III. The Interests of the Community as Justification of New Medical Methods of Research and Treatment.

20. For the moral justification of the doctor's right to try new approaches, new methods and procedures We invoke a third interest, the interest of the community, of human society, the common good or "bonum commune," as the philosopher and social student would say.

21. There is no doubting the existence of such a common good. Nor can we question the fact that it calls for and justifies further research. The two interests of which We have already spoken, that of science and that of the patient, are closely allied to the general interest.

22. Nevertheless, for the third time we come back to the question: Is there any moral limit to the "medical interests of the community" in content or extension? Are there "full powers" over the living man in every serious medical case? Does it raise barriers that are still valid in the interests of science or the individual? Or, stated differently: Can public authority, on which rests responsibility for the common good, give the doctor the power to experiment on the individual in the interests of science and the community in order to discover and try out new methods and procedures when these experiments transgress the right of the individual to dispose of himself? In the interests of the community, can public authority really limit or even suppress the right of the individual over his body and life, his bodily and psychic integrity?

23. To forestall an objection, We assume that it is a question of serious research, of honest efforts to promote the theory and practice of medicine, not of a maneuver serving as a scientific pretext to mask other ends and achieve them with impunity.

24. In regard to these questions many people have been of the opinion and are still of the opinion today, that the answer must be in the affirmative. To give weight to their contention they cite the fact that the individual is subordinated to the community, that the good of the individual must give way to the common good and be sacrificed to it. They add that the sacrifice of an individual for purposes of research and scientific investigation profits the individual in the long run.

25. The great postwar trials brought to light a terrifying number of documents testifying to the sacrifice of the individual in the "medical interests of the community." In the minutes of these trials one finds testimony and reports showing how, with the consent and, at times, even under the formal order of public authority, certain research centers systematically demanded to be furnished with persons from concentration camps for their medical experiments. One finds how they were delivered to such centers, so many men, so many women, so many for one experiment, so many for another. There are reports on the conduct and the results of such experiments, of the subjective and objective symptoms observed during the different phases of the experiments. One cannot read these reports without feeling a profound compassion for the victims, many of whom went to their deaths, and without being frightened by such an aberration of the human mind and heart. But We can also add that those responsible for these atrocious deeds did no more than to reply in the affirmative to the question We have asked and to accept the practical consequences of their affirmation.

26. At this point is the interest of the individual subordinated to the community's medical interests, or is there here a transgression, perhaps in good faith, against the most elementary demands of the natural law, a transgression that permits no medical research?

27. One would have to shut one's eyes to reality to believe that at the present time one could find no one in the medical world to hold and defend the ideas that gave rise to the facts We have cited. It is enough to follow for a short time the reports on medical efforts and experiments to convince oneself of the contrary. Involuntarily one asks oneself what has authorized, and what could ever authorize, any doctor's daring to try such an experiment. The experiment is described in all its stages and effects with calm objectivity. What is verified and what is not is noted. But there is not a word on its moral legality. Nevertheless, this question exists, and one cannot suppress it by passing it over in silence.

28. In the above mentioned cases, insofar as the moral justification of the experiments rests on the mandate of public authority, and therefore on the subordination of the individual to the community, of the individual's welfare to the common welfare, it is based on an erroneous explanation of this principle. It must be noted that, in his personal being, man is not finally ordered to usefulness to society. On the contrary, the community exists for man.

29. 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. Considered as a whole, the community is not a physical unity subsisting in itself and its individual members are not integral parts of it. Considered as a whole, the physical organism of living beings, of plants, animals or man, has a unity subsisting in itself. Each of the members, for example, the hand, the foot, the heart, the eye, is an integral part destined by all its being to be inserted in the whole organism. Outside the organism it has not, by its very nature, any sense, any finality. It is wholly absorbed by the totality of the organism to which it is attached.

30. In the moral community and in every organism of a purely moral character, it is an entirely different story. Here the whole has no unity subsisting in itself, but a simple unity of finality and action. In the community individuals are merely collaborators and instruments for the realization of the common end.

31. What results as far as the physical organism is concerned? The master and user of this organism, which possesses a subsisting unity, can dispose directly and immediately of integral parts, members and organs within the scope of their natural finality. He can also intervene, as often as and to the extent that the good of the whole demands, to paralyze, destroy, mutilate and separate the members. But, on the contrary, when the whole has only a unity of finality and action, its head-in the present case, the public authority-doubtlessly holds direct authority and the right to make demands upon the activities of the parts, but in no case can it dispose of its physical being. Indeed, every direct attempt upon its essence constitutes an abuse of the power of authority.

32. Now medical experiments-the subject We are discussing here immediately and directly affect the physical being, either of the whole or of the several organs, of the human organism. But, by virtue of the principle We have cited, public authority has no power in this sphere. It cannot, therefore, pass it on to research workers and doctors. It is from the State, however, that the doctor must receive authorization when he acts upon the organism of the individual in the "interests of the community." For then he does not act as a private individual, but as a mandatory of the public power. The latter cannot, however, pass on a right that it does not possess, save in the case already mentioned when it acts as a deputy, as the legal representative of a minor for as long as he cannot make his own decisions, of a person of feeble mind or of a lunatic.

33. Even when it is a question of the execution of a condemned man, the State does not dispose of the individual's right to life. In this case it is reserved to the public power to deprive the condemned person of the enjoyment of life in expiation of his crime when, by his crime, he has already disposed himself of his right to live.

34. We cannot refrain from explaining once more the point treated in this third part in the light of the principle to which one customarily appeals in like cases. We mean the principle of totality. This principle asserts that the part exists for the whole and that, consequently, the good of the part remains subordinated to the good of the whole, that the whole is a determining factor for the part and can dispose of it in its own interest. This principle flows from the essence of ideas and things and must, therefore, have an absolute value.

35. We respect the principle of totality in itself but, in order to be able to apply it correctly, one must always explain certain premises first. The basic premise is that of clarifying the quaestio facto, the question of fact. Are the objects to which the principle is applied in the relation of a whole to its parts? A second premise is the clarification of the nature, extension and limitation of this relationship. Is it on the level of essence or merely on that of action, or on both? Does it apply to the part under a certain aspect or in all its relations? And, in the field where it applies, does it absorb the part completely or still leave it a limited finality, a limited independence? The answers to these questions can never be inferred from the principle of totality itself. That would be a vicious circle. They must be drawn from other facts and other knowledge. The principle of totality itself affirms only this: where the relationship of a whole to its part holds good, and in the exact measure it holds good, the part is subordinated to the whole and the whole, in its own interest, can dispose of the part. Too often, unfortunately, in invoking the principle of totality, people leave these considerations aside, not only in the field of theoretical study and the field of application of law, sociology, physics, biology and medicine, but also of logic, psychology and metaphysics.

36. Our plan was to draw your attention to certain principles of deontology which define the limits and confines of research and experimentation in regard to new medical methods to be immediately applied to living men.

37. In the domain of your science it is an obvious law that the application of new methods to living men must be preceded by research on cadavers or the model of study and experimentation on animals. Sometimes, however, this procedure is found to be impossible, insufficient or not feasible from a practical point of view. In this case, medical research will try to work on its immediate object, the living man, in the interests of science, in the interests of the patient and in the interests of the community. Such a procedure is not to be rejected without further consideration. But you must stop at the limits laid down by the moral principles We have explained.

38. Without doubt, before giving moral authorization to the use of new methods, one cannot ask that any danger or any risk be excluded. That would exceed human possibilities, paralyze all serious scientific research and very frequently be to the detriment of the patient. In these cases the weighing of the danger must be left to the judgment of the tried and competent doctor. Nevertheless, as Our explanation has shown, there is a degree of danger that morality cannot allow. In doubtful cases, when means already known have failed, it may happen that a new method still insufficiently tried offers, together with very dangerous elements, appreciable chances of success. If the patient gives his consent, the use of the procedure in question is licit. But this way of acting cannot be upheld as a line of conduct in normal cases.

39. People will perhaps object that the ideas set forth here present a serious obstacle to scientific research and work. Nevertheless, the limits We have outlined are not by definition an obstacle to progress. The field of medicine cannot be different in this respect from other fields of man's research, investigations and work. The great moral demands force the impetuous flow of human thought and will to flow, like water from the mountains, into certain channels. They contain the flow to increase its efficiency and usefulness. They dam it so that it does not overflow and cause ravages that can never be compensated for by the special good it seeks. In appearance, moral demands are a brake. In fact, they contribute to the best and most beautiful of what man has produced for science, the individual and the community.

40. May Almighty God in His benevolent Providence give you His blessing and grace to this end.