HUMAN PERSON: HEATH 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
 World Health Organization (WHO): Health is a state of complete physical, mental
and social well-being, and not merely the absence of disease or infirmity."
 It is the promotion of behavioral living conditions that enable the person to achieve
full mental, physical and relational well-being.
 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.
 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.
 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.
 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.

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.
 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.
 Religious interpretation of illness: 1) punishments by the deity, outraged at some
transgression of man. 2) the result of an inscrutable will of divinity, 3) illness as the
place for intense communion with Christ

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
 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).

Two basic forms of paternalism:

 best interest paternalism: 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.
  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.

 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
 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).
 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;
 The physician is:
-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.

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.
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.
 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.
 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.

Jehovah’s Witnesses and the Blood Transfusion

 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.
 The application of general ethical principles allows the following indications to be
provided:
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;

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;

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;

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.

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:
 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.

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.

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.

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.

 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.
  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.

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.

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.

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.

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.
LEVELS OF JUSTICE

1. 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. The second level of justice concerns the allocation of resources within a nation and
involves: a) 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, b) 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.
3. The third level concerns the delivery of different types of care and diagnostic-therapeutic
prescriptions: 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)

• Conclusion
Illness is more than a clinical, medically circumscribable fact. It is always the condition of a
man, the sick person. With this integrally human view of illness, health care workers must relate
to the patient. 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.