Programme
and texts
of the Congress
Website: http://www.fiamc.org
TEXTS OF THE CONGRESS
| THE CATHOLIC DOCTOR IN THE CHANGING WORLD |
| I should like to greatly thank the FIAMC for the invitation to participate in this scientific session to discuss the mission of the Catholic doctor during the Fiamc 21st World Congress. Today we live in a changing world and this change transforms faster and faster the scenario in which human life develops. The remarkable influence of science and technology, telecommunications and globalization on human living conditions brings about positive and negative results. The balance between them will cause either a retreat or an advance in the development of a community with their consequences in the quality of human life. If we follow the reports about human development submitted by P.N.U.D., other international organisms and multilateral finance entities we will be able to see, a) a rise of life expectancy of 8 years in the last 30 years; a decrease of a 400% in children' death rate; a smaller decrease in malnutrition rate; an increase in literacy rate. Although these rates are highly positive, we cannot deny that there are many countries in the world where the living conditions are below an acceptable level and people's hardships are too many. Among 4,600 inhabitants in developing countries, there are over 850 million illiterate people; almost 1,000 million lack running water facilities and 240 million lack basic sanitary facilities. Nearly 325 million children do not attend school. Children's death rate is still high, with 11 million children under 5 dying every year, i.e. over 30,000 children every day for reasons that could be avoided. About 1,200 million people live on less than a dollar a day and 2,800 million on mess than 2 dollars a day. Still today 17 million people die per year of curable parasitical and infectious diseases. These hardships do not prevail only in developing countries but in the OCDE countries over 130 million people suffer poverty of income, 34 million are unemployed and the average functional literacy rate reaches a 15%. All this goes to show that inequalities among countries still exist and increase and also inside them, not counting the fact that the population transition and the consequent epidemiological transition causes new and serious problems in developing countries. Especially as regards health care, whose influence in the general welfare and in the social and economical development is beyond discussion, today science and technology provide health professionals with new tools to promote , prevent, treat and rehabilitate health but the emphasis on the treatment, the increasing cost of more and more complex techniques and the expansion of medical services have brought forth an unprecedented increase in the cost of medical care and assistance. This increase means not only a higher proportion of expenditure in the national GPO but also a new factor of inequity due to the incapacity of many countries to afford the cost of a fair and universal medical assistance. This creates an ethical problem regarding the assignment of scant resources. This decision may appear at different levels. Thus, we can speak of macro allocation and micro allocation. The Catholic doctor may act at both levels and will bear different responsibilities. The macro allocation will depend on political decisions and on technical sanitary grounds involving the source and origin of financing, ways of producing and distributing and the choice of allocation of resources among the various alternatives that arise while planning the structuring and distribution of sanitary services. Yet this is not the only challenge we must face since the scientific and technological changes of the last decades and the deep cultural, social and political changes have raised new ethical dilemmas or extended the ethical risks run by doctors and all health professionals. Today the respect for the right to live and its intangibility is a source of great controversy absurdly argued by groups and countries who seem to be permanent defenders of human rights but who will not respect life itself. Henceforward, the social and cultural acceptance of abortion and euthanasia means ignoring natural law and beyond doubt the Christian concept of the right to live. As regards abortion more and more countries are already legalizing it and unfortunately, either due to the mother's free will, the application of eugenic theories or as a result of in vitro fertilization with frozen embryos which, on account of outnumber or implant mishaps, are doomed to death. Last year highly developed countries started to legalize euthanasia in the case of terminal patients. Pope John Paul's words at the University of Sacro Cuore in 1984 addressed during the 14th Upgrading Course sound like a premonition, "As has been observed in the case of abortion, the moral condemnation of euthanasia remains unheeded and incomprehensible by those who hold, maybe unconsciously, a view of life irreconcilable with the Christian message, even with the dignity of the human being properly understood. The problem of euthanasia dramatically requires an urgent and consistent endeavour to rebuild an authentic Christian feeling. The delays and neglect could turn into the suppression of innumerable human lives and therewith a serious degradation of all society and mankind could sink to lower and lower levels of inhumanity." This message entails an unavoidable mandate for the Catholic doctor. In such situations as assisted fertilization, reproductive health and others the doctor is forced to make a conscientious objection. As regards this issue, at the meeting organized in Rome by the World Federation of Catholic Medical Associations and the Mater Care International in 2001, I stated, "The conscientious objection formulat3ed by the professionals necessarily poses a clash between rights and forces us to establish limits to fundamental rights. There is no doubt that these objections born in the sphere of the individual conscience arise when we face a concrete legal obligation where there is no alternative behaviour and forces de professional to explain his objection to conforming to the rule. The scientific advances in the field of health have created diagnostic or therapeutic practices which have generated in the professionals who have to apply them serious dilemmas, for which they must question the ethics of the practice, regardless of its legality. It must be made clear that when a concrete regulation offers no alternative to the health professional there should be another regulation that allows him to put forward his objection, and which will thus protect his conscience by implying a non-contradiction with his performance. The lack of a manifest regulation that recognizes the right to conscientious objection could generate conflictive situations, although the existence of a general objection law must be considered enforced by the general principles of the human rights, and law. If there were to be no regulation in the positive law or the jurisprudence should not recognize this right, relieving the professionals from the obligation to perform practices contrary to their conscience, serious harm to the human rights would be generated and a limitation to the work or the qualification of the professionals on account of their ideology or religion. It must be made clear that under no circumstances must the conscientious objection mean any discrimination to the professional exerting that right, to his work destination, professional career or opportunities of training and life-long education. Undoubtedly, the present research trails as regards polynucelotide synthesis, polymorphism detection and in vitro hybridization, Polymerase Chain Reaction (PCR), gene splicing, DNA cloning, DNA sequencing, protein sequencing and in vitro assembly, transplants, transgenics, RNA-ribozymes, monoclonal antibodies, phage presentation, cloning for human reproduction, stem cells and others pose completely new ethical problems which will have to be tackled by specialist in bioethics who will set new suitable approaches to the application of moral rules to scientific practice. Fortunately, the progress of science and technology have come together with a strong development of biomedical ethics. The church, our mother, does not object to science since she knows that both humans' realization and perfection as well as the development and fulfillment of creation are attached to mankind's reign (Gen 1.28) , she rejoices at the technical advancement and progress and she encourages them. It is not just any kind of reign that helps achieve the goals. It is only the reign that implies a real service to mankind's humanization and integral good. Given the fact that in all action upon the world &endash;in all technical activity- mankind is always involved, that very activity requires, from its very entrails the presence of ethics. Only in this way can we call it human. Man's power over the visible world is real and true, but not absolute: he will always be controlled by the well being of people, as John Paul II stated in his address at the Academy of Sciences in its annual week-long study meeting on October 3rd 1981, "I firmly believe in the world scientific community and in particular in the Pontific Academy of Science because I am sure that, thanks to science, progress and biological research as well as any other scientific study and its technical application will be performed in absolute respect for moral rules and in defense of man's dignity, their freedom and equality. Furthermore, it is necessary that science be always accompanied and controlled by the wisdom belonging to the permanent human heritage and which is inspired in God's plan upon creation. The Catholic doctor cannot hesitate to give the right response to the change in scientific research to put it at the service of man's good, integral man in body and spirit and to make medical assistance more universal and more and more equalitarian, a goal we should strive for by applying in practice these theoretical breakthroughs. The patient-doctor relationship has been deeply affected by our present circumstances. The increasing cost of medical assistance, the population's requirements and the epidemiological transition have originated the appearance and growth of financing entities and such new organizational structures as social welfare, health maintenance organizations (HMO), preferred providers organizations (PPO), health insurance companies, prepaid medicine, managed care and others which, although they have helped to the correct distribution and availability of resources, they have seriously distorted the relationship between doctors and patients by shortening consultation time, limiting the possibilities of diagnostic and therapeutic prescriptions, introducing different proceedings for previous authorization of practice and hospitalization. All this has contributed to significantly undermine the relationship between doctor and patient. On account of doctors' greater specialization and the necessary participation of other disciplines as a consequence of high technology complexity, numerous professionals are forced to participate and this makes the human contact between doctor and patient even more difficult. The same can be said about the mistrust generated by many unjustified lawsuits for malpractice which also deteriorates the relationship. The Catholic doctor has a two-fold obligation in face of this situation since not only should he strive for a better and warmer human relation with his patient but he should also incorporate the spiritual dimension in it and treat the patient as a whole, body and spirit. The relevance of the recommendation that Pope John Paul II made to the 1983 General Assembly of the World Medical Association is undeniably relevant, "A second point I wish to highlight before you is the unity of a human being, body and spirit. It is essential that we should not isolate the technical problem from the whole treatment applied to a patient to cure a certain disease and all the more so when the medical science tends to a great specialization in each discipline. The old doctor was before everything else a general practitioner who could see at one go the whole set of human organs and body functions. Also it was easier for him to know the patient's family, his environment, his whole history. Evolution is unavoidable and it tends to the specialization in the tests and the complexity of human social life. At least, you have to make an effort to consider the deep unity of a human being in the obvious interaction of all his body functions but also in the unity of all their dimensions &endash;body, affective, intellectual, spiritual. On 3rd October last year I invited all the Catholic doctors assembled in Rome to keep a constant regard for the human person and the demands derived from their dignity." This relationship with the patient achieves its maximum expression in the assistance given to terminal patients which implies not only the greatest humanitarian help together with the greatest efficiency but also an essential spiritual assistance. This topic deserves particular attention because the tendency to hospitalize patients especially in Intensive Care Units may bring about an isolation from the family. This replacement of the warm, well-known environment of the home by one that has been used with the terminal patient and which is full of monitors, wires and catheters creates the need that all the medical professionals introduce all the elements of humanitarian and spiritual help necessary for the moment of death. Undoubtedly, it is not enough for the patient to get perfect technical assistance, relief from suffering, elimination of pain, kind and personalized assistance but he should also get spiritual assistance and the possibility of exerting religious freedom, as has been sanctioned by the Vatican Concilium II. We could go on and on enumerating responsibilities and challenges generated by modern changes but the answer will always include, apart from the traditional humanism of the doctors, health care professionals and health care institutions affirmed in old textbooks, the religious hallmark of charity. |
