Ethics & Medics
FEBRUARY 1997, VOL. 22, NO. 2

Human Dignity and Health Care

At the heart of the Ethical and Religious Directives is the recognition of the inviolable dignity of each and every human being. It is love for the suffering individual that has drawn Catholics into health care and restrains them from ever doing anything that would harm or violate that individual in any way. At the very beginning of the document, the Directives state: "First, Catholic health care ministry is rooted in a commitment to promote and defend human dignity; this is the foundation of its concern to respect the sacredness of every human life from the moment of conception until death" (Intro. to Part One).

The Meaning of Dignity

There is surely no lack of assertions of the dignity of the human person in our day. In fact, those who would advocate euthanasia and physician-assisted suicide do so with the claim that it is precisely such actions that would be consonant with the dignity of the suffering person. Indeed the advocates of euthanasia call for "death with dignity." Problems arise, however, when one attempts to understand what is meant by the human dignity lauded by so many today. By their own stated positions and advocacy of certain social policies "human dignity" would seem to refer to the ability of an individual to do whatever he may feel inclined to do. Those who have such an understanding of human dignity would naturally become quite dismayed, in fact, perhaps "dismayed unto death," if they would find themselves seriously disabled as the result of an accident or illness and incapable of doing what they might feel inclined to do. Indeed, such a life might well be "not worth living" in their estimation. But is the ability to do whatever one feels inclined to do actually the criterion by which human dignity is judged?

Dignity refers to the excellence or nobility of the person and, even in our day, no one is judged excellent or noble simply for doing whatever one may feel inclined to do-such as drinking to the point of intoxication or lying to another so as to gain an unjust advantage. Dignity is still associated with some understanding of goodness or excellence. But how can a newborn or a patient in a coma be considered good if they are unable to engage in good and noble actions? So the dignity inherent in every human being must have a source other than the noble deeds performed by the individual: there is also a dignity that is given or bestowed, not gained.

It must be stated most emphatically that every human person enjoys an inherent dignity that must be respected and in no way violated, even when such an individual may not be fully competent or may have even acted in evil ways. Indeed, the inviolability of the human person has led to the Church's insistence on moral absolutes; there are some actions that may never be done under any circum-stances, since the performing of them would constitute a violation of the person's dignity: the dignity of the one against whom the action is directed as well as the one performing the action.

The Source of Such Dignity

The question must therefore be asked, whence the dignity of the individual human person is derived, since a person's dignity is inherent, i.e., a permanent and inseparable quality. Yet this quality is not any more necessary than is the existence of the person and does not explain itself. No one necessarily exists. And no one enjoys such self-evident excellence or nobility that he would naturally elicit awe and reverence in the other to such a degree that the other would not even contemplate violating such goodness. The excellence of each individual human being is then to be understood as fundamentally participatory, i.e., it shares in that alone which is of its nature excellent and noble and true and beautiful: God Himself. The Directives make this clear: "The dignity of human life flows from creation in the image of God (Gn 1:26), from redemption by Jesus Christ (Eph 1:10; 1 Tm 2:4-6), and from our common destiny to share a life with God beyond all corruption (I Cor 15:42-57)" (Intro. to Part Two).

This reality concerning human dignity is also seen in the first quotation above from the Directives which speaks of "the sacredness of every human life." In the last analysis, the sacred is properly an attribute of God alone. "I the Lord your God am holy" (Lev. 19:2) Persons, places, things, and times become holy when they have been touched by God. The "sacredness of every human life" is a participatory sacredness. "You shall be holy to me; for I the Lord am holy" (Lev. 20:26).

Morality vs. Legalism

The Catholic moral tradition has always taught that there are some actions that must never be done because they are intrinsically disordered, i.e., they do fundamental violence to the sacredness of human life. People usually lose sight of the relationship that exists between that which is judged to be morally illicit and the violence committed against some good of the human person. It appears to many people that the Church's judgment that certain actions are immoral is little more than an arbitrary expression of distaste, or of a decision to apply some willful strictures against the pursuit of human happiness in order to maintain control over Church members. Tubal ligations and vasectomies, which have been and will be consistently forbidden in Catholic health facilities, strike some as having no more relevance to human goodness and human happiness than eating meat on Fridays, which was once forbidden by the Church. However, the problem is that the one prohibition (against eating meat on Friday) was merely a disciplinary one whereas the other prohibition (against direct sterilizations) cautions against actions which would directly violate individuals in the very core of their being.

The desire to protect the dignity of the human person and to keep it from being violated is at the very heart of the Directives and explains the prohibitions of certain acts which, in the minds of some, appear arbitrary, such as, for example, in vitro fertilization or artificial insemination. In the minds of Catholics, such actions are not wrong because they have been forbidden by Church authorities, rather they have been forbidden in Catholic health facilities because they are wrong and do violence to the dignity of the persons involved.

In the Summa contra Gentiles St. Thomas Aquinas says that God is offended by us-not when we violate His commandments-but when we act against our own good. The commandments were given to us to keep us from acting against our own good! This is precisely why the Directives were given to us. They were drawn up for no other reason than to express the Church's solicitude for the vulnerability of the human person to being used by others.

A legalistic attitude is surely the principal reason Catholic moral teachings, and consequently the ERD, are misunderstood. It would come as a surprise to many, Catholics as well as non-Catholics, that sin is defined in the Catechism of the Catholic Church (cf. 1849) not principally as a violation of God's commandments, but rather as an offense against reason and truth! In other words, sin is an offense against that unique capacity of human beings which is the highest mark of their dignity, their reason, the very image of God within them.

It must be said that the only thing that will truly violate the dignity of an individual is sin. This is one reason the Directives prohibit certain procedures in Catholic health facilities; they are simply beneath the dignity of human beings created in the image and likeness of God and have the quality of sinfulness. As stated repeatedly in the Directives, Catholic health care facilities are concerned with the good of the whole person, physical, emotional and spiritual. But one of these goods cannot be arbitrarily chosen to the detriment of the other. Indeed there is a hierarchy to the goods, so that one ought to be ready to sacrifice a physical good if pursuing it would mean violating a spiritual good. Nothing can come before our relationship with God and the only thing that can impede that relationship, is sin. To paraphrase Our Lord: What would it profit a man to gain the best physical health in the world but to lose his soul?

Dignity and Moral Principles

It is because of the Catholic Church's commitment to the inviolable dignity of each human being that she insists upon such patient rights as informed consent and autonomy, the right of all not to be arbitrarily denied access to health care, especially those who are weak and vulnerable. It is because of the Church's desire to avoid ever violating human dignity that her moral tradition has developed such refined tools of philosophical and moral reflection as the Principle of Double Effect or principles governing material cooperation in evil or distinctions between the direct and indirect voluntary, or ordinary and extraordinary means of preserving life. Part Three of the Directives spells out in considerable detail some of the implications of respecting the dignity of the individual person. Directive 23 states: "The inherent dignity of the human person must be respected and protected regardless of the nature of the person's health problem or social status. The respect for human dignity extends to all persons who are served by Catholic health care."

Health Subordinated to Human Dignity

The dignity of the human person rests in his being created in the image and likeness of God. A direct, willful violation of any person is in some sense an act of sacrilege, doing violence to the image of God and to that degree expressing contempt for the person's Creator. This realization should help health care professionals, and even clergy, keep health care in perspective; the victory over death has already been won by Christ and will never be won by medical researchers. But all must still undergo death as punishment for sin before entering into life everlasting. A "life with God beyond all corruption" (Part Two) must be the goal and aspiration of all. The only thing that would prevent us from enjoying such a life is sin, not blocked arteries. Consequently anything done to preserve or restore our health must not do violence to our inherent dignity. A faithful interpretation and application of the Directives will at least help us maintain the disposition and attitude toward the recipients of health care that are truly consonant with their dignity-and will help health care workers maintain their own dignity.

John M. Haas
President