II. The Interests of the Patient as Justification of New Medical Methods of Research and Treatment.

10. In this connection, the basic considerations may be set out in the following form: "The medical treatment of the patient demands taking a certain step. This in itself proves its moral legality." Or else: "A certain new method hitherto neglected or little used will give possible, probable or sure results. All ethical considerations as to the licitness of this method are obsolete and should be treated as pointless."

11. How can anyone fail to see that in these statements truth and falsehood are intermingled? In a very large number of cases the "interests of the patient" do provide the moral justification of the doctor's conduct. Here again, the question concerns the absolute value of this principle. Does it prove by itself, does it make it evident that what the doctor wants to do conforms to the moral law?

12. In the first place it must be assumed that, as a private person, the doctor can take no measure or try no course of action without the consent of the patient. The doctor has no other rights or power over the patient than those which the latter gives him, explicitly or implicitly and tacitly. On his side, the patient cannot confer rights he does not possess. In this discussion the decisive point is the moral licitness of the right a patient has to dispose of himself. Here is the moral limit to the doctor's action taken with the consent of the patient.

13. As for the patient, he is not absolute master of himself, of his body or of his soul. He cannot, therefore, freely dispose of himself as he pleases. Even the reason for which he acts is of itself neither sufficient nor determining. The patient is bound to the immanent teleology laid down by nature. He has the right of use, limited by natural finality, of the faculties and powers of his human nature. Because he is a user and not a proprietor, he does not have unlimited power to destroy or mutilate his body and its functions. Nevertheless, by virtue of the principle of totality, by virtue of his right to use the services of his organism as a whole, the patient can allow individual parts to be destroyed or mutilated when and to the extent necessary for the good of his being as a whole. He may do so to ensure his being's existence and to avoid or, naturally, to repair serious and lasting damage which cannot otherwise be avoided or repaired.

14. The patient, then, has no right to involve his physical or psychic integrity in medical experiments or research when they entail serious destruction, mutilation, wounds or perils.

15. Moreover, in exercising his right to dispose of himself, his faculties and his organs, the individual must observe the hierarchy of the orders of values-or within a single order of values, the hierarchy of particular rights -insofar as the rules of morality demand. Thus, for example, a man cannot perform on himself or allow doctors to perform acts of a physical or somatic nature which doubtless relieve heavy physical or psychic burdens or infirmities, but which bring about at the same time permanent abolition or considerable and durable diminution of his freedom, that is, of his human personality in its typical and characteristic function. Such an act degrades a man to the level of a being reacting only to acquired reflexes or to a living automation. The moral law does not allow such a reversal of values. Here it sets up its limits to the "medical interests of the patient."

16. Here is another example. In order to rid himself of repressions, inhibitions or psychic complexes man is not free to arouse in himself for therapeutic purposes each and every appetite of a sexual order which is being excited or has been excited in his being, appetites whose impure waves flood his unconscious or subconscious mind. He cannot make them the object of his thoughts and fully conscious desires with all the shocks and repercussions such a process entails. For a man and a Christian there is a law of integrity and personal purity, of self-respect, forbidding him to plunge so deeply into the world of sexual suggestions and tendencies. Here the "medical and psychotherapeutic interests of the patient" find a moral limit. It is not proved-it is, in fact, incorrect-that the pansexual method of a certain school of psychoanalysis is an indispensable integrating part of all psychotherapy which is serious and worthy of the name. It is not proved that past neglect of this method has caused grave psychic damage, errors in doctrine and application in education, in psychotherapy and still less in pastoral practice. It is not proved that it is urgent to fill this gap and to initiate all those interested in psychic questions in its key ideas and even, if necessary, in the practical application of this technique of sexuality.

17. We speak this way because today these assertions are too often made with apodictic assurance. Where instincts are concerned it would be better to pay more attention to indirect treatment and to the action of the conscious psyche on the whole of imaginative and affective activity. This technique avoids the deviations We have mentioned. It tends to enlighten, cure and guide; it also influences the dynamic of sexuality, on which people insist so much and which they say is to be found, or really exists, in the unconscious or subconscious.

18. Up to now We have spoken directly of the patient, not of the doctor. We have explained at what point the personal right of the patient to dispose of himself, his mind, his body, his faculties, organs and functions, meets a moral limit. But at the same time We have answered the question: Where does the doctor find a moral limit in research into and use of new methods and procedures in the "interests of the patient?" The limit is the same as that for the patient. It is that which is fixed by the judgment of sound reason, which is set by the demands of the natural moral law, which is deduced from the natural teleology inscribed in beings and from the scale of values expressed by the nature of things. The limit is the same for the doctor as for the patient because, as We have already said, the doctor as a private individual disposes only of the rights given him by the patient and because the patient can give only what he himself possesses.

19. What We say here must be extended to the legal representatives of the person incapable of caring for himself and his affairs: children below the age of reason, the feebleminded and the insane. These legal representatives, authorized by private decision or by public authority have no other rights over the body and life of those they represent than those people would have themselves if they were capable. And they have those rights to the same extent. They cannot, therefore, give the doctor permission to dispose of them outside those limits.