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The Revision and Updating of the Charter for Healthcare Workers

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The following is the text of Archbishop Zygmunt Zimowski's first talk at the Annual Medicine, Bioethics and Spirituality Conference at the College of the Holy Cross, in Worcester, Massachusetts. Archbishop Zimowski is president of the Pontifical Council for Health Care Workers.

May 6, 2015

Most Rev. Robert MacManus, Bishop of Worcester and Participants of the Healthcare Professionals for Divine Mercy Conference,

I thank you for the invitation to participate in the 11th Annual Divine Mercy., Medicine, Bioethics and Spirituality Conference. I had hoped to be with you during these days of reflection, discussion and sharing, as we walk together the path of our ongoing human and spiritual formation. Unfortunately, due to serious health problems, I could not be with you physically. Nevertheless as I had promised to Fr. Kazimierz and his team, I have tried to send to you some thoughts for reflection.

I wish to take this opportunity to thank you for the prayers you offered for my recovery, I can assure you that during this difficult time of my illness, I have been upheld by the strong hand of God and supported greatly by the many prayers offered for my healing.

It is true indeed that life is a gift from God entrusted to us as stewards. When we are in good health, we may sometimes get the false impression that we are in control of everything, to the extent of even thinking that we are the absolute masters of our own lives. However, it takes an experience like that of serious illness, to realize how much we depend on others, above all as the psalmist affirms that our life is in the hands of God (Ps 31: 14b-15a). This is a truth that is often obscured or challenged in contemporary society by the culture of death. Yes it is true that in the contemporary society where secularization seems to have taken the upper hand, one truly needs courage to stand on their feet and witness to the Gospel values in the medical profession. All of you in your profession, must have experienced already that we live and work in an environment where there is a strong cultural war between the culture of life and the culture of death. It is a challenge but at the same time it is an occasion, a call to witness.

Before I embark on the project of revising and updating the Charter for Healthcare Workers, I wish to emphasize two points which I think underscore the importance of having proper instruments that will support and empower health care professionals in their missions of new evangelization. This is about the call to be witnesses to the culture of life and the importance of conscience formation.

1. The Call to be Witnesses to the Culture of Life
St. John Paul II reminded us that "the Gospel of life is at the heart of Jesus' message. Lovingly received day after day by the Church, it is to be preached with dauntless fidelity as "good news" to the people of every age and culture." Moreover, as he affirms, "we are the people of life because God, in his unconditional love, has given us the Gospel of life." "Only starting with the discovery of this shared identity will we accept that 'we have been sent into the world as a people for life.'"

In September 2013, Pope Francis, while adressing participants in the meeting organized by the International Federation of Catholic Medical Associations, made a strong appeal to Catholic health care workers, which I would like to reiterate here: "be witnesses and diffusers of the "culture of life." He said that 'your being Catholic entails a greater responsibility: first of all to yourselves, through a commitment consistent with your Christian vocation; and then to contemporary culture, by contributing to recognizing the transcendent dimension of human life, the imprint of God's creative work, from the first moment of its conception. This is a task of the new evangelization that often requires going against the tide and paying for it personally. The Lord is also counting on you to spread the "gospel of life."'

2. The Importance of Conscience Formation
In order to witness to the culture of life, besides faith you need first of all to be both informed and convinced. In this way you will have an informed conscience that will help you sail through the rough waters or swim against the tide. The Catechism of the Catholic Church teaches that the dignity of every person demands that all people have an uprightness of moral conscience. This enables us to assume responsibility for our actions.

Vatican Council II refers to conscience as "the most secret core and sanctuary of a man. There he is alone with God, Whose voice echoes in his depths." Our conscience is the guide that helps us choose that which is correct according to God's law and this choice especially is reflected in how we uphold human dignity. In the Vatican II "Declaration on Religious Freedom," we find this "a person must not be forced to act contrary to his conscience. Nor can he be prevented from acting according to his conscience, especially in religious matters." However, somebody rightly noted that 'just like any other emergency warning system, your conscience needs to be properly programmed and calibrated in order to function correctly.' An uninformed, untrained conscience will be unstable and unreliable, consistently misfiring and misleading, or even altogether useless. The risk is that its point of reference will only be one's feelings and opinions or the current trends of culture. Such a conscience is deprived of objective truth, a conscience that is subject to the dictatorship of relativism, a conscience that cannot be trusted.

The Catechism of the Catholic Church defines conscience in this way: "Conscience is a judgment of reason whereby the human person recognizes the moral quality of a concrete act...In all he says and does, man is obliged to follow faithfully what he knows to be just and right." It goes on to say that "Conscience includes the perception of the principles of morality; their application in the given circumstances...; and judgment about concrete acts yet to be performed or already performed." The "moral conscience, present at the heart of the person, enjoins him at the appropriate moment to do good and to avoid evil. It also judges particular choices...in reference to the supreme Good...When he listens to his conscience, the prudent man can hear God speaking."

The Catechism also emphasizes the formation of conscience and says "conscience must be informed and moral judgment enlightened. The education of conscience is indispensable for human beings who are subjected to negative influences and tempted by sin to prefer their own judgment and to reject authoritative teaching."

In the formation of the conscience the Word of God is very fundamental, it is the light of our path, to be assimilated in faith and prayer and put into practice. Besides, "we must also examine our conscience before the Lord's Cross. We are assisted by the gifts of the Holy Spirit, aided by the witness or advice of others and guided by the authoritative teaching of the Church."

It is true that the call for new evangelization requires us to have courage to swim against the current. In order to do so, we must have a well-formed and informed conscience and apply authoritative teaching, not just our own opinions or feelings, to any given decision or choice. This underscores the importance of the ethical formation of health care professionals.

When St. John Paul II instituted the Pontifical Council for Health Care Workers some 30 years ago, he established that one of its duties would be " to stimulate and foster the work of formation, study and action carried out by the various international Catholic organizations in the health care field, as well as by other groups, associations and organizations which, on various levels and in various ways, operate in this sector." He therefore made it clear that the council would also "spread, explain and defend the Church's teachings on the subject of health care, and encourage their penetration into health care practices."

One of the instruments that the Pontifical Council uses to carry on this mission of spreading the teaching of the Church and forming health care workers is the Charter for Health Care Workers, which was first published way back in 1994 and translated in more than 10 languages, to foster its diffusion.

The Charter for Health Care Workers is a deontologica1 code for those engaged in health care. It is an organic and exhaustive synthesis of the Church's position on ethical issues related to medicine, the primacy and absolute value of life: of all life and of the life of every human being. Besides offering guidelines to health care professionals it can be used as instrument of formation for health care workers.

In the past decade since the publication of the Charter, there have been several pronouncements from the teaching office of the Church concerning the developments in the scientific field, their application in medical science and the regulations that ought to guide research and application. This inevitably prompted the Pontifical Council to revise and update the Charter.

3. Revising and Updating the Charter for Health Care workers
3.1 What is New in the Revised Charter

a) Integration of New Scientific Developments and Related Ethical Problems

In particular, issues relating to abortion and euthanasia, although both belonging to the fifth commandment and therefore originally placed under 'dying', have also been treated in the section on life (living), where abortion is referred to as an attack on unborn life. In this context, for example, we have integrated issues related to embryonic reduction, interception and contragestation, ectopic pregnancies, the suppression of life in the presence of particularly severe pathologies such as anencephaly, regenerative medicine applied to human therapeutic cloning aimed at producing embryonic stem cells .... thus reserving the attack properly attributable to euthanasia to the final stage of the life of the person (dying).

With regard then to the integration of specific contents, following the old structure of the life cycle (procreation — living and dying), due consideration has been made of both the advancement of medical sciences and of possible applications and interventions on human life, as well as the magisterial pronouncements after 1994, during the pontificate of St. John Paul II, Pope Benedict XVI and Pope Francis.

b) Integration of New Magisterial Teachings and Review of the Existent Texts

As for the Pontificate of St John Paul II, it is enough to think about the Encyclical letter Evangelium Vitae (March 25, 1995); the Doctrinal Note on some questions regarding the behaviour and commitment of Catholics in political life, published by the Congregation for the Doctrine of the Faith (November 24, 2002). From the Pontificate of Benedict XVI, we can cite the answers to some questions raised by U.S. Bishops concerning artificial nutrition and hydration (August 1, 2007), the Instruction Dignitas Personae on certain bioethical questions (September 8, 2008), and the encyclicals SpeSsalvi (November 30, 2007) and Caritas in Veritatae (June 29, 2009). Likewise from the current Pontificate reference has been made to the Apostolic exhortation Evangelii Gaudium (November 24, 2013).

The result of all this is not only an addition of magisterial new content, but also a review of the theological notes of the documents cited, which already existed in the 1994 edition and last but not least, revisiting the original text in view of the progress of medical-surgical-therapeutic techniques and the new questions linked to them. In this regard, it is sufficient to recall the innovations that have been introduced in assisted procreation and human genetics (freezing of oocytes and embryos, cloning, regenerative therapies using embryonic and adult stem cells, pre-implantation diagnosis, etc.), as well as the progress made in the field of vaccine production, in methods of ascertaining death, with the consequent problems related to eventual organ donation, the possibility of xenotransplantation, and the application of ordinary or extraordinary care to patients in a persistent vegetative state ...

c) Aspects from the Medical-legal Sphere

Other issues considered concern the medical-legal sphere in the exercise of health professions, as is the case, for example, the assessment of the proportionality of care; informed consent and the legal consequences thereof, and for the sick people and their legal representatives, if any; the problem of research and experimentation, both in healthy or ill adults and in children; the limits of the rights and duties of Trade Unions of health workers; the importance and the legal implications of conscientious objection for healthcare providers, for both biologists and pharmacists; the role of ethics committees and clinical ethics advice.

d) Issues of Social Justice

Finally, other problems have in the recent decades acquired greater recognition especially with regard to justice, respect and the principles of solidarity and subsidiarity, opening new frontiers for reflection not considered in the 1994 edition of the Charter. In particular, we have problems relating to prescription and the appropriate use of medicines; access to available medicines and technologies; health policies and the allocation of financial resources in healthcare, with respect, in particular, to sustainable health, drug companies, to rare and neglected diseases; sexual and health education, concerning, in particular, the prevention of sexually transmitted diseases, alcoholism and drug abuse and addiction.

4. Conclusion
I do believe that the result achieved through this revision and updating, though perfectible in some aspects or themes that could be incorporated or discussed further, is a big step forward in the endeavor to provide an up to date and concise instrument or vademecum to support health care workers in their important and delicate mission as ministers of life. The Charter is being perfected even as regards the typographic layout that the text will have to take, also in view of the use that the Charter could play even at the stage of formation of the various health care professionals. After an evaluation by the Plenary, the text will be transmitted to the competent Organs of the Holy See, in order to obtain the required nihil obstat for publication of the new Charter of health care professionals and for translations in different languages. I eagerly look forward to the day when we shall be handing out the first published copy of the revised Charter, and I am convinced this will be very soon.

Thank you for your kind attention.

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