The following is a copy of a discussion between Carlo Maria Martini and bioethicist Ignazio Marino.
When Does Life Begin? Cardinal Martini RepliesAnd the reply is: not immediately with fertilization, but later. With the consequences that follow. Cardinal Carlo Maria Martini and bioethicist Ignazio Marino discuss oocytes and embryos, abortion and contraception, AIDS and euthanasiaby Sandro MagisterROMA, April 24, 2006 – The long dialogue reproduced below was published in number 16/2006 of the weekly “L’espresso,” which went to the newsstands on Friday, April 21: during the same days when the media all over the world were illustrating and commenting upon Benedict XVI’s first year as pope. Cardinal Carlo Maria Martini, 79, a Jesuit and a great specialist in Sacred Scripture, was archbishop of Milan from 1979 to 2002. He now lives in Jerusalem, where he has resumed his biblical studies. Professor Ignazio Marino, a Catholic scientist and bioethicist of international fame, is the director of the transplant center at Jefferson Medical College in Philadelphia. Last April 10, he was elected to the Italian senate for the party of the Democrats of the Left. During John Paul II’s pontificate, cardinal Martini was universally considered the most authoritative proponent of the “progressive” opposition. And the same opinion continues to be circulated about his relation to the current pope. In the past, Martini has rarely expressed himself on the topics treated in this conversation. Even in the first months of 2005, when the discussion for and against the law regulating artificial fertilization in Italy was very lively, and the Church’s hierarchy was expressing itself forcefully, he remained silent. But here, he speaks about it extensively for the first time. And on some points he departs from the positions of the official Church, which is known for its intransigent defense of “every human life from conception to natural death,” without exceptions, and is contrary to artificial fertilization. In this regard, cardinal Martini asks the Church to overcome “the rejection of every form of artificial fertilization, which [...] produces a painful divergence between the practice commonly admitted by the people and sanctioned by law, and the attitude – or at least the theoretical attitude – of many believers.” Furthermore, Martini says he is in favor of the use of “the oocyte at the stage of two pronuclei.” In his judgment and that of professor Marino, in fact, this stage does follow fertilization, but in it “no sign of an individually distinguishable life yet appears”; it is not yet an embryo, and thus it can be manipulated without any objections of a moral nature. Other points on which cardinal Martini shows himself to be permissive, under particular conditions, are: - heterologous fertilization with the sperm or egg of an individual outside the couple; - the insertion “into a woman’s womb – even a single woman – of embryos otherwise destined for destruction”; - permitting single persons to adopt children; - the use of condoms for “spouses when one of them is infected with AIDS,” and more generally as “ a lesser evil.” On the subject of euthanasia, Martini says that “this can never be approved.” But he adds that he does not condemn “the persons who carry out such an act on the request of a person reduced to an extreme condition, and out of a pure sentiment of altruism.” He says the same thing about abortion: “I maintain that respect must be granted to every person who, perhaps after much reflection and suffering, follows her own conscience, even if she decides to do something that I do not feel I can approve of.” And he prefaces these remarks with this: “The pursuit of physical human life is not, in itself, the first and absolute principle. Above this stands the principle of human dignity.” On the fact that there is “a certain collaboration in abortion on the part of the public structures,” the cardinal acknowledges: “I see all the moral difficulty of this situation, but at the moment I would not know what to suggest.” Many questions concerning the origin and end of life, in Martini’s judgment, are “borderline zones or gray areas where what is the true good is not immediately evident.” And therefore “a good rule is to avoid, above all, deciding in haste and discussing at leisure, so as not to create needless divisions.” To the Church hierarchy, Martini says that “prohibitions and no’s will not be very useful, above all if they are premature, even if sometimes one will need to be able to say them.” The Church’s task is rather “to form consciences, teach the discernment of the best choice in every situation, and give the profound reasons for good actions.” Last April 6, speaking to the young people packed into St. Peter’s Square, Benedict XVI recommended to them the “many wonderful books by cardinal Martini, a true master of ‘lectio divinia’, which help us to enter into the living world of Sacred Scripture.” Two weeks later, cardinal Martini responded with the first great act of opposition to this pontificate from the upper levels of the Church.
* * *The dialogue between cardinal Martini and professor Marino was planned and realized – and prepared for publication in “L’espresso” – by Daniela Minerva. Here is the full text: Dialogue on life A conversation between Carlo Maria Martini and Ignazio Marino MARTINI – My dear professor Marino, I read with great interest and attention your book “Credere e curare [Believe and Heal].” I was struck, on the one hand, by your love for the medical profession and your emphasis upon the sick person, and on the other by your objectivity of judgment, your evenhandedness in dealing with borderline topics, where medical demands intersect and sometimes conflict with ethical demands. I have seen how you do not wish to renounce either your professional objectivity as a doctor or your conscience as a man and a believer. All this seems very important for that “dialogue on life” that rightly interests so many of our contemporaries, especially in those limited cases when the great exploits of science and technology arouse wonder and gratitude on the one hand, and concern for the human person and his dignity on the other. All this makes it necessary and urgent to have a “dialogue on life” that does not begin from preconceptions or prejudicial positions, but is open and free, and simultaneously respectful and responsible. MARINO – I also see many reasons for an objective, in-depth, and sincere dialogue on the subject of human life. We are living, in fact, at a special historical time in which scientific progress has revolutionized the human person’s relationship to life, illness, and death. Today, unlike yesterday, one can be conceived in many different ways, one can be cared for with extraordinary therapies, and maintained for a long time on life support, in a state that can be called “life” simply from the point of view of physiological functions. Death is increasingly considered as an exceptional event to be avoided, and not the natural end toward which every human life inevitably moves. These changes do not only influence the course of our existence; they also influence our way of understanding life, illness, and death. For this reason, it is not possible to ignore the countless ethical questions that emerge from the continual changes linked to new technologies and to the possibilities that science places at man’s disposal. The dialogue on these topics and the encounter among people of different backgrounds and different roles within society can contribute to the circulation of ideas and positions aimed at identifying points of commonality, instead of division. On such delicate topics, in fact, the risk is that of falling into simplistic contrasts and self-serving logic that bring no advantages, but only create fractures in society. But if the reasoning is conducted honestly and in a spirit of sincere openness, it is possible to identify common paths, or at least ones that are not too divergent. The beginning of life MARTINI – I am fully in agreement with your premises. Wherever scientific and technological progress create borderline zones or gray areas, where it is not immediately evident what the true good of man and woman are, whether of an individual or of all humanity, a good rule is to avoid, above all, deciding in haste and discussing at leisure, so as not to create needless divisions. I think we could begin some experiment with such a dialogue by starting from the beginning of life, and above all with the increasingly common practice of “medically assisted fertilization,” and with the fate of the embryos that are used for this purpose. There are not a few differences of opinion on this, and also some uncertainties of terminology and practice. Would you like to clarify this point a bit, on the basis of your expertise? MARINO – Today it is possible to create life in a test tube, through artificial fertilization. In the face of fertility problems within a couple, artificial fertilization can serve to complete a family with a child. Nevertheless, in Italy and many other countries this practice spread out not regulated by law. Science and its medical applications have progressed faster than the lawmakers have, and for this reason we now find ourselves facing the problem of thousands of human embryos frozen and preserved in the cold storage facilities of infertility clinics, with no decision on what their fate should be. Current Italian law, in order to avoid perpetuating the production of extra embryos that will not be used, has chosen a simplistic way: creating only three at a time and implanting all of them in the woman’s uterus. But this number, if one reasons on a scientific basis, should be flexible and determined case by case, according to the couple’s medical conditions. But science comes to the rescue to suggest alternatives to the creation and freezing of embryos. There exist more sophisticated technologies than those used today, which provide for the freezing, not of the embryo, but of the oocyte at its stage of two pronuclei, the moment when the two chromosome pairs, the female and the male, are still separate, and a new DNA chain has not yet been formed. In this phase, it is not possible to determine which path the cells will take at the moment when they begin to reproduce: they could produce a baby, or two twin monozygotes. The embryo does not exist, there is not a new genetic patrimony, so there is not a new individual. From the biological point of view, there is not a new life. So can we also think that life is not present from the spiritual point of view, and that there are therefore no problems for a person of faith in evaluating the idea of following this path? MARTINI – I understand how these things upset many persons, especially those most sensitive to ethical problems. And I am also convinced that the processes of life, and thus also those of the transmission of life, form a continuum in which it is difficult to identify the moments of a real and proper qualitative change. The result of this is that when dealing with human life, we must have great respect and reservation in regard to everything that in some way manipulates it or could exploit it, from its very beginnings. But this does not mean that it is not possible to identify moments in which no sign of an individually distinguishable life yet appears. It seems to me that this is the case you are bringing up with the oocyte at the stage of the two pronuclei. In this case, it seems to me that the general rule of respect can accompany the technical treatment that you suggest. It also seems to me that what you are proposing would permit the overcoming of the rejection of every form of artificial fertilization that is still present in not a few circles, and which produces a painful divergence between the practice commonly admitted by the people and sanctioned by law, and the attitude – or at least the theoretical attitude – of many believers. In any case, I maintain it is opportune to make a distinction between homologous fertilization and heterologous fertilization. But it seems to me that a radical rejection of every form of artificial fertilization is above all based upon the problem of the fate of the embryos. In the proposal that you illustrate, this problem could be overcome. Heterologous fertilization MARINO - You have also referred to the distinction between homologous and heterologous fertilization. This is a quite controversial question. In fact, if a couple’s desire to create a family cannot be realized because of infertility problems or the presence of genetic diseases in one of the two potential parents, why not have recourse to the sperm or egg of a person outside the couple? Couldn’t this represent a solution for meeting this family’s desire? Does genetic patrimony still matter more? Reflecting on this topic, my first assessment would be in favor of heterologous fertilization, if this is the only means for having a child and if becoming pregnant is important for the woman. But I have also faced those who maintain that it is not rare for heterologous fertilization to introduce an imbalance in the couple between the biological parent, who transmits part of his or her DNA to the child, and the other. Some of the studies published in scientific journals and conducted in countries where heterologous fertilization is permitted have highlighted the fact that nuclear families can be created that are psychologically unbalanced in favor of the parent who has transmitted part of his or her genetic patrimony to the child, as if one parent were somehow more valuable than the other. Another question concerns transparency: should the child conceived by heterologous fertilization be informed of this fact? And, if the answer is in the affirmative, is it right to follow a path that can create psychological traumas, even if this is done from the desire to have a child? Does outlawing the recourse to heterologous fertilization mean limiting citizens’ freedom, or should it be interpreted as a way of safeguarding future generations? MARTINI – The objections of a psychological nature that you have recalled are some of the reasons that have prevented more than a few couples from proceeding along the way of heterologous fertilization, even if this can involve suffering on the part of some. From the ethical point of view, a related issue is the protection of the privileged relationship that is instituted between a man and a woman in marriage. Nevertheless, my personal reflections also turn to the situations that are created with the various forms of adoption and foster care, where apart from the genetic patrimony it is possible to establish a real emotional and formative relationship with persons who are not parents in the physical sense of the word. I would, therefore, be prudent about expressing my views on the cases that you bring up, where it is not possible to resort to the sperm or egg of the couple itself. This is all the more true in cases in which the fate of embryos otherwise destined for destruction must be decided, and in which the implantation of these in a woman’s womb – even a single woman – would seem to be preferable to their pure and simple destruction. It seems to me that we are in those gray areas of which I spoke earlier, in which the correct view probably stands on the side of those who reject heterologous fertilization, but in which it may not be opportune to demonstrate a certainty that is still waiting for confirmation and experimentation. Research on embryonic stem cells MARINO – The problems related to embryos have also provoked bitter discussions over the use for research purposes of stem cells taken from embryos. The June 2005 referendum in Italy on medically assisted procreation asked for, among other things, the abolition of the article of law number 40 that prohibits the use of these stem cells. It can be conjectured from a scientific point of view, though this is not yet confirmed, that embryonic stem cells are better suited for research purposes, to identify therapies for the cure of very serious illnesses from Parkinson’s to Alzheimer’s and so forth. There exist other types of stem cells, obtained from adult tissues or the umbilical cord, which already today are being used with some success. Almost all the researchers agree on the fact that it is not necessary to create embryos for the sole purpose of obtaining stem cells: cellular material for conducting research can be bought, and besides, many studies conducted recently on rats have demonstrated the possibility of obtaining cells that have the same characteristics as embryonic stem cells without needing to create embryos. What remains unsettled is the question of the embryos preserved in the infertility clinics and which will most likely never be used by any couple. Their end is certain, but is it better to let them die in the cold, or to use their precious cells for research purposes? In the view of religious orthodoxy, these are lives, and as such they cannot be suppressed in order to obtain cells for therapeutic purposes, even if one day these embryos would be destroyed anyway. It’s a question of the distinction between killing and them and letting them die. Can this point be overcome ethically? Is it not opportune to ask for the donation of embryonic stem cells to laboratories in order to support research on diseases that are incurable today? MARTINI – First of all, I am struck by the prudence with which you speak of the therapeutic efficacy of stem cells. I seem to have understood that we are still in the field of research, and that it is therefore not honest to publicly proclaim certitude on the curative efficacy of these cells before this has been duly proven. I am also happy on account of the fact that it is no longer held necessary to create embryos with the purpose of producing stem cells, and that alternative methods have been developed which do not pose problems of conscience. This is one more reason to trust in the intelligence that the Lord has given to man that he might overcome the problems posed by life. It is in the name of this same intelligence that I do not find it thinkable to use embryonic stem cells for research. This would be contrary to all the principles enunciated to this point. The existing frozen embryos MARINO – Your reply permits me to expand upon our reflection on the fate of existing embryos, even beyond what has been hypothesized above. When these are not to be used, what would be the ethical thing to do? At present no solution has been identified, except that of leaving the test tubes in the freezers. But is it ethically correct and acceptable to tolerate that thousands of human embryos should remain frozen in the infertility clinics, simply waiting to expire in the cold over the passing years? Could they not, for example, be destined for single women who want to become pregnant? Or for couples with problems linked to genetic illnesses who cannot have recourse to normal artificial fertilization to avoid the risk of transmitting a genetic defect? MARTINI – It seems to me that here we are facing a conflict of values, which is more evident in the case of the single woman who wants to become pregnant, but which also exists, for the reasons I explained above, in the case of couples who for serious medical reasons cannot have recourse to normal artificial fertilization. Where there is a conflict of values, it seems to me more ethically meaningful to favor the solution that permits a life to flourish, rather than let it die. But I understand that not everyone is of this opinion. I would only like to avoid a clash on the basis of abstract and general principles where, instead, we are in a gray area that it is proper to enter free from dogmatic judgments. Adoption for single persons MARINO – Then there are other problems connected to the development of life, and in particular to the care that society should have for children who do not have a family. In these cases, there appears the possibility for the usefulness, the necessity almost, of adoption. In Italy today, adoption is not allowed for single persons, and more generally the legislation is very complex and makes every sort of adoption difficult. I ask myself whether, from the ethical point of view, it is better for a child who has been orphaned or abandoned by his parents to spend his life in an institution or on the street rather than having a family composed of a single parent? Are we sure that this is the right way to guarantee the best upbringing possible for this child? Besides, if one of the parents loses a spouse, even after the birth of their first child, no one thinks that the child should not continue to live in his nuclear family, even if there is only one parent. Or again, the Church maintains that in the presence of a fetus, no matter what the circumstances, the woman must be invited to bring her pregnancy to term, even if the father is absent or is opposed to the pregnancy, thus making this a matter of supporting a mother who will, in practical terms, be single. So why not support adoption by single persons, once assurance has been made of the potential parent’s motivation, financial means, and ability to assure a peaceful upbringing for the adopted child? MARTINI – You are raising serious and reasonable questions on a complex topic, where I do not have sufficient experience. But I think that the point of departure is the condition that you voiced at the end. That is to say, what is necessary is to assure that those who care for adopted children have the proper motivations and also the means and capacity to assure a serene upbringing for them. Who fulfills these conditions? In the first place, this certainly includes the family composed of a man and a woman with wisdom and maturity, and who can also provide a network of intrafamilial relationships to foster the child’s growth from every point of view. Lacking this, it is clear that other persons, including singles, could provide some essential guarantees. So I would not limit myself to just one possibility, but I would leave it to the experts to determine what is in fact the best solution, here and now, for this child. The goal is to assure the most favorable conditions that are practically possible. So when there is the possibility of choosing, the best choice must be made. Abortion MARINO – One of the most difficult issues to face, one that is constantly brought up precisely because of its delicacy and complexity, is abortion. In Italy, the state has regulated this matter by striving to preserve both the principle of women’s self-determination and liberty of conscience for doctors, who may choose to exempt themselves. In recent years, we have seen the effects of abortion legislation in Italy. As much as we all recognize that abortion always constitutes a failure, no one can deny that the law has permitted the reduction of the overall number of abortions, and has kept clandestine abortions under control, avoiding risk to women’s lives through disasters like perforation of the uterus made by “midwives” to induce abortion. What is the Church’s stance in the face of extreme cases like that of woman who has been violated, a pregnancy in an adolescent of eleven or twelve years old, a woman without the economic means to raise a child? If one admits the principle of the choice of the lesser of two evils, or, as the Catholic Church suggests, that of entrusting the decision to the individual conscience (“conscientia perplexa”: a situation in which moral judgment is uncertain, and making a decision is difficult), wouldn’t it be ethically correct to express this point of view openly, and support it publicly? MARTINI – This is a very painful issue, one that causes great suffering. Certainly, in the first place one must will to use every possible and reasonable means to defend and save every human life. This does not change the fact that reflection can and should be given to the very complex and diverse situations that can arise, and that every factor should be considered that serves to protect and promote human life. But it is important to acknowledge that the pursuit of physical human life is not, in itself, the first and absolute principle. Above this stands the principle of human dignity, a dignity that in the view of Christianity and many other religions involves an openness to the eternal life that God promises to man. We can state that this is where the definitive dignity of the person lies. But even those who do not share this faith can comprehend the importance of this foundation for believers, and the necessity in any case of having deep reasons for upholding the dignity of the person always and everywhere. Christians find their deepest reasons in the words of Jesus, who affirmed that “life is worth more than food, and the body more than clothing” (cf. Matthew 6:25), but exhorted us not to be afraid of “those who kill the body, but do not have the power to kill the soul” (cf. Matthew 10:28). So human life must be respected and defended, but it is not the supreme and absolute value. In the gospel according to John, Jesus proclaims: “I am the resurrection and the life: he who believes in me, even if he dies, shall live” (John 6:25). And Saint Paul adds: “I maintain that the sufferings of this present moment cannot be compared with the future glory that must be revealed in us” (Romans 8:18). So there is a dignity to existence that is not limited to physical life alone, but looks to eternal life. That said, it seems to me that even on a painful topic like that of abortion (which, as you say, always represents a failure) it is difficult for a modern state not to intervene at least to prevent the situation from becoming lawless and arbitrary. And it seems to me that, in situations like ours, it would be difficult for the state not to create a distinction between acts punishable by law and acts which it is not convenient to punish by law. This does not at all mean a “license to kill,” but only that the state prefers not to intervene in all possible cases, but strives to reduce the number of abortions, to prevent them by all means possible, especially after a certain period of time after the beginning of pregnancy, and seeks to diminish as much as possible the causes of abortion and to demand precautions so that the woman who decides nevertheless to carry out this act, in particular in situations not punishable by law, will not be seriously injured or killed. This happens in particular, as you recall, in the case of clandestine abortions, and so all things considered it is a good thing that the law should contribute to reducing them, and eventually to eliminating them. I understand that in Italy, with the existence of the National Health Services, this involves a certain cooperation in abortion on the part of the public structures. I see all the moral difficulty of this situation, but I would not know what to suggest at the moment, because any solution that might be sought would probably involve negative aspects. For this reason, abortion is always something dramatic, which can in no way be considered a remedy for overpopulation, as it seems to me happens in certain countries. Naturally I do not intend to include in these assessments those limited situations, which are extremely painful and perhaps also rare, but do in fact present themselves, in which a fetus gravely threatens the mother’s life. In these and similar cases, it seems to me that moral theology has always upheld the principle of legitimate defense and of the lesser evil, even in the case of a reality that demonstrates the dramatic and fragile nature of the human condition. For this reason, the Church has also proclaimed as heroic and an exemplary gospel witness the action of those women who have chosen to avoid any damage to the new life they carry in their wombs, even at the price of giving up their own lives. But I am unable to apply this principle of legitimate defense and/or the lesser evil to other extreme cases that you hypothesize, nor could I endorse the principle of the “conscientia perplexa,” which I do not quite understand. It seems to me that even in the cases in which a woman cannot, for various reasons, manage to care for her child, there should be no lack of other persons offering to raise and care for him. But in any case, I maintain that respect must be granted to every person who, perhaps after much reflection and suffering, follows her own conscience, even if she decides to do something that I do not feel I can approve of. Compensation for organ donation? MARINO – There is an issue that directly concerns me, since for more than twenty-five years I have been involved in organ transplants. Thanks to transplants, today thousands of persons who were otherwise destined for certain death have been healed and lead a full life from all points of view. The primary limitation on the expansion of this therapy is the insufficient number of donations, and thus of organs to transplant, and as a result many persons die on the waiting list. In order to increase the number of donors, in some countries, mainly Great Britain, the hypothesis has been advanced of establishing compensation for the families that agree to donate their relatives’ organs after death. This could probably lead to an increase in the number of donations and transplants, and so respond to the needs of sick people on a waiting list for organs to save their lives. But this hypothesis contains the premises for unequal treatment. Is there not a risk of creating a situation in which only the less fortunate, through the incentive of compensation, would be willing to donate organs, while the more prosperous would limit themselves to receiving them? And shouldn’t donation, by its very nature, be always and exclusively based upon the principle of equality? MARTINI – Personally, I feel very strongly what you affirm at the end, the importance of the principle of equality and the extremely serious dangers of an hypothesis of compensation for organs. It seems to me that the right alternative is promoting as much as possible the principle of donation, and increasing public awareness in this matter. It is truly to be hoped that no one will die on a waiting list while there are organs available. HIV and AIDS MARINO – The question of equality leads us directly to considering problems and illnesses that afflict millions of persons all over the world, above all in the poorest and most disadvantaged countries, for which the idea of equality remains a faraway dream, if not an utter utopia. How can we not think immediately of AIDS? Around 42 million persons in the world carry the HIV virus. In 2005 alone, according to the data provided by the agencies of the UN, 3 million persons died of AIDS, while 5 million new infections were recorded. 60 percent of the carriers of the virus live in the poorest countries of sub-Saharan Africa, involving an average of 5-10 percent of the population, up to 25-30 percent in some countries, like Botswana or Zimbabwe. HIV is the scourge of a continent that produces, not only sick people, but orphans, poverty, the impossibility of improving the conditions of life. In the Western world, the virus is kept under control today thanks to progress in pharmaceutical therapies that permit an HIV-positive person to lead a completely normal life, with a life expectancy similar to that of persons not affected by the virus. Until a few years ago, the annual cost of drugs for an HIV-positive person was around ten thousand euros, a prohibitive figure that could be managed only by countries with a national health system. Today the prices have fallen through competition, coming down in the middle of 2003 to 700 euros for brand name drugs (produced by multinational pharmaceutical companies) and around 200 euros for generic drugs manufactured by India, Brazil, and Thailand. In spite of these important strides, in many African countries the per capita health expenditure does not exceed 10 dollars per year, so that in fact access to drugs and therapies to fight AIDS is denied, and the virus continues to spread. We know that AIDS can be fought in part through prevention and the use of condoms. How is it acceptable not to promote the use of condoms to contribute to controlling the spread of the virus? Is it or is it not the duty of governments to make choices and decisions in this matter? And with respect to the official doctrine of the Catholic Church, would this not be a case of opting for a lesser evil, and contributing to saving many human lives? MARTINI – The figures that you cite provoke distress and heartache. In our Western world, it is rather difficult to become aware of how much suffering there is in certain nations. Having visited them personally, I have witnessed this suffering, which is mostly born with the greatest dignity and almost in silence. Everything possible must be done to oppose AIDS. Certainly, in some situations the use of condoms can constitute a lesser evil. Then there is the particular situation of spouses, one of whom is infected with AIDS. The infected one is obligated to protect the other partner, who should also be able to take protective measures. But the question is instead whether it is convenient that the religious authorities be the ones to promote such a means of defense, almost as if it were believed that the other morally sustainable means, including abstinence, should be put in second place, while the risk arises of promoting an irresponsible attitude. So the principle of the lesser evil – which is applicable in all the cases provided for by ethical doctrine – is one thing, while the matter of who should express such things publicly is another. I believe that prudence and the consideration of the different particular situations will permit everyone to contribute effectively to the fight against AIDS without this fostering irresponsible behavior. But I believe that the moment has come for our dialogue to pass to another series of problems concerning life, and precisely the problems that regard its end. It is necessary to live with dignity, but this also means dying with dignity. Now, as you know, this is where extremely serious problems are posed, especially in the West. The end of life MARINO – You are certainly thinking above all of euthanasia, a word around which great confusion is always created because it is given multiple meanings. For this reason, I prefer not to speak in abstract terms, but to express myself in a very concrete manner. Is it or is it not permissible for a person to voluntarily induce the death of another, who may be seriously ill and in prey to devastating physical pain, in order to alleviate this pain? In the face of an irreversible situation in which death is inevitable, I maintain that it is absolutely necessary to administer drugs like morphine, which alleviate pain and enable the sick person to endure the passage from life to death with greater tranquility. This is what is done, in these dramatic circumstances, in all the resuscitations in the United States. In my work in the United States, I myself have in many instances decided to suspend all treatment, in spite of my suffering because a doctor always wants to be able to save the life of his patient. It is a painful moment for the family, and, I assure you, for the doctor as well, but it is an honest acceptance of the fact that one can do nothing else than avoid prolonging suffering that is useless and damaging to the dignity of the patient. Italy is still greatly lacking in this regard, in the absence of a law regulating this matter, to the point that if I followed the same kinds of procedures in our country, I could be arrested and convicted of homicide, even though it were simply a matter of not exhaustively applying meaningless treatments. But I do not agree with the administering of poisonous substances in order to stop the sick person’s heart and so induce death. But although I condemn the act, I am not sure that the person who carries it out can be condemned. I’ll give an example: a recent Oscar-winning film, “Million Dollar Baby,” depicts the drama of a woman reduced to a semivegetative state after a serious sports injury, who asks a man, her main point of reference in life, to help her put an end to her physical and psychological suffering. The man initially refuses, but then agrees, because he believes this is an act of great love toward the human being he cares most about. Although I am not able to justify the idea of suppressing a life, I ask myself how in similar situations one can condemn the act of a person who acts upon the request of a sick person, and out of a pure sentiment of love? And on the other hand, is it licit to accept the principle of not condemning a person who kills? MARTINI – I agree with you that the action of someone who induces another’s death can never be condoned, in particular if it is a doctor, whose aim is the life of the sick person, not death. But neither would I condemn those persons who carry out such an action at the request of a person reduced to extreme circumstances and out of a pure sentiment of altruism, nor those in disastrous physical and psychological conditions who ask for this themselves. But I also maintain that it is important to make solid distinctions between actions that bring life and those that bring death. The latter of these can never be approved. I maintain that, on this point, what must always prevail is that deep sentiment of fundamental trust in life, which, in spite of everything, finds meaning at every moment of human existence, a meaning that no circumstance, however adverse, can destroy. But I know that nevertheless one can undergo temptations of desperation over the meaning of life, and think of suicide for oneself or others, and for this reason I pray first of all for myself and then for others, that the Lord may protect each of us from these terrible trials. In any case, it is very important to be close to those who are seriously ill, especially those in the terminal stage, and make them feel that they are loved and that their existence nonetheless has great value and the possibility for great hope. The doctor, too, has an important mission in this regard. Life-prolonging measures and the interruption of treatment MARINO – to this topic is that of life-prolonging measures. Current technology is capable of keeping alive sick people who, until a few years ago, were not even brought into a resuscitation facility. Scientific progress even permits the artificial prolonging of the life of a person who has lost all hope of returning to an acceptable state of health. For this reason, it seems urgent to face the problem of the interruption of treatment. Every form of excessive treatment should be avoided, because this is opposed to respect for human dignity. For the Church, the suspension of treatment is considered as the acceptance of a natural event, a decision not to force matters any further. The Catechism of the Catholic Church says: “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of 'over-zealous' treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.” There exist legal instruments, such as the living will, which allow an individual to indicate precisely, and in a moment of emotional tranquility, the point to which one desires to accept recourse to extraordinary treatment. The living will represents a highly valid tool for helping the doctor and the family to make the final decision. This should be based upon flexible rules, and should identify a person of trust capable of interpreting the desires of that individual, keeping in mind further scientific progress. Many countries have adopted this with good results. In Italy, a draft law was presented to the senate some time ago, but is still awaiting debate. Would this not be the moment to begin a serious and shared reflection to introduce as soon as possible into our country as well a law on the end of life, one of the most important moments of our existence? MARTINI – I think the passage that you cited from the Catechism of the Catholic Church says it all. But if one wants to legislate in this matter, it is important that loopholes not be created for the so-called euthanasia we spoke of earlier. For this reason, I am also uncertain about the instrument of the living will. I have not studied this topic, and I would not be able to give a decisive judgment. I maintain with you that a serious and shared reflection on the end of life could be useful, as long as it is truly serious and shared, and does not lend itself to partisan speculation, and above all that it does not somehow bring in opportunities for a decision on one’s own death that would be repugnant to the deep meaning of life, as has been said above. Science and the meaning of limitation MARINO – In conclusion, I would like to propose a more general reflection. Knowledge, scientific progress, and technological advances create extraordinary opportunities for the growth of our planet, but at the same time they place great power in the hands of researchers and scientists, linked to the fact that they are able to intervene in the mechanisms that regulate the beginning of life and its end. Science runs faster than the rest of society, and also faster than the parliamentarians, who are charged with establishing rules, but most often are incapable of intervening fast enough. In my way of seeing things, there should be a firm request for an assumption of responsibility on the part of every scientist involved in a field of research that intervenes in the essence of life, on its creation and end. Leaving intact the principle that rational evaluation is indispensable, the researcher’s sense of judgment should also be disciplined by a sense of responsibility balanced with an assessment of the risks and consequences. It is not a question of appealing to faith or religion, but of emphasizing a position of conscience on the part of every scientist. This does not mean wanting to arrest scientific progress, but to preserve and respect our most precious good, that of life. But history unfortunately teaches us that an appeal to individual responsibility is sometimes not enough. For this reason, scientists must provide all the useful information they have, and in the end it should be the parliamentarians, or better, the transnational institutions, to establish the rules on the basis of the citizens’ common judgment. MARTINI – We are all full of wonder and amazement, and thus also of gratitude to God, for the extraordinary scientific and technological progress of these years, which permits and will permit us to understand always more and better how to provide for the health of the people. At the same time we are aware, as you say, of the great power in the hands of researchers and scientists, and of the firm assumption of responsibility that should permit them to conduct their research while always evaluating the risks and consequences of their actions. These should always contribute to the good of life, and never the contrary. For this reason, one most also know how to stop sometimes, instead of pushing the limits. I am inclined to foster hope in these men’s sense of responsibility, and I would like for them to have that freedom of research and initiative which permits the advancement of science and technology, while at the same time respecting the unassailable parameters of the dignity of every human person. I know also that we cannot stop scientific progress, but we can help it to be increasingly more responsible. As you say, it is not a question of appealing to the faith or to religion, but of pointing to the ethical sense that each of us has inside. Certainly, even good and timely laws can help, but as you affirm, today science runs faster than the parliamentarians. So what is needed is a leap forward in conscience, and a better than good will to make sure that man does not devour his fellow man, but serves and aids him. The transnational institutions must also be aware of the danger we all run, and of the need for timely and responsible intervention. Each of us must play a part in all of these matters: the scientists, the technicians, the universities and centers of research, the politicians, the governments and parliaments, public opinion, and the Churches as well. As far as the Catholic Church is concerned, I would like to emphasize its formative role. It is called to form consciences, to teach the discernment of the best choice in every situation, and to give the profound reasons for good actions. In my view, prohibitions and no’s will not be very useful, above all if they are premature, even if sometimes one will need to be able to say them. What will be most useful is a formation of the mind and heart to respect, love, and serve the dignity of the person however it is manifested, with the certainty that every human being is destined to participate in the fullness of the divine life, and that this could also require sacrifice and renunciation. It’s not a question of oscillating between rigorism and laxity, but of giving the spiritual motivations that induce love of neighbor as oneself, or rather as God has loved us, and also to respect and love our body. As Saint Paul affirms, the body is for the Lord and the Lord is for the body. Our body is a temple of the Holy Spirit who is within us and whom we have from God: for this reason, we do not belong to ourselves, and we are called to glorify God in our body; that is, in the totality of our existence on this earth (cf. 1 Corinthians 6:13, 19-20). __________ For a comparison between the positions of cardinal Martini and those of the Catechism of the Catholic Church, see, in the Catechism itself, the paragraphs on abortion and the inviolability of the unborn life (2270-2275), euthanasia (2276-2279), and artificial fertilization (2374-2379):
> Catechism of the Catholic Church __________ For a comparison between the positions of cardinal Martini and those recently expressed by Benedict XVI on a topic touched upon by both of them, see the speech the pope gave to the conference on “The human embryo in the preimplantation phase”:
> Benedict XVI to the Pontifical Academy for Life, February 27, 2006 In it the pope said: “God's love does not differentiate between the newly conceived infant still in his or her mother's womb and the child or young person, or the adult and the elderly person. God does not distinguish between them because he sees an impression of his own image and likeness (Gn 1: 26) in each one. He makes no distinctions because he perceives in all of them a reflection of the face of his Only-begotten Son, whom 'he chose before the foundation of the world. He destined us in love to be his sons according to the purpose of his will' (Eph 1: 4-6). This boundless and almost incomprehensible love of God for the human being reveals the degree to which the human person deserves to be loved in himself, independently of any other consideration – intelligence, beauty, health, youth, integrity, and so forth.” __________ About the protection from the spread of AIDS, see the speech the pope gave to a group of African bishops, June 10, 2005:
> To the Bishops of South Africa, Botswana, Swaziland, Namibia and Lesotho In it the pope said: “The traditional teaching of the Church has proven to be the only failsafe way to prevent the spread of HIV/AIDS. For this reason, the companionship, joy, happiness and peace which Christian marriage and fidelity provide, and the safeguard which chastity gives, must be continuously presented to the faithful, particularly the young,” __________ On this website, on the Church’s efforts in the dispute over artificial fertilization in Italy:
> How Italy Voted on June 12, Who Lost – And Why (24.6.2005)
> Embryos Welcome: Ruini Wins the Referendum, and Sets an Example (16.6.2005) __________ English translation by Matthew Sherry:
traduttore@hotmail.com For the latest articles go to the English home page:
> www.chiesa.espressonline.it Sandro Magister’s e-mail address is
s.magister@espressoedit.it
