The new pope and medical ethics

Given that more than 37 million people world-wide are living with HIV,¹ the late pope's opposition to the use of condoms attracted much criticism. Indeed, some critics blamed John Paul II directly for the loss of millions of lives from AIDS in Africa, where the Catholic church is flourishing; 2.3 million died in 2004 in sub-Saharan Africa alone. The new pope, Benedict XVI (formerly Joseph Ratzinger), also comes from the conservative wing of his church and is therefore very likely to endorse the encyclical of Pope Paul VI that bars Catholics from using any kind of artificial contraceptive.² But what do we really know of his views on condom use and other medical and ethical issues?

As a cardinal, Joseph Ratzinger led the Congregation for the Doctrine of the Faith, an organisation descended from the holy inquisition. He worked closely with Pope John Paul II and was known to share many of his views. Three years ago Ratzinger wrote that “there are final boundaries we cannot cross without turning into the agents of destruction of creation itself.”³ Indeed, in his first homily as pope he stated that he would continue to underline unequivocally “the inviolability of human beings, the inviolability of human life from conception to natural death.”⁴ In response to the papal election the former Anglican archbishop of Cape Town, Desmond Tutu, said, “We would have hoped for someone more open to the recent developments in the world, the ministry of women, and a more reasonable position with regards to condoms and HIV/AIDS.”⁵

Yet Cardinal George Cottier, one of the Vatican's most influential theologists, supports the use of condoms as defence against HIV in special cases.⁶ Furthermore, Cardinal Lozano Barragan, effectively the Vatican's minister of health, has said that a spouse has the right to use a condom or oblige their marriage partner to do so in self defence against HIV infection.⁷ Will Benedict XVI accept and even develop this revolutionary idea for Catholics?

The defence of life is an essential Catholic philosophy, enshrined in the most influential and controversial encyclicals signed by past leaders of the Roman Catholic church: Humanae Vitae of Paul VI (1968)² and Evangelium Vitae of John Paul II (1995).⁸

The Catholic church is traditionally against abortion, which it sees as a contravention of moral law, with the legal status of the unborn child starting at conception.⁹ The church is also against euthanasia, which it considers to be a form of murder.¹⁰ Might the Vatican allow the condom's ability to defend life, albeit only within marriage, to take priority over its ability to prevent conception?

The Catholic church opposes the use of stem cells derived from the human embryo.¹¹ It is not, however, against scientific progress and supports some controversial recent advances such as adult stem cell research and xenotransplantation, despite their ethical problems. The Vatican supports organ transplantation,¹² and it sets ethical limits only around any related loss of human dignity, the use of the body as “a container” of organs, and any failure to use objective criteria to confirm the death of the donor.

Ratzinger wrote three years ago: “It is legitimate to accept the culture of transplanted tissue and donation of organs spontaneously and in all conscience” and also declared: “I enrolled in the organisation (for organ donors) years ago and carry the paper saying that my organs will be made available to whoever may need them. It's a sign of love.”¹³

Since becoming pope, Joseph Ratzinger has not made a direct statement on the use of condoms to protect against HIV. His previous views on pro-life issues worry many observers, particularly those campaigning for better health in less developed countries, but it may be unfair to judge him only on the basis of his past opinions. It is still not clear whether, and by how much, the Catholic church is interested in abandoning its traditional pro-life position. This seems unlikely to happen, given the recent support by Pope Benedict XVI to calls for a boycott of an Italian referendum on fertility rules.¹⁴ Nor is it clear whether a change in the pope's position on condom use would change the behaviour of many of the more than one billion Catholics around the world.