re: "Vatican releases updated guidelines for bioethical questions" (Catholic News Service / OSV Newsweekly, 2/6/17)

Gretchen R. Crowe, Editor-in-Chief
Our Sunday Visitor Newsweekly,
200 Noll Plaza
Huntington, IN 46750
osvletters@osv.com

Dear Ms. Crowe,

Back in February, you announced the updating of the Vatican's original Charter for Health Care Workers (Vatican Radio listed those "new references of the Magisterium, after 1994, that appear in the [updated] Charter."). Thanks to the translation work of the National Catholic Bioethics Center, hard copies of the New Charter for Health Care Workers are now available in English.  It is simply the best compendium of Catholic medical ethics / bioethics, to be supplemented with relevant medical information and original magisterial teaching.  

Like the original, the New Charter consists of sections on procreating, living, and dying, between its introduction and conclusion.  In its introduction, it reminds us that the vocation of health care is to be greatly honored.  All that it then goes on to proclaim about human procreation rests on 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.”  While the Church clearly prohibits embryo "transfers," some suggested the possibility of an exception for "embryo adoption" (aka, "snowflake adoption") was not settled with Dignitas Personae (n. 18-19) of 2008.  I find nothing in the New Charter to sustain the idea of an exception.

The section on "Living" is the Charter's largest, covering a vast array of areas.  Like Dignitas Personae (n. 23), the New Charter offers NO guidelines for any supposed "moral" use of either "interceptives" or "contragestatives."  It has long struck me as disingenuous to deny or downplay the very, very real risk of causing an abortion by emergency [so-called] contraception in Catholic hospital emergency rooms (cf., 

• Rebecca Peck, MD, Walter Rella, MD, Julio Tudelo, PharmD, PhD, Justo Aznar, PhD, and Bruno Moznegga, MD, Does levonorgestrel emergency contraceptive have a post-fertilization effect? A review of its mechanism of action, Linacre Quarterly, April 2016;
• Rebecca Peck, MD, Chris Kahlenborn, MD and Walter B Severs, PhD, FCP, Mechanism of action of levonorgestrel emergency contraception, Linacre Quarterly, February 2015;   
• Fr. Juan Vélez, MD and Rebecca Peck, MD, The Postovulatory Mechanism of Action of Plan B, NCBC Quarterly, Winter 2013)

While footnote #167 might seem to infer a favorable judgment on the use of Induced Pluripotent Stem Cells, Dignitas Personae (n. 30) appears to preclude their use.  Dr. Diane Irving has told us that "'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).

While some have acted as though the Church has already issued a definitive judgement on brain death criteria, Dr. Peter Colosi (Our Sunday Visitor Newsweekly, 8/8/12) reminds us that "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."  The updated 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."

The Charter's section on "Dying" also speaks of "Civil laws and conscientious objection."  Personally, I wish that the Charter reprinted - in its entirety - a 6/9/05 letter from the president of the Pontifical Academy for Life, in which he reviewed "The principle of licit cooperation in evil."

Thank you,

re: Vatican Updates Health Care Charter (National Catholic Register, 2/13/17)

Thanks to the translation work of the National Catholic Bioethics Center, hard copies of the Vatican's Updated Charter for Health Care Workers are now available in English.  It is the best compendium of Catholic medical ethics / bioethics, which you will want to supplement with relevant medical information and original magisterial teaching.  Like the original, the updated charter consists of sections on procreating, living, and dying, between its introduction and conclusion.

In its introduction, the Charter reminds us that the vocation of health care is to be greatly honored.  All that the it proclaims about procreation rests on 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.”  While the Church clearly prohibits so-called embryo "transfers" from one woman to another, some have suggested - even after the Vatican's Dignitas Personae of 2008 - that a door might be yet be ajar for consideration of exceptions for so-called "snowflake adoptions." I find nothing in the Charter to support this.

The section on "Living" is the largest in the Charter and covers a vast array of areas, including potentially abortifacient "interceptives" and "contraceptives."
Like Dignitas Personae before it, the Charter offers NO guidelines for any supposed "moral" use of interceptives or contragestatives, indicating the need for change in practices at Catholic hospitals.  From a medical standpoint, Doctors (Rev.) Juan Vélez, Rebecca Peck, Chris Kahlenborn, Walter B. Severs, Walter Rella, Julio Tudelo, Justo Aznar and Bruno Moznegga, as well as the Catholic Medical Association, have been warning us that there is NO way to use interceptives or contraceptives without the very real risk of causing abortion.

While footnote #167 might seem to infer a favorable judgment on the use of Induced Pluripotent Stem Cells, Section 30 of Dignitas Personae appears to preclude their use.  Dr. Diane Irving tells us that "'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).

The Church has NOT issued a definitive judgement on brain death criteria.  Dr. Peter Colosi (Our Sunday Visitor Newsweekly, 8/8/12) notes that "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."  The updated 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."

Looking at The Updated Charter for Healthcare Workers (excerpts with comments and pictures added)

The original Charter for Health Care Workers is available online.  Hard copies of the English translation of the Updated Charter are now available. Vatican Radio (2/6/17) noted that "The new references of the Magisterium, after 1994, that appear in the Charter are [with links added]:
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 [English translation] (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)."

• Introduction: Ministers of Life

•  Procreating
  
  (Fertility regulation; Medical responses to marital infertility; Prenatal and preimplantation diagnosis; Freezing embryos and oocytes; New attempts at human generation and procreation)

• Living
  (Human life inviolable and 'indisposable; Abortion and the destruction of nascent life; Embryo reduction; Interception and contragestation; 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; Regenerative therapy;
  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; 
  Biomedical research and experimentation; 
  Organ and tissue donation and transplantation; 
  Determination of death; 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 Annointing of the Sick;
  Ethics committees and clinical ethics counseling;
  Health care policies and the right to preservation of health)
  

• Dying
  
  (Dying with Dignity; Civil laws and conscientious objection; 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; Euthanasia )
  
  
• Conclusion

Saint Peter's University Hospital "Advance Directive for Health Care" is misleading and out of date

In recent years, the Church has provided tremendously needed clarification about end of life care (cf., St John Paul II, 3/20/04, Congregation for the Doctrine of the Faith, 2007,  USCCB, 2009), which is not properly evident in Saint Peter's University Hospital "Advance Directive for Health Care."  While that document may include a 1998 "Advance Directive for Health Care: A Catholic Perspective" approved by NJ's Catholic Bishops, it also includes a clearly inappropriate 1995 "Advance Directive for Health Care" from the Medical Society of New Jersey.  This could easily create the impression that Catholic medical ethics are merely a set of sectarian idiosyncrasies.

Yesterday, copies of Saint Peter's University Hospital "Advance Directive for Health Care" were being distributed at a street fair in Trenton.

Conscience: "that still small voice that people won't listen to. That's just the trouble with the world today" (Jiminy Cricket)

I regularly contact elected officials in support of positions advocated by the Pa Catholic Conference and the USCCB, including conscience protections in health care.  Yet, I fear that we may be losing sight of the ultimate reason that we need these protections.  As per one former John Cardinal Krol Chair of Moral Theology:

"The Catholic Church opposes direct sterilization, and the use of contraceptive drugs and devices, including those which may cause abortion, not as a matter of 'company policy,' but as a matter of moral conviction that these practices violate the true dignity of the human person. One cannot promote the true good of individuals and society by facilitating and promoting practices that are, in fact, injurious to persons" (Msgr. Kevin T. McMahon, STD, Catholic World Report, 4/18/12).

Just "company policy" or recognized as "injurious to persons"?

I can find only 30 NFP-only physicians in Pennsylvania and only six in Greater Philadelphia (cf, http://onemoresoul.com/nfp_by_state/PA).  Kudos to Drs.George Isajiw, Alfred Maurielle II, Monique Ruberu, Lester Ruppersberger, Eleanor Tiongson, and William Williams!  Bravo Bravissimo Doctors!  Yet, with regard to Catholic hospitals in the Archdiocese of Philadelphia....

• None of the six is presently in the directory of the Mercy Health System of Southeast Pa, while Mercy claims to provide "Women's Health Services" (See 1). 
• None of the six is presently in the directory of St. Mary Medical Center, while St Mary claims to provide "Women's Health Services" (See 1).  I am troubled that St. Mary's directory includes three specialists in Maternal Fetal Medicine (See 1,  2, and 3), each of whom is an "Abington Perinatal Associate" (See 1a, 2a, and 3a.), when a 4th Abington Perinatal Associate has been reported to be involved with fetal "reduction" (See 1,  2, and 3.).  
  
• Dr Ruberu is indeed in the directory of Holy Redeemer.  Holy Redeemer's directory also includes five physicans (i.e., 1, 2, 3, 4, 5) from Reproductive Medicine Associates of Philadelphia or Abington Reproductive Medicine, which offer services, recognized by the Catholic Church as "injurious to persons."

Can we expect that the practice at Catholic hospitals will follow the Catholic Medical Association's call to discontinue all use of Plan B, because of the danger of abortion?

• "Given increased scientific information suggesting the post fertilization effect of Plan B, the CMA issued a position paper in Sept. 2015 urging healthcare facilities to discontinue using Plan B. The CMA strongly encourages a more thorough and accurate approach, thereby avoiding the falsehood that the drug does not induce abortion. The entailed risk of taking a human life through Plan B's MOA is ethically unacceptable. This is because we are obliged to choose the morally safer course of action, which in this case can only be realized by not having recourse to the use of Plan B" (Catholic Medical Association, 11/29/16).

Especially because some products sold as "contraceptives" can act in an abortifacient manner, ads for providers of contraceptives should have no place in any Catholic media.  Do we see such in some parish bulletins because of inadequate notions about ''cooperation''?  Taking him somewhat out of context...

"The principle of cooperation was never intended as a tool to rationalize the promotion of evil. We must not look for 'loopholes' in Catholic moral teaching to excuse ourselves from the prophetic witness that this moment demands. Cooperation is not an option" (Msgr. Kevin T. McMahon, STD, Catholic World Report, 4/18/12)

And in my opinion, neither Saint Mary's Advanced Directives and Living Wills nor Holy Redeemer's Making Your Own Health Care Decisions clearly specify

• Catholic teaching with regard to nutrition and hydration, and that 
• health care services cannot honor advance directives (e.g., non-specific directives to forego nutrition and hydration) opposed to Catholic teaching.

"When the money keeps rolling in, you don't ask how."    

What I am writing is certainly not news to those familiar with Catholic health care institutions or pro life concerns.  Yet, nothing seems to be changing.  While the National Catholic Bioethics Center offers trainings/certifications, don't exorbitant CEO salaries (See Philadelphia Inquirer.) simply provide disincentives for change?  As per the character Che from Evita, "When the money keeps rolling in, you don't ask how."  It seems to me that the situation calls for much more than a "continuing ed" approach:

''the diocesan bishop is obliged, if necessary, to make known to the faithful the fact that the activity of a particular charitable agency is no longer being carried out in conformity with the church's teaching, and then to prohibit that agency from using the name 'Catholic' and to take the necessary measures should personal responsibilities emerge'' (Apostolic Letter Issued 'Motu Proprio' of the Supreme Pontiff Benedict XVI on the Services of Charity, 4/11/12).

Thank you,

Pope Francis to the Roman Rota, 1/21/17 (excerpts)

"I must repeat the need for a 'new catechumenate' in preparation for marriage....the preparation for marriage should become an integral part of all the sacramental procedure of marriage, as an antidote that prevents the proliferation of null or inconsistent marriage celebrations.  A second remedy is that of helping newly-weds to follow the path of faith and in the Church also after the celebration of marriage....as I have said to you many times, it takes great courage to marry in the times in which we live. And those who have the strength and the joy to take this important step must feel the affection and the concrete closeness of the Church next to them" (Pope Francis to the Roman Rota, 1/21/17).