“The conquests of biomedical research and the new social and healthcare realities that have come to pass since 1994, as well as the pronouncements of the Magisterium of the Catholic Church that have been emanated in the ambit of life and health sciences (those of the Pontiffs John Paul II, Benedict XVI and Pope Francis, and the documents of the Congregation for the Doctrine of the Faith and the Pontifical Academy for Life), have made it necessary to revise and update the Charter for Healthcare Workers”, he explained. “The Charter has however kept its original structure as a tool in a serious preparation and continuing formation of healthcare workers at an ethical level, to maintain the necessary professional competence and their vocation as ministers of life”.

“Firstly, attention has been paid to a broader spectrum of people involved in the biomedical field: alongside the classic professional figures in healthcare (medical, nursing and auxiliary personnel), other figures have been considered who in various ways work in the world of health, such as biologists, pharmacists, local healthcare workers, administrators, legislators in healthcare matters, and workers in the public and private sector. Some new articles are addressed to them specifically, and a special responsibility is required of them in the performance of their service. All these workers carry out their daily practice in an interpersonal relationship, marked by the trust of a person marked by suffering and illness, who resorts to science and the knowledge of a healthcare worker, who comes towards them to assist and heal them.

The Charter seeks to support the ethical loyalty of the healthcare worker, in the choices and behaviour in which this service to life takes its form, and this loyalty is outlined following the stages of human existence – generating, living, dying – as moments of ethical and pastoral reflection.

Thus, continues Spagnolo in the section, “Generating”, “the criteria are specified further for the treatment of infertility and with reference to natural methods not only for the regulation of fertility but also as methods for obtaining a pregnancy. There is also an article on the freezing of ovarian tissue (Article 38) as an ethically sustainable option in the case of oncological therapies that may affect a woman’s fertility. The new attempts at human reproduction in the laboratory are also taken into consideration (Article 39): between human and animal gametes, the gestation of human embryos in animal or artificial wombs, the asexual reproduction of human beings by means of twin fission, cloning, or parthenogenesis other similar techniques. All these processes are contrary to the human dignity of the embryo and procreation, and are therefore considered morally unacceptable.  Among prenatal diagnoses, acceptable for certain conditions, attention is instead drawn to pre-implantation diagnosis (Article 36), considered unacceptable inasmuch as it is an expression of a eugenic mentality that legitimises selective abortion to prevent the birth of children suffering from various diseases”.

In the “Living” section, the existing position regarding abortion is confirmed, with the insertion of new articles regarding embryonic reduction, interception, contragestation, anencephalic foetuses, ectopic pregnancies, and the protection of the right to life (Articles 51-59). Attention is also turned to the issue of prevention and vaccines, the subject of recent public debate (Articles 69-70). Timely from a scientific point of view is the reference to gene therapy and regenerative medicine (80-82). At the social level, the document focuses on the issue of access to medicines and technologies by the people (Article 91), access that even today, above all in developing countries and especially those characterised by political instability or limited resources, is not guaranteed to broad sectors of the population, and especially in the case of so-called ‘rare’ and ‘neglected’ diseases, accompanied by the concept of ‘orphan drugs’ (Article 92). Healthcare providers and their professional associations are asked to take the lead in raising awareness of institutions, charities and the health industry, so that the right to health protection is extended to the entire population, leading to healthcare justice, safeguarding the sustainability of both research and healthcare systems. Also new are the references to the involvement in testing of minors or adults unable to decide, on vulnerable subjects, and on women of childbearing age in emergency situations”.

“Finally, this section highlights the role of clinical ethics consultation (Article 140), which may help to identify ethical conflicts and doubts, which individual healthcare workers, patients and relatives may experience in clinical practice, thus facilitating resolution with diagnostic and therapeutic choices shared at the patient’s bedside, in the framework of values proper to medicine and ethics”.

The section on “Dying” examines the attitude towards the patient in the terminal phase of illness, “which verifies the professionalism and ethical responsibilities of healthcare workers (Article 145). In this area, a very current aspect considered by the Charter – the subject of many discussions in the Italian Parliament in these days – is the reference to the expression in advance by a patient of his wishes (Article 150) regarding the treatments he would or would not like to undergo should he no longer be able to express his consent. The Charter affirms that the reasonable will and legitimate interests of the patient should always be respected, but the doctor is not a mere executor, and conserves the right and the duty to deny a request should his conscience not permit it”.

“An equally significant theme is that of nutrition and hydration, even artificially administered (Article 152), considered to be among the basic care due to the dying, other than when they prove too burdensome to the latter or are not of any benefit. Their unjustified suspension may have the sense of an act of euthanasia, but they remain obligatory inasmuch as and to the point that they can be shown to achieve their aim, which is the hydration and the nourishment of the patient. The ethical validity of palliative deep sedation in the phases close to the moment of death are confirmed, performed according to correct ethical protocols and submitted to constant monitoring”.

This section takes as its basis “the protection of the dignity of dying, in the sense of respecting the sick in the final phase of life, excluding both the anticipation of death (euthanasia) and its deferment with so-called ‘aggressive’ medical treatment”.

“Certainly, the Charter cannot be exhaustive with regard to all the problems and issues that arise in the context of health and sickness”, Professor Spagnolo concluded, “but it has been produced in order to offer the clearest guidelines possible for the ethical problems that must be faced in the world of health in general, in harmony with the teachings of Christ, and with the Church’s Magisterium”.

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 (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).