In this sense St. Thomas Aquinas affirms that "moral acts and human acts are the same thing" (Idem sunt actus morales et actus humani: Summa Theologiae, I-II, 1, 3). The well-known axiom agere sequitur esse also derives from this. Human actions are but the revelation (and at the same time the effective coherence) of the human being.
These fundamental references to man as person will suffice.
Person is the human being, in his wholeness of body, psyche and spirit. The person is an indissoluble mixture of corporeity and spirituality (corpore et anima unus, as according to the Council in the constitution Gaudium et spes, 14). This is ab initio.
The person is always and only an end, and therefore a subject, never a simple mean, or instrument, or thing or object. On the façade of Saint Dénis in Paris, on the occasion of a journey of the Pope, the following writing appeared: "A young worker is worth more than the entire universe". It is an echo of what in the past centuries a great and unsurpassed theologian, St. Thomas Aquinas, wrote: "the person is that which is most perfect in the universe" (Persona significat id quod est perfectissimum in tota natura: Summa Theologiae I, q. 28, a.3).
The person is rational and volitive being, it is ethical subject free and responsible, it is subject tied to the absolute. It is, according to an anthropology open to transcendence, imago Dei, living image of God, made in his image and likeness. That which human reason perceives with intuition and somehow reaches, finds its firm affirmation, and its surprising and deep elucidation, in the word of God who becomes manifest to man, and in the faith with which man receives the divine revelation. In this sense the religious way of looking at human life corresponds perfectly to the reality of the person. Only this way of looking is able to reach the totality and depth of the truth of the person, and hence of human life.
What we just synthetically said is always and in any case true. Always, and therefore in every phase and condition of life of the human being. We must underline that the more the human being presents himself as "in need" of being acknowledged, respected and promoted in his personal dignity - and hence when he is small, sick, poor, et cetera - the more he engages others in their attention, in their care and in their support, in one word in their human solidarity. We can note that the democratic path is such insofar as everyone, truly everyone, enjoys equality in human rights. But that is de facto possible, when we have the wisdom and the courage to "start from the last", from the youngest and weakest. In this sense the so-called "preferential option for the poor", besides the language used, is not simply an ecclesiastical and pastoral question: it is also a civil question, it is a question of true and mature democracy.
Always and in any case. This second qualification "in any case" intends, not so much to make the medical art and profession avoid - were it necessary - the risk of considering persons as numbers, but rather to positively draw attention to the uniqueness of every person, of the single human life, which is the aim of research and treatment, and therefore of love and of service, on the part of the many health workers. We read in the exhortation Christifideles laici "The individual is absolutely irreducible to all that which would press him and ruin him in the anonymity of the collectivity, of the institution, of the structure, of the system. The person, in his individuality, is not a number, the person is not the ring of a chain, nor the workings of a system. The most radical and powerful affirmation of the value of every human being was made by the Son of Man in his becoming incarnate in a woman's womb. The Christian Christmas keeps telling us of this also (n. 37).
In a Congress of Catholic obstetricians and gynaecologists this reference to Christmas is all but secondary. It is absolutely necessary: it is the most powerful and demanding reference to how every human life that is born must be considered and treated, since, as the Vatican II Council teaches us, "with incarnation the Son of God became united in some way to every man" (Gaudium et spes, 22).
Moral conscience and its objection
In front of human life, of the human life of every person there is the moral duty of respect, of defence, of their advancement in their different forms, that find their root and their drive in the love of life. It is a matter of "justice" with reference to the fundamental right of every human being. The minimum threshold of this love is the "do not commit murder".
But if killing should be "imposed", even if under certain conditions, by a civil law? Or, if this should be "requested" by others, starting from the woman? How can and how must the doctor behave?
In his speech the Pope says: "The conflict between social pressure and the demands of right conscience can lead to the dilemma either of abandoning the medical profession or of compromising one's convictions". And immediately he adds: "Faced with that tension, we must remember that there is middle path which opens up before Catholic health workers who are faithful to their conscience. It is the path of conscientious objection, which ought to be respected by all, especially legislators".
In order to be faithful to its structure and its function, the doctor's moral conscience cannot but object to abortion in its different forms. As the encyclical Evangelium vitae states: "Christians, like all people of good will, are called upon under grave obligation of conscience, not to cooperate formally in practices which, even if permitted by civil legislation, are contrary to God's law. Indeed, from the moral standpoint, it is never licit to cooperate formally with evil " (n.74).
In this sense it is important to have clear and precise ideas on the contents and meanings of conscientious objection.
In this way, to start with, everybody should avoid the misunderstanding of deeming conscientious objection to an abortionist law a specifically religious problem or a problem of Christian faith. In fact we speak of conscientious objection, and not of religious or Christian or Catholic conscientious objection. Without doubt Christians find in their faith deeper and more original reasons to refuse abortion: hence the faith in God one and absolute Lord of the life of every human being, in God supreme legislator and universal avenger of the blood unjustly spilled, in God whose image is impressed in a lasting way in the inner fibres of every man, et cetera. But the problem of conscientious objection is not necessarily and exclusively a religious, confessional question: it is an ethical and professional question. Conscience, in fact, insofar as it is opening and receiving objective reality, must refuse to go against rationally and scientifically attested and recognized "values". The deontological codes of doctors, which are not confessional at all, often recognize that: "the doctor to whom services are asked in contrast with his conscience or with his clinical conviction, can refuse his services, unless this behaviour is of serious and immediate harm to the health of the assisted person " (Italian Deontologic Code, art. 19).
Concerning the legitimacy of the doctor's conscientious objection to an abortionist law, an answer is necessary to those who would accuse objectors of boycotting a law of the State, showing in such a way social insensitiveness.
In Italy, conscientious objection is a right explicitly recognized by law n. 194/1978, which in art. 9 provides for it and regulates it. But the legitimacy of conscientious objection has another positive reference, beyond and above law n. 194: it is the Italian Constitution itself, which, even if it does not provide for it expressly, however includes sufficient elements to found its validity. And this is the case when the Constitution fixes as basic points of reference for its norms the person's centrality and the respect of his most characteristic freedoms, among which the freedom of conscience is fundamental (art. 2, 19, 21).
In this way a democratic and pluralistic State, precisely because it is respectful of everybody's freedom of conscience, cannot but create the legal premises so that those citizens who (although they declare their fidelity to the State) do not agree with a norm in contrast with their conscience can concretely express their objection and their dissent.
But it is possible to go beyond the "legal" recognition of conscientious objection on the part of a civil legislation. The existence itself of such right, which exists and is pressing even in the hypothesis of a missed recognition on the part of the positive law, is even more decisive. That which lately has characterized conscientious objection is that it presents itself as a native right of the person, besides being a universal and inalienable right: it is founded on the person's dignity and freedom, so that the person cannot be forced to act against his conscience's conviction. In this case, it is the conviction of the absolute impossibility to dispose of any human life, even of the conceived and not-yet-born human life, on the basis of the law written in the heart of man which peremptorily orders "do not commit murder": it is an impossibility which remains even if the State grants the "right" to abortion.
Another clarification refers to the moral obligation to raise the conscientious objection with reference to abortion. It is well-known that not all the rights create, always and in any case, as many moral obligations, especially if serious: the existence of a right does not necessarily imply the moral duty to use it, to practice it. However, in the case of abortion, there is full and perfect correspondence between right and duty: the right to conscientious objection with reference to abortion, on account of the extraordinary gravity of the values involved (the right to life of the innocent and helpless human being), creates an ethical demand, a real moral obligation to raise it, when on account of our profession and environment we can be asked by civil law to intervene with acts that are necessarily and specifically abortive.
Meanings and obligations of conscientious objection
After what was said above, one can better understand the two fundamental meanings that conscientious objection has.
First of all, a personal meaning is given, since the individual who objects shows and lives his coherence with himself, his loyalty to the convictions of his conscience. Acting thus, the individual underlines the difference existing between "moral" values, perceived by one's conscience, and "legal" values, set by the law of the State, and declares himself openly available and determined to defend the first undergoing, at most, punishment by the State.
The value of such a personal coherence becomes even brighter and more precious: bright, compared to the easy identification between legality and morality; and precious, compared to the personal, professional and social risks to which conscientious objection, practically and under certain conditions, exposes and which this Congress has examined closely.
At the same time, a meaning is given that goes beyond the individual and involves the community itself: it is the social meaning of a denunciation and of a positive objection to the arbitrary act committed by the public authority with the issuing of an unjust, iniquitous law.
While the conscientious objector denounces the injustice of a law that emerges as violence and not at all as an authentic service to the common good, he calls for the actual respect of pluralism, as essential component that cannot be given up of democracy. This call becomes ever more necessary as the legislations of all or almost all of the countries, the dominant mentality and widespread abortive practice become more "totalitarian".
The many and severe difficulties encountered by the conscientious objectors objecting to abortion must be strongly denounced. They are difficulties which come to the risk - better to the reality - of a marginalization that is easier the more monolithic (in an abortionist sense) the social "system" in which one lives is (especially the "culture" that is widespread and accepted in an uncritical way), in particular the health care "system".
Precisely these difficulties show the need for a more community-oriented reading of the moral problem of conscientious objection and as a consequence of a more community-oriented intervention in order to face it. A convinced and decided solidarity and joint responsibility is ever more requested, which will have to express itself according to a twofold horizon.
The first horizon is the "inner" one, that is that of a major cohesion among conscientious objectors, called to support and defend one another: in this sense it is possible to constitute ourselves into an "association", with different and specific aims, from legal advice to economic interventions.
The second horizon is the "outer" one, that of a close and habitual relationship between the medical and paramedical personnel and the community (ecclesiastical, at least, but not only) within which the personnel operates. In this sense the community also has some precise responsibilities towards the conscientious objector. Is the decrease in young doctors of an interest towards conscientious objection not due, perhaps, to the widespread insensitiveness of not few ecclesial communities?
The Pope concludes his speech reintroducing some operative and concrete programmatic lines which demand everybody's engagement: "Wherever the right to train for and practice medicine with respect for one's moral convictions is violated, Catholics must earnestly work for redress. In particular, Catholic universities and hospitals are called to follow the directives of the Church's Magisterium in every aspect of obstetric and gynaecological practice, including research involving embryos. They should also offer a qualified and internationally recognised teaching network, in order to help doctors who are subject to discrimination or unacceptable pressure on their moral convictions, to specialize in obstetrics and gynaecology".
Rome, June 20th, 2001