HUMAN PERSON:

BETWEEN
HEATH AND ILLNESS
 HUMAN PERSON

Illness confronts man with a dark dimension of his existence, that

of vulnerability.
Vulnerability as the constitutive structure of man has been
assumed by some authors as a horizon of meaning of bioethical
discourse.
 2.1. Health and Illness

The traditional category of health was typically medical in

nature because it defined health as the absence of illness and
took as its starting point illness understood as deviation from the
ideal conditions of functioning and integrity of the organism.
 2.1. Health and Illness

New visions of health and illness in the 20th century:

A first view recognizes in the state of health and illness
subjective experiences inscribed in the flow of existence.
 2.1. Health and Illness

Health corresponds to the usual perception of one's personal

equilibrium, while illness derives from the rupture of this
equilibrium and is accompanied by a more or less painful
experience, with emotional colorings dependent on the illness
itself and the severity of its symptoms, as well as on the
representation that the subject and, more generally, a certain
cultural environment make of it
 2.1. Health and Illness

The understanding of an illness cannot disregard individual

experiences and a metaphorical interpretative system, which
necessarily conditions our medical and ethical approach.
 2.1. Health and Illness

In this perspective, healing is not reduced to the simple

restoration of organic parameters of normality, but involves the
achievement of a new balance, through a process of
understanding and empowerment.
 2.1. Health and Illness

The merit of these contributions is that they allow one to grasp

the importance of personal experiences and, therefore, emphasize
the importance of quality of life in relation to one’s ideal of a
good and desirable life.
 2.1. Health and Illness

A second line of trend, which is widespread, especially among

international organizations, tends to broaden the notion of health
and illness from the purely biomedical realm to social, work,
recreational, educational, housing, and food structures.
 2.1. Health and Illness

To this expanded understanding can be referred the famous

definition of health offered by the World Health Organization
(WHO) in its Protocol of Constitution, July 22, 1946:
Health is a state of complete physical, mental and social well-being, and
not merely the absence of disease or infirmity."
 2.1. Health and Illness

Health promotion, then, is more than the removal of pathogenic

noxae or the restoration of an ideal psychophysical normality;
It is the promotion of behavioral living conditions that enable the
person to achieve full mental, physical and relational well-being.
 2.1. Health and Illness

Health is increasingly becoming a goal to be pursued collectively,

an index of a society's progress, a test case for those with public
responsibilities.
 2.1. Health and Illness

Being an essential good of the person, it is reasonable and proper

for society to strive to recognize and promote for everyone the
right to health.
 2.1. Health and Illness

The expression right to health cannot mean the right to be healthy,

because the condition of health is often not attainable through
medicine or other humanly accessible means.
Rather, there is the right to be helped by society and socialized
medicine to regain or maintain one's health.
 2.1. Health and Illness

Christian anthropology, so careful to emphasize the unity of the

person in its multidimensionality, gives a holistic notion of health
and illness, in which bodily, psychic and spiritual elements
concur and interact, without forgetting the indispensable
relational resonances.
 2.1. Health and Illness

In this context, health care is not limited to medical-surgical

therapies, but extends to prevention, rehabilitation, and
improvement of the bodily aspect, while much emphasis is given,
alongside the physician's function, to the autonomy and
responsible commitment of the person.
 2.1. Health and Illness

True health is the harmonization and integration of all human

forces and energies, physical, psychic and spiritual;
it is the ability to respond day by day to one's personal
vocation by giving the best of oneself, in every situation and
from one's limitations.
 2.2. Health and Illness in Theological
Perspective

For Christ, physician of souls and bodies, the liberation of man

from the grip of sickness and suffering is an essential part of the
work of salvation.
 2.2. Health and Illness in Theological
Perspective
Miraculous healings are signs of meaning of his redemptive mercy
for humanity and a consoling witness to the life-giving power of
love.
Therefore, B. H³ring writes:
 a biblically grounded theology is therapeutic, it is healing in all its
perspectives. It implies a diagnosis of man's infirmity, his sinfulness and
alienation, his sufferings because of an alienated world, authoritarian
structures, unhealthy socio-economic conditions and relationships, etc.
 2.2. Health and Illness in Theological
Perspective

Religious interpretation of illness:

punishments by the deity, outraged at some transgression of
man.
the result of an inscrutable will of divinity,
illness as the place for intense communion with Christ
 2.2. Health and Illness in Theological
Perspective

Within the religious interpretation of illness, a recurring aspect is

that of considering illness and suffering as punishments by the
deity, outraged at some transgression of man.
 2.2. Health and Illness in Theological
Perspective

A punitive conception of illness, which refers back to a magical

and cosmonaturalistic understanding of health and thus illness,
has the effect of pinning the sick person down in his helplessness
and crushing him under the additional weight of moral
condemnation.
 2.2. Health and Illness in Theological
Perspective

Another interpretation fatalistically recognizes in sickness the

result of an inscrutable will of divinity, independent of any
personal guilt, sometimes aimed at tempering the soul of the sick
person or leading him to purification and maturation.
 2.2. Health and Illness in Theological
Perspective

Without denying the aspect of truth contained in this

interpretation of suffering that appeals to the mysterious will of
God-which is then the culmination of Job's sapiential meditation
on innocent pain, however, it is necessary to emphasize the
difficulty of agreeing the providential fatherhood of the God of
Jesus Christ with such a painful will for man.
 2.2. Health and Illness in Theological
Perspective

Undoubtedly the most persuasive religious response is the one

that sees illness as the place for intense communion with
Christ, who redeemed us by taking our place as sinners and
embracing the cross out of pure love.
 2.2. Health and Illness in Theological
Perspective
Salvifici doloris 19,
 In the Cross of Christ not only is the Redemption accomplished
through suffering, but also human suffering itself has been redeemed.”
This affirmation leads the sick person to recognize in illness a
tangible expression of the fragility of existence, but also to
glimpse the possibility of living it in the power of love.
 2.2. Health and Illness in Theological
Perspective

The crucified Christ has already visited and taken upon himself
every pain, so that there is no human place that cannot become a
place of encounter with his mercy.
 2.2. Health and Illness in Theological
Perspective

Thus, the Christian is able to signify what appears humanly an

absurdity, the nonsense of illness and death, and to live even these
extreme experiences of existence as possibilities for
authenticity, discovering in the event of suffering an original
form of the experience of living.
 3.THE DOCTOR-PATIENT
RELATIONSHIP

In the preservation and restoration of health, an essential role is

played by the physician.
 3.THE DOCTOR-PATIENT
RELATIONSHIP

In the classical perspective, the physician is a vir bonus sanandi

peritus (a good man skilled in healing) and his essential virtue is
philanthropy, an almost religious dedication to man that
translates into feelings of sympathy, benevolence, and humanity.
 3.THE DOCTOR-PATIENT
RELATIONSHIP

This physician’s dedication is animated by love for the sick

person and is able to heal him with his science, but the abysmal
cognitive gap that exists between doctor and patient leads to a
completely unbalanced interpersonal relationship, in which
the patient's autonomy is completely absorbed in the physician's
omnipotent decision-making.
 3.THE DOCTOR-PATIENT
RELATIONSHIP

The physician thus performs a parental function toward the sick

person, a function that is both maternal and paternal: he in fact
cares for the sick person (maternalism) and decides and chooses
for his good (paternalism).
 3.THE DOCTOR-PATIENT
RELATIONSHIP

Two basic forms of paternalism:

best interest paternalism
 fiduciary paternalism.
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP

In the best interest paternalism, the physician, convinced that

he is the only one capable of knowing the good of the sick
person, does not involve the patient in clinical decisions and
generally disregards his possible dissenting wishes.
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP

In fiduciary paternalism, it is the sick person himself who, for

various reasons, devolves all decisions to the doctor, as in the
case where he does not feel able to understand exactly the
meaning and riskiness of some interventions.
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP

He prefers to rely on the doctor's expertise.

Sometimes the sick person cannot dispose of himself, as in the
case of very young children, severely mentally handicapped, or
coma patients, nor are there guardians or family members who
can direct the doctor's actions, so it will be the health care
provider who will decide what seems best to him for his patient.
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP

In our century, the paternalistic model has been harshly opposed,

because it no longer responds to the sociocultural situation of
Western countries.
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP
In keeping with the individualism and subjectivism that
characterize our culture, it is considered more in keeping with the
dignity of the person and more respectful of his or her rights to
place emphasis on the patient's autonomy over the doctor's
convictions and decisions, whereby, excluding situations of
emergency and incapacity, the patient cannot and should not
delegate any decisions to health professionals, so that he or she
always retains full control over his or her life.
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP

In this perspective, the doctor-patient relationship often takes on

the appearance of a contractual relationship, in which the
doctor-patient relationship is traced back to an ordinary business
relationship, governed by law by precise rules of professional
propriety (expertise, secrecy, justice, truthfulness, fidelity to
covenants).
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP

In the autonomist model, the medical pole of

beneficence/nonmaleficence is completely reabsorbed into the
patient pole.
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP

While it is true that paternalism, especially in its strong version,

does not respect the adult's right to self-determination, on the
other hand, absolute autonomy de-empowers the physician,
depersonalizes the doctor-patient relationship, and empties the
principle of beneficence of meaning.
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP

Charity and autonomy should not be pitted against each other, but
an attempt should be made to overcome strong paternalism and
subjectivist autonomism by developing a new kind of relationship
that synthesizes the values of beneficence with those of
autonomy.
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP

In the doctor-patient relationship, it is not enough for the

physician to act correctly, but he or she must be able to act
virtuously, that is, as an experienced, respectful, prudent friend;
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP

The sick person, for his or her part, is not a passive subject, nor a
mere client who makes use of the physician's technical skills, nor
a jealous defender of his or her own prerogatives against the
physician's attempts to dominate, but he or she himself or herself
relates to the physician as a friend, with trust and confidence,
without thereby abdicating his or her own individuality and
decision-making capacity.
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP

This model has been called by Pedro Lain Entralgo model of

medical friendship.
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP

The philanthropy of the Hippocratic physician thus revives, in

entirely new situations and sensitivities, in the row or friendship
that imprints the doctor-patient relationship, in that therapeutic
alliance in which the physician is
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP

capable of compassion,
capable of putting himself in the place of the other by
empathically sharing his experience of need and illness,
capable of deciding with him and possibly for him, not in his
place, in his best interest, for his authentic and integral good.
 2.3. THE DOCTOR-PATIENT
RELATIONSHIP


We are faced with a friendship that, modeling itself on the
example of the Good Samaritan (Lk 10:29), knows how to finally
expand to the dimensions of agape and that for this reason from
ethics becomes almost religion.
 2.4. RESPECT FOR AUTONOMY

The person, even in the situation of frailty and need caused by

illness and physical decline, must remain at the center of any
health care intervention as the main person responsible for his or
her own life and mental and physical integrity.
 2.4. RESPECT FOR AUTONOMY

The necessary and often painful dependence on health care

providers and family members must therefore not become an
opportunity to deprive the sick person of his or her rightful
autonomy, nor to dispossess him or her of his or her life and
destiny.
 2.4.1. Consent to Health Care Acts

The right to autonomy demands, in fact, that the patient be aware

of and responsible for the interventions made on him.
Consent to therapeutic acts is implied when the patient undergoes
his or her prescribed therapies.
 2.4.1. Consent to Health Care Acts

The patient is sure that the doctor wants his or her good, and the
doctor knows that the patient, by turning to him or her, has
already granted him or her responsible trust.
 2.4.1. Consent to Health Care Acts

Explicit consent is required, however, and cannot be presumed

when it involves procedures that pose a significant risk to
psychological and physical integrity or that may be contrary to
the patient's moral convictions.
 2.4.1. Consent to Health Care Acts

In order to be able to give valid consent, the patient must be self-

possessed and adequately informed (as far as he or she can
understand) about the meaning, purposes, risks, and benefits of
the interventions to which he or she will be subjected.
 2.4.1. Consent to Health Care Acts

In the case of children and the mentally handicapped, their

current capacity for self-determination will be taken into account,
and family members or guardians will be consulted for a decision.
However, it remains for the health care provider to take charge of
the patient's health because of the principle of beneficence.
 2.4.1. Consent to Health Care Acts

Finally, it should be noted that sometimes the refusal to undergo a

certain procedure is dictated more by fear or fatigue than by
reasonable motives and full freedom: in such cases the physician
will have to gently but decisively bring the patient to lucidly
consider what his or her true good is.
 2.4.1. Consent to Health Care Acts

On the other hand, accepting the ancient aphorism that "the will
of the sick person is the supreme law" does not mean, however,
that the physician loses his or her freedom of decision-making.
 2.4.1. Consent to Health Care Acts

The physician has the right to refuse an intervention (e.g., an

abortion), if it conflicts with his or her conscience, or a therapy or
diagnostic assessment requested by the patient, if he or she
believes it is risky or unnecessary.
 2.4.1. Jehovah’s Witnesses and the Blood
Transfusion

Applying the Old Testament prohibition against eating blood to

blood transfusions, the Jehovah’s Witnesses believe that
transfusion is a transgression of divine law and therefore cannot
constitute a morally acceptable means of providing for a person's
health.
 2.4.1. Jehovah’s Witnesses and the Blood
Transfusion

Regardless of the plausibility of the above interpretation and our

own personal opinion, it is clear that here it is a matter of
respecting Jehovah's Witnesses' freedom of conscience, just as
Catholics rightly demand that theirs be respected.
 2.4.1. Jehovah’s Witnesses and the Blood
Transfusion

The application of general ethical principles allows the following

indications to be provided:
 2.4.1. Jehovah’s Witnesses and the Blood
Transfusion
Adult: the conscience of the person must always be respected,
even when it is believed to be an erroneous or false conscience.
 the physician will try to persuade the sick person, but can never
force him or her with physical or psychological violence.
 Indeed, the refusal of transfusion is not motivated by a suicidal
intention, but is dictated by a subjective revulsion for that precise
therapeutic means;
 2.4.1. Jehovah’s Witnesses and the Blood
Transfusion

Child: in the case of parental refusal to necessary therapy, the

physician must appeal to the Juvenile Court; in the case of
absolute and manifest urgency, blood transfusion may be given
without prior appeal to the competent authority, but one is
required to forward to it a notice of the incident;
 2.4.1. Jehovah’s Witnesses and the Blood
Transfusion

Incapacitated person (e.g., comatose): relatives do not have the

right to refuse blood transfusion for him, even if he were an
adherent of Jehovah's Witnesses, so the doctor will practice the
most appropriate therapeutic interventions, especially if there is
an urgent condition;
 2.4.1. Jehovah’s Witnesses and the Blood
Transfusion
Physician: there is as yet no conscientious objection rule for
transfusions, but a Jehovah's Witness physician who refrains from
performing blood transfusions should refer to a colleague those
patients who, according to current protocols, need them.
 In an emergency, omitting a necessary transfusion would constitute a
serious crime of omission.
 2.4.3. Refusal of Futile Treatment
This concerns a particular situation of refusal of treatment by the
sick person or his or her family members. It is constituted by the
refusal of therapeutic overkill, which is the insistence on the use
of medical-surgical aids that do not significantly change the
natural and irreversible course of the disease, not improving and
indeed worsening the quality of life of the terminal patient. We
will discuss this when we deal with the sick person between
care and abandonment.
2.4.4. Experiments and Informed Consent

Experimentation on human subjects, called clinical trials, is

essential to test the effectiveness of a therapy on a large number
of patients and now involves almost all university clinics and a
great many hospital departments.
2.4.4. Experiments and Informed Consent

Patients' participation in clinical trials must be carried out with

respect for their right to autonomy, information, and to
receive available treatment, and therefore involves signing a
consent form from which they should clearly state:
2.4.4. Experiments and Informed Consent

freedom and voluntariness;

The ability to withdraw at any time;
adequate information about the purposes, possible personal benefits,
and the risks of experimentation;
information about existing treatments and their efficacy, with the
assurance that they can refuse or stop the trial and avail themselves of
them;
information on how to proceed, including the use of placebo.
2.4.4. Experiments and Informed Consent

Lending oneself freely and consciously to the experimentation of

new medical and surgical discoveries can be meritorious if the
risk is reasonable and accepted in a humanitarian spirit for the
advancement of science for the benefit of society.
2.4.4. Experiments and Informed Consent

However, the alleged benefits to be gained from experimentation

cannot in any way or under any circumstances justify the
instrumentalization of the sick.
2.4.4. Experiments and Informed Consent

In the case of children or subjects who are not fully conscious,

parents and guardians may not expose them to a risk to their life
or health unless there is a well-founded hope for a benefit to the
subject or there is no other therapy besides the experimental one.
2.4.4. Experiments and Informed Consent

Supervising the correctness of experimental protocols and respect

for the rights of subjects involved in trials, especially if they are
sick subjects, is the task of ethics committees under the laws of
each country, within the framework of international documents
that have been issued and updated several times, starting with the
World Health Organization's foundational Declaration of Helsinki
in 1964.
2.5. THE COMMUNICATION OF TRUTH

The sick person has the right to know the truth about his or her
real clinical situation (diagnosis, treatment, prognosis) because
his or her health and life belong primarily to him or her, and not
to family members or doctors.
2.5. THE COMMUNICATION OF TRUTH

Health care providers, therefore, have a duty to communicate

the truth to the sick person, even if prudence and experience
sometimes advise postponing an integral communication of the
truth to more opportune times. It is not always possible to tell
everything right away.
2.5. THE COMMUNICATION OF TRUTH

The truth must be communicated by taking into account the

psychological situation of the sick person, his or her concrete
receptive abilities, and his or her intellectual and cultural
possibilities to understand the information we give him or her.
We must put ourselves on the side of the sick person, empathize
with him and try to understand what is best for him at that
moment.
 2.6. THE PROTECTION OF
CONFIDENTIALITY

Every person has the right to the defense of his or her intimacy
and the protection of the natural reserve surrounding the concrete
situations of his or her existence.
 2.6. THE PROTECTION OF
CONFIDENTIALITY

The person, in fact, reveals some important things about his or

her life or allows them to be brought to light within a fiduciary
relationship.
 2.6. THE PROTECTION OF
CONFIDENTIALITY

The patient, in order to receive adequate health help, must

sometimes reveal details of his or her life and does so knowing
that, by tacit agreement, secrecy will be maintained about any
information thus known.
Secrecy is the health care provider's response to the patient's trust.
 2.6. THE PROTECTION OF
CONFIDENTIALITY
The doctor’s confidentiality is a feature of the doctor-patient
relationship and was explicitly protected as early as the ancient
Hippocratic Oath:
Anything that during the treatment or even outside of it I will have seen
and heard about people's lives and which is not to be disclosed, I will
keep silent, holding these things as a secret not to be revealed.
 2.6. THE PROTECTION OF
CONFIDENTIALITY
In the vast majority of states, the law protects a person's privacy
by punishing violations of patient confidentiality.
Included in the legally protected health professional secrecy are
 the medical history,
 diagnosis,
 prognosis, and
 specific treatment, along with related documentation.
 2.6. THE PROTECTION OF
CONFIDENTIALITY

Disclosure of the secret is permitted when there is just cause:

 If it is mandated by law (mandatory reports and certifications);
 If it is authorized by the person concerned;
 If it is requested by those who have guardianship of a minor or
incapacitated person.
 2.6. THE PROTECTION OF
CONFIDENTIALITY

There are differing opinions as to whether the danger of

contagion is a just cause to disclose the secret, when the sick
person, for example, an HIV-positive person, does not want to
take any precautions to avoid infecting others.
 2.6. THE PROTECTION OF
CONFIDENTIALITY

 For some, where there is a conflict of values, the social good must
prevail;
 for others, the right to secrecy must prevail, also in view of the fact
that if trust in health care providers were lost, the social damage would
be even greater.
 In practice, an attempt will be made to persuade the person to disclose
his or her condition to those concerned,
 2.7. THE RIGHT TO HEALTH

Every person has the right to medical care and the promotion of
his or her mental and physical health regardless of sex, race,
census, or religion.
 This principle of justice is based on the equal dignity of human beings
and the natural solidarity that exists among them.
 2.7. THE RIGHT TO HEALTH

There is first of all a planetary level of health justice, based on the

common dignity of humans and international solidarity.
The task of ethics is to keep our consciences awake about our
responsibility to all of humanity, without locking ourselves into
selfish particularisms, which are all the easier when resources
begin to become scarce even for us.
 2.7. THE RIGHT TO HEALTH

The second level of justice concerns the allocation of resources

within a nation and involves,
 the general economic policy choices to decide what fraction of the
total available resources should be allocated to health care, compared
to what is spent,
 the criteria by which to allocate human and material energies (which
are not unlimited) between research, prevention, diagnosis, basic
therapies, and specialized and expensive therapies.
 2.7. THE RIGHT TO HEALTH

The third level concerns the delivery of different types of care

and diagnostic-therapeutic prescriptions
 2.7. THE RIGHT TO HEALTH

At this level, too, we can distinguish two areas of decision-

making:
to decide which categories of patients should receive a certain
treatment (e.g., to to establish general criteria that are as
objective as possible for the admission of a patient with renal
failure to dialysis or transplantation)
 2.7. THE RIGHT TO HEALTH

To make concrete decisions, on a case-by-case basis, as to

 whether a particular patient should receive a more sophisticated
and expensive treatment, or
 whether it is right to provide a more ordinary and less expensive
treatment, or
 whether one patient in a given situation should be preferred to
another, for example, on a transplant waiting list.
 2.7. THE RIGHT TO HEALTH

Some non-exceptional situations can be given in which the civil

rights of health workers conflict with the right to care,
particularly in the case of conscientious objection and the right
to strike.
 2.7. THE RIGHT TO HEALTH

Regarding conscientious objection, we note that in principle a

physician is obliged to provide his or her services to sick people
who request them, but there are practices that are not intended to
treat pathologies or that a physician might perceive as contrary to
his or her conscience and to essential values recognized by law.
 2.7. THE RIGHT TO HEALTH

In this case, the physician may legitimately refrain from

complying with the patient's request. In the case of abortion, for
example, the law provides for conscientious objection, but the
law itself protects the life of the person by requiring the
intervention even of objectors when, during an abortion act, the
woman's life is in danger.
 2.7. THE RIGHT TO HEALTH

Regarding the strike, we observe that a real situation of conflict

can be given between the professional and human responsibility
of the health care worker and his right to strike and thus between
the right of the sick person to be cared for and the union rights of
the health care worker.
 2.7. THE RIGHT TO HEALTH

The purpose of a public service strike is to exert pressure on

the civil administration.
In view of the serious inconvenience caused to people, and
to sick people in particular, it would be good to resort to
strike action only as a last resort, after experimenting with
forms of pressure that do not interrupt care.
 2.7. THE RIGHT TO HEALTH

When no other way is seen to achieve a legitimate end,

doctors and nurses may also go on strike, subject to what is
provided for in the laws and keeping before their eyes the
value, delicacy and irreplaceability of their service to
society.
 Conclusion

Illness is more than a clinical, medically circumscribable fact. It

is always the condition of a man, the sick person.
 Conclusion

With this integrally human view of illness, health care workers

must relate to the patient.
 Conclusion

It is a matter for them to possess, along with due technical and

professional competence, an awareness of values and meanings
with which to make sense of illness and their work and to make
each clinical case a human encounter.