The moral limits of medical research
The First international Congress of the Histopathology of the Nervous
System took place in Rome in 1952. The ethical questions to which the
clinical experimentation of those years gave rise were a cause of grave
concern to many doctors, to the point that the organizers asked the Pope
to make a pronouncement on the moral limits of biomedical research.
What gave rise to this concern?
It was the beginning of what has been described as the "golden
age" of research. People were convinced —
in the period just before the end of the war —
that scientists were as important as generals. There was a popular idea
that science would contribute to winning the battle for peace and
against disease and poverty. Public and private funding began to flow to
hospitals and laboratories.
On the front line of medical science, antibiotics were curing
infections that had previously been fatal, and psychoactive drugs seemed
to promise a life free from anxiety or depression.
Progress was already being made in the field of organ transplants.
The optimism of scientists was widespread and the public seemed to have
blind trust in the progress of medicine.
In this atmosphere many doctors were tempted to give science their
unquestioning support. In some clinical situations, it became almost
normal to involve a patient, without warning him or asking his
permission, in high risk operations or totally experimental treatment.
The doctors responsible for these initiatives claimed that their
conduct, abusive and at times degrading, was justified by the results
they hoped to achieve: the cure and prevention of disease, the increase
in knowledge, the social prestige of science and the prestige of the
researchers themselves.
Actually these inadmissible methods should never have been allowed
and they still give rise to indignation and embarrassment in the medical
world. They had been rightly condemned even several years before the
promulgation of the Nuremberg Code, an enlightened and demanding ethical
guide with regard to medical experimentation on human beings.
Unfortunately, this Code was not widely circulated. Various doctors,
not without a touch of cynicism, chose to believe that the norms it
contained did not concern them, since it referred exclusively to the
Nazi doctors who performed such inhuman experiments in the Nazi
concentration camps.
In this troubled climate, Pius XII gave his historic discourse on 14
September 1952 to 427 doctors and researchers from various countries.
Taking up the task of interpreting moral law in his address to the
gathering of researchers and doctors, the Pope emphasized three basic
principles:
The moral responsibility of the researcher
1. The researcher cannot abdicate his moral responsibility.
"In the most serious and profound matters", Pope Pius said,
"the man in the physician is not content with examining from a
medical point of view what he can attempt and succeed in. He also wants
to see his way clearly in regard to moral possibilities and
obligations".
To be an ethical monitor is the true function of the committees for
ethical research: their role cannot be limited to watching over the
security and safeguarding the dignity of the subjects of research: they
should also preserve researchers from the risk of inadmissible treatment
of other human beings.
All human interests must be subjected to higher moral norms
2. The interests of science, and paradoxically, those of the subject
himself, like those of society, have no absolute value: they must be
subordinate to the higher moral norms.
— The interests of science
Science is a great good, an excellent value that cannot be despised
and whose promotion is a morally noble act. Yet it does not represent
the highest value to which all other values must be subject.
The Pope demonstrates this with a simple, profoundly human argument:
he says that the patient's personal right to physical and spiritual life
in keeping with his human integrity, as well as retaining confidence in
his own doctor, are values that axiologically exceed the interests of
science. These values might appear banal in relation to scientific
breakthroughs, yet medicine cannot exist without them.
— The interests of the patient
On the one hand, the Pope condemns the "strong" paternalism
on the part of the doctor. "The doctor has no other rights or power
over the patient than those which the latter gives him". Without
the free and informed consent of the patient or of his legal
representative, the doctor cannot treat the person's body.
Moreover, Pius XII recalls that the subject of the research is not
the absolute master of himself, of his body or of his soul, but as a
wise user of the spiritual and physical life which he has received from
God, has only a limited, although not exclusive, right to dispose of
himself. He cannot, therefore, confer upon others greater rights than he
legitimately possesses; for example, it is not licit for him as a
clinical subject to risk his physical integrity and/or freedom in
medical research that involves him as the subject of experimentation
when this might involve destruction, mutilation, injury or other risks.
His personal autonomy has a limit, which is defined by each person
for his own overall psychological and physical well-being. This limit
also conditions the doctor in his treatment of a patient who entrusts
himself to him.
— The interests of the community
Pius XII said that "the community is the great means intended by
nature and God to regulate the exchange of mutual needs and to aid each
man to develop his personality fully according to his individual and
social abilities", and that the common good, public health and
social well-being are most important values.
However, the Pope adds, the good of human persons cannot be
sacrificed for these goods. There is an intangible individual sacredness
of far greater value than the medical interests of the community.
Pius XII also recalls that the great post-war trials brought to light
the atrocious experimentation perpetrated on human beings in the name of
a presumed benefit to society. He speaks of the contemptuous attitude
doctors adopted towards patients, which had taken hold of the minds of
doctors who, with calm objectivity, described certain experiments that
aimed to benefit the community, without mentioning their ethical aspects
either due to superficiality or indifference.
Understanding the true meaning of 'moral demands'
3. The Pope concluded his historical discourse with an allusion to
the fact that imposing even ethical limits on science can provoke
misunderstanding or antipathy. He therefore insisted that the limits he
had outlined were not a brake nor an obstacle to progress, but that
"the great moral demands force the impetuous flood of human thought
and will to flow... into a certain channel".
Moral demands set limits on science to increase its power, usefulness
and efficiency, to prevent it from "overflowing" its banks and
"causing destruction". Moral demands, the Holy Father
concluded, are an element that has contributed to the best and most
beautiful of what man has produced.
This address awakened many consciences. It was reprinted, quite
rightly, in many anthologies of the ethics of biomedical research
published in the decades that followed and has been quoted in various
books and articles. The core of its message —
that the interests of science and of the community can never prevail
over the individual — has even
been included, since 1975, in the Helsinki Declaration of the World
Medical Association.
Today, over 50 years later, the Pope's address of 14 September 1952
is as timely as ever.
|
