needed background on the New Charter for Health Care Workers

The original Charter for Health Care Workers (1995) was published during the pontificate of Saint Pope John Paul II and is available online.  A long awaited English language translation of an update became available in 2017. 

"The new references of the Magisterium, after 1994, that appear in the Charter are:

John Paul II’s Encyclical letter Evangelium vitae (1995);

John Paul II, Discourse to participants in the International Congress on transplants (29 August 2000), no. 4: AAS 92 (2000), 823-824;

The Encyclical Letters of Benedict XVI, Spe salvi on Christian hope (2007) and Caritas in veritate (2009);

Benedict XVI, Discourse to participants in the International Congress promoted by the Pontifical Academy for Life on the theme of organ donation (2008);

Pope Francis’ Apostolic Exhortation Evangelii Gaudium, on the proclamation of the Gospel in Today’s World (2013);

Pope Francis, Message to the participants in the General Assembly of the Pontifical Academy for Life on the occasion of the twentieth anniversary of its institution (2014);

Congregation for the Doctrine of the Faith, Responsa ad quaestiones ab Episcopali Conferentia Foederatorum Americae Statuum propositas circa cibum et potum artificialiter praebenda [Responses to Certain Questions of the United States Conference of Catholic Bishops on Artificial Nutrition and Hydration] (2007);

The Instruction of the Congregation for the Doctrine of the Faith, Dignitas personae (2008);

Pontifical Academy for Life, Prospects for Xenotransplantation - Scientific Aspects and Ethical Considerations (Vatican City, 2001);

Pontifical Academy for Life, Moral reflections on vaccines prepared from cells derived from aborted human foetuses (2005)"

[links added] (Holy See Press Office, 2/6/17)

As per the National Catholic Bioethics Center,

"The New Charter for Health Care Workers is a revision and updating of the earlier 1995 edition, also produced by the Pontifical Council for Health Care Workers. The work is divided into three major sections: 'Procreating,' 'Living,' and 'Dying,' each of which lays out authoritative teachings in medical ethics grounded in the traditional resources of the Church. There are extensive citations to magisterial documents. The book will be of service to all who are working in healthcare, especially those in Catholic facilities or who are attending to Catholic patients. The text has been faithfully translated from the Italian by The National Catholic Bioethics Center and is the official Vatican text in English [Considering that it would be the rare bilingual person with skills in both Italian and English for such a translation, one is left to wonder who on the NCBC staff qualified as the Italian/English translator?]. From the Preface: 'The Charter certainly cannot amount to an exhaustive treatment of all the problems and questions that come up in the field of healthcare and sickness, but it was produced to offer the clearest possible guidelines for the ethical problems that must be addressed in the world of healthcare in general, in harmony with the teachings of Jesus Christ and the magisterium of the Church.'"

It appears to only be hard copies of the NCBC's English translation that are available; it is not online.

INTRODUCTION: MINISTERS OF LIFE

As did the original Charter, the New Charter reminds us that the vocation of health care is to be greatly honored:

"1....[Our] dignity is elevated to a further level of life, that of God’s own life, inasmuch as the Son, in becoming one of us, makes it possible for human beings to become ‘children of God (Jn 1: 12), ‘partakers of the divine nature’ (2 Pet 1: 4)….the respect for the human person that human reason already demands is further accentuated and reinforced….”

"9….the therapeutic ministry of health care workers participates in the pastoral and evangelizing activity of the Church.... Service to life thus becomes a ministry of salvation, or a proclamation that fulfills Christ’s redeeming love. ‘Just such people – doctors, nurses, other health care workers, volunteers – are called to be the living sign of Jesus Christ and His Church in showing love toward the sick and suffering,’ in other words, ministers of life.”

PROCREATING

The Church's recognition of the truth that “11….The inseparable bond between conjugal love and human generation, imprinted on the nature of the human person, is a law by which everyone must be guided and to which everyone is held” underlies its teachings with regard to Fertility Regulation and Medical Responses to Marital Infertility.

Within the boundaries of the Archdiocese of Philadelphia (i.e., Pennsylvania's Bucks, Chester, Delaware, Philadelphia, and Montgomery Counties), there are only nine physicians (i.e., Joseph Harryhill, George Isajiw, Gregory Lubiniecki, Alfred Mauriello, Monique Ruberu, Lester Ruppersberger, Pedro Solanet, Eleanor Tiongson, and William Williams) to be found in an NFP- only directory - only two of whom are OBGYN doctors (i.e., Ruberu and Ruppersberger).

• Holy Redeemer lists 24 OBGYNs (as well as 6 gynecologists), yet only one is named Ruberu or Ruppersberger.
• Holy Redeemer lists 7 physician specialists in "reproductive endocrinology", each of whom is associated with either Abington Reproductive Medicine or Reproductive Medicine Associates of Philadelphia, both of which provide offerings from a smorgasbord of prohibited services.
• Mercy Health of SE Pa (includes Mercy Fitzgerald, Mercy Philadelphia, and Nazareth) lists 5 gynecologists, none of whom is named Ruberu or Ruppersberger.
• St Mary Medical Center list 45 OBGYNs, none of whom is named Ruberu or Ruppersberger.
• St Mary Medical Center lists 8 physician specialists in "reproductive endocrinology", each of whom is associated with either Abington Reproductive Medicine or Reproductive Medicine Associates of Philadelphia, both of which provide offerings from a smorgasbord of prohibited services.
• St Mary Medical Center list 3 physician specialists in "maternal fetal medicine."  Drs Richard Latta and Stephen Smith are also associated with Abington Perinatal Associates, which is part of Jefferson:"The outcome of most high-risk pregnancies today can be improved significantly with skilled intervention.Perinatologists (specialists in high-risk pregnancy) of Jefferson's Division of Maternal-Fetal Medicine in Philadelphia can help you manage or reduce possible complications [Does this include embryo reduction (i.e., abortion)?] if you are considered a high-risk pregnancy"
Judging by their own physician directories, it does not appear that Catholic hospitals within the Philadelphia Archdiocese are prepared to consistently provide authentic obstetric and gynecological care.

Recognition that "The inseparable bond between conjugal love and human generation, imprinted on the nature of the human person, is a law by which everyone must be guided and to which everyone is held” also underlies proclamation of truth about Prenatal and Preimplantation diagnosis and Freezing Embryos and Oocytes.  The Church has been clear in its prohibition of embryo "transfers" from one woman to another.  Despite its very words, some read the Vatican's 2008 Dignitas personae as leaving a door ajar for consideration of an exception for so-called "snowflake adoptions":

"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;[38] 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'.[39]"

There is nothing in the New Charter to support belief in exceptions for so-called "snowflake adoptions."  

"The inseparable bond between conjugal love and human generation, imprinted on the nature of the human person, is a law by which everyone must be guided and to which everyone is held” also underlies proclamation of truth on New Attempts at Human Generation and Procreation.

LIVING

Church teaching is reviewed, re: Human Life Inviolable and "Indisposable", Abortion and the Destruction of Nascent Life, Embryo Reduction, and Interception and Contragestation.  As the Vatican's 2008 Dignitas personae explained:

"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,[43] 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,[44] 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'.[45] 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.[46]"

In the aftermath of Dignitas personae, some claimed (and still claim) that there could be a legitimate exception for use of Plan B in Catholic hospitals.  Bishop Elio Sgreccia, president of the Pontifical Academy for Life, confirmed that there was no such exception (cf., LifeSiteNews.com, 2/29/08).  In private conversation, a NCBC ethicist dismissed Bishop Sgreccia's confirmation as resulting from the bishop's supposed limited English!  Yet like Dignitas personae, the new Charter offers NO guidelines for any supposed "moral" use of an interceptive or contragestatives, which certainly indicates the need for a change in practices at Catholic hospitals.

As per Fr. Juan Vélez, MD (an Opus Dei priest who also has a doctorate in dogmatic theology) and Rebecca Peck, MD, ''there is no safe period to give LNC-EC during a woman's cycle when it may be efficacious to prevent pregnancy without significant likelihood that it will have an abortifacient effect'' (The Postovulatory Mechanism of Action of Plan B, NCBC Quarterly, Winter 2013). 

Writing with Dr. Peck, we have also been alerted to abortifacient potential by Chris Kahlenborn, M.D. and Walter B. Severs, Ph.D., F.C.P. (Mechanism of action of levonorgestrel emergency contraception, Linacre Quarterly, February 2015; ), and 

Drs Walter Rella, Julio Tudelo, Justo Aznar and Bruno Moznegga (Does levonorgestrel emergency contraceptive have a post-fertilization effect? A review of its mechanism of action, Linacre Quarterly, April 2016). 

The Catholic Medical Association has indicated the need for change in 2015 and again in 2016, when it wrote: "The entailed risk of taking a human life through Plan B's MOA is ethically unacceptable."

Most recently, Dr. Chris Kahlenborn's "Plan B: Current Controversies" (2018) explains the tragic current situation in Catholic hospitals

In "Living," Church teaching is also reviewed, regarding Ectopic Pregnancies, Anencephalic Fetuses, Conscientious Objection, Defending the Right to Life, Prevention, Prevention and Vaccines, Medical Prevention and Society, Sickness, Diagnosis, Interventions on the Genome, Gene Therapy, and Regenerative Therapy.

• As reference #167 might seem to infer a favorable judgment on the use of Induced Pluripotent Stem Cells (Is the NCBC translation accurate?), Section 30 of Dignitas Personae appeared to preclude their use. "One of the top researchers in the field of stem cells has said that iPS (induced pluripotent) stem cells, the 'embryo-like' cells hailed by many as the answer to the ethical problems presented by embryonic stem cells, are 'probably' actually already embryos and have already, with the right conditions and treatment in the lab, developed into 'complete animals' in experiments.... LifeSiteNews.com spoke with Dr. Dianne Irving, a former bench biochemist researcher with the National Institutes of Health in the US, who confirmed Dr. Gurdon’s assertion, saying, 'Some iPS cell are potentially embryos'....Given the ability of cells to be reverted to the embryonic stage, she said, 'any human cell can be used for reproductive purposes,' so pro-life people must start making very careful distinctions about what type of cell is being created and used and the methods used to obtain them...." (LifeSiteNews, 4/23/13)

"Living" also reviews Church teaching on Treatment and Rehabilitation, Prescription and Appropriate Use of Pharmaceuticals, Access to Available Medications and Technologies, Sustainable Health, Pharmaceutical Companies, Rare or Neglected Diseases, Pain Relief Treatments, Informed Consent of the Patient, and Biomedical Research and Experimentation.

• As per the USCCB's Ethical and Religious Directives for Catholic Health Care Services, “31….the greater the person’s incompetency and vulnerability, the greater the reasons must be to perform any medical experimentation, especially nontherapeutic."

"Living" also reviews Church teaching on Organ and Tissue Donation and Transplantation and Determination of Death:

• Dr. Peter Colosi (Our Sunday Visitor Newsweekly, 8/8/12) has pointed out that "Some medical doctors and theologians doubt that brain-dead donors are actually dead. This would mean that the removal of the vital organ is the act by which the donor dies, but the Catechism (No. 2296) states, '[I]t is not morally admissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons'.... Eminent Catholic critics of brain death are Dr. Paul Byrne of St. Charles Mercy Hospital in Oregon, Ohio, and Josef Seifert of the International Academy of Philosophy in Liechtenstein and Granada, Spain. The medical studies of Dr. Alan Shewmon of UCLA Medical School are quite convincing indications that brain dead people are not dead, or at the very least that we do not have moral certainty that they are." While some maintain that the Church pronounced favorably on brain death in 2000, Pope John Paul II’s statement did not offer an unequivocal endorsement. The New Charter includes this 2008 cautious quote from Pope Benedict XVI: “In an area such as this, in fact, there cannot be the slightest suspicion of arbitration and where certainty has not been attained the principle of precaution must prevail. This is why it is useful to promote research and interdisciplinary reflection to place public opinion before the most transparent truth on the anthropological, social, ethical and juridical implications of the practice of transplantation."
• If you click and move to 22:25, you will hear a debate between neonatologist and clinical professor of pediatrics Dr. Paul Byrne and National Catholic Bioethics Center President John Haas, PhD (NOT a physician). While  Haas may have had the stylistic upper hand in the debate, Byrne suggests that Haas is "misleading the world" on so-called "brain death."  Listening to this debate, one could get the idea that Haas was mistakenly claiming that Saint Pope John Paul II had unequivocally endorsed brain death criteria (cf., Kresta in the Afternoon, 1/8/14).

"Living" also reviews Church teaching on The Removal of Organs from Pediatric Donors, Xenotransplants, Transplantation and Personal Identity, Abuses in Transplantation, Forms of Dependence, Drug Dependence, Alcoholism, Tobacco Dependence, Psychotropic Drugs, Psychology and Psychotherapy, Pastoral Care and the Sacrament of the Anointing of the Sick, Ethics Committees and Clinical Ethics Counseling, Health Care Policies and the Right to the Preservation of Health.

DYING

Church teaching is reviewed, re: Dying with Dignity and Civil Laws and Conscientious Objection.  The new charter references the Pontifical Academy for Life, Moral reflections on vaccines prepared from cells derived from aborted human foetuses (2005).  In that letter, Bishop Elio Sgreccia addressed "The principle of licit cooperation in evil":

"The first fundamental distinction to be made is that between formal and material cooperation. Formal cooperation is carried out when the moral agent cooperates with the immoral action of another person, sharing in the latter's evil intention. On the other hand, when a moral agent cooperates with the immoral action of another person, without sharing his/her evil intention, it is a case of material cooperation.

"Material cooperation can be further divided into categories of immediate (direct) and mediate (indirect), depending on whether the cooperation is in the execution of the sinful action per se, or whether the agent acts by fulfilling the conditions - either by providing instruments or products - which make it possible to commit the immoral act.

"Furthermore, forms of proximate cooperation and remote cooperation can be distinguished, in relation to the "distance" (be it in terms of temporal space or material connection) between the act of cooperation and the sinful act committed by someone else. Immediate material cooperation is always proximate, while mediate material cooperation can be either proximate or remote.

"Formal cooperation is always morally illicit because it represents a form of direct and intentional participation in the sinful action of another person.10 Material cooperation can sometimes be illicit (depending on the conditions of the "double effect" or "indirect voluntary" action), but when immediate material cooperation concerns grave attacks on human life, it is always to be considered illicit, given the precious nature of the value in question11.

"A further distinction made in classical morality is that between active (or positive) cooperation in evil and passive (or negative) cooperation in evil, the former referring to the performance of an act of cooperation in a sinful action that is carried out by another person, while the latter refers to the omission of an act of denunciation or impediment of a sinful action carried out by another person, insomuch as there was a moral duty to do that which was omitted12.

"Passive cooperation can also be formal or material, immediate or mediate, proximate or remote. Obviously, every type of formal passive cooperation is to be considered illicit, but even passive material cooperation should generally be avoided, although it is admitted (by many authors) that there is not a rigorous obligation to avoid it in a case in which it would be greatly difficult to do so." 

The New Charter also reviews Church teaching on Nutrition and Hydration, The Use of Analgesics in the Terminal Stage, Telling the Truth to the Dying Person, Religious Care of the Dying Person, Destroying Life, and Euthanasia.  Dr. Chris Kahlenborn (11/22/16) has explained some of the reasons why we should be concerned about how well Catholic teaching is being applied.

"I have found that, in general, hospice and palliative care personnel try to dissuade patients from assisted nutrition and hydration. In my opinion, the reasons for this vary. Unfortunately, financial pressure often plays a significant role. Patients who forego ANH are frequently transferred to hospice centers and die within days from dehydration, thereby allowing hospitals to reduce their lengths of stay. In addition, insurance companies save money when a patient foregoes ANH since they do not have to pay the many expenses involved in treating these fragile patients. Today, insurance companies are actively putting pressure on hospitals to increase their number of palliative care consults, which is quite revealing....

"Some practitioners have the arrogance to state rather definitively that dying from dehydration is not painful. But, how can anyone know what a patient in this state is experiencing unless they themselves have experienced it? Anyone who has been moderately to severely dehydrated has noted the phenomenon of stinging eyes, dry skin, burning urine, and pain with swallowing. It would follow that the patient who is no longer given water would experience similar symptoms....

"Many people, often under the guidance of their lawyer, have living wills which specify what type of medical treatment they wish to have or forego should they have a terminal illness. There are several problems with this. First, the living will is a rather rigid document, often prepared years prior to the occurrence of the patient’s first medical illness, after which circumstances and opinions have often changed. Second, many physicians interpret a living will as a 'do not resuscitate (DNR)' order, so that, if you are admitted for a non-terminal illness, you could be categorized as a DNR patient, when that may not be your wish. Third, patients with living wills, in general, will get less aggressive hospital treatment. My advice is to speak with a trusted friend or family member and make them your power of attorney for healthcare decision maker instead of obtaining a living will....

"I think it would help if a more specific statement were made by the Church, especially since this is such a confusing area for the public and for most Catholics, including physicians. I suggest the following statement, which several theologians/scholars* have reviewed and believe is consistent with Church teaching**:


'The Church rejects either the act or omission which, of itself or by intention, causes death in order to eliminate suffering; therefore, any omission of nutrition and hydration, by itself or with the intention to cause or hasten a patient’s death, must be rejected. Therefore, we must hold for a presumption in favor of providing nutrition and hydration for every patient-especially the dementia or stroke patient who receives hospice, comfort or palliative care. If a patient is not able to sustain himself (herself) by oral intake of food and water, then assisted nutrition and/or hydration (e.g., intravenous fluids, total peripheral nutrition {TPN} and/or a PEG tube) should be offered and should not be withheld or considered burdensome except for rare exceptions in which they could acutely worsen a person’s medical outcome (e.g., giving intravenous fluids to a patient who is experiencing an acute episode of congestive heart failure). These measures are ordinary treatments and therefore cannot be based on a person’s 'quality of life.' Patients who suffer from dementia or stroke should not die due to dehydration and/or malnutrition. The symptoms of dehydration should be treated with oral or assisted fluids and not via pain medications or sedatives such as morphine or lorazepam.'"