Zenit: Cardinal Lozano Barragán on Future of Health Care

Cardinal Lozano Barragán on Future of Health Care

"Putting Technology at the Service of Man"

ROME, OCT. 6, 2007 (Zenit.org).- Here is the address delivered by Cardinal Javier Lozano Barragán, the president of the Pontifical Council for Health Care Ministry, during a conference co-sponsored by the Vatican dicastery and the Acton Institute, titled "Health, Technology and Common Good." It was held at the Pontifical Gregorian University on Oct. 28.

* * *

My Dear Friends, Ladies and Gentlemen,

I have been honored to welcome all of you into this one-day conference which reflects themes based on Health, Technology, and Common Good. Well, I shall do this duty with pleasure, on behalf of the joint organizers of this Conference: The Acton Institute and the Pontifical Council for Health Pastoral Care.

First of all, it is my duty to welcome all the distinguished speakers of the day. We have a wide spectrum of topics as well as experts for each session. So let us give all of them a hearty welcome and wish that they will enlighten us throughout the day. Then, to all the participants so that the reflections of today will lead us to more fruitful action in the future.

I have been asked to present "The Future for Health Care: Putting Technology at the Service of Man." Well, I am to do that presentation in two divided sessions, one in the beginning as I am doing now, and the other at the end of the day as closing remarks.

Part I: Introduction

Therefore, at this moment I shall try to introduce briefly the day's theme: Health, Technology and the Common Good. First of all, there needs to be a clear understanding of what health is; because technology must be oriented to health, and to the future of care health. I am sure Monsignor Jean Laffite is an expert to explain it to us in detail. It has been my experience as the president of the Pontifical Council for Health Pastoral Care that there is a lot of confusion regarding health, even among political leaders as well as Church leaders. Many bishops from all over the world, when they come to visit the Pontifical council, had asked me to present for them what does it mean health today, especially when there are lot of technological developments. So I prepared especially for them a short volume called "Metabioethics and Biomedicine."

My point is there are people who seriously want to understand clearly what health is, especially at this period of globalization, when they are bombarded with partial or unclear information, especially from various international organizations, NGOs and other associations who are involved in health care. There is clearly a paradigm shift in the ethical reflection on health. This so called "New Paradigm" is supposed to be the official thought of the United Nations and its various bodies like WHO and UNESCO.[1] It is supported by four NGOs in particular: "Women's Environment and Development Organization," "Earth Council," "Green Peace" and "International Planned Parenthood Federation."

According to its proponents the objective of the new global ethics is to achieve global well-being within the confines of sustainable development. This global well-being is what forms the target also known as World Health Organization Quality of Life (WHOQOL) and is defined as: "the perception by the individual of his position in life, within the context of the culture and system of values in which he finds himself, and in relation to his goals, expectations, models and interests."

It covers six areas: 1. Physical health, 2. Psychological health, 3. Level of independence, 4. Social relations, 5. Context (economy, freedom, security, information, participation, environment, traffic, climate, transport…) 6. Spirituality. Aside from social duties, the basic factors are autonomy and self-determination.

One of the precepts of this new paradigm is "Health For All". Health for all is defined as at Alma Ata: "the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

It requires ten aspects: health education, adequate nutrition, clean drinking water, basic health care, maternal infant care, immunization against the major contagious diseases, prevention and control of local endemic diseases, suitable treatment in the event of common disasters and illnesses, access to basic medicines and reproductive health.

Although apparently there are values in this new paradigm shift what is basically wrong is an ideology that is "closed to the transcendent." First of all, there is an ethical subjectivism and relativism. Since there no objective validity in their argument those who hold to this thinking concentrate their activities above all in "lobbies," to seek or buy consensus. Their thinking is based on a distinction made between the human being or individual and the person. In any case, there are only rights for the person, not for the human being or the individual.

One is a person only when he acts as such in the complex world of interrelationships of sensorial, mental, conscious, social activities, symbolic gestures, etc. If, at any given moment, someone is not capable of acting as such, he ceases to be a person and is simply a human being or an individual, deprived of any right that could be described as human right. This gives rise to questions related to health issues of the individual in relation to technological advancement, especially concerning the right to life of the fertilized egg, the human state of the "pre-embryo" or the embryo, the right to abortion, the ban on eugenics, euthanasia, etc.

As background of this way of thinking we find the confusion between well-being and happiness. And also the concept of liberty as something absolute and closed in itself.

In contrast with the position of the New Paradigm, we can approach to the authentic concept of health such as is described by the servant of God John Paul II: According him health is a tension towards harmony at the physical, psychological, spiritual and social level, and not mere absence of illness, and which enables man to fulfill his God-given mission in the stages of life he finds himself.[2]

Part II: The Future of Health-Care: Putting Technology at the Service of Man.

Following this pontifical description of health, what will be the future of the technology in the field of health, if it will be authentic progress?

Addressing the participants of the Plenary Assembly of the Pontifical Council for Health Pastoral Care, Pope Benedict XVI said: "The health of the human being, of the whole human being, was the sign chosen by Christ to manifest God's closeness, his merciful love, which heals the mind, the soul and the body…. Going to the aid of the human being is a duty: both in response to a fundamental right of the person and because the care of individuals redounds to the benefit of the group. Medical science makes progress to the extent that it is willing to constantly discuss diagnosis and methods of treatment, in the knowledge that it will be possible to surpass the previous data acquired and the presumed limits. Moreover, esteem for and confidence in health-care personnel are proportionate to the certainty that these official guardians of life will never condemn a human life, however impaired it may be, and will always encourage endeavors to treat it. Consequently, treatment should be extended to every human being, meaning throughout his or her entire existence. The modern conception of health care is in fact human advancement: from the treatment of the sick person to preventive treatment, with the search for the greatest possible human development, encouraging an adequate family and social environment."[3]

Therefore, when we speak about putting technology at the service of man we are considering humanity as such and for the common good in general. As the Second Vatican Council had observed, "Every day human interdependence grows more tightly drawn and spreads by degrees over the whole world. As a result the common good, that is, the sum of those conditions of social life which allow social groups and their individual members relatively thorough and ready access to their own fulfillment, today takes on an increasingly universal complexion and consequently involves rights and duties with respect to the whole human race. Every social group must take account of the needs and legitimate aspirations of other groups, and even of the general welfare of the entire human family."[4]

In today's globalized world we need to think in terms of human connectivity. Some of the modern technologies in health care themselves are connecting human race. An example is "eHealth" or health-care delivery supported by information technology, of digital data -- transmitted, stored and retrieved electronically -- in support of health care, both at the local level and at a distance.

Internet has helped connect so many medical personnel by providing information on the latest achievements in health technologies, thanks to servers installed by medical faculties and medical journals. Another example would be "Telemedicine."

When the patient and doctor are in far away places, they could use modern communication technologies (two way interactive consultation and digital image/data transmission) to send radiology images, laboratory reports, medical records, etc.

Telemedicine has proven very efficient, especially in emergency situations like NASA (The National Aeronautics and Space Administration) intervening in the 1985 Mexico City earthquake, or the 1988 earthquake in Armenia. In 1994 they have improved it into ACTS or Advanced Communication Technology Satellite.

In 1996 TIP (Portable Telemedicine Instrumentation Pack) was made available for easy transportation by health care personnel. Today we can speak of telesugery, teleradiology, teledentistry, teledermitology, telepathology, teleoncology, telepsycology, telecardiology, teleneurology, telenursing, etc.

The European Health Telematics Observatory's (EHTO) assertion is illustrative: health telematics activities are used by hospitals (34%), telephone utilities (14%), academic institutions (12%), clinicians (12%), governments (7%) and social services (4%).[5]

Some of the technologies enhance the past groundbreaking achievements in health care science: the concept about "public health", Epidemiology and its branches like Neuron Epidemiology, Cardiovascular Epidemiology, Cancer Epidemiology, etc., Health Economics and Health Management and so on. This last one branch has helped form health policies where there is awareness that spending on health care "is not an expenditure but an investment." This has also helped strategies of preventive and promotive measures in health care.

During my pastoral visits around the world, it is very heartening for me to see dozens of immaturely born children being cared in the incubators by well-trained, diligent and gentle health care personnel; or hundreds of children born to HIV infected mothers saved due to the timely administration of AZT. In the same way the news coming from a country in Africa that the death toll could be reduced to 1 from an average of 26 every month, thanks to the assistance they are getting from the Good Samaritan Foundation for the purchase of anti-retroviral medicine as well as basic nutrients.

Technology and Bioethics

What are the main principles that must lead the future of health technology? We try to answer regarding the biomedical field. As a general principle we can establish this; that which builds man is good, and that which destroys him is bad.

We know that Biomedical technology holds a great deal of promise in the areas of diagnosis and treatment of diseases. Strong health care systems invariably rely heavily on access to and use of health technologies. But we must also be aware of the fact that technology and medicine are only a part of the health care system and undue insistence on their capabilities may give more emphasis in meeting the demands of the providers than that of the human persons. The ultimate criterion in the use of all technologies must be the good of man. Everything technologically possible need not be ethically oriented. For this, ultimately we need a bioethics that is open to the transcendent.

In discussing the sciences of life and reflecting on the experimental sciences that manipulate life, one wonders about correct human behaviour in relation to human life, deficiency in human life, increase in human life, improvement in human life, procedures to be followed to obtain this improvement and deviations to be avoided. As a final condition, we find ourselves before the binomial necessity-satisfaction. This means that there is a living subject that aspires at improving himself, to do this he must journey along a path, and to do this he must plot the path, and to do this he must first know where he is heading for. Within the context of life, it is necessary to know what life is, what is the better life that one desires, the path to be followed and the path to be avoided in this journey, for instead of donating life, it could be taken away. In other words, biotechnology appears as a project for the building of man through the life and health sciences, that can build or destroy.

The horizon for Ethics in itself is finality. The horizon of Technology is only the possibility. The technology itself, is neuter, can build or destroy man. All depends from its direction, and the direction is given to Technology by Ethics. Therefore, in order to have a true code of bioethics, which provides us with rules of behaviour in the area of health and life, the first, question we must ask ourselves concerns the project for man, which involves the manipulation of life and health. Authentic Bioethics must appear as the project to improve human life and includes all the life and health sciences as its base, as that "intus legere" (inte-lecto, reading from inside) which in any analysis always concerns the final synthesis of what cannot be anything other than the construction of human life.

For a vital project to function (like any other project), it is necessary to understand the living reality that expects improvement as much as possible. This is a path that belongs to Bioethics. Here, we find rules which cannot simply be formulations or imperatives external to the person, instead they are real constructions of the same person and which little by little bring it nearer to the "better person", thereby increasing its density.

This complexity brings him to a consciousness of his reality which means being relational, open and thus embarking on his journey, that is, freely opening himself up to the Other, which in this case is the fulfillment of the Power of Truth and Love, which is precisely God. To attain freedom, Man in his project for development, opens himself up to the force of genuine progress in Biotechnology in order to ascertain, each time ever more that his vital completeness is in constant harmony with God, with all of humanity and with the whole surrounding environment.

And now, if we try to pass over the natural way of thinking to Revelation of God, in Catholic thought, this Ethics that is open, "objective", real, and with no constrictions, opens up to full communication with God the Almighty Father who brings about in us the Truth of His Son through His Incarnation, Passion, Death and Resurrection. He fulfils all our aspirations by bringing us along the Way that is Christ, in the fullness of the Love of His Spirit. Catholic Ethics and Bioethics are the Christ's journey within us, to His Father through His death and resurrection, in the Love of the Holy Spirit. In this way, Bioethics will be the journeying within us of the Spirit along the paths of the life and health sciences. "Those led by the Spirit are the children of God" (Romans 8,14). The Spirit infuses in man the ability to journey towards the total construction of Christ -- this ability are the virtues -- and directs him into the comprehension of Christ Himself as a way, by means of the Commandments and the Sermon on the Mount.

We Christians know that the only possibility for the true vital construction of man is the resurrection. Stated in concrete historic terms, the only possibility for vital construction is union with Christ, who died and rose from the dead. This is the only Ethics that is objectively valid and to which all the authentic values found in non-Christian ethics come close to and as such are indicators of the sole reality which goes beyond illusions of vital permanence.

According to the Roman Catholic view, the construction of man is a theandric construction where divine and human actions intertwine. In translating these actions into principles of valid action for guiding Biomedicine, we can state the following:

1. The human being is a creation of God, it is from Him he comes and to whom he must tend as his exemplary and final Cause. The person is in the image of God, member of the Body of Christ, citizen of the people of God.

2. Human life is received from humanity, not as property but to be administered. Human life is inviolable from its very conception to its natural end. The dignity of the human person is inviolable. It is on this that all Anthropology and Bioethics is based.

3. The origin to human life must lie solely in marriage and solely as the fruit of the marital act.

4. Spouses are not the cause of human life but the instruments of God in
communicating life.

5. From Christ, the human person is capable of reflection, is an end in himself and can never be considered as a means.

6. The human person has his freedom and responsibility that he must put to practice in order to attain fulfillment. There is no freedom without responsibility that in turn implies respect for the freedom of others.

7. The totality is above the part and sometimes the part must be sacrificed in favor of the totality. The human person is in solidarity and must tend towards the common good.

8. The only explanation of life and its single source is Christ who died and was raised to life. If death and suffering are considered in unity with the death of Christ they are the only source of life.

9. In this context, the three principles of subjective Bioethics: autonomy, beneficence and justice, can be accepted and justified.

10. The human person is the synthesis of the universe and is the reason for everything that exists. Biomedical science and technology must be at the service of human life and not vice versa, namely, such knowledge should be used to develop man and never to destroy him.

Conclusion

If then we make an attempt to define Catholic Bioethics and so, try to synthesize principles that lead the authentic future of health Technology we can enounce the following as conclusion of this paper: The Bioethics is "The systematic and detailed study of the conduct that constructs man through the health and life sciences in order to walk in Christ towards the Father, the fullness of life, by the power of the Holy Spirit".

This theological vision implies a profound structural dialogue with all sciences and technologies involved, with all the unifying ideas from the analyses, made by the different philosophical and theological schools, also in dialogue with other religions, bearing in mind that it is a behavioral study and therefore cannot be solely a line of reflection but must be concretized as a guiding light to resolve the difficult problems raised by science and technology.

Javier Cardinal Lozano Barragán
president
Pontifical Council for Health Pastoral Care
Vatican City

[1] See Kim Yersu, 1999. "A Common Framework for Ethics of the Twenty-First Century." UNESCO, Division of Philosophy and Ethics. Cited Nov. 15, 1999, at www.unesco.or.kr/ethics/yersu_kim.htm.

[2] See John Paul II, "Message for the World Day of the Sick for the Year 2000," "Dolentium Hominum," 42 (3, 1999), No. 13.

[3] Benedict XVI, Address to the Plenary Assembly of the Pontifical Council for Health Pastoral Care, March 22, 2007.

[4] "Gaudium et spes," No. 26.

[5] See Department of Essential Health Technologies (WHO), "Information Technology in Support of Health Care", p. 2 at http://www.who.int/eht.