Dolentium Hominum N.56

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DOLENTIUM HOMINUM N. 56 – Year XIX – No. 2, 2004

JOURNAL OF THE PONTIFICAL COUNCIL FOR HEALTH PASTORAL CARE

CARDINAL JAVIER LOZANO BARRAGÁN, Editor-in-Chief CORRESPONDENTS BISHOP JOSÉ L. REDRADO, O.H., Executive Editor REV. FELICE RUFFINI, M.I., Associate Editor REV. MATEO BAUTISTA, Argentina MONSIGNOR J. JAMES CASSIDY, U.S.A. REV. RUDE DELGADO, Spain REV. RAMON FERRERO, Mozambique REV. BENOIT GOUDOTE, Ivory Coast EDITORIAL BOARD PROFESSOR SALVINO LEONE, Italy REV. JORGE PALENCIA, Mexico REV. CIRO BENEDETTINI REV. GEORGE PEREIRA, India DR. LILIANA BOLIS MRS. AN VERLINDE, Belgium SR. AURELIA CUADRON PROFESSOR ROBERT WALLEY, Canada REV. GIOVANNI D’ERCOLE, F.D.P. DR. MAYA EL-HACHEM REV. GIANFRANCO GRIECO REV. BONIFACIO HONINGS EDITORIAL STAFF MONSIGNOR JESÚS IRIGOYEN REV. JOSEPH JOBLIN DR. COLETTE CHALON REV. VITO MAGNO, R.C.I. MRS. STEFANIA CASABIANCA DR. DINA NEROZZI-FRAJESE DR. ANTONELLA FARINA DR. FRANCO PLACIDI DR. MATTHEW FFORDE REV. LUCIANO SANDRIN REV. BERNARD GRASSER, M.I. MONSIGNOR ITALO TADDEI DR. GUILLERMO QWISTGAARD

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Cover: Glass window Rev. Costantino Ruggeri

Poste Italiane s.p.a. Spedizione in Abbonamento Postale - D.L. 353/2003 (conv. In L. 27/02/2004 nº 46) art. 1, comma 2, DCB Roma DH n.56 ing 1-64 1-09-2004 17:23 Pagina 2

Contents

XII WORLD DAY OF THE SICK TOPICS SHRINE OF OUR LADY OF LOURDES, FRANCE - 11 FEBRUARY 2004 24 Challenges for Christians in Europe in Medicine and Health Care 6 Letter of the Holy Father H.Em. Card. Javier Lozano Barragán John Paul II 30 Praying in Sickness and Health 8 Account of the XII World Day H.E. Msgr. José L. Redrado, O.H. of the Sick Don Dariusz Giers 38 The Charismatic Management of the Hospital Order of St. John of God 12 May Our Immaculate Lady Fra José L. Garcia Imas, O.H. Watch over the Sick John Paul II 48 Bioethics in UNESCO Msgr. Jean-Marie Musivi Mpendawatu 2 13 To You we Entrust the Sick, the Elderly, and People who are Alone 51 Genetic Disease John Paul II Predisposition and Choice Jim Brugarolas 14 The Virgin Mary is a Wonderful Sign of the Victory of Life over Death John Paul II TESTIMONY 15 Homily 54 Witness of a Life in Illness H.Em. Card. Javier Lozano Barragán Dr. Antonio Torralbo Moreno Laura Rigual Corrantes

ADDRESSES BY THE HOLY FATHER 57 Pastoral Care in Health in America and the Caribbean: towards a History 18 Message of John Paul II on the of Pastoral Care in Health Tenth Anniversary of the Establishment H.E. Msgr. Jorge Jiménez Carvajal of the Pontifical Academy for Life

19 Address of John Paul II 62 Presentation of the to the Plenary Assembly of the XIX International Conference Pontifical Academy for Life H.Em. Card. Javier Lozano Barragán

20 Address of John Paul II 62 Programme of the to the Participants at the International XIX International Conference Congress on “Life-sustaining Treatments and the Vegetative State: Scientific Advances and Ethical Dilemmas”

The illustrations in this edition are taken from the book: “Galicia instante eterno” Photographs by Carlos Rodríguez Published by Ediciones y Producciones Ferramulín, S.L. - Vigo, 1995.

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XII World Day of the Sick

Shrine of Our Lady of Lourdes, France 11 February 2004 DH n.56 ing 1-64 1-09-2004 17:23 Pagina 6

Letter of the Holy Father

ON 28 JANUARY 2004 THE HOLY FATHER JOHN PAUL II APPOINTED HIS EMINENCE CARDINAL JAVIER LOZANO BARRAGÁN HIS SPECIAL ENVOY TO THE CELEBRATION OF THE TWELFTH WORLD DAY OF THE SICK

To our Venerable Brother 6 JAVIER Cardinal LOZANO BARRAGÁN President of the Pontifical Council for Health Care Workers (for Health Pastoral Care)

Coinciding with the hundred and fiftieth anniversary of the dogmatic definition of the Immaculate Conception, what the Mother of the Lord pronounced at the grotto of Massabielle re-echoes pleasingly in our hearts and is full of consolation. It is, therefore, very suitable that the Twelfth World Day of the Sick should be celebrated when the whole Church remembers the first apparition of the Immaculate Virgin, Health of the Sick, in that town.

Also with gladness we learn that this event will be preceded by two days in order to illuminate the subject the Immaculate Conception and health in the Christian roots of Europe and to renew health pastoral care in the world and particularly in Europe through the celebration of the above-mentioned anniversary.

Certain, therefore, of the importance of this reality, we have kindly thought of you, our Venerable Brother, the President of the Pontifical Council for Health Care Work- ers, collaborating diligently with us for the pastoral care of the sick.

For that reason, by this letter, we appoint and nominate you EXTRAORDINARY ENVOY to represent us in the above mentioned celebration this coming 11 February.

Verily we desire that you take our paternal and sincere greetings to all those who participate in this gathering, especially our sick brothers and sisters as well as health

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care workers. In our name you will also preside over the liturgical celebrations, fer- vently exhorting the participants to fulfil the invitation of the merciful Mother, who at Lourdes asked for penance and prayer, and to offer, in union with Jesus Crucified and the same Virgin of Sorrows, their own bodily and spiritual infirmities for the whole of humanity.

Finally, our Venerable Brother, while entrusting your mission to the intercession of the Immaculate Virgin Mary, we, at the same time, desire that you lovingly impart in our name the Apostolic Blessing, bearer of every good and testimony of our good will, to all those will take part in the Twelfth Universal Day of the Sick.

From the Vatican, 28 January 2004, in the twenty-sixth year of our Pontificate. 7

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Account of the Twelfth World Day of the Sick LOURDES, 9-11 FEBRUARY 2004

The Twelfth World Day of the pontifical delegation in- composed, first of all, of the the Sick was solemnly cele- cluded the two Canons of the Secretary of the Bishops’ Con- brated at Lourdes in France, a diocese of Tarbes and Lour- ference of France, Rev. small town at the foot of the des: Rev. Pierre-Marie Char- Bernard Hayet; the Ordinary Pyrenees, where, commencing riez and Rev. Henri Fréchou. of the diocese of Tarbes and on 11 February 1858, ‘a lady The group of people belong- Lourdes, H.E. Msgr. Jacques dressed in white’ appeared ing to the Pontifical Council Perrier; and the Rector of the eighteen times to the young for Health Pastoral Care that Sanctuary, Rev. Raymond shepherd girl, Bernadette went to Lourdes included the Zambelli. Soubirous. Since that time following: the Bishop-Secre- Lourdes has become the desti- tary of the Pontifical Council, nation of a great many pil- H.E. Msgr. José Luis Redrado; The Celebration grims, a ‘capital’ sanctuary of some Officials and collabora- of the World Day the world of pain and suffer- tors of the same Pontifical ing, a place, as the Holy Father Council; as well as priests, re- Following tradition, the 8 has put it, where Our Lady in ligious and members of the Twelfth World Day of the Sick person wanted to ‘express her laity involved in various ways was also characterised by three maternal love in particular to- in pastoral care in health in principal aspects: the pastoral, wards the suffering and the various countries of the world. the theological, and the liturgi- sick’. The celebration of this year cal. The principal reason for the brought to mind the early days decision to choose this Marian of the World Day of the Sick The pastoral aspect: town was the fact that 2004 is when, after being established the meeting of the Bishops and the one hundred and fiftieth by John Paul II, it was held for their delegates anniversary of the proclama- the first time on 11 February in tion of the dogma of the Im- Lourdes. The round table of Bishops maculate Conception, Taking in charge of pastoral care in this truth as its point of depar- health and their delegates from ture, a truth revealed explicitly The Preparations various European countries at Lourdes, this World Day for the World Day was dedicated to the principal sought to address the follow- subject of the World Day, ‘the ing subject: ‘the Immaculate Announced and established Immaculate Conception and Conception and health in the by the Message of the Holy health in the Christian roots of Christian roots of Europe’. Father, the celebration of the Europe’. This meeting took More specifically, the inten- Twelfth World Day of the Sick place at the ‘Centre Accueil tion was to reflect on ‘how to in Lourdes was the subject of Notre-Dame’ on the morning renew pastoral care in health numerous preparatory initia- and afternoon of Monday 9 in the world and in particular tives. The Pontifical Council February. in Europe’. for Health Pastoral Care se- Cardinal Javier Lozano Bar- This event of great value cured the diffusion of the Mes- ragán introduced the proceed- was promoted by the Pontifi- sage of the Holy Father ings and in his paper he out- cal Council for Health Pastoral through the mass media. Vati- lined the principal directions Care together with the Bish- can Radio transmitted the prin- of pastoral care in health and ops’ Conference of France, cipal initiatives connected its present-day situation in the represented by His Eminence with the celebration. The Church at a world level. Cardinal Philippe Barbarin, brochures containing informa- Listing the negative aspects the Archbishop of Lyons, who tion and the programme of the that have a bad impact on the is responsible for pastoral care World Day were prepared by health care world in the old in health in this Conference, our Pontifical Council and by Continent, the President of the and the Bishop of Tarbes and the Episcopal Commission for Pontifical Council referred to Lourdes, H. E. Msgr. Jacques Pastoral Care in Health of secularism in particular. As a Perrier. France. current of thought this presents His Eminence Cardinal In order to engage in suit- a distorted picture of pain, suf- Javier Lozano Barragán, Presi- able preparations for this fering and death. Another neg- dent of the Pontifical Council World Day, the President of ative aspect, on which secular- for Health Pastoral Care, was our Pontifical Council person- ism exercises a strong influ- appointed Special Envoy of ally went to Lourdes, where he ence, is the lack of workers in the Holy Father to the Twelfth held a series of meetings with pastoral care in health, and in World Day of the Sick. Others the organising committee for particular of workers who be- appointed to be members of the World Day, which was long to religious orders.

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The Cardinal concluded by values as trust and hope in pro- of the state are still not emphasising the proposals to viding valuable help to pa- favourable to, and are ill-dis- be made: those of the Gospel, tients. Amongst the principal posed towards, the Catholic of the Pope and of the Pontifi- challenges, reference should Church, which has to work cal Council, which provide be made to the secularisation without levying charges and solid bases and sufficient re- of public institutions, the pres- supported by charitable dona- sponses to the complex prob- ence of Muslims, and the pre- tions. lems of pastoral care in health sent-day debate on euthanasia, Msgr. Sergio Pintor, the Di- in Europe. in which the Catholic voice is rector of the Office of the Bish- At a more detailed level, the clear and decisive. ops’ Conference of Italy that present-day state of this form The role of the Church in deals with pastoral care in of pastoral care was illustrated Poland was then described by health, described the role of the by the Bishops and their dele- Rev. Marian Wnuk. He laid Church in Italy. He asked for a gates. These came from Bel- emphasis on the fact that the concrete commitment to create gium, France, England, Ire- Church has always worked in a ‘European Forum’ on health land, Italy, Luxembourg, the health care field, but care in order to share and com- Poland, Romania, Spain and stressed that only in recent municate experiences and pro- Switzerland. years, after once again obtain- vide new prospects for action The Bishop of Bruges in ing full liberty, has the Church on behalf of sick people, who Belgium, H.E. Msgr. Roger been able to work in peace, en- are, indeed, the subjects and Vangheluwe, dwelt at length gaging in planned initiatives at the protagonists of the world of upon the subject of euthanasia, a local and national level. The health and health care. which has been recently ap- proved by the Belgian govern- 9 ment. He emphasised the efforts made by the whole of the Church to oppose this law, as well as the Church’s struggle against secularism and the secularisation of Catholic hospitals. The subject of euthanasia was also present in the paper given by Rev. Joseph Roduit, the Abbot of the Abbey of Saint-Maurice in Switzerland. Amongst the various grave problems that the Church has to address in Switzerland, the Abbot referred to: the high consumption of drugs, increasing levels of infertility, and the family planning programmes implemented by the government, programmes which are irreconcilable with the Catholic vision of the family. most important initiative is the The debate on the first day, In Spain as well, as emerged annual pilgrimage to health which was broad-ranging and from the paper given by the care workers to Czestochowa, detailed, brought out the major Archbishop of Palencia, H.E. which since 1994 has involved role of the Church in Europe, Msgr. Rafael Palmero Ramos, a large number of adherents which tries to provide sound where the new evangelisation and high levels of interest. In pastoral solutions to the prob- has produced certain fruits in addition, there is the annual re- lems of secularism, secularisa- the health care world, the atti- treat for hospital chaplains. tion, emigration, the weaken- tude of certain extremist Strong emphasis is also placed ing of faith, and the low num- groups in favour of euthanasia on the catechesis and on train- ber of religious vocations. have given rise to worry. ing at the Faculty of Medicine The papers given by the of that town in order to incul- The theological aspect: team responsible for pastoral cate Christian values in the fu- the day of study care in health within the Bish- ture generations of medical for health care workers ops’ Conference of France doctors. were very interesting. These In Romania, on the other On 11 February, at the papers demonstrated that hand, as the Auxiliary Bishop ‘Palais des Congres’ of Lour- health is a ‘priority good’ in of Iasi, Msgr. Aurel Perca, des, and in the presence of a France, and that the priests pointed out, the situation is large number of medical doc- working in hospitals, although dramatic. Most of the popula- tors, paramedics, and people they are few in number, man- tion of this country is Ortho- active in the world of health age to transmit such Christian dox (85%), and the structures and health care, the day of

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study dedicated specifically to homily declared: ‘we believe transformed into individual such groups was held. that there is always a harmo- nocturnal prayer in front of the As the first speaker, Cardi- nious search for Christ in the Most Holy Sacrament, which nal Javier Lozano Barragán Christian roots of Europe. was displayed on the altar of analysed in detail the follow- May Mary in her Immaculate the Basilica of Our Lady of the ing subject: ‘the new para- Conception help us to find Rosary. digm: bioethics closed and such harmony once again!’ bioethics open to the transcen- The Cardinal then invited all 4. The solemn concelebration dent’. those present to live out three of the Eucharist After referring to certain days of prayer and reflection of 11 February facts connected with the ori- in Lourdes at a deep level with At 9.30 the Special Envoy gins of bioethics, the President Mary. of the Pope, Cardinal Javier of the Pontifical Council for Lozano Barragán, was wel- Health Pastoral Care sum- 2. The Holy Mass of Tuesday, comed at the entrance of the marised the two principal cur- 10 February underground Basilica of St. rents of contemporary thought. Cardinal Philippe Barbarin, Pius X. H.E. Msgr. Perrier The first follows the approach the Archbishop of Lyons, read the letter of the Pope ap- of the ‘new paradigm’ and in- presided over the concelebra- pointing the Special Envoy. volves bioethics closed to the tion of the Eucharist at the The reading in French of the transcendent; the second, on Basilica of the Immaculate Message of John Paul II for the other hand, involves Conception on Tuesday morn- the World Day of the Sick was bioethics open to the transcen- ing. In extending a warm made by the Rector of the dent. It is not surprising that greeting to those taking part in Sanctuary, Don Zimbelli. Then 10 these currents, which are op- the Twelfth World Day of the the solemn concelebration of posed to each other from the Sick, the Cardinal expressed the Eucharist commenced. outset, give rise to opposing his personal satisfaction at the The liturgical assembly was approaches to specific ques- fact that France, and in partic- made up of 25,000 people and tions such as in vitro fertilisa- ular the Marian sanctuary of was very numerous. The tion, cloning, stem cells, the Lourdes, had been chosen for Gospel, in addition to being manipulation of embryos, the the celebration of this World proclaimed in French, was al- transplant of organs, euthana- Day. so read out in Italian, Spanish sia, and palliative cures. It is and English. The texts, in Ger- thus necessary to be very pre- 3. The Eucharistic procession man and Dutch, were to be cise when dealing with these and the administration seen on large video screens. subjects. Nobody can doubt, of the anointing of the sick The following participated the Cardinal emphasised, that On the same day, 10 Febru- in the concelebration together ‘we are not for closed horizon- ary, at 17.00, the Eucharistic with the Special Envoy of the tal bioethics; we are for open procession began. The large Pope: Msgr. Carlo Caffara, the vertical bioethics directed to- assembly of the faithful, led by Archbishop of Bologna; Msgr. wards the transcendent’. Cardinal Javier Lozano Bar- Jaques Perrier, the Bishop of Two other papers were giv- ragán, began its journey at the Tarbe and Lourdes; Bishop en during the afternoon. Rev. modern church of St. José Luis Redrado, the Secre- Arnaud de Vaujuas, who is in Bernadette, located on the oth- tary of the Pontifical Council change of teaching at the er bank of the Gave, and went for Health Pastoral Care; Ms- Catholic Institute of Toulouse towards the underground gr. Thomas Kwaku Menasi, and a doctor of medicine, Basilica of St. Pius X. Within the Bishop of Obuasi (Ghana); spoke about ‘applications in this Basilica the solemn liturgy Msgr. Rafael Palmero Ramos, the field of biogenetics’. Rev. of the word was celebrated, the Bishop of Palencia; Msgr. André Cabes, a theologian and during which the Special En- Adalbert Ndzana, the Bishop a former chaplain of Lourdes, voy of the Pope administered of Mbalmayo (the Cameroon); and Dr. Patrick Thellier, the the sacrament of the anointing Msgr. Giuseppe de Falco, the Director of the Medical Office of the sick to a number of sick Bishop of Sulmona-Valva; of the sanctuary, spoke on the people who had gathered in Msgr. Beniamino de Palma, ‘the Immaculate Conception front of the altar. The most the Archbishop of Nola; Dom and the sick at Lourdes’. moving moment was the Jospeh Roduit, the Abbot of blessing of the most holy Saint-Maurice; Msgr. Aurel The liturgical aspect: sacrament amidst the sick peo- Perca, the Auxiliary Bishop of the moments of prayer ple. Iasi; Msgr. Massimo Giustetto, Emeritus Bishop of Beilla; 1. The opening Holy Mass, 4. The prayer vigil Don Zimbelli, the Rector of Monday 9 February There were two significant the Sanctuary, together with The opening Holy Mass moments of prayer during the another seven hundred priests, took place in the crypt be- prayer vigil of Our Lady of amongst whom presbyters tween the Basilica of the Lourdes, At 21.00 over ten who are Officials of the Pon- Rosary and the ‘Higher’ Basil- thousand pilgrims took part in tifical Council for Health Pas- ica, and was presided over by the torchlight procession with toral Care. Cardinal Javier Lozano Bar- the recital of the rosary. This During his homily Cardinal ragán who during his brief collective prayer was then Javier Lozano Barragán point-

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ed out that ‘the Immaculate The greeting given by the Conclusion Conception brought Mary to Holy Father to the large num- full harmony and full health at ber of volunteers who were The celebration of the the Assumption through the present in the Basilica was al- Twelfth World Day of the Sick painful pathway of the so very expressive: ‘I am at Lourdes had a special sig- cross…To understand the Im- pleased to address a word of nificance not only because of maculate Conception as full- keenly-felt appreciation to the exceptional character of ness of harmony is to return in those who, with simplicity and the place where it was held. a really new way to the roots a spirit of service, place them- Beyond this, four significant of European Christian culture. selves next to the sick, trying moments in the recent history It is also to understand Lour- to alleviate their suffering’. of the Church were also com- des as a place in which God, Thanks to the modern tech- memorated: the one hundred through the intercession of niques of communication, the and fiftieth anniversary of the Our Lady, grants healing so ‘bridge’ of prayer and sharing proclamation of the dogma of very often, applying the re- between Rome and Lourdes the Immaculate Conception; demption that Christ offers us. was not only a moving mo- the one hundred and forty Thus Lourdes becomes a privi- ment but also a moment of sixth anniversary of the first leged centre for the New strong spiritual renewal. apparition of Our Lady to Evangelisation of European Bernadette Soubirous; the culture’. 6. The torchlight processions twentieth anniversary of the Before the final blessing, Every evening at 21.00 a publication of the encyclical the Holy Father appeared on torchlight procession began: letter Salvifici doloris on the the large video screens. His the crowd of pilgrims began salvific meaning of suffering; words, spoken during the from the grotto of the appari- and the eleventh anniversary 11 general audience held in the tions, went along the side of of the first celebration of the Paul VI Hall, echoed through the river Gave, and then World Day of the Sick on 11 the Marian valley and passed through the streets that February 1993, also held in touched the hearts of thou- lead to the heart of this Marian Lourdes. In relation to this sands and thousands of suf- town, before finishing at the fact, Pope John Paul II wrote: fering people: ‘Under your great Square of the Rosary in ‘Lourdes, one of the Marian protection we look for shelter, front of the Basilica of the Im- sanctuaries that is most dear to Immaculate Virgin of Lour- maculate Conception. Those the Christian people, is a place des’. ‘I now turn’, said the taking part in the procession, and at the same time a symbol Pontiff, ‘to those who have with their lit torches in their of hope and grace within a experienced the burden of hands, recited the prayer of the framework of the acceptance suffering in their bodies and Holy Rosary. The mysteries and the offer of salvific suffer- their spirits. I would like, at were read and recited in vari- ing’. the same time, to observe that ous languages. The procession human existence is always a ended with the soft singing of Don DARIUSZ GIERS, gift of God, even when it is ‘Hail Queen’. On Monday this Official of the Pontifical Council marked by the physical suf- procession was led by the Spe- for Health Pastoral Care, fering of humanity’. cial Envoy of the Holy Father. The Holy See.

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May Our Immaculate Lady Watch over the Sick JOHN PAUL II, DURING THE ANGELUS OF 8 FEBRUARY 2004, REFLECTED ON THE TWELFTH WORLD DAY OF THE SICK CELEBRATED ON 11 FEBRUARY 2004

Dear Brothers and Sisters, could it be otherwise? The Immaculate Con- ception of Mary is, in fact, the first fruit of 1. The World Day of the Sick will be cele- the Redemption brought about by Christ and brated next Wednesday, 11 February, Memo- the pledge of his victory over evil. The spring rial of Our Lady of Lourdes. The principal of water bubbling from the ground from events will take place precisely in Lourdes, which the Virgin asked Bernadette to drink is where Mary Most Holy appeared to St reminiscent of the power of Christ’s Spirit Bernadette Soubirous, presenting herself as who heals human beings completely and the “Immaculate Conception”. Furthermore, gives them eternal life. this year is the 150th anniversary of the Dog- ma of the Immaculate Conception, pro- 3. May Our Lady watch over those who 12 claimed by my venerable Predecessor Bl. will be taking part in the forthcoming events Pius IX, whose feast we celebrated yesterday. scheduled at Lourdes: the meetings on pastoral health care in European countries and 2. The close connection between Our Lady on the special relationship between Mary Im- of Lourdes and the world of suffering and ill- maculate and the sick. Let us entrust to the ness is well known. The sick have always Blessed Virgin the solemn Eucharistic Cele- been the chief persons at the shrine which bration at which my Special Envoy, Cardinal came into being at the Grotto of Massabielle, Lozano Barragán, President of the Pontifical and over the years Lourdes has become an Council for Health Pastoral Care, will be pre- authentic stronghold of life and hope. How siding.

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To you we Entrust the Sick, the Elderly, and People who are Alone THE CATECHESIS OF JOHN PAUL II DURING THE GENERAL AUDIENCE, IN THE PAUL VI HALL, WEDNESDAY, 11 FEBRUARY 2004.

1. Today our thoughts turn to the famous from God, even when it is marked by physi- Marian Shrine of Lourdes located in the cal suffering of any kind; it is a “gift” to be Pyrenees Mountains which continues to at- made the most of for the Church and for the tract great crowds of pilgrims from all over world. the world, including numerous sick people. Naturally, those who are suffering should This year Lourdes is the venue for the main never be left alone. In this regard, I eagerly events of the World Day of the Sick, where address a word of heartfelt appreciation to the coincidence with the liturgical memorial the people who, with simplicity and a spirit of Our Lady of Lourdes is now an estab- of service, take their place beside the sick, lished tradition. seeking to alleviate their sufferings and as far The shrine was chosen not only because of as possible cure them of their ailments, its strong connection with the world of sick- thanks to the progress of the art of medicine. 13 ness and with the pastoral approach of I am thinking especially of health-care work- health-care workers. Lourdes was thought of ers, doctors, nurses, scientists and re- above all because 2004 is the 150th anniver- searchers, as well as hospital chaplains and sary of the proclamation, on 8 December volunteer workers. Caring for a suffering 1854, of the Dogma of the Immaculate Con- person is a great act of love! ception. In Lourdes in 1858, four years later, the Virgin Mary appeared to Bernadette 4. “Sub tuum praesidium...”, as we prayed Soubirous in the Grotto of Massabielle, pre- at the beginning of our meeting. “Under your senting herself as the “Immaculate Concep- protection we seek refuge”, Immaculate Vir- tion”. gin of Lourdes, who present yourself to us as the perfect model of creation according to 2. Let us now make a spiritual pilgrimage God’s original plan. To you we entrust the to the feet of the Immaculate Virgin of Lour- sick, the elderly, the lonely: soothe their pain, des, to take part in the prayers of the clergy dry their tears and obtain for each one the and faithful and especially of the sick people strength they need to do God’s will. gathered there. The World Day of the Sick is May you support those who toil every day a forceful appeal to rediscover the important to alleviate the sufferings of their brethren! presence of suffering persons in the Christian And help us all to grow in the knowledge of community and to appreciate ever deeper Christ, who by his death and Resurrection their precious contribution. From a merely defeated the powers of evil and death. human standpoint, pain and sickness can ap- Our Lady of Lourdes, pray for us! pear absurd realities: but when we let the light of the Gospel shine on them we succeed in understanding their deep salvific meaning. “From the paradox of the Cross”, I stressed in my Message for Today’s World Day of the Sick, “springs the answer to our most worry- ing questions. Christ suffers for us. He takes upon himself the sufferings of everyone and redeems them. Christ suffers with us, en- abling us to share our pain with him. United to the suffering of Christ, human suffering becomes a means of salvation” (n. 4).

3. I now address all who feel burdened by suffering in body and spirit. Once again, I express my affection and spiritual closeness to each one. At the same time, I would like to remind you that human life is always a gift

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The Virgin Mary is a Wonderful Sign of the Victory of Life over Death ADDRESS OF JOHN PAUL II IN ST. PETER’S IN THE AFTERNOON OF WEDNESDAY 11 FEBRUARY 2004 TO THE THOUSANDS OF SICK AND DISABLED PEOPLE GATHERED IN THE VATICAN BASILICA TO TAKE PART, ON THE OCCASION OF THE TWELFTH WORLD DAY OF THE SICK, IN MEMORY OF THE BLESSED VIRGIN OF LOURDES, IN THE SOLEMN CONCELEBRATION OF THE EUCHARIST PRESIDED OVER BY CARDINAL CAMILLO RUINI ON BEHALF OF THE HOLY FATHER.

Dear Brothers and Sisters, have a special resonance this year, here in the Vatican Basilica where 150 years ago Bl. Pope 1. Once again St Peter’s Basilica has opened Pius X solemnly proclaimed the Dogma of the wide its doors to the sick: to you who are pre- Immaculate Conception of Mary. And it is present here, and in spirit to the sick across the cisely the Immaculate Conception, a truth that world. I greet you with deep affection, dear introduces us into the heart of the mystery of 14 friends. From this morning, my prayers have Creation and of the Redemption, that inspired been dedicated especially to you and I am now my Message for Today’s World Day of the delighted to meet you. With you, I greet your Sick. relatives, friends and the volunteers who have accompanied you. I greet the members of the 3. In looking at Mary our hearts are opened National Italian Union for Transporting the to hope, for in her we see the great things God Sick to Lourdes and International Shrines accomplishes when we render ourselves (UNITALSI), as well as the directors and op- humbly available to doing his will. The Im- erators of the Opera Romana Pellegrinaggi maculate Virgin is a marvellous sign of the that is celebrating its 70th anniversary this victory of life over death, of love over sin, of year. In particular, I greet and thank Cardinal salvation over every physical and spiritual ail- Camillo Ruini who has presided at the Holy ment. She is a sign of comfort and never-fail- Mass, the concelebrating Bishops and priests, ing hope (cf. Lumen Gentium, n. 68). What we the men and women religious and all the faith- admire already fulfilled in her is a pledge of ful present. what God wants to give to every human creature: fullness of life, joy and peace. 2. Twenty years ago on the Memorial of Our May contemplation of this ineffable mystery Lady of Lourdes, I published the Apostolic comfort you, dear sick people; may it illumine Letter Salvifici Doloris on the Christian mean- your work, dear doctors, nurses and health- ing of human suffering. At the time, I chose care workers; and may it sustain your precious that date thinking of the special message that activities, dear volunteers who are called to the Virgin addresses from Lourdes to the sick recognize and serve Jesus in every needy per- and to all the suffering. son. May Our Lady of Lourdes watch over Today, too, our gaze turns to the venerable everyone as Mother. Thank you for the prayers image of Mary which stands in the grotto of and sacrifices that you also generously offer Massabielle. At its base are the words: “I am for me! I assure you of my constant remem- the Immaculate Conception”. These words brance, and affectionately bless you all.

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Homily of Cardinal Javier Lozano Barragán HOMILY GIVEN DURING THE HOLY MASS AT THE END OF THE TWELFTH WORLD DAY OF SICK, LOURDES 11 FEBRUARY 2004

Though utopias express ar- celebrating the XII World Day also the meaning of the corpo- dent desires of the heart, they of the Sick in Lourdes, reflect- real and spiritual healings that may become dangerous being on the Dogma of the Im- take place in the grotto of cause they remain within the maculate Conception and its Massabielle” (Message of His sphere of fantasies and thus es- relationship to health, within Holiness John Paul II to the trange us from reality. Howev- the context of the Christian President of the Pontifical er, they serve as a stimulus to roots of Europe. We, therefore, Council for Health Pastoral progress and in their own way intend to renew Health Pas- Care, for the XII World Day of reflect the teleological axis of toral Care in the world, espe- the Sick, the Vatican, 1 Decem- every culture. When an extra- cially in Europe, through the ber 2003, nn. 2-3). ordinary utopia becomes an as- celebration of the 150th an- The Christian culture of Eu- tounding reality, then this niversary of the proclamation rope bears in its most impor- utopia which has become “top- of this dogma. ia” life, naked reality, consti- In his message for this tutes in fact the authentic cul- World Day of the Sick, which 15 tural axis, which is worthy of we listened to a little while being called real universal cul- ago, the Holy Father John Paul tural teleology. II, tells us that “the Immaculate This happened with the Conception foreshadowed the death and resurrection of harmonious intertwining of the Christ: culture is life and anti- ‘yes’ of God and the ‘yes’ that culture is death. The only goal Mary would pronounce…This of culture is life; and when the ‘yes’ of hers, on behalf of terror of death hangs over life mankind, reopened the doors every day, true culture will of Heaven to the world, thanks consist in finding an antidote to the incarnation of the Word for death. Man has always of God in her womb through tant elements the desire to un- searched for this remedy, in the action of the Holy Spirit derstand nature in its basic every time and place. Howev- (cf. Lk 1: 35). In this way, the constitution and transform it er, in our days, tired of the original project of creation was for its own utility; the desire search that seemed useless to restored and strengthened in for universal cohabitation, pro- him, he takes refuge in a Christ, and in this project she, moted by objective social or- paralysing scepticism that is the Virgin Mother, also found a ganisation through appropriate associated with the epicurism place. Here is to be encoun- laws; the acknowledgement of the predominant economic tered the keystone of history: and respect for creation as a globalisation, in conformity with the immaculate Concep- gift of God to man; and as the with the maxim of “let us eat tion of Mary began the great key factor and only valid tele- and drink for tomorrow we work of the Redemption, ology of the whole history of shall die.” Inebriated by tech- which was actuated in the pre- humanity, the incarnation of nological progress, modern cious blood of Christ. In Him the Son of God and his salvific man strongly reacts against every person is called to fulfil death and resurrection, to anything that invites him to himself or herself to the full which we incorporate our- raise his head, look beyond the perfection of holiness (cf. Col selves to overcome evil and daily routine and focus on the 1: 28). The Immaculate Con- obtain salvation. true horizon of life in the his- ception was thus the dawn that The last two fundamental el- torical reality of God made promised the radiant day of ements are deeply inculturated man, by the benefit of Whom Christ, who, by his death and in the first two, thus making he overcomes death through resurrection, would re-estab- the sum total of all four the ba- his resurrection. If he accepts lish full harmony between God sic root of the European cul- this horizon, then culture ac- and mankind. If Jesus is the ture. However, we realise at quires its true meaning in the source of life that defeats the same time that these are rich mystery of infinite new- death, Mary is the caring moth- contested in modern and post- ness, which sets the virtue of er who meets the hopes of her modern society. Above all, the hope as the central driving children by obtaining for them central fact is rejected, that is, force of a history that progress- the health of their souls and Christ as the only salvation and es towards an unexpected nov- bodies. This is the message decisive teleology of history elty. that the sanctuary of Lourdes and culture. It is exactly with this back- constantly re-proposes to the Amidst the negation of ground that we thought about devout and to pilgrims. This is Christian transcendence, there

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is no wonder that health is de- pain prophesied by Simeon. ing to the Christian roots of fined as “a state of perfect True, this was harmony with European culture in a truly re- physical, mental and social suffering, but victorious in the newed way. It would also mean well-being, and not just the ab- Resurrection and Ascension of understanding Lourdes as a sence of illness”, ending up in Christ: and this victory meant place where God on several this way in a mere utopia, since the Assumption of Mary. occasions granted healing this kind of health is only an il- The Immaculate Conception through the intercession of the lusion. led Mary to complete harmony Blessed Virgin, applying the In the Jubilee Year Message and total health in the Assump- redemption that Christ offers to for the World Day of the Sick tion, through the painful way of us. In this way, Lourdes be- 2000, Pope John Paul II uses the cross. In her, the Christian comes a privileged centre for a more distinct description. model of true health, which in the New Evangelisation of Eu- Though he agrees that health her Son hung on the cross and ropean culture, as a sign of the does not consist in the mere ab- blossomed in the Resurrection, actual presence of the King- sence of illness, he does not is portrayed. Since then, the dom of God, which is harmo- consider it as a state of perfect right tension towards the only ny, peace and health in the well-being. Rather, he defines possible harmony is the glori- birth of a new community of it as a tension towards harmo- ous cross. We can therefore say nations that wants to rise vigor- ny which is not only physical, that health is not just the ab- ously and abounding, away mental and social, but also psy- sence of illness. Rather, it is the from the impairment of seek- chic and spiritual (Jubilee Mes- physical, psychic, social and ing mere economic interests. sage for the World Day of the spiritual glorious cross, which May the Lord Jesus, through Sick, November 2000, n. 20). is actually the only acceptable the Immaculate Conception of 16 In today’s Message the Pope tension towards true harmony. his Mother, grant new vigour speaks to us about the inter- Here the cross is “spiritu- to European culture so that it twining between the “yes” of alised”, or rather, the Holy may embrace the new evange- God, which He had in the origi- Spirit, due to his All-powerful lisation, which starts from nal project for creating man, Love makes sure that the cross health in this Sanctuary of and the “yes” that Mary pro- of awful death becomes the Lourdes, in order to truly in- nounces on behalf of all glorious cross, source of life culturate the Gospel message mankind, in order to become and happiness, of true harmony in the innermost roots of the the Mother of God. It is here and true health. “Ubi salus New Europe. May health, un- that the fullness of the harmony mundi pependit”. This joy derstood as harmony, peace, which had been distorted in the urges us to be patient and to al- joy, happiness, technical, sci- past by the first sin of man, is ready have the solid hope of entific and medical progress realised. The second Adam is resurrection, because the Love that is respectful of human life, then born, the true first man in of the Spirit demands healing and used for the benefit of all, total harmony with God, Christ as a sign of the Kingdom of be the maternal mantle, with the Lord. He is the Son of the God that is already present. which the immaculate Concep- second Eve, the true Mother of This is the significance of the tion, Our Lady of Lourdes, the living, Mary, in perfect har- miracles done by Christ, and covers her children, who ven- mony with God from the very this is the meaning of the erate her with so much love! moment of her conception: her Christian paradigm of health, Immaculate Conception. which is the logo of our Dicast- H.Em. Cardinal JAVIER This Marian harmony was to ery: the Good Samaritan. LOZANO BARRAGÁN be very painful, it meant the Understanding the immacu- President of the Pontifical Council for Health Pastoral Care, Passion and the Cross together late Conception as fullness of the Holy See. with Christ: it is the sword of harmony would mean return-

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Addresses by the Holy Father DH n.56 ing 1-64 1-09-2004 17:24 Pagina 18

Message of John Paul II on the Tenth Anniversary of the Establishment of the Pontifical Academy for Life

Venerable Brothers, 3. Your contribution is also invaluable to Distinguished Ladies and Gentlemen, intellectuals, especially Catholics, “who are called to be present and active in the leading 1. With pleasure I send you my Message centres where culture is formed, in schools on the occasion of the day on which you are and universities, in places of scientific and commemorating the 10th anniversary of the technological research...” (Encyclical Letter foundation of the Pontifical Academy for Evangelium Vitae, n. 98). The Pontifical Life. Once again I express my gratitude to Academy for Life was set up for this pur- each one of you for the Academy’s high- pose, with the specific task “to study and to quality service of spreading the “Gospel of provide information and training about the life”. I greet in particular Prof. Juan de Dios principal problems of law and biomedicine 18 Vial Correa, President, Bishop Elio Sgreccia, pertaining to the promotion and protection of Vice-President, and the entire Administrative life, especially in the direct relationship they Council. have with Christian morality and the direc- First of all, I thank the Lord with you for tives of the Church’s Magisterium” (Motu your useful Institution which was added ten Proprio Vitae Mysterium, n. 4; L’Osservatore years ago to the others created after the Romano English edition [ORE], 9 March Council. The doctrinal and pastoral bodies 1994, p. 3). of the Apostolic See are the first to benefit In a word, your highly responsible role in- from your collaboration with regard to the cludes the complex subject known today as knowledge and facts that decisions in the “bioethics”. I thank you for your commit- area of moral norms regarding life require. ment to examining specific issues of great in- This is the case with the Pontifical Councils terest and likewise for furthering the dialogue for the Family and for Health Pastoral Care, between scientific investigation and philo- as well as in response to requests from the sophical and theological reflection, guided Section for Relations with States of the Sec- by the Magisterium. Researchers, especially retariat of State, from the Congregation for those who work in the field of biomedicine, the Doctrine of the Faith and from other Di- must be made more and more aware of the casteries and Offices. beneficial enrichment that can derive from combining scientific rigour and the claims of 2. As the years have passed, the impor- anthropology and Christian ethics. tance of the Pontifical Academy for Life has become more and more evident. However, 4. Dear brothers and sisters, may your ser- while progress in the biomedical sciences vice now with ten years of experience contin- gives us a glimpse of promising prospects for ue to be increasingly appreciated and sup- the good of humanity and the treatment of ported and provide the desired results in the chronic and distressing diseases, it also fre- field of the humanization of biomedical sci- quently presents serious problems concern- ence and the convergence of scientific re- ing respect for human life and the dignity of search and faith. the person. To this end, I invoke upon the Academy for The growing control of medical technolo- Life continuous divine assistance through its gy in the process of human procreation, dis- Patroness, the Virgin Mary, and as I assure coveries in the fields of genetics and molecu- my remembrance in prayer to each one, I im- lar biology, changes in the therapeutic treat- part a special Apostolic Blessing to you all, ment of seriously-ill patients as well as the which I willingly extend to your collabora- spread of currents of thought of a utilitarian tors and your loved ones. or hedonistic inspiration are factors that can lead to aberrant conduct as well as to the From the Vatican, 17 February 2004 drafting of laws which are unjust with regard to the dignity of the person and the respect that the inviolability of innocent life requires.

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Address of John Paul II to the Plenary Assembly of the Pontifical Academy for Life SATURDAY, 21 FEBRUARY 2004

Dear Brothers and Sisters, in spouses who long to find “in their child a confirmation and completion of their recipro- 1. I am pleased to be able to personally cal self-giving” (Donum Vitae, II, A, n. 1). meet all of you, members of the Pontifical Consequently, I would like to encourage sci- Academy for Life, on this special occasion entific research that seeks a natural way to when you are celebrating the tenth anniver- overcome the infertility of the spouses, and sary of the Academy’s foundation. You are likewise to urge all specialists to perfect commemorating all the people who con- those procedures that can serve this end. I tributed to its birth, with a special thought for hope that the scientific community – I appeal the distinguished and meritorious Prof. particularly to those scientists who are be- Jérôme Lejeune, your first President, whose lievers – may advance reassuringly on the memory I cherish with gratitude and love. road to true prevention and authentic treat- 19 I thank Prof. Juan de Dios Vial Correa, ment. President, for his kind words, and I also greet the Vice-President, Bishop Elio Sgreccia, and 4. The Pontifical Academy for Life will not the members of the Administrative Council, fail to do everything in its power to encour- expressing to one and all my appreciation for age every valid initiative which aims to avoid the great dedication with which you support the dangerous manipulation that is part of the the Academy’s activity. processes of artificial procreation. May the community of the faithful itself 2. You are now taking part in two “Study strive to support authentic research channels Days” devoted to the topic of artificial pro- and, when making decisions, resist techno- creation. The subject is proving full of seri- logical possibilities that replace true parent- ous problems and implications which de- hood and is therefore harmful to the dignity serve careful examination. Essential values of both parents and children. are at stake, not only for the Christian faithful In support of these wishes, I cordially im- but also for human beings as such. part my Blessing to you all, which I willingly What emerges ever more clearly in the pro- extend to all your loved ones. creation of a new creature is its indispensable bond with spousal union, by which the husband becomes a father through the conjugal union with his wife, and the wife becomes a mother through the conjugal union with her husband. The Creator’s plan is engraved in the physical and spiritual nature of the man and of the woman, and as such has universal value. The act in which the spouses become parents through the reciprocal and total gift of themselves makes them cooperators with the Creator in bringing into the world a new human being called to eternal life. An act so rich that it transcends even the life of the parents cannot be replaced by a mere technological intervention, depleted of human value and at the mercy of the determinism of technological and instrumental procedures.

3. Rather, it is the scientist’s task to investi- gate the causes of male and female infertility, in order to prevent this situation of suffering

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Address of John Paul II to the Participants at the International Congress on “Life-sustaining Treatments and the Vegetative State: Scientific Advances and Ethical Dilemmas”

SATURDAY, 20 MARCH 2004

Distinguished Ladies and Gentlemen, been able to emerge from a vegetative state. On the contrary, many others unfortunately 1. I cordially greet all of you who took part remain prisoners of their condition even for in the International Congress: “Life-Sustain- long stretches of time and without needing ing Treatments and Vegetative State: Scientif- technological support. ic Advances and Ethical Dilemmas”. I wish In particular, the term permanent vegeta- to extend a special greeting to Bishop Elio tive state has been coined to indicate the con- 20 Sgreccia, Vice-President of the Pontifical dition of those patients whose “vegetative Academy for Life, and to Prof. Gian Luigi state” continues for over a year. Actually, Gigli, President of the International Federa- there is no different diagnosis that corre- tion of Catholic Medical Associations and sponds to such a definition, but only a con- selfless champion of the fundamental value ventional prognostic judgment, relative to the of life, who has kindly expressed your shared fact that the recovery of patients, statistically feelings. speaking, is ever more difficult as the condi- This important congress, organized jointly tion of vegetative state is prolonged in time. by the Pontifical Academy for Life and the However, we must neither forget nor un- International Federation of Catholic Medical derestimate that there are well-documented Associations, is dealing with a very signifi- cases of at least partial recovery even after cant issue: the clinical condition called the many years; we can thus state that medical “vegetative state”. The complex scientific, science, up until now, is still unable to predict ethical, social and pastoral implications of with certainty who among patients in this such a condition require in-depth reflections condition will recover and who will not. and a fruitful interdisciplinary dialogue, as evidenced by the intense and carefully struc- 3. Faced with patients in similar clinical tured programme of your work sessions. conditions, there are some who cast doubt on the persistence of the “human quality” itself, 2. With deep esteem and sincere hope, the almost as if the adjective “vegetative” Church encourages the efforts of men and (whose use is now solidly established), women of science who, sometimes at great which symbolically describes a clinical state, sacrifice, daily dedicate their task of study could or should be instead applied to the sick and research to the improvement of the diag- as such, actually demeaning their value and nostic, therapeutic, prognostic and rehabilita- personal dignity. In this sense, it must be not- tive possibilities confronting those patients ed that this term, even when confined to the who rely completely on those who care for clinical context, is certainly not the most fe- and assist them. The person in a vegetative licitous when applied to human beings. state, in fact, shows no evident sign of self- In opposition to such trends of thought, I awareness or of awareness of the environ- feel the duty to reaffirm strongly that the in- ment, and seems unable to interact with oth- trinsic value and personal dignity of every ers or to react to specific stimuli. human being do not change, no matter what Scientists and researchers realize that one the concrete circumstances of his or her life. must, first of all, arrive at a correct diagnosis, A man, even if seriously ill or disabled in the which usually requires prolonged and careful exercise of his highest functions, is and al- observation in specialized centres, given also ways will be a man, and he will never be- the high number of diagnostic errors reported come a “vegetable” or an “animal”. in the literature. Moreover, not a few of these Even our brothers and sisters who find persons, with appropriate treatment and with themselves in the clinical condition of a specific rehabilitation programmes, have “vegetative state” retain their human dignity

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in all its fullness. The loving gaze of God the the vegetative state is prolonged beyond a Father continues to fall upon them, acknowl- year, cannot ethically justify the cessation or edging them as his sons and daughters, espe- interruption of minimal care for the patient, cially in need of help. including nutrition and hydration. Death by starvation or dehydration is, in fact, the only 4. Medical doctors and health-care person- possible outcome as a result of their with- nel, society and the Church have moral duties drawal. In this sense it ends up becoming, if toward these persons from which they cannot done knowingly and willingly, true and prop- exempt themselves without lessening the de- er euthanasia by omission. mands both of professional ethics and human In this regard, I recall what I wrote in the and Christian solidarity. Encyclical Evangelium Vitae, making it clear that “by euthanasia in the true and proper sense must be understood an action or omission which by its very nature and intention brings about death, with the purpose of eliminating all pain”; such an act is always “a serious violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person” (n. 65). Besides, the moral principle is well known, according to which even the simple doubt of 21 being in the presence of a living person already imposes the obligation of full respect and of abstaining from any act that aims at anticipating the person’s death.

5. Considerations about the “quality of life”, often actually dictated by psychological, social and economic pressures, cannot take precedence over general principles. The sick person in a vegetative state, First of all, no evaluation of costs can out- awaiting recovery or a natural end, still has weigh the value of the fundamental good the right to basic health care (nutrition, hy- which we are trying to protect, that of human dration, cleanliness, warmth, etc.), and to the life. Moreover, to admit that decisions re- prevention of complications related to his garding man’s life can be based on the exter- confinement to bed. He also has the right to nal acknowledgment of its quality, is the appropriate rehabilitative care and to be mon- same as acknowledging that increasing and itored for clinical signs of eventual recovery. decreasing levels of quality of life, and there- I should like particularly to underline how fore of human dignity, can be attributed from the administration of water and food, even an external perspective to any subject, thus when provided by artificial means, always introducing into social relations a discrimina- represents a natural means of preserving life, tory and eugenic principle. not a medical act. Its use, furthermore, Moreover, it is not possible to rule out a should be considered, in principle, ordinary priori that the withdrawal of nutrition and and proportionate, and as such morally hydration, as reported by authoritative stud- obligatory, insofar as and until it is seen to ies, is the source of considerable suffering for have attained its proper finality, which in the the sick person, even if we can see only the present case consists in providing nourish- reactions at the level of the autonomic ner- ment to the patient and alleviation of his suf- vous system or of gestures. Modern clinical fering. neurophysiology and neuro-imaging tech- The obligation to provide the “normal care niques, in fact, seem to point to the lasting due to the sick in such cases” (Congregation quality in these patients of elementary forms for the Doctrine of the Faith, Iura et Bona, p. of communication and analysis of stimuli. IV) includes, in fact, the use of nutrition and hydration (cf. Pontifical Council “Cor 6. However, it is not enough to reaffirm the Unum”, Dans le Cadre, 2, 4, 4; Pontifical general principle according to which the val- Council for Pastoral Assistance to Health ue of a man’s life cannot be made subordi- Care Workers, Charter of Health Care Work- nate to any judgment of its quality expressed ers, n. 120). The evaluation of probabilities, by other men; it is necessary to promote the founded on waning hopes for recovery when taking of positive actions as a stand against

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pressures to withdraw hydration and nutri- support to enable the family to break out of tion as a way to put an end to the lives of its isolation and to help it to realize that it is a these patients. precious and not a forsaken part of the social It is necessary, above all, to support those fabric. families who have had one of their loved In these situations, then, spiritual coun- ones struck down by this terrible clinical con- selling and pastoral aid are particularly im- dition. They cannot be left alone with their portant as help for recovering the deepest heavy human, psychological and financial meaning of an apparently desperate condi- burden. Although the care for these patients tion. is not, in general, particularly costly, society must allot sufficient resources for the care of 7. Distinguished Ladies and Gentlemen, in this sort of frailty, by way of bringing about conclusion I exhort you, as men and women appropriate, concrete initiatives such as, for of science responsible for the dignity of the example, the creation of a network of awak- medical profession, to guard jealously the ening centres with specialized treatment and principle according to which the true task of rehabilitation programmes; financial support medicine is “to cure if possible, always to and home assistance for families when pa- care”. tients are moved back home at the end of in- As a pledge and support of this, your au- tensive rehabilitation programmes; the estab- thentic humanitarian mission to give comfort lishment of facilities which can accommo- and support to your suffering brothers and 22 date those cases in which there is no family sisters, I remind you of the words of Jesus: able to deal with the problem or to provide “Amen, I say to you, whatever you did for “breaks” for those families who are at risk of one of these least brothers of mine, you did psychological and moral burn-out. for me” (Mt 25: 40). Proper care for these patients and their In this light, I invoke upon you the assis- families should, moreover, include the pres- tance of him, whom a meaningful saying of ence and the witness of a medical doctor and the Church Fathers describes as Christus an entire team, who are asked to help the medicus, and in entrusting your work to the family understand that they are there as allies protection of Mary, Consoler of the sick and who are in this struggle with them. The par- Comforter of the dying, I lovingly bestow on ticipation of volunteers represents a basic all of you a special Apostolic Blessing.

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Topics

Challenges for Christians in Europe in Medicine and Health Care

Praying in Sickness and Health

The Charismatic Management of the Hospital Order of St. John of God

Bioethics in UNESCO

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Challenges for Christians in Europe in Medicine and Health Care

Introduction which case the only guiding available basis, and that one principle of conduct is utili- must only follow the current? Perhaps nowadays in Eu- tarianism. From the epistemological rope one of the main chal- problem there necessarily aris- lenges for Christians in the es an ethical problem. But be- field of medicine and health I. The Fundamental hind the epistemological prob- care is the progress of science Challenge for lem one finds the metaphysi- in the area of biological Medical Culture cal problem too. Nowadays, to chemistry, especially in bio- mention metaphysics seems genetics. We could here The fundamental challenge like talking of something eso- speak about FIVET, stem in medicine and healthcare is teric, belonging to the dark cells, cloning, embryos or the question whether there age of human thought that has pre-embryos and their refrig- still exists an objective and already been surpassed by sci- 24 eration, the use of tissues immutable norm by which to ence. Moreover, science is al- from human embryos, genet- measure the ever growing mu- so out-moded by the presence ic therapy, the mapping of the tability of experiments in the of evolving daily life, mute human genome and the field of science and life. A but perceptible in an ephemer- patents for this genome, eu- similar question could be al presence. But if we do not genics, manipulation of the asked as to whether man in his pay attention to the demagogic chromosome, chromosome integral perception of himself thoughts of the public squares, identity and privacy, its com- is the measure of all of hu- of some websites, editorials of mercial, political or medical manity, or if every individual periodicals, various media use, palliative care, organ is so distinct and without a re- transmissions, or the claims of transplants, cerebral death, lationship to others that he post modernity, and we look the privatization or socializa- closes in to himself as the eth- for a serious thought of one tion of the health care ser- ical norm. In this case it who is really concerned about vices, the right to health or to would be impossible to have a finding a right direction for health care, etc. global norm that indicates the life, I think that it would not The question is: why are behavior to be followed: be ingenuous to say that we these scientific and technical everyone would be the center can arrive at the final conclu- issues challenges for Chris- and source of any decision sion and plainly ask ourselves tians? Certainly not because taken in any field; and his de- whether being exists or not. of progress, since science and cision would be obligatory for If starting from experience faith are not opposed to each others according to his own we overcome total skepticism, other. I do think that the chal- power of imposition; econom- we will necessary arrive at the lenge for Christian lies be- ical, technical, scientific, and “intuition of essence” as the yond laboratory experiments even military for that matter. last evidence principle, and in the field of biogenetics. It In other words, the chal- there we will find what we call is in bioethics, or more pre- lenge for Christians in the the first principles, the princi- cisely in “metabioethics”. field of medicine and health- ple of identity, of contradic- Today people speak of care is the validity or invalidi- tion and of convertibility: global ethics, and it is com- ty of objectivity in ethics. “What is, is”. monly said that Christian “Nothing can be and not be ethics is outdated, given cur- 1. The metaphysical and at the same time.” rent pluralism which does not epistemological challenge “Being, truth and the good look to old models. It is there- are inter-convertible”. fore necessary to forge new As we try to give an answer, ethics, the ethics of consensus we must recall the epistemo- 2. The ethical-metaphysical whereby everybody agrees logical problem: what is the fi- challenge with the opinion of the major- nal criterion of truth? How do ity or of the special groups ac- we arrive at evidence? What Understanding that being, cepted because of their scien- about verifiability in physical truth, and good converge, and tific progress, technology and experimentation, the clear and verifying in our own minds wealth. Or else, one may pre- distinct ideas as to first princi- that being, truth, and good fer to avoid ethical discus- ples and the intuition of converge in each of us in a sions and problems, such that essence? Or is it that there is limited way, we must accept scientific praxis is guided by simply no criterion of evi- that we are part of a harmonic the cost/benefit dynamics. In dence, no valid knowledge, no or disharmonic whole in daily

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life. We are therefore con- walking of the same nature of unlimited goal of man is called scious that we have a neces- man towards his own realiza- natural law. Natural law is the sary relationship. We also be- tion as being and as truth; that being that expands itself, the come conscious that we can is, the way that is convenient truth that progress, and the grow. Our being has an inner to him as such, the way to- good that realizes itself ever dynamism growing towards wards his own good. more in an unrestrained dy- truth and good. This good is the model we namism, which satisfies and This relation implies a nec- attempt to reach in a persistent makes happy. essary dynamism that in- walk. From the consciousness cludes “being” as a starting of our limit and the desire to 3. The challenge to open point, but also “to become” go further and reach more and being to Revelation what we are not yet, as the more truth, more and more point of arrival. “To become” good, arises the necessity for a The challenge for the Chris- receives the qualification of way, which must be constant- tian now is to consolidate his “Good”, because it is suitable, ly pursued. And this way is ethics in the dynamism of be- and that which fits somebody ethics. This way is the true ing, and acknowledge that the is good. Experimenting the and objective fulfillment of fullness of being is called necessity “to become”, the ne- the subject: his being, truth, God. He proclaims that God cessity for the “suitableness” and goodness are realized to- was incarnated in His Son Je- of good, one sees that what gether as interconnected re- sus Christ, and the only way fits must be realized continu- cipients. No good is possible to God is Christ (Jn 14:6). ously because the human ca- if there is no being and truth at Therefore, the challenge pacity to grow is indefinite, the same time. Therefore there now is to pass from meta- and therefore one must walk 25 towards a model that means fulfillment in being, in truth and in goodness. This continuous walking from “being” to the “Being”, from “truth” to the “Truth”, from “good” to the “Good” is ethics. It is that which objec- tively realizes the subject. It enables the subject to grow assimilating the object that is found in its growth. Conse- quently, the excluding contra- position between subjective and objective is not valid. The objective “ob-jacet” (is there, outside the subject), is true; but that which “ob-jacet” makes itself subjective (it is now in the subject), one as- similates in one’s continuous walking towards the realization of one’s own being, truth and goodness. Since the existence of the finite being opens its way in- definitely, it is necessary that there exists a prospect of ar- riving at the infinite itself. The way towards this infinite full- is no ethics without being and physics to revelation in ethics. ness is precisely ethics. The truth. This being and truth As we said, ethics is the result objective indication of the make the good objective, be- of the convergence between subjective way is called natur- cause the being and truth that being, truth and goodness, and al law. It is the being that ex- permit growing is out of the revelation tells us the reality pands itself, the truth that en- subject and is assimilated by about them. Passing from ab- lightens itself, and the good the subject. So ethics is at the stract thought to the concrete, that realizes itself continuous- same time the subjective and the metaphysical principle of ly in an unrestrainable dy- the objective in mutual rela- convertibility of being that namism. It is the authentic tionship. tends toward the infinite, cul- convertibility between being, Because the growing capac- minates in the principle of fol- truth and goodness. Therefore ity has no limits, it is necessary lowing Christ, where the good natural law is not an outmod- that the goal in ethics must be to be acquired is Christ him- ed concept based in a biologi- fullness without borders, the self, God, who satisfies all the cal constant, but the legitimate infinite. The way towards the human potentialities of being,

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truth and goodness. So natural ture. From Judaism is taken the and value human life. This law opens itself to divine law, concept of holiness; from Bud- means defending human life without lacunas and contra- dhism, serenity and impassivi- from its conception till its nat- dictions. Rather, in it there is ty; from Hinduism, respect for ural end. unexpected harmony or ful- animals; from Islam, the virtue It is also said that as a nec- fillment because of the gift of of justice; and from Christiani- essary character of global the Lord. Through a growing ty, charity and mercy. They ethics the norm cannot have a participation one then arrives think that with pluralism, one unique meaning, because it all at divinization (not a kind of can build global ethics which depends upon the use of lan- idealistic pantheism of some deserves worldwide consensus. guage. Speaking in political confused ideologies on reali- It is clear that in all reli- terms may not be the same as ty), becoming son of God in gions there are elements of speaking in scientific terms; the same Son of God. So great value. The challenge in the same applies to philosoph- ethics is the way of Christ: his understanding and respecting ical and sports language, or infinite Love that leads him to this “pluralism” is to find the theatrical and economic lan- give life as a gift to all of us. Therefore Christian ethics is impossible without faith and it consists in a close union with the self-giving Love of Christ. Ethics then becomes an action of the Holy Spirit.

26 4. The challenge of global ethics

The most urgent challenges are not to answer with prohi- bitions or licenses to make this or that biogenetic practice, but to acknowledge a universal norm. Furthermore, the challenge is placed in the very roots of European culture: whether its fundamental values are no longer valid. Another challenge is that of not being involved in excesses of rhetoric such as “global ethics must be absolutely new, it must break the Christian method that belonged to another cultural epoch, which is already dead.” There is in fact the challenge of offering a “global” answer rooted in the basis because of which it is guage, or even the language of fundamentals of culture, one possible to attribute value to the intimacy of love and the that goes beyond a subjective those elements. The answer is home. Therefore, nothing is and arbitrary position. because they refer to what obligatory. Here we find an- Nowadays people try to man is and wishes; they corre- other challenge for Christians build new ethics as a “col- spond to his being, his truth in the field of medicine: to lage”: proposing valuable ele- and his goodness; this is the prove that the different fields ments from major religions meaning of the expression of of language use do not make and pretending that with the man’s own dignity; the an- reality but reality shapes the sum total of these it will be swer is because they translate diverse fields of language. Re- possible to construct a new into practice the correct con- ality can be expressed in sev- paradigm acceptable to all. In duct of the human person. eral forms, but it is the same, this new spirituality (they do Again we find ourselves in unique and unchangeable in not call it a religion), valid ele- front of the challenge to show the truth and goodness of ments present in different that man as such is not merely man, and it is evident in his creeds are not rejected. They a futile abstraction, but the ba- own being. are brought together to form sis of any ethics that pretends Sustaining the validity of global ethics. In this way, and to design the way for man’s truth as transparency of the in particular from the religions full realization. entity of the reality is not the of the American native com- Consequently, the first pos- same as remaining in an im- munities, are taken respect for tulate of a global ethics is to mobility opposed to the fre- nature and the necessary inter- always defend the absolute netic rhythm of actual life. action between man and na- dignity of the human person, From the beginning of west-

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ern thought, there has been the between themselves. This concrete points that are also antithesis being-becoming. background damages and important and fundamental The solution is not to elimi- makes authentic scientific challenges for Christians in nate part of the antithesis; but progress impossible, especial- the field of medicine; they are to find the equilibrium upon ly in biological chemistry the concept of health and the which ethics is based. Grow- studying biogenetics. practice of pastoral care in ing and continuous vital After the discovery of health. change presupposes a subject genes, whose complexity in who at the same time changes man is comparable to a piano 1. What is health? and remains; because if he with three billion various pairs does not remain he destroys of keys that must be played We have the concept of himself and dies; and if he during the whole life time, and health given by the WHO: “A does not change, his inactivity seeing the diversity of each of perfect physical, mental and kills him. In order to subsist, a those keys, because they are social well-being and not only culture must have the vital ca- distinct from each other, one the absence of illness”. pacity to change, coinciding sees that it is impossible to un- If we examine this defini- with the primordial con- derstand the beginning of life tion seriously, we realize that science of its permanence. from a mechanicalistic point it is not sustainable: it speaks The first challenge for the of view, and therefore to un- of a perfect well-being and European Christian in the derstand man through a sci- this is a utopia. However, its field of medicine and health ence based on concepts which assertion that health in not on- care is the ethical challenge. It do not surpass the parameters ly the absence of illness is re- is the challenge to give an eth- of the extension from a me- markable. ical and inculturated answer chanical perspective that im- This definition underlines 27 in the new circumstances of poses a quantitative order the physical, mental and so- the wonderful progress of starting from closed unities. cial aspects of health. It is true contemporary science and This perspective which is that the meaning of health is techniques. But avoiding only quantitative, giving coor- complicated because it is committing suicide through a dinated knowledge of one fac- linked with life and many subjective relativism that also tor after another, without con- times it is understood as life opens the door to economical, sidering the relation between itself. We know that life is or- political or technocratic dicta- them, is not adequate. It is nec- ganic unity and death is the torships. essary to have another vision, disintegrations of this unity. the vision of simultaneity, the From this base, we can in a 5. The challenge holistic vision. One has to ap- first approach say that health of mechanicalism ply the perspective of rela- is the tendency towards unity. tions: whereby a point relates So health would not be perfect There is also another chal- itself to many other points. well-being but rather the bat- lenge especially in the field of This challenge is very im- tle against the disintegration biogenetics in relation to the portant: scientific knowledge of the unity of human life; that background of the contempo- is not the only valid knowl- is, a fight against death, a dy- rary sciences of health and edge. For holistic knowledge namism towards total harmo- medicine; it is the challenge of there is the necessity of going ny, but not harmony itself. overcoming mechanicalism. beyond scientific knowledge In some areas of scientific in order to consider totality 2. Health and harmony thought, one more or less ex- and simultaneity, and not only plicitly has the Cartesian Ra- manipulability, but also obser- Therefore, health is for har- tionalism of “clear and distinct vation. Observation knowl- mony, or to be more precise, ideas” as a starting point. This edge, the former knowledge it is a certain way to walk to- though, in its initial formula- of medicine, is not over, it wards harmony, a continuous tion, means the total indepen- must be added to the contem- search for harmony, although dence of the three self-suffi- porary knowledge of manipu- this harmony, at least in this cient substances: “God”, lability. To practical contem- world, is not totally attain- “Conscience” and “Exten- porary manipulability in med- able. sion”. These three substances icine one must add humble This harmony is not only designed themselves totally observation, as well as re- physical, but also psychologi- independently from each oth- spectful admiration and, why cal, social, and finally spiritu- er and in their inner constitu- not, adoration. The challenge al. As physical, it is the tention. When in the evolution of is to prove scientifically that sion towards the good func- this thought “the Extension” definitely man is not the mas- tioning of the organism, a prevails as a unique substance ter of his life. work of eliminating sickness worthy of consideration, then and being healthy; this would one finds whole empiricism, involve also some relational which as an ideological back- II. The Challenge state like the ecological equi- ground to scientific investiga- to Evangelize Health librium. As psychological, it tion proceeds from the basis means vital tension. That is of quantitative knowledge of That said about the complex the tension towards self con- unities that are independent context, let me now touch two sciousness, towards self-do-

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minion and consciousness of measured in varied ways ac- of Christ to heal the sick. But one’s proper place in the mi- cording to the different stages the challenge is: do these cen- lieu where one lives. As so- of life: the parameters for ters truly evangelize through cial, it is the tension towards measuring the health of a ba- the world of sickness and the complementary relation- by may not be the same used health? Does Europe become ship with others. It is growing for determining the health of evangelized through these in the social aspect of the hu- an old person. Health is the centers? Is there a Christian man personality. It proceeds capacity that everyone re- concept of illness and health from within the person, to the ceives from God to accom- in them? Are these centers home and further on to the plish the mission entrusted to witnesses to the resurrection bigger or the international en- him. Continuing in the line of of Christ? the paradox we can say that The challenge arises be- death itself is the maturity of cause it is necessary not to health, but only when death confuse a philanthropic center means the fulfillment of the with a charity center that received mission, and uniting ought to be devoted to evan- with the death of Christ, as a gelization. gateway to the individual’s own resurrection. Then, the 2. Evangelization of pastoral tension arrives at maturity: care in health full harmony As a consequence of the 4. A definition of health Christian concept of health, 28 the core of pastoral care in If we desire to summarise, health is witnessing to the we can say that another chal- Resurrection of the Lord. Pas- vironment. And as spiritual, lenge for Christians in the toral care in health must be a health is the tension towards field of medicine and health ministry that gives valid an- the whole unity of the human in Europe is that of making swers to the profound prob- being: towards his physical, the true meaning of health un- lems of human existence, psychological and social uni- derstood. We try to describe it such as illness, suffering, fication. It means the unity of as: “A tension towards physi- pain, death, etc. And the fun- life as a project that will be cal, psychological, social and damental answer must be en- fulfilled and gives sense to the spiritual harmony, and not tering the Mystery of God, other aspects of the personali- only the mere absence of ill- touching and experiencing in ty. As spiritual tension, it is ness, which enables the per- the fact of one’s own suffer- the tension in love, and to- son to accomplish his mission ing and death, the pain, suf- wards more intensive love. So received from God, according fering and death of Christ; health consists in loving total his stage of life”. This is in and also realizing how one’s self-donation to others. substance the description of own suffering was assumed health given by the Holy Fa- by the suffering of Christ, in 3. Spirituality and Health ther John Paul II in his mes- his passion. This is the first sage for the World Day of the step; the second step is the ex- This spiritual tension is the Sick in the Jubilee of 2000. perience of the Resurrection. challenge of health for us as It means to find happiness in Christians because it is the the same suffering. The first tension towards total donation III. The Challenge to stage will be the actualization to God and to others, under Evangelize of the resurrection in the ful- the action of the Holy Spirit. Health Pastoral Care filling “suffering” of the pa- True life consists in being as- tient; the second will be em- similated to the highest dona- 1. Catholic health centers bracing death not as total tion of Christ in his death and frustration but as the day of resurrection. This is the true In the Catholic Church we loving encounter with the harmony of health that pene- have 113,257 health centers risen Christ. And the chal- trates and influences the other run by Catholics; the question lenge consists in being con- harmonies. Our challenge is to is: do these centers offer true scious that this encounter is fill the existing gap between health pastoral care? It is true not possible with our own hu- temporal and eternal health. that in many of these centers, man forces but only by the They are both related and especially in Europe, one re- power and guidance of the eternal health is prepared for ceives excellent services, they Holy Spirit, in the sphere of by temporal health. achieve medical excellency, the life of love. As a paradox, health that have outstanding technical in- It is evident to those who leads towards the absence of struments, and some of them profess the Catholic faith that illness may coexist with ill- take care of poor people who all we say is not mere words, ness, but only in the instance have no insurance at all. rather it is translated into con- where illness does not hinder These centers are inspired by crete actions. The first action the tendency towards harmo- Christian charity and are also is the sacrament of the Eu- ny. It means that health is a fulfillment of the command charist, which is at the center

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of all pastoral care in health, tle, which does not arrive at ed this car forgot to put in it because pastoral care in the very roots of European the steering wheel, or at least health is the Eucharist, lived culture. an electronic device to control at the edge of existence, it; it is running crazy, disori- where death is glorification, entated and without brakes. according to the language of Conclusion What will happen? What can St. John in his Gospel. we do? The challenge for pastoral The theme was “Chal- I suggest that as a first mea- care in health is not to be lenges for Christians in Eu- sure one must mount onto this caught up in a weak theism rope in Medicine and Health- vehicle and put in it the steer- and in the practice of human care”. I think that all the chal- ing wheel, or an electronic de- compassion, but to put in ac- lenges can be reduced to one: vice to guide it. Exactly this is tion all the dynamism of our the direction of medicine and the challenge I tried to meet faith as something that we healthcare. And not exactly in this paper: to mount the au- truly believe, not only as a how it must be, but what it is. tomobile of current medicine proclamation, but as a unique Today, medicine has pro- and healthcare and insert into vital practice. The content of gressed very much. We could it the steering wheel, or an pastoral care in health consti- compare it with a very power- electronic device and brakes. tutes the reason why we are ful car, which is very beauti- Christians. This content ful and elegant, with plenty of H. Em. Cardinal JAVIER LOZANO BARRAGÁN means going beyond a light technical instruments, now President of the Pontifical Council superficial pseudo-cultural running at maximum speed. for Health Pastoral Care, cover of a mere Christian ti- But the engineer who invent- the Holy See. 29

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Praying in Sickness and Health LORD, TEACH US HOW TO PRAY (LK 11:1-4)

I will begin this brief reflec- place and began praying there’ – in his name (Jn 14:13; tion with two texts that deal (Mk 1:35); 16:23-4). with prayer. The first is from b) ‘he went up on the hill St. Augustine: he who learns to side, to pray there’ (Mk 6:46); Jesus Listens to our Requests pray, learns to live, says the c) ‘then he took Peter and saint. The second is from a John and James with him, and Jesus listens to the requests master of the spiritual life, the went up on to the mountain of those who turn to him. The Benedictine, Don Anselmo side to pray’ (Lk 9:28); Evangelists describe various Grün. His book entitled ‘Prayer Jesus prayed before choos- moments that are suitable to as Encounter’ begins with the ing the Apostles (Lk 6:12-19): such petition. Here are some following words: ‘There are Jesus prayed before the texts that demonstrate the pos- many people who pray who see Transfiguration (Lk 9:28), and itive approach of Jesus to- their own prayer as a mono- before the resurrection of wards those who make a re- logue and ask themselves, Lazarus (Jn 11:41-2); quest to him: when they are at prayer, Jesus prayed on the Mount – The virgin of Cana: Jn 2:1- 30 whether in fact they are not ad- of Olives: ‘he fell upon his 12). dressing an empty wall. For face in prayer’, and did this – The Samaritan: Jn 4:1-26. other people, it is difficult to three times (Mt 26:39-44); – The nobleman: Jn 4:46-50. find the words to begin a dia- And on the cross: – The lepers: Lk 5:12-14. logue with God and often they a) for others: ‘Father, for- – The centurion: Mt 8:5-13. give up because they do not give them for they know not – The woman sinner: Lk know what to say or what to what they do’ (Lk 23:34); 7:48. say to Him. The key to all this b) for himself: ‘My God, my – The sick man at the pool: is to be found in encounter and God, why hast thou forsaken Jn 5:5-8. dialogue. To find God, it is nec- me?’ (Psalm 22); – The Chanaanite woman: essary to have found oneself, c) and praying he yielded up Mt 15:22-28. just as to engage in dialogue it his spirit: ‘Father, Father, into – The blind man of Jericho: is necessary to know how to your hands I commend my Mk 10:50-52. keep quiet and to listen. From spirit’ (Psalm 31). At the same time he himself this point of view, prayer is the He also left us, amongst oth- taught us: ask and seek (Mt fundamental experience of life er prayers, two great prayers: 7:7). He guarantees prayer’s because it pre-supposes discov- the Lord’s Prayer (Lk 11:1-4) effectiveness ‘Everyone that ery of oneself, discovery of the and the priestly prayer (Jn 17). asks, will receive; that seeks, other person, and discovery of Jesus, therefore, is a model will find...’ (Mt 7:8). everything else, which is God’. for prayer because he prayed, We have a great priest, Jesus and prayed frequently. Christ, to whom we can turn in order to receive mercy and Jesus: the Model for Prayer Jesus Tells us find the grace for suitable help, how we Must Pray as the Letter to the Hebrews The disciples asked Jesus to observes (Heb 14-16). teach them how to pray. They He teaches us to pray and St. Augustine says that ‘Je- had listened to him during his gives us lessons on how we sus prays for us as a priest, sermons speak about the sub- should pray: prays in us as our head; we ject of prayer, how it was – not like the heathens (Mt turn to him as our God. We needed, and how to pray. It 6:7); thus recognise in him our was certainly the case that they – not like the hypocrites (Mt voice, and in us his voice’ had seen him pray many times; 6:5); (Enarratio in Psalmos, 85, 1). they had seen in him an exam- – purified before prayer ple, a model, and hence the re- through forgiveness (Mk The Teaching of the Apostles quest that they made: ‘Lord, 11:25); teach us how to pray’. Yes: – with faith: everything that In their letters, the Apostles Christ is the model for prayer. you ask for with faith you will often have prayers, especially receive (Mt 21:22); of praise and thanksgiving, Jesus Prays: – like a poor man: Lk 18:9- and they also lay emphasis up- 14 the Pharisee and the publi- on assiduous prayer (Rom He passed the night in can; 12:12; 1 Cor 7:5): to God (Heb prayer (Lk 6:12); – with perseverance, untir- 13:15), through Jesus (2 Cor Amidst the din and preach- ingly (Lk 18:1); the parable of 1:20; Col 3:17), in the Holy ing, Jesus withdrew: the troublesome friend (Lk Spirit (Rom 8:15, 26), its ef- a) ‘he went away to a lonely 11:5-8); fectiveness in achieving holi-

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ness (1 Tim 4:5), prayer of definitions, or better descrip- 50; Jn 20:24; Lk 5:12-13; Mk praise (Eph 5:19ss; Heb 13:15; tions, of what constitutes pray- 8:22). In his Confessions, re- Ap 19:5), action of thanksgiving. Given the evocative title ferring to God, St. Augustine ing (Col 3:17), petition (Rom of this volume, my attention says: ‘such very ancient and 8:26; Phil 4:6) and interces- naturally turns to a small work such very new beauty’. ‘You sion for everyone (Rom that came into my hands dur- touched me and now I burn 15:20). ing my holidays when I was from the wish to obtain your about to finish this paper. I peace’ (Libro 7, 10, 18; 10, Lord, Teach us how to Pray cannot resist offering here 27). some brief reflections on this To pray is to struggle, it is to This is the cry that springs small volume (cf Ana Maria offer. This is the prayer of Ig- up in the Apostles when they Cámara Menèndez, Primeros natius di Lojola: ‘Take, Lord, see their Master pray. pasos para orar, STS, and receive all my freedom ... This is the cry that springs Barcelona, 2001). You gave it to me...’ This is the up in the whole of the Church, To pray means to look, says prayer of Charles de Foucauld: indeed in all of us, when we the author of this short book: ‘I ‘I place myself completely in realise that the need for prayer wish for nothing else but that your hands, without any reser- is a fundamental value of you look at him’ says St. Tere- vation...’ This is also what Christian life. sa. ‘All those who were in the Teresa of Jesus said (Vita 25): To pray is to give meaning synagogue fixed their eyes on ‘May your will, Lord, be done to life, it is to breathe, ‘it is him’ (Lk 4:14-21). ‘And the in me ... if this brings trials, learning to live’ (St. Augus- Lord turned and looked at Pe- give me strength and let them tine); and ‘it is speaking to ter, and Peter remembered...’ come’. God’ (St. John Chrysostom); (Lk 22:61). To pray is to sing. this is 31 without prayer one loses the To pray is to seek, it is to what the Psalmist says: ‘I will sense of the absolute; and recognise. Maria does this in sing forever the mercy of the without prayer our apostolate, the canticle of the Magnificat; Lord...’ (Psalm 135). our pastoral work, become she recognises the action of To pray is to trust; this is the transformed into mere activity: God in her life. cry of Paul: ‘...He to whom I have given my confidence...’ (II Tim 1:12). ‘My trust is in Christ and in him alone is my stability, in his suffering is my courage and in his imitation my gladness’ (St. Teresa). ‘Trust Him and He will help you’ (Ecccl 2:6). ‘The Lord is my shepherd, therefore will I lack nothing...’ (Psalm 23). To pray is to be born again, it is to celebrate, and it is to be glad. This is expressed chaste- ly by Teresa d’Avila when she says: ‘The prize of loving him is not reserved to us in the next life; in this life begins the re- ward’ (Path of Perfection, 4:6). ‘And so they began their merry-making’ (Lk 15:20-24) this is the return of the Prodi- gal Son. To pray is to render thanks, ‘because His mercy is eternal’ (Psalm 135). As we can observe, to define prayer means to box it up in a reductive way; it means to reduce its meaning. Just as there ‘Prayer is the key to the morn- To pray is to abandon one- are many ways of praying, so ing and the bolt of the night’ self, ‘to abandon oneself to the in the same way there are (Ghandi). hands of God’, as St. Teresa many ways of defining prayer. To pray is to speak to God, said. as St. Ambrose says: ‘We To pray is to touch Jesus: to Lord, Teach us how to Pray speak to God when we pray, see, to contemplate, to touch, we listen to God when we read and to preach (1 Jn 1:1-2). To That is to say, teach us to lis- His words’ (De officiis min- touch and to allow oneself to ten to your voice; teach us to istrorum, I, 20, 88). be touched, what better prayer receive what you give us; There are a large number of could there be? (cf. Lk 7:36- teach us to live and breathe

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spiritually; teach us to place silence, a silence that was full to know your Creator? Return, ourselves in the breath of the of messages. I say again, to your heart. And Spirit; and teach us to know Have you not noticed that examine what you feel about how to listen. when St. Matthew tells us God, there within where you Prayer is an alive encounter, about the adoration of the yourself were His image’. like friendship: friends need to Three Wise Men he makes In the Rule of St. Augustine see each other, to speak to each clear that they did not say a (2,12), we find written: ‘When other, to look at each other; word? The text of the Evange- you pray to God, with psalms and they need to spend time list says: ‘they found the child and hymns, the heart should together. A friend needs to en- there, with his mother Mary, feel what the voice professes’. gage in dialogue with a friend, and fell down to worship him; In our mass media society, and a lover needs to engage in and opening their store of trea- made up of the television, dialogue with his beloved. As sures, they offered him gifts of newspapers, computers, the ra- Teresa d’Avila observed: ‘It is gold and frankincense and dio, and loud music, it is not friendship, a matter very often myrrh’ (Mt 2:11). easy to be silent, to turn off the of being alone with he whom They were engaged in a noise that surrounds us, to qui- we know loves us’. great prayer, which was with- eten so many empty, idle, ba- The same happens with the out words; they contemplated nal and arrogant words, to si- believer, who needs to speak and they worshipped. lence all those words which to God, and needs to listen to Noise is the enemy of sound out in the air and then listen to the Word that creates, forgives, welcomes, and saves: a Word full of communication 32 and messages. It is not easy to create a desert in the heart of a city; that is to say find a meaning to our lives, which are so full of empty words. Mary provides us with a wonderful example. The Evangelist St. Luke says of her: ‘Mary treasured up all those sayings, and reflected on them in her heart’ (Lk 2:19). In prayer, we cannot forget that we are engaging communication with God, and at times we feel the temptation to speak and speak endlessly. In- timacy with God is His initiative, a gift, and for this reason prayer is an exercise of faith. His voice. The simpler prayer prayer. External noise, the lack ‘Prayer becomes interior to is, the more it becomes diffi- of a context, an inappropriate the extent that we become cult to translate it into words; place ... but above all internal aware of He to whom we are silence is the best sign. noise: circumstances, worries, speaking’ (St. Teresa of Jesus, This can be understood bet- feelings, experiences; if all of Path of Perfection, 26). ter if we bear in mind that this is not ‘controlled’, prayer prayer is an encounter between becomes very difficult. It is ‘It is not Easy to Pray’ man and God, an encounter of difficult to find God when friendship, and an encounter there is noise. One day I asked a ‘clausura’ between friends. And the more The prophet Elijah saw the nun, and thus an ‘expert in trust grows within friendship, passing of God not in a hurri- prayer’: what is prayer for the less words becomes neces- cane, not in an earthquake, and you? I would now like to re- sary; silence, at times, is full of not in fire. He found it in si- produce some of the phrases communication, it is full of lence, ‘in the still small voice’ from her answer: ‘My experi- messages. (cf. 1 Kings 19:11-13). ence of God? ... I will tell you In the life of the holy curate ‘Return to your heart’, only the moment I am now liv- of Ars we learn that he once writes St. Augustine (Com- ing is the darkest period of my asked an elderly man who ment on the Gospel of St. John life, but I also feel that it can spent hour after hour in church 18, 10), ‘why flee and get lost be, that it is, the richest time of apparently without praying far from yourself? Why wan- my life. But what a price I what he was doing there. The der around? Return! Where? have to pay! It seems to me elderly man answered him: ‘I To the Lord. He is waiting for that I won’t find a way out, look at him, he looks at me, you. Return first to your heart, and I do not know how it will and both of us are happy’. It is you who are an exile and a all end’. certainly the case that that el- wanderer. You do not recog- I find a great richness of derly man had learnt to pray in nise yourself and yet you want prayer in this answer: this

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darkness, this knowledge that therefore, is surprised if in our this difficult’ (John Paul II, God is to be found there, this modern society the subject of Letter on Holy Thursday, walking in silence, in the pain prayer appears in ‘modern 1979, n. 10). of not seeing Him. sensing means of communication’, for In prayer we discover what Him, that He is present even in example in Internet, almost as we have to do, prayer moves aridity, and despite everything, though it was a kind of conta- us, frees us from inertia, frees struggling, praying, listening gion. us from laziness, and leads us to His distant voice, feeling The publishing house ‘Cas- to conversion, to humility, to His presence as a shadow and siopea’ has a website trust, and to perseverance. knowing that He is guiding (www.lalode.com) and since Prayer grants us peace, gives your steps, you life. These are 1996 has offered in this area a us serenity. If we do not pray the fruits of intense prayer, of wonderful service of reflection we lose the ‘taste’ for prayer, contemplative prayer. to begin the day. This service our faith and our apostolate And through this brief and is called ‘Good Morning’. One grow weaker; without prayer, graphic experience, this fe- needs only open the pro- our love for our neighbour be- male religious suggested to me gramme and one can find a comes a philanthropic service as follows: word of help, a message, and and our apostolate becomes a – ‘I believe that after a cer- some people call it ‘a letter mere human organisation. tain fashion everybody prays; from God’. What is the use of a very even those who do not believe, A new website is available beautiful car if it does not have who habitually say: ‘I speak to (www.novena.it) which is an engine? It is of use only to a God in my own way’, which completely dedicated to museum. In the same way, a demonstrates the need for a su- prayer: prayers for little girls Christian and religious life perior Being...’. and little boys, prayers for var- without prayer is like a beauti- 33 – ‘The path of prayer is ex- ious circumstances, texts from ful car which does not have an tremely varied and greatly de- Mother Teresa of Calcutta and engine, which does not have pends on the state one is in and from J.M. Nouwen. This is life, and which is a kind of or- the kind of period one going something that is original, not nament. through. Each person must invasive, advisable, and lively; pray according to the method it is a source of prayer, as is Lord, Teach us how to Pray that he or she prefers, what is demonstrated by the various important is to pray and to testimonies which use such A contemplative, Carlo Car- pray well...’ phrases as ‘this is a phenome- retto, has told us about his per- – ‘God has his special way nal initiative, it is beautiful to sonal history: ‘Ever since I un- of speaking and praying; He take care of the spirit ...’ To re- derstood that God mattered in does so from ‘within’, begin- ceive prayers, through Inter- my life, I have felt that the real ning with the person, without net, into our homes helps to problem was that of prayer, substitutes. For this reason, give a truer and more concrete this is because it is in prayer what is needed is fidelity to meaning to everything (Vito that one establishes vital union this encounter, to this listening, Magno, ‘Pregare al computer’, with God. This has been an ex- to this concern, and being con- in Rogate ergo, n. 8/9, pp. 23- perience that has not disap- stant to the time that each per- 24). pointed me’. son has available and propos- To pray is not easy, it is es; a great deal of prayer, very Lord, Teach us how to Pray something that involves com- little prayer, but prayer every mitment, and it is tiring: this is day. nobody will pray for you, Jesus prayed many times something that everyday expe- because He wants to speak to and taught us how to pray; in rience tells us, that experts of you, specifically to you; He teaching us how to pray, he the spirit tell us, namely the will do this to another person creates within us the wish for contemplatives. But if we do in another way, in a different prayer, nostalgia for prayer; not pray, or if we pray badly, way’. one learns to pray by praying. all our pastoral programmes Such was the reply of this We cannot pray if the wish will be of no use because they contemplative nun. to do so is not born within us, will not have the force of God, if God does not have a privi- they will remain mere human ‘Let us Employ Modern leged place in our lives. As St. projects. It is impossible to en- Instruments to Pray’ Augustine says: ‘Whoever gage in real pastoral work and wants and cannot, does not take important decisions, if we It has been said, and I be- want at all’ (On Grace and listen only to each other as we lieve that this is a truth con- Free Will, 25, 31). This means sit around a table. We organise firmed by the scholars of dif- that in order to pray one must activities, meetings and con- ferent religions, that nothing ‘want’ to pray and be interest- ferences, all with a view to unites men so much as prayer. ed in the things of God: for the evangelisation. But what is the We can see how contemporary things that we want and which result? What are the fruits? man has a great need for interest us we always have Time passes, we move and act, prayer; the methods, the in- time. but the seed does not grow. struments and the forms vary, ‘Prayer helps is to believe, Something is lacking, and this what is important is the sub- to hope and to love, even when something is certainly prayer, stance of prayer. Nobody, our human weakness makes the soul of an apostolate.

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In an address to the Superior This was also the witness of not an extra activity; prayer is Generals of various religious the Apostles in the upper room not an obligation, it is a need institutes, Pope John Paul II where they dwelt: ‘All these, (cf. Pedro Muñoz Peña, Apren- urged them to find time for with one mind, gave them- der a orar, p. 188). prayer: ‘You should not fear to selves up to prayer, together We have priorities in life, we frequently remind your broth- with Mary the mother of Jesus, do one thing after another, ac- ers that a pause of real worship and the rest of the women and cording to what is urgent and has greater spiritual value and his brethren’ (Acts 1:14). necessary. In the Christian life, fruit than the most intense ac- Jesus, too, taught us to have the same thing occurs: one tivity. This is the most urgent a constant and persevering thing is more urgent and nec- ‘observation’ that religious spirit in prayer: ‘Ask, and the essary than another; prayer is must place in opposition to a gift will come; seek, and you one of the priorities because society in which efficiency has shall find; knock and the door God is at the centre of things, become an idol, on whose altar will open’ (Mt 7:7). and, therefore, we should dedi- human dignity is by no means During a difficult moment in cate time to Him: time for rarely sacrificed. Your houses Jerusalem, Jesus said to the God, as a norm, priority time must be above all else centres Apostles: ‘Watch and pray that for God in our organisation of prayer, of gathering togeth- you may not enter into tempta- chart, in our work schedule. er, of dialogue, both personal tion; the spirit is willing It is a question of priorities: and communitarian with Him, enough, but the flesh is weak’ without prayer, charity does who is and must remain the (Mk 14:38). not function and our pro- first and principal interlocutor In discussing prayer, Prof grammes of pastoral work, as in the unfolding of the work of Ravasi speaks about three rays well, do not function. 34 your days’’ (L’Osservatore Ro- of light: the first is the intima- We priests, male religious, mano, 25 November 1978, pp. cy that is revealed in particular female religious, and members 1-2). in the Lord’s Prayer: Father, of the laity involved in pastoral The following thought is al- Daddy, dear father; the second care must become an example so from St. Augustine: ‘How is constancy: prayer is not an of prayer because we pray and can the man who does not re- emotion, it is not lightening, an pray well. A bishop, a priest, a member God in rest and relax- experience linked to need; it is, male religious, a female reli- ation remember Him in hurry instead, the constant breathing gious, a member of the laity, or and work?’ (Comment on of the soul which does not halt parents who pray, all become Psalm 62,15). even during the night; the third able to ensure that faith, hope, A chaplain from the United ray of light in prayer lies in the love and the holy life are born. States of America said: ‘We efficacy of prayer: ‘ask, and ‘Our Father who art in heav- can work to the utmost, get the gift will come’. This is an en/You are not surrounded tired, we can plan, programme efficacy which in truth does about, but for greater love...’, ... but if we abandon prayer we not conform to the canons of said Dante Alighieri (Purgato- lose time. To pray is not an op- our hopes, the projects of our rio XI, 1-21). tional: it is a commandment’. minds, but rather to the pro- As the Russian philosopher, The Lord himself says this: ‘I jects of God ‘because my Vladimir S. Solovev (1853- am the vine, you are its thoughts are not your 1900), said when discussing branches; if a man lives in on thoughts’ (Is 55:8). the Lord’s Prayer: ‘Our Father me, and I in him, then he will For this reason, it is a fine who art in heaven, the father of yield abundant fruit; separated experience to abandon our- a new holy life within us: hal- from me, you have no power selves to His gifts even when lowed by thy name, may the to do anything’ (Jn 15:5). they seem to us to be gifts that truth be sanctified in our faith. The Lord said the following were unhoped-for and unex- Thy kingdom come, which is through his Prophet: ‘Not by pected (cf. Gianfranco Ravasi, all our hope. Thy will be done, might, nor by power, but by Secondo le Scritture ciclo C, may everything and everybody Spirit, says the Lord of hosts’ Piemme, 1997). be united in a single love. Be (Zac 4:6). our guide to fullness according For this reason, we are con- Lord, Teach us how to Pray to your true way because yours vinced of everything that we in the power and the glory for say; we are convinced that One learns to pray by pray- ever and ever’. prayer is important for spiritual ing, just as one learns to walk life, for our apostolate; it is like by walking. There is, there- Lord, Teach us how to Pray water for fish, like oxygen for fore, an irreplaceable approach life, and like wings for a bird. to praying – prayer. We need to pray to be con- John Paul II said this with Prayer is not an extra in life, verted and thus to grow in our the following words from the it is something that is central in spiritual lives. Prayer makes us New Testament: ‘Use every life. Hence the need for us to see what we are and places us kind of prayer and supplica- change our attitudes: prayer is on the journey towards what tion. pray at all times in the not something that is indepen- God wants us to be. For this spirit; keep awake to that end dent of life, it is not something reason, by praying we certain- with all perseverance; offer that is isolated: it is a moment ly become converted. your supplication for all the joined to life; prayer is a mo- We need to pray in order to saints’ (Eph 6:18). ment that is born from life, it is become holy, we must excel

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‘in the art of prayer’ (NMI, n. man of prayer. If you want to holiest and swiftest path to 32). know the forms of astuteness reach it is a life of constant and ‘There is no holiness with- of Satan and defend yourself deeply felt prayer. out prayer’, said the Pope to against his deceits, be a man of We need to pray to thank those taking part in the annual prayer. If you want to live joy- God for all His benefits. We assembly of the ‘renewal of ously and walk with calm need to learn to give thanks the Holy Spirit’ (Rimini, April along the path of penitence and to learn to live out our re- 2001). and work, be a man of prayer. lationship with God. ‘Prayer is the beginning of If you want to distance vain The Lord is waiting for our life’ is the title of a book by thoughts and worries from words and our actions of Mother Teresa of Calcutta. your soul, be a man of prayer. thanksgiving. Jesus complains ‘Everything begins with If you want to strengthen your when he sees hearts closed and prayer. If we do not ask for soul and if you want to con- unable to give thanks. Only one of the lepers returned to thank him: ‘Were not ten healed? Where are the other nine?’ ‘Yes, dear brothers and sisters, our Christian communities must becomes genuine ‘schools’ of prayer, where the meeting with Christ is expressed not just in imploring help but also in thanksgiving, 35 praise, adoration, contemplation, listening and ardent devo- tion, until the heart truly ‘falls in love’. Intense prayer, yes, but it does not distract us from our commitment to history: by opening our heart to the love of God it also opens it to the love of our brothers and sisters, and makes us capable of shaping history according to God’s plan’ (NMI, n. 33). We who have received the gift of vocation to a life of special consecration are asked by the Pope to be more ready to engage in prayer, to engage in the contemplative experience love from God, we cannot firm that your heart is on the (cf. NMI, n. 34). have love, and even less can path of God, be a man of we give love to other people’ prayer, because in prayer is re- We Need to Pray Always (Mother Teresa). ceived the anointing and the The Pope asks: ‘Is it not one grace of the Holy Spirit, who This is true for all people in of the ‘signs of the times’ that teaches everything. Lastly, if all circumstances, given the in today’s world, despite wide- you want to uproot all vices need of the Christian commu- spread secularisation, there is a from your soul and put in their nity. St. Paul is a very fine ex- widespread demand for spiri- place all the virtues, be a man ample of this concern, which, tuality, a demand which ex- of prayer, exercise yourself in indeed, is expressed in many presses itself in large part as a prayer, because this is the parts of his letters. Thus of the renewed need for prayer?’ pathway by which the soul ris- Jews he writes: ‘they have all (NMI, n. 33). es to the contemplation and the the good will of my heart, all Yes: we need to pray. Here I experience of celestial things’ my prayers to God, for their would like to quote a wonder- (cf. Antonio Royo Marin, Ser salvation’ (Rm 10:1) and to the ful passage from St. Bue- o no ser santo, BAC, Madrid, Ephesians he writes: ‘I never naventura: ‘If you want to bear 2000). cease to offer thanks on your the adversities and miseries of Father Royo Marin, in the behalf, or to remember you in this life with patience, be a work which I have just quoted my prayers’ (Eph 1:16). In St. man of prayer. If you want to from, says that prayer is the Paul we also find: ‘And this is obtain the virtue and the forge of love; in it one in- my prayer for you; may your strength to defeat the tempta- flames charity and illuminates love grow richer and richer...’ tions of the enemy, be a man of the soul with its flames, which (Phil 1:9) and ‘We give thanks prayer. If you do not want to are both light and life at the to God... continually in our mortify your will with all his same time. If holiness is love, prayers for you’ (Col 1:3). And passions and appetites, be a intimate union with God, the to Timothy the Apostle St.

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Paul recommends prayer for lescence I wrote about my exis what remains, this is the all men: ‘This first of all I ask, perience as a patient and this substance of life. In those days that petition, entreaty and account was published in num- a pamphlet of the Office of thanksgiving should be offered ber 12 of the review Camillia- Reading on the Seventy-one for all mankind, especially foe nun bearing the title ‘I have Blesseds of the Order, martyrs kings an queens and others in Never Felt so Accompanied’. I of the Spanish Civil War, fell high station, so that we can would like to communicate into my hands. And I felt a live a calm and tranquil life, here what I wrote about prayer shiver when I read those texts. and dutifully and decently as during my illness. I saw in those martyrs gen- we may. Such prayer is our du- ‘I have seen that prayer is erosity, love for the sick, faith ty, it is what God, our Saviour not easy, above all else during in God, vigour in difficult mo- expects of us’ (1 Tim 2:1-4). the acute moments of illness, ments, and I said to myself: especially ritual prayer, daily spirit! And I saw that it was prayer; the prayer to be found true, that human and Christian in my book was difficult, I felt life matures with suffering and that it was not my prayer dur- prayer. ing the period that I was then Another experience accom- living through’. panied me during my illness: I My prayers in my hospital felt the prayer of other people bed and later in the small near to me as never before. chapel of the community were Many people told me that they on the whole made up of ex- were praying for me and I real- clamations: Lord, may your ly felt this ‘push’, this strength, 36 will be done, but give me the and I thought: if men are near strength to follow it I often ad- to you, how can God also not dressed the Lord with this cry. be near to you? I remember that one day, af- Although we can pray at ter my second relapse, I prayed any moment, ‘illness, and ‘Praying in Sickness to the Lord with the words of above all else serious illness, and in Health’ Psalm 136: ‘But shall we sing is a propitious moment for the Lord’s song in a foreign prayer ... This prayer is of In many circumstances in land?’ And I said to myself: great importance in creating a our lives we turn to God to that is true, it is difficult, and I climate of peace in the sick praise Him, to bless Him, and applied it to myself, because person and his family rela- to thank Him. The Bible is full my illness and my doubts were tives, in giving courage to of these facts: men and women at that time a foreign land for those who suffer, in finding of the Old Testament and the me; not being able to have a the strength that is needed in New Testament, and the whole normal life was a foreign land; pain, and in encouraging trust of the history of the Church, and the very many medical in God ... For this reason, it is are eloquent witnesses to this tests, the very many analyses, very often the case that with fact. and the very many injections, the seriously ill person it is The Catechism of the and all the rest, were also a more important to pray to him Catholic Church, in the same foreign land. than to talk to him, to propose way, in the fourth part of the I also identified with the cry prayer to him, to help him, to section entitled ‘Christian of the Psalmist: ‘Lord my God, suggest certain forms of Prayer’, brings together in an I cried out to you and you prayer to him. Prayer must re- exhaustive and wonderful way healed me ...’ (Psalm 29). spond to the situation and the a real summary of the meaning The feast of St. Peter and St. feelings that the sick person is and the practice of prayer in Paul was also a moment of experiencing. In prayer made the life of the Church. The strong prayer I felt joy, up of lament one should be contents of this section are an courage and apostolic strength near the sick person, in si- authentic source of inspiration. near to me. lence; in prayer of supplica- Man has prayed in sickness ‘I know to whom I have en- tion one should pray with him and in health, and has done so trusted myself… I have fought and reaffirm his trust in God;. with different gestures and the good fight, I have finished in the request for forgiveness words. The Psalms constantly my journey ... the grace of God one should remind him of the talk to us about this reality, one does not abandon me’ (An- mercy of God; in prayer of should only engage in prayer tiphony). grace one should evoke the according to one’s state of ‘The Lord is my strength gift of life...; in prayer of inter- mind: praise, action of grace, and my song; He has saved cession one should help the supplications for healing. me’ (Antiphony 2, Praises, sick person to come out of I would like to tell you about first week). ‘Bow down then, himself and think of other a personal experience of mine. before the strong hand of God people. We should not, in ad- In 1995 I had an emergency ... Throw back on him the bur- dition, neglect prayer for the ulcer operation. The matter den of all your anxiety; he is sick and in particular for the was serious, or so they told concerned for you’ (1 Pt 5:6- seriously ill. And when the me, but I almost did not realise 7). sick person cannot pray, the the fact ... During my conva- At the end of everything this Church should pray for him.

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Chaplains, the heads of parish- ther’ (cf. St. Cyprian, Com- Fede, Istruzione circa le preghiere per ot- tenere da Dio la guarigione (Paoline, Mi- es, and workers providing pas- ment on the Lord’s Prayer, lan, 2000). toral care in health must know eleventh week, Office of “La oración del cristiano en la enfer- how to stimulate this prayer in Readings). medad”, Labor Hospitalaria (January- February 1971). the family relatives of the sick Teach us, Lord, how to pray. DOMENICO MOSSO, Bendire (ElleDICi, person and in the Christian Certainly the Apostles saw Turin, 1991). community’ (cf. José A. Pago- him pray and were stimulated ANSELM GRÜN, La oración come en- cuentro (Narcea, Madrid, 1997). la, ‘Hacia una muerte más hu- and moved; they prayed with ANSELM GRÜN, Buscar a Jesús en lo mana y más cristiand’, in Sem- their Teacher: ‘Our Father, cotidiano (Narcea, Madrid, 1998). anas de estudios Trinitarios, el who art in heaven, hallowed EMMA FATTORINI, Tempi dell’uomo, tempi di Dio (Guerini, Milan, 1999). Dios cristiano e y el ministerio by thy name, thy kingdom Rogate, n. 12, December 2000. del la enfermedad, Salamanca, come, thy will be done...’ ENZO BIANCHI, Il libro delle preghiere 1996). Amen. (Einaudi, Turin, 1997). ANTHONY BLOON, Preghiera viva (Gribaudi, Milan, 2000). Praying with the Heart, H.E. Msgr. J. REDRADO, OLIVER CLÉMENT, Taizé, un senso alla Setting an Example in Prayer Secretary of the Pontifical Council vita (Paoline, Milan, 1997). for Health Pastoral Care, P. MUÑOS PEÑAS, Aprender a orar the Holy See. (San Paolo, Madrid, 2001). Lastly, we need to pray with GIANFRANCO RAVASI, Perché il cuore the heart, we need to pray set- possa cantare (Piemme, 1997). Pastoral Letter of the Bishops of Pam- ting an example, and with the Bibliography plona and Tutela, Bilbao, San Sebastian witness of a holy life. ‘Do not and Vitori, La oración cristiana hoy agitate your prayers every- JOHN PAUL II, Oraciones (PPC, (Lent and Easter, 1999). Madrid). ANGEL MORENO, “Piego”, on the sub- where with disordered voices S. ALFONSO M. DE LIGUORI, El gran ject of prayer, in Vita Nuova, 19 April ... God does not listen to the medio de la oración (Ediciones Popu- 1996, 15 February 1997, 17 May 1997, 37 voice but to the heart’. lares, Mexico). 17 July 1997. Catechesimo della Chiesa Cattolica - MAXIMILIANO HERRAIZ GARCIA, La Pray not only with words Parte quarta: La Pregiera cristiana (Li- pregiera, una storia d’amicizia (EDB, but also with facts. As the breria Ed. Vaticana, 1993). Bologna). Psalmist says: ‘Speak in your E. BIANCHI, “Pregiera”, in Dizionario J.A. PAGOLA, Salmos para rezar desde hearts’ (Psalm 4:5). The new di Teologia e Pastorale Sanitaria (Ed. la vita (PPC, Madrid). Camilliane, Turin, 1997). MOTHER TERESA, La oración principio man ... first of all says: ‘Fa- Congregazione per la Dottrina della de vida (PPC, Madrid).

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The Charismatic Management of the Hospital Order of St. John of God

Introduction because the reality covered by lation to clinical histories will our hospital order is vast and allow them to provide a suit- This paper was presented at diversified. In order not to veer able response when they have the general assembly of the away from the indication to to consult the relevant data. Hospital Order of St. John of travel light, a simple journey Despite this fact, they be- God, held in Tagaytai in the has been chosen. lieve that a personal computer, Philippines on 1-6 December Each of you can imagine a if they can install one, will help 2003. place in our planet in which their gathering and compiling The author, Fr. José L. Gar- our hospital order is present, of statistics. cia Imas, a religious of St. John and in this theoretical (but per- As regards the dynamics of of God, obtained a good haps not so very technical) their work, our protagonists do grounding with his studies and place we may locate a centre not live where they work and above all has obtained great for the prevention of illness. they thus need a form of trans- experience in management at a In the same way, we may port. Given the limits of their provincial level. imagine that this centre has resources, they will use a The subject of this paper is brought with it a team created means of public transport, 38 addressed with reference to a by one of our brothers, a which, indeed, travels to where specific context: the Hospital women co-worker and a they want to go once a week. Order of St. John of God, a re- woman volunteer, who have For this reason, if they want ligious order which is the own- established a project for the to do things in an efficient way er of two hundred and thirty prevention and promotion of they must plan their stays at the health-care structures. Its pub- health for the people who live clinic in line with the journey lication in the review Dolen- in the region. they have to make. As a result, tium Hominum meets the need After gathering information they will also have to establish to present criteria for charis- on the state of health of the res- the day in each week when pa- matic management. Every- idents, they consult the infor- tients will be treated. thing that a religious order says mation that is available, they Progressing with their pro- about itself can be illuminating meet the local authorities, they ject, they arrange how they and stimulating for many other observe people’s real situa- will organise their mission and groups. tions, and they then decide to they decide to get into contact The author, naturally dedicate their attention to the with the local authorities in or- enough, cannot cover the sub- disease that they consider to be der to illustrate to them their ject completely in this paper, the most urgent: AIDS. plan and its objectives. but he can establish the bases, When they plan the estab- As one can readily under- the foundations, upon which lishment of this service, the stand, time has to be devoted to health-care management can first element that they have to meetings with these authori- be developed within a group take into consideration is to ties, with the future users of the that, principally speaking, has find an area, even a very small clinic, and so on. a charism at its core. It is for area, where they can work, be- Given that they want to im- this reason that one asks cause without such a space ac- plement a cohesive project, whether the management in- tion is not possible. They are they dedicate time and space to volved matches up to the fun- not very ambitious and they amalgamating the planning damental idea. are ready to accept even a with work meetings, and they small house in the countryside strive to acquire a certain cohe- or even a large tent. sion as a group. 1. By Way of Example Our protagonists do not seek In presenting the project much but in order to do a good they are well aware that they In our world, in this ever ex- job, even a minimal job, they must be open to the opinions, panding ‘global village’, we reach the conclusion that they to the suggestions and to the must act concretely and think must establish the equivalent contrasts that may emerge. in universal terms. I thus invite of a clinical history for every They have given themselves you to engage in this simple person in their care. the goal of ensuring that their journey with me, because even They would like to work project will be welcomed and though we will not need much with the help of a computer, accepted by everyone. luggage we certainly must em- but such a system is not as- They decide to inform them- ploy a significant amount of sured and, envisaging difficul- selves as to whether local cul- imagination. ties, they are forced, at least for tural rules or traditions exist, We could take any of our the moment, to work with a pa- and they try to educate them- works of care and assistance as per system, and thus it is that selves about them. They want a point of reference, from the they need an archive. It is clear to be scrupulous about the simplest to the most complex, that correct archive work in re- rules and regulations that have

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to be respected so these ser- hospital order in the hope that crete reality of any institutional vices can be begun, and about this fund will support them for project both in the world of the architectural requisites that the next five years. In ex- health and health care and in have been laid down. change, they undertake to send the social world. Above all, and in a special an annual report on the activity Nobody can fail to notice way, they will keep open a that they have engaged in and that it we wanted to transfer channel of dialogue with the on the expenditure and income this experience o the reality of local population, whenever this of their apostolic project. the hospital of the Fatabene- is necessary, before beginning After a year’s work our ideal fratelli of Regensburg, for ex- the project at a practical level. team has drawn up the project, ample, with its seven hundred A start cannot be made if peo- has presented it, has obtained hospital beds, intensive care ple are against you. all the approval necessary, and unit, and first aid departments, Now comes the most deli- has received economic help. multiple services, high technol- cate part: it should not be for- The local authorities and citi- ogy and enormous sets of qual- gotten that the financial dimen- zenry are favourable and thus ified staff, the process would be sion has to be dealt with and our team is now in a condition very much more complex. thus the members of the group must see how much the launching of the project will cost and what resources will be needed every month in order to sustain it and thus prevent it from being shut down after a short period of time. 39 After examining the situation of the area, they discover that the authorities cannot meet the costs of the building and that the local citizens are in financial difficulties and cannot pay even a minimal part of the costs of an examination or even purchase the medicines prescribed to them for prevention. In order to finance the launching of the project, they to begin their pastoral project. In the same way, if we want- learn that there is an Italian The project has been drawn ed to apply it to the group that NGO which specialises in this up in all its details but there re- provides mental health ser- field, and they present the pro- mains the question of who will vices of St. Boi, with its units ject to this organisation: they benefit from it, i.e. the final for care for the acutely ill and describe the buildings, the users. For this reason, the for the chronically ill, with equipment, the costs and the members of the group have to over three hundred outside work plan and so forth in order test the proposed initiative and units, the presence of nurses in to obtain financing for the the real response obtained to it. prisons, the units for psychi- start-up. Beginning with this informa- atric confinement in prison Believing that the demand tion, it will be necessary to etc., the elements to consider on the part of patients will in- study the evolution of the pro- would multiply, as would, of crease with time, they decide ject in order to obtain the high- course, the complexity of the to write a complete informa- est level of impact and interac- project. tion statement on the health tion. care project once it has been Lastly, given that the best launched – the buildings, the form of prevention is the 2. What Management equipment, the costs, work avoidance of infection, our Involves plan, etc. – because they think apostolic unit must decide up- that they will return to ask for on the way of avoiding infec- We will take as our point of further help if it subsequently tion by this disease, and in the reference the experience of our becomes necessary to expand most difficult scenario it must apostolic unit in order to try to the project. also provide the means by derive from it a number of con- As regards ordinary costs, which to avoid such infection. clusions about what manage- they fail to find an organisation The members of the unit are ment involves. I would like to that is prepared to support such aware that all this must be done offer a premise: management costs. They want the patients to with due respect for the specif- can be applied to all the fields contribute in part to the costs ic protocols that may have of life but in order to be practi- of management but this is not been published on the subject. cal I will limit myself to our possible. They thus decide to I would like to emphasise situation, to the provision of present the project to the Com- that this simulated experience care for, and the welcoming of, mon Fund for Missions of their could be applied to the con- the sick.

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A basic consideration have a contact with reality and with an on-going decision- A mission a theoretical approach that al- making process. lows the reaching of conclu- There is another fundamen- Without a mission it is im- sions. tal point about deciding which possible to reach any specific Starting from the needs ex- enriches its meaning. To de- point. There have been ‘gurus’ pressed, one reaches the con- cide involves taking risks; the who have promised an easy crete option to be followed: person who decides, the team economic result but at the there are many needs but it is that decides, and the institution same time have left this ap- necessary to make an effort that decides, are all taking proach out of the equation. that involves synthesis or con- risks. This is something that is Time has clearly revealed that clusions, As human beings, as inherent in the process and un- there are limits to projects of a human project, we must deal certainty is guaranteed. the ‘take the money and run’ with limitations, and it is not Taking decisions forms a kind. In a few words, do not possible to meet all needs; in- part of the process, just as try- look behind you to see the dis- deed, we need to choose, we ing to reduce the impact of the aster that you have left behind need to decide. risk factor to a minimum also you. forms a part of that process. People who dedicate them- Options The process described in our selves to thinking about the imaginary journey has as its field of management refer in Here we encounter a crucial central element the reduction clear terms to this point: hav- point in management: decid- of the risk factor, and this, we ing a mission is an essential ing. Management and making should never forget, is always part of every economic pro- decisions are bound up in an present. Indeed, we may say of 40 ject. In addition, without a inseparable way; indeed, they the members of the group that: mission it is not possible to im- form part of the same reality. – They will try to secure plement a management pro- Once the reality and the vari- agreement with the authorities. ject. There can be something ous needs are known, the fol- – They should ensure that else, but a management project lowing steps are made, the fol- the citizens do not engage in – in the company, in an institu- lowing decisions: opposition. tion, in a foundation, in a confessional body etc. – without a mission is something that is impossible. In the case of our example, this mission is not explicit, and people could observe that this is not a happy way by which to begin a reflection. I would like to make a brief observation, namely that in the case we have before us we began by referring to a work of a Hospital Order and at the present time I – Deciding on the needs or – A clearly important role believe that this order has not the need that have (has) to be should be given to the in- lost sight of the fact that it al- met. volved parties. ready has a clear mission, as – Deciding which resources – They will try to respect the an original concept and a pro- are needed in order to imple- culture of the local area. ject to be implemented, and ment the project. – They should obey the rules thus in the working unit that – Establishing how these re- and norms that exist in this has been outlined a mission is sources can be obtained. field. already present. – The organisation of fi- These are all integral parts nance. of the decision-making Elements to be taken – Proceeding with criteria of process, and everything is di- into consideration assessment. rected towards trying to reduce The reality – Etc. the impact of the risk factor to These are all concrete work- a minimum. A management project can- ing options; they are all deci- not be placed on the margins sions that have to be taken. The objectives. of reality, or better: if this is Further down the line, man- The work programme what is desired then this can be agement will also involve de- done, but it will end up by be- cision-making as a process, With respect to objectives, ing an intellectual abstraction, not decisions that are taken but we could give many orienta- a figment of the imagination, as a set of decisions that tions, but I will confine myself something that is merely ficti- emerge, with an examination here to certain general fea- tious. In the case of providing of the reality and the informa- tures. As regards objectives, care and welcome, this reality tion that is supplied to us and the only thing that I will seek must bring out a need, or dif- should be changed. In other to do is to answer certain sim- ferent needs, but it must also words, we are dealing here ple questions, which could be

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many in number but which I Legislation of concepts and orientations will limit to the following: are being introduced. – What do we want to do? This is a subject that in the It would be advisable to – How do we want to do it? past was hardly ever taken into maintain a minimal critical at- – When will we do it? consideration, but which is titude because in various situa- – When do we think we will now very important; perhaps, tions proposals relating to do it? indeed, too important: social management could be made When answering the first and health workers run the risk that in appearance are neutral question, the ‘what’, we will of living paralysed by the fears but which in fact are not so at speak about quantity, the vol- about whether they are obey- all and involve an economic ume of activity that we want to ing or not obeying the law. risk and the risk of causing ex- engage in. In the contemporary world, clusion. In the following section, that one cannot propose to society a of ‘how’, we will be thinking service that is at the margins of Information. Communication about our forms and ways of law. On the contrary, great at- working, with reference to the tention should be paid to limit- Social and health-care works quality of our services. ing professional responses so are for society but society must In the subsequent section, as not to be caught out by go- be aware of them, must know that of ‘when’, we will intro- ing against the law. how they function and work, duce the factor of time by dis- Legislation determines all and in addition must present its tributing our work plans over the spaces within which action views on them before they are time. Not everything can be can take place, and this certain- begun. done at the same time. Indeed, ly varies from country to coun- It is often the case that the it is necessary to plan the ac- try. But it is also true that there rejection of a social work that 41 tion that is engaged in. has been a certain harmonisa- takes place in a sphere of ac- The ‘where’ has a funda- tion of the contents of the leg- tions that are very intense is mental spatial element: it de- islation and norms that direct provoked by almost secret atti- lineates the space, the place such action, elements that in tudes which, although in some and the sphere of our action. the European Union go under contexts they are understand- the name of ‘directives’. These able, are in this instance not Resources refer to: health care and social justifiable. services; architecture, installa- The age when institutions In the world economic reali- tions etc.; and the world of could do as they pleased has ty that we live in, this has be- work and security in the work become something that become a very important factor, place. longs to the past in most coun- which is at times too impor- To speak about everything tries. Now a project that is ap- tant, if not, in fact, the only fac- covered by the legislative proved solely by the body that tor. We need only draw near to sphere goes beyond the para- promotes it is something that is the publicity that all health- digms of this paper. However, I no longer accepted in society. care bodies engage in to see will now present certain indi- Now information on the that in a clear or concealed way cations regarding the world of context, the needs, the legal re- they are talking to us about work. quirements, previous authori- means, their own and perhaps The world of work relations sations etc. are all required and only theirs, even though they has perhaps lost some of the demanded. try to sell themselves in other virulence that it had in the past. At the present time a great ways. Without having become a field deal of time is required to cre- It is true that without means that is easy to manage, and it is ate a relationship and establish no action is possible in the my view that this is something contacts with the local area for field of health and health care that will be difficult to accom- which the project is pro- or in the social field. It is true plish, it now has very clear fea- grammed. The advantages and that they are important ele- tures: we all agree that the disadvantages are weighed, ments in the project, but they rights of workers are losing and concessions and agree- are certainly not the only ele- ground; the world of sub-con- ments are made before the pro- ments. tracting and outsourcing is ject is launched. I will not dwell at length up- leading to very precarious Trajectories for the placing on this point. The means in- working conditions for which of a resource, such as the kind volved can be of a physical, the employing organisation of resource indicated above, al- human or financial character. does not feel directly responsi- low many obstacles to be The first involve buildings, in- ble but in which, nonetheless, avoided, obstacles that could stallations, equipment, technol- it participates. The temporary arise in the future when possi- ogy etc. The second involve character of labour contracts is ble delays could mean that a staff and personnel, in our case at the basis of the precarious return on the resource is diffi- professional workers, volun- character of work. cult to obtain. tary workers, benefactors, and In the legislative area and in The ordinary working of a members of our religious or- particular in the area of work, work requires the social work- der. The third are the funds that creativity in management is in ers to be informed with a cer- are needed to implement, and a state of constant evolution, tain regularity, and the authori- sustain, the project. and today changes at the level ties, the competent officials,

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the users, the professional Assessment decades, in addition to what workers and the benefactors to has already been indicated in be kept informed about our in- In practice: this paper, you also need tentions, both during the ‘qui- – What can happen? Our ob- courage and honesty: et’ moments and in the context jectives may not be reached. – Courage in order to pose a of difficult situations. – What should we do? Ex- primary and fundamental ques- The obtaining of invest- amine why our predictions tion: what need is this work ments is an inescapable part of were wrong. meeting at the present time? each initiative. Opinions have – Where should we begin in – Honesty in accepting the to be tested, information veri- carrying out this assessment? remote possibility that there fied. The more we know about On the basis of our predictions are no answers to this question. our work the better our condi- by analysing what has hap- I have already experienced tions of work will be. pened and using external fac- this process and I can assure tors that we may learn about. you that a great deal of courage The environment In our assessment we should and rectitude are required in analyse whether we have order to face up to this ques- For many years organisms of reached our objectives or not. tion, especially if one discov- an economic character – we If such success is not possible ers that an answer to it does not lay emphasis on the fact that we can always make some cor- exist. each one of our works is such – rections, but we can do this on- Together with other brothers were seen as a closed reality ly if a preventive approach has and co-workers we have ad- with a specific worth deter- been previously engaged in. If dressed this situation, which is mined by income and expendi- such has not been done, assess- pleasant for no one. 42 ture. ment is not possible and thus it I would like to lay stress on With the passing of time we will not be possible or feasible this point: once the question have seen that this was a partial to introduce suitable correc- has been raised, and the pres- vision, an incomplete vision, tions. ence or absence of an answer because economic organisms The most suitable work has been discerned, the process had a direct relationship with method is one that applies as- to follow is the same, as long, nature, from which they re- sessment to objectives and all that is, as one is prepared to be ceived a set of resources and to the components involved. Tra- loyal to one’s mission. which they returned varying ditionally, assessment is car- levels of waste materials. ried out on the basis of objec- Amongst us the idea is in- tives, but assessment can be 3. What is our Point creasingly gaining ground that applied to all elements: of Departure the resources of nature are not – The mission, and every- for Management? limitless and that waste, in thing that lasts over time, can varying ways according to how and must be assessed. When reference was made in it is treated or abandoned, can – Reality is not something this paper to objectives, one of be an impossible burden for that is static; it is always in the factors to be taken into con- the difficult equilibrium of our evolution. sideration was ‘where’ we planet. – For this reason, our option, want to act. Moving now to Economic organisms in the if we want to respond to this this third point, it can be ob- field of social services, and in a changing reality, can involve served that the meanings of more significant way in the being forced to promote this term vary. field of health-care services, changes. In the objectives a physical are consuming the resources of – This stage can lead us to element is referred to, a place, the environment, some of change our means or to look a space in which we want to be which are in reality in very for new means, in addition to present in order to promote our short supply. applying new resources. apostolic mission. In this case The economic organisms – Legislation is a constant of we are referring to a philoso- that work in the social services change and is becoming in- phy, to an identity; we are es- and above all in the health-care creasingly complex. tablishing the criteria by which services produce waste that This last point requires one we want to manage our work. contaminates the environment, further observation. It is proba- The answer to this question and some of them, such as radi- ble that some of those present seeks to establish the bases of ology, nuclear medicine, biolo- will pose the following ques- what we must see as the specif- gy and biochemistry, are doing tion: ‘in the case of a new work ic identity, the specific criteria, so in a special and demanding we can take it for granted that of a Hospital Order, We should way in relation to nature. the proposal is valid. But what not think that taking about a Here there is room for great should be done in relation to a charism is something that is sensitivity in management and work that has been under way exclusive, that involves search- we must be able to commit for some time (years or ing for exclusivity. This, in- ourselves to service to man and decades)? deed, would be an error. We contemporary society, but at I would like to say, my should not think that we are the same time we must avoid brothers and sisters, that in the seeking to bring out something compromising the future of na- case of a work that has been that belongs to us alone. Obvi- ture. under way for years or ously enough, this charism can

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belong to other people and to the negative, even though it whether they are in Asia, other bodies as well. would be better for that work America or Africa, the field in We should not confuse the to be managed by the order, which we can work is very ex- different parts. Everything in- even if all the advantages were tensive because these services dicated in the second point in its favour, that work would are not assured or because eco- cannot be, and must not be, ig- still be excessive. nomic crises have destroyed nored. In organising manage- This is the ultimate meaning what was previously achieved. ment this should be taken into of our mission, against which In these places, where are account and addressed when we cannot go. we and with whom do we any of our works is implement- work? In these countries there ed, whether it is large or small. Reality are various non-governmental Taking this as a starting organisations (NGOs), both of point, the specific, individual Throughout the medieval a confessional character and and characterising points must period and for a large part of otherwise, that constitute a sol- be established. It is true that in the modern age in Europe, the id presence in the promotion of ordinary life so many differ- ences cannot be established and that things come to be amalgamated, but in reflection it is equally true that these complementary approaches have to be engaged in. The Hospital Order has a fundamental element of refer- 43 ence for these criteria – its constitution. Its general statutes are a very practical and very concrete document that must be borne in mind as a point of reference. Lastly, we have recently engaged in an initiative involving reflection that found expression in the specific subject of our presence in society through our Identity Card. religious orders played an es- health-care services and social sential role in the field of services. What is our specific Mission health and health care and in contribution in this context? the field of the social services. The mission of the Hospital In most situations the state was The option Order is clear and evident: to not very much concerned to be witnesses to the mercy of systemise things and as a result In the light of our mission, in God towards those who are there was no body that was re- the light of actual reality, the sick and in need. This has to be sponsible for these services. question is simple: what deci- the lens that enables us to focus Today, in Europe, govern- sions should be taken? all the other indications. ments guarantee coverage for Our constitutions and our Any work of the Fatabene- these needs of their citizens. In identity card leave an enor- fratelli, at the beginning of the this situation, what is the spe- mous space open to us to be twenty-first century, must be cific character of our project? present on our planet – both in able to answer the following Voices that are critical of the industrialised countries and in question: in this work does the system allow us to discover developing countries – in the mercy of God towards those that not all the inhabitants of world of health and health care who suffer or who are in a state Europe are citizens who have and in the world of social ser- of need find expression? their social and health needs vices. Certainly an answer in the met: what can we say about Going forward rather and affirmative can involve differ- this situation? emphasising the urgent impor- ent shades and aspects and Can we find in the old conti- tance involved, perhaps it there can be moments of un- nent works of care that are in would be a good idea to intro- certainty, even moments of open competition with the duce some questions on the darkness, in discovering it. anonymous companies that suitability of our option for all Everybody is, and will be, an seek to satisfy these needs in our works. expression of the limitations of an approach based on the pur- As was said in point 2 in this every human work. suit of profit? paper, it is necessary to take There is, however, a fact that Should we be a part of this decisions constantly and ‘in a we cannot avoid: if the answer struggle? And if we should be process’, to use a phrase that is in the negative, if there is a part of it, what should our has already been employed, some work of the Hospital Or- specific contribution be? because it is precisely a der in which the answer is in In developing countries, process that we are dealing

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with here, that is to say a deci- ginning with his charism, his speaking about resources and sion-making process. But let us mission, which can involve a their use: be clear on this point – we are specific dimension. Indeed, we – Non-profit making bodies. dealing with a decision-mak- must strive to ensure that it – Beneficial and social char- ing process that begins with does involve such a dimension. acter. what is specific to us. The charism cannot lead us to – Financial balance. In choosing in favour of our define ourselves with reference Will it be enough to point presence, perhaps it would be to a work programme as any out that we do not seek prof- good to retrieve something of other administrative body, as its? There are NGOs that are our original radical approach, any other company or NGO, non-profit making and provide to make an effort to discover would. the same services. more specific spaces, places in I do not have a practical ori- I would like to go further which our presence and com- entation as to how to address and say that there are profit- mitment can allow us a pro- this question but I have certain- making organisations that are claiming that goes beyond me- ly observed the reality in- present in all our sectors and diation. volved; I have observed the ex- their good work is appreciated by both their users and by society as a whole. Why do we continue to use resources in the special way that characterises us if profit making is already present in this area or clearly intends to 44 be? We are a body that provides social benefit; this is something that is clear. We all agree that this does not involve concern about resources: there are people who trust us, and this is sufficient for them to give us something of what they possess so that we can use it. Thus, when one is dealing with ‘where’ and ‘how’ we apply these resources are we able to argue that there always exists a social-beneficial ele- Our reality has become a re- perience of our religious order; ment in what we do? To what ality of mediation, that is cer- and I believe that a large part needs are we allocating these tain, but perhaps we should of the diversity that our works funds? propose again to ourselves the express has been the result of I believe that the question of task of discovering essence in the creativity which our broth- financial balance does not re- presence. ers and co-workers have quire much comment. If this demonstrated in providing a balance is not achieved, prob- The objectives. response to new needs in an- lems may emerge – in particu- The work programme cient presences or to needs in lar the very survival of the new places. work – in the medium term. In The ‘what’, the ‘how’, the The mark of our mission, the the case of a work that cannot ‘when’ and the ‘where’ allow a risk and the responsibilities in- achieve this balance, what basic orientation, as I tried to volved in implementing these happens? And what happens if explain in a summarising fash- works, must, I believe, be in the specific case the work is ion when speaking about man- points of reference for us when a valid one? And vice versa, agement. The ‘what’, the we establish new work pro- should we be satisfied when ‘how’, the ‘when’ and the grammes, both in old works we witness situations that in- ‘where’ have an immense field and in new projects. volve the pursuit of the accu- of action if we strive to give Comfort, the fact of feeling mulation of wealth? them practical expression be- good, are situations that in the I do not feel that I can pro- ginning with our charism. short and medium term can ap- pose anything here; I am not When I spoke about mission I pear to be not very charismatic, as courageous as our founder, said that we should not base even though the work, in terms who had a lot of debts…but ourselves only on exclusivity. of facts and figures, presents we should ask ourselves Mission is something specific no clouds on its horizon. whether the positive imbal- that should not be interpreted ances accumulated in the long as being exclusive. Resources term are not perhaps more The focal point of the work dangerous than the debts in- programme is that this is a Three very clear phrases are curred for the project that we work of St. John of God, be- used in the identity card when are trying to defend.

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Legislation who ensure that our works ex- right. Here was a paradox: the ist, that is to say collaborators, promoter of health, the force – In the sector of health and voluntary workers, benefac- that should re-establish life, health care and/or social sectors, brothers etc., have the op- was polluting the area the tor. portunity to know about our most. – In the architectonic field, reality. Because of its very work dy- in the field of equipment, etc. Transparency in manage- namic, the quantity of means – As regards the world of ment means that beyond fi- that are needed for a hospital work, remuneration, and work nance – and this is a legal im- and that are used by it, for ex- safety. perative – society can and ample, could provoke situa- The Hospital Order has a must be informed about our tions of tension as regards this great deal to say and do in rela- data. balance. As a result, on the ba- tion to this subject. Are we to I find it hard to believe that sis of what is specific to us, it see ourselves as promoters of society and its agents really is our responsibility to estab- initiatives or is our approach a have such information, given lish what is correct, even when defensive one? the difficulties that our ac- we are in situations that we are We are all seeing the conse- counts brother encounters in unable to solve. quence of the new laws and learning about some of our regulations, which should be works. Assessment respected and which often do With a certain frequency re- not supply sufficient funds to ligious life is invited to engage In point 2, I pointed out all this end. For this reason, in tasks of denunciation, of the elements that can and must should our approach as a Hos- prophecy. Can we recognise be assessed in order to define pital Order, for example in re- that management, works of management. The characteris- 45 lation to subjects such as safe- care and assistance, or even tic that distinguishes us is the ty, at least at the level of reflec- the economy, are spaces for place and the criteria on which tion, be one of promotion, this invitation? we base the assessment of even though this has repercus- An institution that shuts it- each of these components. sions at the level of the effi- self up in an excessive way in Here mission is of primary im- ciency and performance of our its works runs the risk of portance. works, or do we want every- adopting defensive attitudes, I would like to emphasise thing to stay as it is? and if this occurs the mission the fact that we can carry out As regards work relations: of denunciation ceases to exist an assessment in a variety of – What should we do when as a proposal in a gradual way, ways. What is at stake is what the market is throwing the his- without being noticed. identifies us, and thus this im- toric rights of workers into the press, this special feature, must wastepaper basket? The Environment be evident when we subject – What should our attitude the whole of our work plan to be when sub-contracting dam- Today, for the Fatabene- assessment. ages the net remunerations of fratelli, balance and harmony If we show that we have an workers? in relation to nature must be a identity, if we make clear that a – Should we take part or not constant concern of our works. mission calls us and encour- in the trend of outsourcing ser- What we are seeking, namely ages us to action, in assessment vices in a drastic way with the the overall health of the per- we cannot leave this identity to sole intention of reducing staff son, is something that we lay one side, otherwise we would and reducing work risks? increasing emphasis on, and leave incomplete, and without – To what point should tem- lifestyle, it should be pointed effect, what we consider to be porary contracts arrive in our out, can be a source of health. specifically ours. sector? The promotion of health, the promotion of a healthy life, Information. Communication can be a good project for our 4. Specific Subjects hospital project. A healthy life for the Future The identity card employs a pre-supposes an existence that very clear phrase here: trans- is in balance with nature; in Somebody might rebuke us parency in management. This our case, to paraphrase, we for not finding time to predict also applies to transparency in could say: healthy manage- the future, and that person the field of information. For ment in balance with nature. would be right. We are not ex- years I have known the general Obviously enough, it is not periencing very glorious mo- accounts brother of our reli- very plausible to promote a ments for forecasts because, as gious order and for years I healthy life in cases where our specialists point out to us, have heard how many difficul- centres are a source of constant agents outside technology ties he encounters in obtaining contamination. By way of ex- have acquired a very important information that is clear and ample, I would like to offer role. verifiable on the economic sit- some comments on a hospital The long term is confirming uation of certain realities of in my province that had to deal Keynes’s famous phrase to the our order. with the protests of citizens effect that in the long term ‘we Transparency in manage- against its chimney, and there are all dead’. Specifically be- ment means that the people can be no doubt that they were cause of this situation, specifi-

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cally because of the reality and posed to large and centralised they are real protagonists of the development of our soci- provincial administrations that the work. ety, I believe that institutions run the risk of becoming dis- People are prepared to par- such as ours must aim at the tant from reality, and this is my ticipate when they see that long term. view for three reasons: they there is space for their involve- We cannot create the future run the risk of becoming dis- ment, if spaces for delegation – the future will be what the tant from reality, they concen- are established beforehand, if future will be. But we can trate on the economic aspect it is clearly shown that there is work, and work a great deal, to alone, and they end up by pro- space for personal involve- establish the foundations for viding answers to questions ment. the future that we can build, or without doing anything at all. However, let us not forget to put it better, we have a re- We propose two gears for a that a process such as this responsibility to aim for the fu- central administration: the de- quires prudence, assistance ture that we hope for. If exter- centralisation of the manage- and accompanying by the nal agents do not allow this, ment of works and the central- Provincial Curia. we must remedy the situation isation of the management of so as to return once again to those aspects of works that are Delegation: why? working for that future that we not connected with the provi- So that the managers and ad- want to have. sion of care and assistance. ministrators see themselves as The works must acquire a called, pushed, to be commit- 4.1. Central administration real direction in their work, a ted to the present and the fu- projection, and they should ture of every work. A strong central administra- take the form of autonomous So as to proceed with the 46 tion is what international or- bodies. The Provincial Curias delegation of responsibility to ganisations want to have. A must defend, support and cor- ensure that the section heads, strong and powerful adminis- rect this reality and this project the supervisors, middle-level tration is what nearly all inter- where necessary. management and other profes- national organisations possess. I believe that one of the ele- sional workers perceive that A central administration that is ments that a Hospital Order they, too, are invited in this a slave to economic results, to can display today is a plurality project to take on functions to short-term economic results, is of presences and the creativity construct the future and the what has become the norm in a that this involves. present of the work. significant number of interna- Centralisation can be an ex- To form new teams that feel tional organisations. cessive weight for creativity as committed to the search for You do not have to be a a basis for care. Even at the new forms of interdisciplinary clairvoyant to draw this con- cost of losing effectiveness response to the needs of man clusion. There are many exam- from an economic point of starting from this base. ples of central managers and view, and of running the risks To achieve creativity at the administrators who are closed of possibly losing control, moment of identifying new inwards. This is not a matter of which should be avoided, I in- needs and deciding what re- the actual size of the company vite priority to be given to cre- sponses to give to them. but of a temptation that ends ativity in the administration I recognise that a very sensi- up by prevailing, a temptation and management of works, tive subject is involved – pow- that sooner or later arrives. and this is more feasible when er. Delegation involves the Isolation and the making of there is decentralisation. giving of power and in some decisions at the margins of re- Centralisation of what is not circumstances this can arouse ality is a question of time. At strictly connected with the pro- fear and mean that we feel in- times it happens in the short vision of care allows agility in secure. To begin with, if we term; at others many years the movement of funds and delegate this means that we have to pass. In both situa- their application. Experience must allow others to act and do tions, the distance, the terrible teaches us that Provincial Cu- so according to their styles and distance, of reality, at times rias are freer, more solidarity- criteria. To delegate so that hard reality, means that we in- inspired and generous, when people do things as we would vent reality. they share their available ex- do them has no purpose. Not long ago I was listening cess resources. Works, on the I believe that a defensive at- to a reflection on an ecclesial other hand, always find rea- titude towards power can in- question, of importance in the sons for not transferring their volve an implicit trap. A defen- government of the Church, surplus. sive attitude can close down which in laconic but convinc- the spaces of creativity, of in- ing form was as follows: too 4.2. Centres novation. With the giving of much time is dedicated to pro- power an achievement of cre- viding answers to questions Delegation. Participation. ativity is not guaranteed, but and nothing is done. Distance This is the step that follows experience has taught me that from reality, cold distance decentralisation. It involves there is greater freedom to pro- from reality, was one of the delegating to the managers of pose, to suggest, and to give an conclusions of the speaker works the capacity to take de- impetus. With the giving of about why this took place. cisions in these spheres. In this power, in the long term, au- For this reason, I am op- way such people will feel that thority itself is gained.

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4.3. Legal status come independent legal enti- centres, there will be many ties. I believe that this step ‘frontier areas’ in which a I have put the question of le- would allow us greater free- brother will have a very special gal status in the third sub-sec- dom to contribute, to support role. Where life enters a state tion but I do not consider it to and to stimulate. of crisis, and our society is be a subject of secondary im- I believe that this is a logical tempted to say that an action is portance for the future of our step in decentralisation and not worthwhile, we encounter institution. I believe that it is delegation. If in the end every- a privileged space for a Brother necessary to find new formulas thing reaches the desk of the of St. John of God, indepen- for the legal status of our Provincial Father, little ground dently of the country or conti- works. has actually been gained. nent in which he is present. I could dedicate time to ex- I believe that gospel-inspired I well know that this is a pro- plaining my vision of sub- boldness will be lacking given ject that involves risks, a large sidiary responsibility in the that the brake of comfort and number of risks, but in this contemporary legal formula positions that think that ‘we are century what other space re- but I would not like the image well off as we are’ can have a mains for our brothers which of defence to be replaced by great influence and leave us does not involve risks? Let us the image of danger in direct- rooted to the spot where we are not forget that in many places ing my reflection. standing. I know of religious where we our presence is to be I believe that we have ar- orders in Spain that have not found there are private profit- rived at a suitable moment in wanted to face up to the future, making organisations that are the history of our order to be- despite the challenges. This is prepared to occupy our posi- gin to free ourselves from the something that they show all tion, and if they have not man- burden that oppresses us. I sin- too clearly in their attitudes to aged to do so as yet, they will 47 cerely believe that the burden their works. manage to within a short space of our works is such that we What I am proposing, I may of time. are leaving behind us our free- observe, some Provinces have We brothers do not have a dom, our creativity of action. already achieved, I do not monopoly on charism, but I be- To paraphrase a maxim re- know whether this is the result lieve that we are called to be peated in religious life, I be- of the criteria adopted or of a the guarantors of this philoso- lieve that the burden of works legal imperative, but for some phy, of this identity, and to today does not allow us to have years things have been work- keep watch so that the project light luggage, and if a reli- ing well. For example, our is not limited to being an eco- gious, an institution, loses its brothers and co-workers in nomic reality. In the times we agility, this conditions his/its France have a great deal to say live in this is a matter of no freedom and thus the freedom on this subject. small account. of his/its response. The challenge should be ad- I would like to introduce the 4.4. And our brothers? dressed. idea that some works, perhaps the greatest and those projected In this project, which in- Fra. JOSÉ L. GARCIA IMAS, towards the future, could be- volves hospitals and social O.H.

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Bioethics in UNESCO

Ten have passed since the consultation and debate in vance by placing it within a then Director General of UN- which questions about the ad- framework of values that safe- ESCO, Dr. Federico Mayor, vance of genetics and biotech- guards the life and dignity of created the International nologies are raised. the human person. One is deal- Bioethics Committee. This or- The historical-scientific con- ing here with placing man once gan has produced two interna- text of the last decade of the again at the centre of the scien- tional documents: the ‘Univer- twentieth century favoured the tific endeavour and thereby sal Declaration on the Human emergence within UNESCO avoiding his exploitation as a Genome and Human Rights’ of a greater awareness of the mere means, being convinced, (1997) and the ‘International subject of bioethics, together to employ the words of Mon- Declaration on Human Genetic with the political desire of the taigne, that ‘science without a Data’ (2003). By the autumn of international community to conscience is merely the ruin 2005 the ‘Universal Declara- equip itself with instruments of the soul’ (‘science sans con- tion on Bioethics’ should also and means that would be suit- science n’est que ruine de have been proclaimed. These able in responding to this plan- l’ame’). are international instruments of etary challenge. Indeed, the a rather moral character but end of the twentieth century 48 which nonetheless have not will be remembered as an ex- 1. The Ten-year Commitment failed to influence not only the traordinary decade because of of UNESCO in Relation legislation and the norms of in- the formidable scientific dis- to Bioethics dividual States but also the cul- coveries that took place in the ture, the education and the field of the life sciences: the In illustrating the ten-year lives of the peoples of our birth of the first cloned mam- commitment of UNESCO in planet. This is because these mal (the sheep ‘Dolly’); de- relation to bioethics I will declarations are the bearers of rivations from human embryo dwell upon the two important a vision of science and life and cells; and the titanic effort of international documents on of a philosophy about man that the international scientific bioethics that it has drawn up do not always respect the life community to achieve the se- so far and which were adopted and the dignity of human be- quencing and the mapping of by the general conference of ings. the human genome. member States in 1997 and This paper on the concept of As the scientific patrimony 2003. bioethics in UNESCO seeks to of mankind and a formidable offer some elements that are potential for its well being, 1.1. The Universal Declaration relevant to the bioethics that these discoveries have turned on the Human Genome are dominant in an internation- out to be – above all with re- and Human Rights al context – and in a special spect to some of their applica- way in UNESCO – and which, tions in the reproductive The outcome of five years of in the name of cultural and and/or therapeutic field – am- work, this document was unan- philosophical pluralism, lead biguous or even ambivalent as imously adopted by general ac- to a levelling of values, are regards, for example, human clamation at the twenty-ninth formed on the basis of consen- cloning (‘yes’ or no’ to repro- session of the general confer- sus, and favour a political-pro- ductive and/or therapeutic ence of UNESCO (1997) and cedural approach to questions cloning), research on and the adopted by the United Nations and issues. use of embryo stem cells (is it at its general assembly held in Ten years or so ago, as has licit or not to carry out re- 1998. The fundamental idea of already been observed, the then search on and use embryo this declaration is the protec- General Director of UNESCO, stem cells?) and the commer- tion, within the field of re- Dr. Federico Major, had the ad- cialisation and patenting of search on the human genome mirable idea of creating the In- certain gene sequences (what and its applications, of every ternational Bioethics Commit- can or cannot be commer- human being, with respect for tee at UNESCO. This was an cialised and/or patented as re- his dignity and rights. For this independent, pluralist and in- gards the human genome be- reason, the declaration has two terdisciplinary organ made up cause of intellectual property frameworks: of personalities and men of sci- rights?). ence and culture from all the At a cultural level, the speed 1.1.1. The dialectic of free- regions of the world and from and the unstoppable character dom of research and the rights different professional back- of scientific progress over re- of the person involved. In this grounds, in which would be ex- cent decades has provoked in sense, the declaration refers to pressed the moral and social society an awareness of the practices against the dignity of hopes of society. In short, the need to draw up and clarify the person such as reproductive International Bioethics Com- ethical rules and principles that cloning (art.11). Respect for mittee has become today an in- are sound and able to inform the rights of people is defended ternational force of reflection, scientific and technological ad- by the principles and norms of

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the declaration in relation to come of studies and debates sents general provisions to be expressed free consensus, con- carried out by the International applied to the whole of the de- fidentiality, and the defence of Bioethics Committee and the claration before addressing its people’s private lives. Inter-governmental Bioethics various parts. Committee. In October 2003 Sections C, D and F deal re- 1.1.2. The protection of hu- the declaration in question was spectively with the gathering man rights as regards the ge- adopted by the thirty-second of samples that are then used netic particularities of human general conference of UN- for the production of human beings, which leads the decla- ESCO. genetic data; the treatment of ration to formulate norms The fundamental principles such data; their use and their against forms of discrimina- on which the declaration is conservation. Each section tion, to define the ownership of based are respect for the pri- deals with specific questions: genetic data, and to clarify the vate life and the autonomy and the consensus of the person, principle of the confidentiality the rights of the individual. his possible withdrawal and of genetic data associated with Centred round the gathering, the right not to be informed; an identifiable person. the treatment, the use and the genetic advice; questions relat- conservation of human genetic ing to access to, and the quali- The declaration in question data, this declaration takes into ty and the security of, the data; does not limit itself to the con- consideration genetic and pro- the confidentiality of the genet- text of UNESCO. Through its teomic data, as well as biologi- ic data and their conservation, adoption by the general assem- cal samples. making these data anonymous, bly of the United Nations it be- The declaration also estab- the free circulation of human came universal in all the meanings of that term. 49 Appreciation of the work achieved by the declaration – many of its principles and norms can be subscribed to – does not prevent the formula- tion of certain critical reserva- tions about some of its points. The way in which article 1 is formulated, according to which the human genome is the patrimony of humanity, even though in a symbolic sense, is debatable because the human genome belongs first of all to individuals. Article 11, which mentions only reproductive cloning as a practice against human dignity, could lead one to think that so- called ‘therapeutic cloning’ is morally licit. On this point, the international bioethics committee of UNESCO did not up date, in conformity with article 11, the list of practices and techniques that are in opposition to the dignity of man. Lastly, by limiting itself to lishes a clear distinction, on the genetic data, the regulation of laying down an ethical posi- one hand, between the various the cross-border flow of genet- tion, without envisaging a ju- purposes for which human ge- ic data, the sharing of benefits; ridical mechanism that re- netic data are gathered and and the management of data at quires the norms of the decla- used, and, on the other, be- a national level, to give only a ration to be observed, this doc- tween the various stages of few examples. ument remains a mere declara- their collection, treatment, use Section D deals with the tion of intent. and conservation. promotion and the implementa- After a preamble involving tion of the declaration, and 1.2 The International eight considerations, there is emphasises the duty of States Declaration on the regulatory part made up of to implement its legislative and Human Genetic Data twenty-seven articles placed in regulatory principles, as well seven sections. Each article has as action as regards education, The second document of an a title indicating the subject training and information. international character drawn matter, as is the case with inter- The ethical-juridical frame- up by UNESCO, the Interna- national texts of this kind. work of the declaration allows tional Declaration on Human Section A deals with defini- defence against some of the Genetic Data, was also the out- tions, whereas Section B pre- harm that can be caused by the

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gathering, treatment, use and cies of the family of the United bioethics. The various interests conservation of human genetic Nations). of a commercial, financial or data to the exercise of, and re- political character obstruct the spect for, the dignity of the hu- 2.2. A critical assessment upholding of transparent forms man person, human rights, and of the above orientation of behaviour based on the fundamental freedoms. sacrosanct duties to engage in In article 3 on the identity of 2.2.1. The ‘reconciling and truth and responsibility in the the person, proposed by the consensual’ approach to bioethical debate. delegation of the Holy See dur- bioethics that transpires from ing the final drafting, the dec- the speech of the Director Gen- 2.2.7. Cultural diversity (the laration, giving emphasis to eral consecrates the so-called sixth principle) is upheld at the freedom, avoids falling into de- ‘procedure bioethics’ that pre- same time as the ontological terminism by attributing to ed- vails in international forums. unity of human beings who ucational, social, environmen- Moral principles and values share the same human dignity tal and genetic (etc.) factors have their foundation in the and have the same rights and their right role in the construc- ‘consensus’ that one should freedoms. tion of the identity of the per- reach in questions connected son. with life. As in the case of the Univer- Conclusions sal Declaration on the Human 2.2.2. Confusion in the rela- Genome and Human Rights, tionship between bioethics, In his communication to the International Declaration medical ethics and deontology those responsible for missions on Human Genetic Data has reigns because the bioethics at UNESCO, Mr. Koichiro 50 only a declaratory value, and proposed by the speech of the Matsuura confirmed that a thus it does not have a mecha- Director General takes the process is underway at an inter- nism that allows the applying place of medical ethics and de- national level which involves of pressure on States and ap- ontology. The language of the international legitimation peals to them to respect the these last is employed without, of procedure and consensus rules that it contains. however, taking into consider- bioethics in opposition to ation the moral imperatives metabioethics. Such bioethics and the deontological norms are without authentic moral 2. The Bioethical inherent in these disciplines. values and principles and could Orientation of UNESCO be defined instead as bio-law. 2.2.3. Common values or Two opposing visions of 2.1. The structure of the speech universal ethical references bioethics now hold the stage: emerge or derive, according to bioethics that is democratic The speech of the Director the Director General, from the and consensual and is based General to the permanent dele- discussions of experts as a re- upon the rules and principles of gates to UNESCO, which was sult of the consensual method. international law and human given on 20 June 2003, amply rights; and bioethics that is ob- illustrates the cultural and 2.2.4. The pragmatism jective and open to humanistic philosophical assumptions to which is a presented as a first and transcendent values. be found in the seven axiologi- principle of the bioethics pro- Although it is possible to cal principles, as well as the gramme of UNESCO overval- agree with the statement of the five axes, around which the ues the subjective empirical Director General to the effect bioethics programme of UN- experience to the detriment of that the purpose of the ESCO is organised. The a metabioethics of objective bioethics of UNESCO is the speech of the Director General principles and values which protection and the defence of revolves around seven bioethi- can be acceded to thanks to the dignity of the human per- cal principles (pragmatism, a reason illuminated by faith. son against possible abuses multidisciplinary approach, and/or ‘dérives’ produced by a transparency, participation, 2.2.5. The multidisciplinary distorted use of the knowledge communication, cultural diver- approach (the second princi- and results of genetic research, sity and the appropriation of ple) suffers from an imbalance it is not possible to agree with results) and five larger axes between an excessive empha- the cultural and philosophical (the identification and analysis sis on the scientific dimension assumptions that underlie the of ethical questions and issues, which, for its part, encourages axiological matrix of the the establishment of principles a scientistic and positivistic bioethics promoted by UN- and norms of an ethical char- mentality, as well as an impov- ESCO or with the methodolo- acter of universal application, erished reference to the princi- gy of procedure and democrat- the strengthening of the ability ples and values of open objec- ic consensus by which views to engage in scientific research tive morality. or judgements as to what is lic- and bioethical studies, the pro- it are arrived at. motion and sensitisation of 2.2.6. Transparency (the professional and political third principle) as an ethical Msgr. JEAN-MARIE MUSIVI spheres, as well as the general imperative for scientists and MPENDAWATU, Study Assistant, public, in relation to bioethical bioethical experts is severely the Pontifical Council questions and issues, and co- contested by the eclecticism for Health Pastoral Care, operation between the agen- that characterises procedure the Holy See.

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Genetic Disease Predisposition and Choice

In western countries, breast mor suppressor genes such as that will find expression in a cancer is the most frequent p53 or the neurofibromatosis child and an adult if allowed visceral type of cancer in type 1 and 2 (NF1 and NF2) to develop. Every mother women. Women’s lifetime genes are associated with can- knows that no two siblings risk of breast cancer is ~10%. cer. Some mutations affect are the same and no sibling While the majority of cases genes that do not directly pre- could substitute for another. A are sporadic, about 10% are dispose to cancer but that also choice is being made, the em- inherited. In these situations, result in transmissible dis- bryo without the mutation is a parent passes onto their off- eases such as hemophilia or selected, the others are dis- spring a faulty copy of a gene cystic fibrosis. carded. The underlying prin- that increases the child’s risk Faced with this situation ciple in this choice is that life of breast cancer. This mutated some women elect not to have with a disease predisposition gene will in turn be transmit- children. Others, base their is less worthy than life with- ted to their offspring. A sig- decision on the results of a out it. The dignity of life is nificant percentage of inherit- prenatal test. Yet others have therefore being made contin- ed breast cancers are account- recourse to in vitro fertiliza- gent upon health. ed for by mutations in the 51 breast cancer 1 and 2 tumor suppressor genes (BRCA1 and BRCA2). The estimated lifetime risk of breast cancer in women who inherit mutations in BR- CA1 or 2 is 50-85%. BRCA1 and 2 mutations also increase the risk of other malignancies such as ovarian cancer. Com- pared to sporadic cases, women who inherit mutations in the BRCA genes, tend to develop breast cancer at an earlier age. About 10% of these patients are diagnosed with breast cancer during their reproductive age. This poses an important dilemma. Women with breast cancer who are found to have a mutation in BRCA1 or 2, will pass the mutation to their offspring. Their children will have a 50% chance of inherit- ing the mutated gene. This is also the case for women in families known to carry one of the mutations who may not tion coupled to prenatal ge- This philosophy is devas- be affected by breast cancer netic diagnosis. In this situa- tating. It implies that sick themselves but that have been tion, eggs are fertilized in vit- people are less worthy of life found to carry the mutation. ro and screened for the pres- than those that are not. It While these women suffer ence of the mutation. Only would appear therefore that the agony of an uncertain fu- fertilized eggs that lack the sickness strips human beings ture and perhaps the conse- mutation are implanted. of their right to life. Instead of quences of breast cancer, it is It is important to realize, inspiring us to respond with only logical that they try to however, that this approach is mercy, we respond to illness spare their children what they based on a principle of eugen- with death. This attitude also themselves have to go ics. Embryos with a disease has profound dehumanizing through. (or in this case a predisposi- effects on society. Taken to Aside from breast cancer, tion to develop a disease) are the next level, it could be ar- there are other diseases that not implanted, and are in fact gued that health is merely an are linked to genetic muta- destroyed. Every embryo has indication of normality and tions. Mutations in other tu- a unique genetic constitution that only the life that falls

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within a realm of defined nor- screening of male germ lin- We have been created for eter- mality is worthy of existence. eage is likely to be more com- nity. Life’s ultimate goal is not While it is obvious that par- plex. While other alternatives self preservation, but rather to ents are not responsible for exist such as adoption, the un- bring life to fulfillment, which their own genetic makeup or derlying problem remains. entails the acceptance and en- for that of their children, At the core there is a mis- actment of God’s plan for us. many women feel responsible guided perception about the This requires faith, to believe for transmitting a faulty gene meaning of life. Paraphrasing that God knows best and that on to their offspring. New re- the Holy Father, in a society He loves us, in fact, that He search efforts are required. It that has lost sight of God, loves us more than we love is conceivable that unfertil- man becomes unintelligible. ourselves. We were created in ized eggs could be screened When death is perceived as His image and He raised us up out for the presence of the the termination of existence, to live the life of God. The mutation. Since the analysis life’s most important goals meaning of life is revealed to of the egg itself would result become self preservation and us by Christ. We are called to in its destruction, this would self gratification. In this con- a life of love and dedication to have to be performed through text, illness is perceived as others. The main obstacle to the analysis of daughter cells evil. Illness is evil on the ba- living this way is sin. The generated in the process of sis of attacking what is con- bondage of sin was broken by egg development. These eggs sidered to be the supreme Christ. But he chose to re- could be introduced in the good, physical well being. deem us through suffering. Falopian tubes and made Suffering, while the conse- Albeit in a mysterious way, available for fertilization. quence of the original sin is suffering can transform us in- 52 While technological develop- not evil. Christianity seeks to to Christ and can be united to ments might relieve some remind us that there is life be- his redemptive sacrifice. women from the burden of yond death. Our life on earth transmitting to their children is like the life of a baby in her Dr. JIM BRUGAROLAS, a faulty gene, this technology mother’s womb, a short pre- M.D., Ph.D. may not be accessible to amble. The baby cannot fath- Dana Farber Cancer Institute and everyone. In addition, men om what will come after birth, Brigham and Women’s Hospital Harvard Medical School can also transmit to their off- and neither can we fathom Boston, Massachusetts spring the mutated gene and what will come after death.

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Testimony

Witness of a Life in Illness

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Witness of a Life in Illness

1. The Human and available to everyone, includ- person’s faith, hope and love Christian Profile ing the teachers. for other people. Being a wit- of our Daughter Laura For us it was a moment of ness, a person feels the im- great joy when the lecturers pelling need to proclaim, share Laura was a young woman and the students thanked us for and transmit what he or she has of twenty-one, a fourth-year the contribution of her work heard, seen and experienced. law student at university, a nor- and her love within the univer- In living out the stages of mal girl, of her times, who had sity when she was in good this witness, there can be no everything that she could want health, and for her greatness of doubt that the illness of our at that age: a family, success in spirit during the period of her daughter was the greatest event her studies, health and a fiancé. illness. What a great truth in- of our existence. These mo- She had finished her studies at deed we find in these words: ments of our witness are the the College of the Maids of the ‘what will you give me, earth?’ deep roots of every other wit- Sacred Heart in Cordoba, ‘What you sow’. ness. where she had received, as she had from her home, that seed of 2. The Stages of Witness 3. The Event 54 the treasure of faith that was to bear fruit in the acceptance of In order to understand in a After a summer spent in full her illness and her suffering. more effective way the event health and at the beginning of a During her illness she said to and to discern in it the presence new course, Laura was struck her mother: ‘Mummy, after so of God, we think that it is es- by a sudden, aggressive and in- many years with the sisters, sential to share the various mo- curable illness which in only their founder, St. Rafaela ments of our life witness, a wit- sixth months was to carry her Maria, could help me’. Her ness that is not the outcome of to her death. This illness in- mother replied: ‘at the best, our efforts or our apostolic volved cancer of the brain and God’s plans will be others’. commitment and enthusiasm, the spinal column, and this re- And she always finished in the even though out role was very quired an operation and radia- same way: ‘things will go as important. If such were the tion treatment in cycles and led God wants’. case, this would amount to to paralysis, weight loss, etc. When she was at boarding bearing witness to ourselves What was really important was school, amongst her human and not to the wonders that the fact that in our family we values there stood out an ap- God works in our lives. God discovered that behind this proach and a readiness to help takes an initiative, comes to us event there was God, who marked by constant service to and transforms the event into loves us. other people. When we went to work of His grace. visit the school her teachers An event. Witness comes said to her: ‘Lauretta, you are through an event that at times is 4. How we Experienced near to the beyond, intercede happy and at times is painful. the Event with God for all of us, those of A discovery. Beyond this us that have known you, loved event we discover the presence Both we ourselves and, sur- you, and educated you’. of God, who loves us. prisingly, Laura as well, ac- She followed a course of An encounter. If God is there cepted the will of God. COU at the College of the and if we place no obstacles in We began to live out our ‘Salle’ in Cordoba where, once the way, then the encounter faith with a greater depth: ma- again, at the top of her scale of with Him will take place. turing it, transmitting it, cele- values was her spirit of service, A change. Every encounter brating it, and trying to experi- and this was so much the case with the Lord produces a ence the joys and the sadness of that at the end of the course she change in a person’s life, which every day! For us it was clear was unanimously awarded by can no longer continue to be that the future was God! her teachers and the other stu- the same. A person’s heart is di- Very soon these approaches dents the medal of exemplary rected towards God and from produced their fruits. We could classmate. being a heart of stone it is perceive that she accepted her Lastly, at the Faculty of Law transformed by God into being illness, how it matured her per- she left such a mark behind her a heart of flesh. sonality, how it enlarged her when it came to human values Acceptance of the will of faith, how it strengthened her that her lecture notes are for God. If all of this takes place, will, how it purified her heart, everyone a point of reference then a person is in a condition which became cleaned of the because of the quality and com- to accept God’s will, however dust that had been acquired mitment she expressed in them, painful the event may be. during her life’s journey. Laura but above all because of her Being a witness. This is noth- realised that the hopes of her generosity in making them ing else but the expression of a young man, her passion for her

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career, her friendships, the en- In only six months she the test, and all this despite the vironment, etc., were coming reached perfection after many fact that she would have to to an end. years. God subjected her to tri- leave all those things that she Despite this fact she was als and made her worthy of her- lived out in such a deep and very keen to live and placed self. She was grateful to God committed way. great hopes in science and in and was loved. Her young life was like a the power of God. At the same One of the great experiences flower open to a precious exis- time, there was a great spiritual of the last days of her life was tence with God, whom she growth in her, in which suffer- the celebration of the sacra- loved. At the end, her serene ing began to be resurrection ments of reconciliation, the Eu- and almost transfigured face and the sacraments a grace and charist and the anointing of the perceived the loving joy of her a spiritual balm. sick: nearness to fullness and a imminent encounter with God. The illness managed to make waiting room leading on to the Her fiancé displayed an iron- clad loyalty with a love that goes beyond time. For him, as well, the witness of Laura was a ‘light for the journey’. Her friendships, her boy and girl companions, received a strong shaking of witness which led them to reflection and to being an example, mark- ing them for ever. In hospitals, both in those in 55 Cordoba and in those in Seville, she called people’s attention to the peace, the joy, the serenity and acceptance of her illness, to the wonderful way she behaved with everyone and to her maturity, despite her young age. She called upon, and led, the staff of the hospitals to reflect. what was ordinary, extraordi- loving encounter with the Fa- For many patients the way in nary; it managed to achieve a ther. which this young girl lived out great step forward in her daily her illness and the wisdom of spirituality. In the face of fear, the cross of Jesus Christ was a she challenged death with her 5. Other Experiences spiritual balsam and consola- smile and her beautiful love, tion for their own illnesses. filling everyone with hope and Here, in these experiences Lastly, we include the expe- making us enjoy the nearness her aunt, Maruja, will provide rience of the priest, Don Anto- of the life beyond. the testimony of the family, her nio Evans Martos, who at the In the last days of her life she fiancé, her friends, the staff of present time is the secretary said to her mother: ‘Mummy the hospitals in which she re- general of the diocese of Cor- I’m dying’, and her mother ceived treatment and care, and doba: replied: ‘My daughter, look up, of other patients. When Antonio and Laura already you can see the bright In her family. In a very spe- told me that their daughter Lau- light of the world beyond and cial way she loved her brothers ra wanted me to administer to the Father who is waiting for and sisters, and above all her her the sacrament of the anoint- you with open arms to wel- little sisters. She saw herself as ing of the sick they told me come you. There, there is no the second mother of these last about her phenomenal ap- illness or suffering’. Laura’s because there was quite an age proach to receiving it: she was answer was: ‘Mummy, help me difference between them and without any fear, in a state of to pass over to the other side’. their mother. peace, ready at any moment to Consoling words, passionate She left behind her great hu- accept the will of God, and words full of self-abandonment man pain for all us all, but at marked by a profound experi- to the Lord; words which for all the same time great peace at ence of faith. We thus decided of us are a great treasure. having seen how she embraced that after celebrating the sacra- For us a flower was broken her cross and how she placed ment of penitence we would in the fullness of youth and one herself in the hands of the Lord administer the sacrament of the of our models was smashed. with simplicity, humility, love, anointing of the sick during the However, we would like to and at times even with joy. Her celebration of Holy Mass, to- share with you how we lived happiness was immense during gether with the whole of her and continue to live with joy the many hours that they ac- family. how for her the teachings of the companied her during her long And this is exactly what we Book of Wisdom were being periods in hospital, where her did. After the simple and pro- fulfilled. attitude of patience was put to found experience of the sacra-

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ment of penitence, of personal pacity, love…and she found faith, a domestic church that encounter with the faithful everything softer and lighter… lived out a very bitter experi- mercy of God who welcomes How clearer everything is ence, that of entrusting to God us as we are and loves us, the when one begins taking faith as a young person who knowingly whole of her family gathered one’s starting point! accepted her journey to heaven round her bedside and the im- These were the approaches by placing herself in the hands provised altar in order to live that were proclaimed and lived of God. out as a domestic church the out with simplicity and natural- celebration of our faith. ness and which acted as a At every moment we wanted preparation to receiving the 6. Messages of this Life to stress that what we were do- sacrament of the anointing of Witness ing was a celebration because the sick. When, after the homi- we were placing ourselves in ly, we prepared to administer – In order to be credible we the hands of God, His grace, this sacrament, everyone gath- must be witnesses. There are His strength, His love and His ered together in saying the many teachers but there is not presence. He filled, and gave prayer of the litany so that at an equal number of witnesses. meaning to, everything that we every moment Laura could The teacher speaks about what were experiencing. He was our count on the power, the he learns and the witness talks safety, our hope and our peace. strength, and the consolation of about what he lives out and ex- We had faith and we pro- God. In silence we then placed periences. claimed that we had faith. We our hands on her head…Her – Salvation is to be found in knew that the moment had grateful face, her serene ex- illness, in the cross, in death, come when Laura had reached pression, and her approach of and in resurrection. 56 the end of her life, even though prayer in welcoming the gift of – In the new evangelisation she was at the beginning of true the Holy Spirit, were really people are needed who bear fullness of life and health. moving. witness to the word and to life We chose as a reading the Fully aware and deeply with joy. Letter to the Colossians 1:24- moved, Laura received the – One can be young, happy, 28. We did this in order to com- sacrament, welcomed the grace normal and of these times, municate to everyone that Lau- of the Holy Spirit, and placed which we have been called to ra, too, was thankful for, and herself completely in the hands live through. But at the same considered a privilege, being of God. time we should also be witness- able to collaborate, through the All of this helped to prepare es to the ministry of salvation contribution of her suffering, for the offertory and the conse- of Jesus Christ. with the passion of Christ for cration of the Holy Mass. This Our gratitude goes to those the redemption of the world was her last and final offertory, many people who prayed and and the good of the Church; her absolute and total consecra- accompanied us so as to make that these were not theories, tion to Christ. The whole of the these experiences possible. It that there she was, offered, en- Mass was marked by a strong goes in particular to Msgr. José trusted and grateful, living in intensity and constituted a great Luis Redrado who allowed us Christ the will of God and feel- experience of faith. The smil- to share his paper and who is ing the redemptive value that ing and grateful serenity of now opening to us the path by her life certainly had. Lauretta struck everyone. It which to be operators and wit- The reading from the Gospel was her anointing, her last nesses of the new evangelisa- was that of St. Matthew 11:25- Mass, the consecration of her tion with words and lives made 30 because we, too, praised life to God, the culminating into an offering to God. God for having revealed to us point of her life, her entry into that He would give us every- fullness…and she experienced Dr. ANTONIO TORRALBO thing and take nothing away – it with an absolute intensity, re- MORENO, neither illness nor pain nor that ceiving it in communion and Diocesan Delegate for Pastoral necessary pathway through being afterwards in a deep and Care in Health, Spain death. Laura praised God be- serene state of grace. LAURA RIGUAL COLLANTES cause, joined to Christ, she had This was an authentic experi- Diocesan Sub-delegate everything: light, strength, ca- ence of personal and family for Pastoral Care in Health, Spain

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Pastoral Care in Health in America and the Caribbean: Towards a History of Pastoral Care in Health

‘The world of health is cer- Care (DEPAS). The recent cre- driguez, on the subject ‘Ethics tainly been the subject of spe- ation of the Pontifical Com- and Handicapped People: An cial attention on the part of the mission for Pastoral Assistance Active Model for Medical Church down the centuries. to Health Care Workers on 11 Care’; and h) Sister Susanna Following the teachings and February 1985 by the Apos- Rodriguez, on the subject the example of Jesus, she has tolic Letter Dolentium ‘Ethics and Medicine Faced always showed her nearness to hominum in the form of a Motu with Handicapped People’. the sick, like the Good Samari- Proprio certainly contributed to Dr. Eduardo Zubizarreta tan of the gospels. On many this initiative. The year before took part in the debates to talk occasions and in many places the Holy Father had already on ‘Ethics and Medicine. Fam- the Catholic Church has been, published his apostolic letter ily Planning’, as did Rev. and continues to be, a pioneer Salvifici doloris in which he Manuel Marco, who spoke on and a promoter of health both encouraged Christians to pro- ‘Integral Care for the Hospi- through supplementary activi- mote, organise, complete and talised Patient’, and Dr. Hugo ties and through carrying out extend their ministry to the Obligio, who offered a contri- 57 her specific pastoral mission’. sick and those who suffer. bution on ‘The Organisation of These words of Cardinal Ange- This first meeting was pro- Catholic Doctors and Humani- lo Sodano, at the First Meeting moted by the Department for sation’. of Latin America and the Social Pastoral Care (DEPAS) The conclusions of the meet- Caribbean on Pastoral Care in and the International Federa- ing referred in particular to the Health (1989), in his letter ad- tion of Catholic Medical Asso- ethical aspects of family plan- dressed to Msgr. Fiorenzo An- ciations (FIAMC), with the ap- ning, transplants, the terminal- gelini, who at that time was proval of the Pontifical Com- ly ill, AIDS, and drug addic- President of the Pontifical mission for Pastoral Assistance tion.1 Council for Pastoral Assistance to Health Care Workers. The to Health Care Workers, sum- principal objective of the meet- marise the role of the Church ing was to examine, in an open 2. The Second Latin in the world of health down her dialogue and in the light of the American Meeting history. Magisterium of the Church, the on Pastoral Care Although the Church in ethical questions and the ques- in Health (1989) Latin America and the tions connected with humani- Caribbean has always worked sation relating to the sector of The first Latin American in the field of pastoral care in health and health care in Latin meeting reawakened many health, nonetheless her action America and to make certain concerns as regards the field of as a consolidated field of pas- commitments as regards the the humanisation and evangeli- toral care of Bishops’ Confer- tasks and the mission of the ec- sation of health and health ences and the Latin American clesial community in this field. care. However, certain shared Episcopal Council (CELAM) The meeting was divided in- guidelines that could have di- is rather recent. At this confer- to three parts: a conference, de- rected pastoral care in health at ence I would like to present bates, and group work. The fol- a continental level were absent. certain ‘contributions’ to an lowing speakers gave papers at Indeed, in some countries pas- understanding of the historic the conference: a) Rev. José toral care in health was identi- journey of pastoral care in Luis Redrado O.H., on the sub- fied with pastoral care for sick health in this continent. ject ‘Evangelisation and Pas- people, something that gave a toral Care in Health’; b) Rev. protectionist emphasis to the Domingo, on the subject ‘The study of the subject. 1. The First Latin American Church and Human Health’; c) The consultancy team on Meeting on Pastoral Care Dr. Zoilo Cuéllar, on the sub- pastoral care in health of the in Health (1989) ject ‘The Humanisation of CELAM was entrusted to Rev. Medicine’; d) Dr. Herbert Viz- Adriano Tarrán, and the draw- The First Latin American carra, on the subject ‘Ethical ing up of a working document Meeting on Pastoral Care in Problems in Psychiatry’; e) Dr. which would serve as a basis Health was held at Bogotá on Gabriela Gueriero, on the sub- for starting the discussion was 2-6 October 1989. It was in ject ‘Transplants: Ethical As- entrusted to a team from the that year that the CELAM in- pects’; f) Dr. Elba de Giorgiut- Cammilian Centre of Colom- corporated the area of pastoral ti, on the subject ‘The New Ge- bia. At that moment pastoral care in health into its global netics: Medical Applications of care in health in the continent plan by allocating to it the De- the Methods of Pre-natal Diag- acquired a new dynamic be- partment for Social Pastoral nostics’; g) Dr. Hernando Ro- cause the working document2

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which was sent in good time to the methodology of the meet- dent of the Pontifical Council all the countries involved was ing, in addition to the papers for Health Pastoral Care, on transformed into an instrument that were presented, ample pastoral care in health; by Ms- for reflection and debate in the space was also given to the gr. Romulo Emiliani, the Apos- episcopal commissions on pas- work of groups dedicated to tolic Vicar of Darién, Panama, toral care in health and the specific subjects in the drawing on presence in the world of grassroots movements and or- up of papers and the drafting of pain; and by Msgr. Patricio ganisations dealing with this the final document. Flores, the Archbishop of San- field. The final document had t’Antonio EEUU, on ‘the worst Thus, on 14-18 September three parts: 1) the approach to epidemics of our time: AIDS 1994, the second Latin Ameri- the reality of health and health and drugs’. can Meeting on Pastoral Care care in Latin America and the Msgr. Lozano Barragán pro- in Health was held in Quito, Caribbean; 2) the theological posed certain very concrete Ecuador. Delegates from Ar- bases; 3) pastoral care in orientations: a) that pastoral gentina (3), Bolivia (2), Brazil health. This last part presented care in health should form an (2), Colombia (4), Costa Rica the concept of pastoral care in effective part of the ordinary (1), Ecuador (1), Guatemala health, its objectives and its di- planning of each of the dioce- (1), Paraguay (1), Peru (1), mensions; the characteristics of ses of America and Bishops’ Porto Rico (1), Uruguay (1), the agents of this kind of pas- Conferences; b) that the Bish- and Venezuela (2) were present toral care; the centres that pro- ops’ Conferences of the conti- at the meeting, as was Cardinal mote pastoral care in health; nent should foster the union of Luis Aponte Martinez, the and some guidance as regards Catholic hospitals, chaplains, Archbishop of San Juan in Por- operational structures.3 medical doctors, patients and 58 pharmacists in a national and international plan; c) that emphasis should be placed in the dioceses of America on concern with, and the fight against, smoking, alcohol and HIV, which are some of the principal maladies that most cause deaths in adults; d) that each diocese should become committed to promoting the culture of life against the culture of death with practical programmes that express themselves in the preferential option for the poor and respect for un- born life; e) that we pastors should become aware of the need for a specific form of pastoral care for the elderly and for the morality of palliative care; f) that priests in the to Rico. Msgr. José Vicente This document went round parishes of America should Eguiguren, the Vice-President the whole continent. It became give priority to pastoral care in for Latin America, and Rev. transformed into an obligatory health in its broadest sense; g) Jorge Techera, the executive teaching document for the that in the seminaries of Amer- secretary, represented Caritas. training of the agents of pas- ica, pastoral care in health in In addition to the leading toral care in health active in the particular should be taught, figures of DEPAS, the follow- world of health and health with emphasis on contempo- ing also took part in the organi- care. At the same time, the rary bioethical programmes sation of the meeting: Rev. need was felt to broaden reflec- that involve genetic engineer- Adriano Terrara, Dr. Italo Bar- tion on the subject of training. ing. ragán, Director of the OPS in For his part, Msgr. Emiliani Ecuador, and Dr. José Carlos urged an active presence by the Cuentas, Director of UNICEF 1. Pastoral Care in Health bishops, priests and pastoral Ecuador, on the study of ques- in the Synod of America agents in the world of pain and tions connected with health (1997) exclusion with the provision of and health care in the conti- solidarity and hope to those nent; Rev. Julio Munaro, on the The special assembly for who suffer. For his part, Msgr. biblical-theological founda- America of the Synod of Bish- Patrick Flores invited the Syn- tions of pastoral care in health; ops was held in 1997. In the od fathers to work together in and the lawyer Isabel synod hall three papers on the two specific fields: HIV and Calderon, on the analysis of subject of pastoral care in drug addiction. the situation of pastoral care in health were given: by Msgr. Pope John Paul II was to deal health in the region. As regards Javier Lozano Barragán, Presi- with these concerns in his post-

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synod exhortation Ecclesia in cal Council for Health Pastoral gramme for the Analysis of America. With regard to drugs, Care, gave the inaugural paper Health, Dr. Carlos Castillo-Sal- the Pope asked for special at- and it addressed ‘the Presence gado; its managerial assessor tention to be paid to the victims of the Church in the World of Dr. José Romero Teruel; and of drug addiction and at the Health’. Dr. José Romero Teru- its co-ordinator Dr. Carlos Cu- same time he called for joint el, of the Pan American Health neo. The CELAM was repre- action to combat the phenome- Organisation, spoke on ‘Health sented by its President, Msgr. non of the drug trade (nn. 24, Policies in Latin America and Jorge Jiménez Carvajal; its 61). As regards the field of inte- the Caribbean’. Dr. Alvaro Di- General Secretary, Msgr. Fe- gral health, he stressed the ur- az offered an analysis of ‘the lipe Arizmendi; the Executive gent need for ‘total giving in Situation of Pastoral Care in Secretary of the DEPAS, Rev. favour of human life from the Health’. Rev. Leo Pessini gave Francisco Hernández Rojas; moment of conception until the a paper on ‘the Identity of Pas- and by the Rector of the moment of natural death’ (n. toral Care in Health’. Rev. Lu- ITEPAL, Rev. Leonidas Ortiz. 63) and for a pastoral and ethi- ciano Sandrin, President of the In addition to the participants cal approach to ecology (n. 25). International Institute of sent by the World Bank, Dr. Health Care Pastoral Theology Xavier E. Coll, Director of the of the Camilianum of Rome, Department of Human Devel- 4. The Third Latin presented a reflection of pas- opment of the Regional Office American Meeting toral theology on ‘the Agents of Latin America and the on Pastoral Care in Health of Pastoral Care in Health’. Caribbean, and Mrs Katherine (1998) The methodology of the meet- A. Bain, regional specialist for ing took into account the ex- civil society, also took part in These orientations of the change of experiences on the some sections of the meeting. 59 synod were a positive stimulus training of agents and the The meeting had three major for the organisation of the group drafting of illuminating moments: 1) the speeches of Third Latin American Meeting principles and core issues of greeting of the Director of the on Pastoral Care in Health training, in addition to orientat- OPS and the President of the which was held in Santo ing papers.4 CELAM, together with the Domingo, the Dominican Re- The conclusions of the third presentation of the participants public, on 16-20 September meeting were appended by and the respective organisa- 1998, with the collaboration of Rev. Adriano Tarrarán and the tions; 2) an exchange of infor- the Episcopal Commission of team of the Camillian Centre mation on the work of the OPS Social Pastoral Care-Caritas of to the ‘Latin American Guide and the CELAM, and also on the Bishops’ Conference of the to Pastoral Care in Health’, their financing and their work Dominican Republic and the which was published in the re- methodologies; and 3) an iden- Catholic University of Santo view Medellin. tification of certain shared Domingo – UCDS. The sub- fields of work in the various ject of the meeting was ‘The countries of Latin America and Training of Agents of Pastoral 5. The CELAM-OPS the Caribbean. Care in Health’. Sixty-one del- Meeting (1999) The general commitments egates took part in the meeting, adopted were the following: and they represented Argentina A meeting of the heads of a) to generate awareness in the (3), Brazil (2), Colombia (7), the Latin American Bishops’ various welfare, political eco- Chile (3), Guatemala (3), Haiti Councils and the Pan Ameri- nomic and religious states, (5), Honduras (1), Mexico (2), can Health Organisation was that investment in health re- Peru (7), Porto Rico (1), the held on 16-17 November 1999 duces exclusion and injustice; Dominican Republic (20), and in Washington DC at the head- (the joint effort of the OPS and Venezuela (5). quarters of the OPS. the CELAM is itself an at- Msgr. Javier Lozano Bar- The objectives of this meet- tempt to reduce injustice); b) ragán, President of the Pontifi- ing were the following: to pro- to condemn the unjust situa- cal Council for Health Pastoral mote mutual acquaintance; to tions that exist in the field of Care, as a representative of the exchange work experiences health and health care and pro- Holy See, chaired the meeting. from the various sectors, in mote elements in favour of Dr. José Romero Teruel, asses- particular experiences connect- health; c) to promote certain sor of the Pan American Health ed with health; and to identify general themes in all our work Organisation (OPS) was also certain common fields of col- such as concern about child- present, as was Rev. Francisco laboration at a regional level. hood, adolescents and women, De Llanos Pena, delegate of As representatives of the and in particular preventive the Department for Pastoral OPS, the following participat- education as regards HIV, al- Care in Health of the Spanish ed in this meeting: its Director coholism, smoking, and inte- Bishops’ Conference. Msgr. General, Dr. George A.O. Al- gral sexual education; d) to Carlos Talavera Ramirez, Pres- leyne; its Vice-Director, Dr. give priority to all our actions ident of the DEPAS, and its ex- Mirta Roses Periamo; the Di- in the countries most in need ecutive secretary, represented rector of its Department for the in the region: Bolivia, Haiti, the CELAM. Promotion and Protection of Honduras, Nicaragua and Msgr. Javier Lozano Bar- Health, Dr. José Antonio Solís; Guatemala. ragán, President of the Pontifi- the head of its Special Pro- Certain concrete commit-

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ments were also adopted, ed concrete commitments to the psychology of health and amongst which the following promote a set of programmes illness; evangelisation and pas- may be emphasised: a) to plan for the training of pastoral toral care in health; the cele- a programme of systematic workers in the world of health bratory dimension: praying training of the agents of pas- and health care. and the sacraments of the sick. toral care in health, perhaps Thus the Department for So- The fourth level. The year with the conferring of a diplo- cial Pastoral Care (DEPAS) 2003: the culture of life: ethical ma in pastoral care in health or and the ITEPAL organised a questions; the humanisation of preventive education for situa- course for a diploma in the hu- health and health care; the the- tions at risk; b) to up-date manisation of health and pas- ology of the body; the presence training as regards the reality toral care in health, which has of the Church in the world of of health and health care in four central focuses: the psy- health and health care down Latin America and the cho-social, the ethical, the the- the centuries, with emphasis on Caribbean; the Special Pro- ological and the pastoral. Latin America. gramme for the Analysis of Complementary laborato- Health of the OPS will provide 7.1. The diploma in the ries: human rights and health; this service to the CELAM; humanisation of health the rights of the sick; education and c) to explore, together with and pastoral care in for health: the solving of con- the Department for Ecu- health (2002-2003) flicts; groups of mutual assis- menism (SECUM) of the tance and the working out of CELAM, the possibility of a The taking of this diploma pain (pastoral care of hope). joint initiative of an ecumeni- has as its aim that of offering to Those who attend the pro- cal character in the field of pastoral workers (priests, reli- gramme are given a diploma in 60 health and health care. gious, members of the laity) an the humanisation of health and integral training that takes into pastoral care in health. account the sociological, theological-biblical, psychological 7.2. Training in pastoral care and spiritual aspects of the sub- in health in seminaries ject so that they can engage in pastoral service in a profes- In April 1999 the CELAM sional way and meet the needs published its textbook on pas- of the world of health and toral care in health as a part of health care. the series of basic texts for The programme involves Latin American seminaries as a 480 hours of attendance and is contribution to the training of organised into four levels: future priests. This publication The first level. The year was under the direction of the 2000: ethics and bioethics I; Latin American Secretariat for the care relationship I; the Renewal (SELARE) of the 6. The Fourth Latin Church, a healing community; Hospital Order of St. John of American and Caribbean the identity of the worker in the God. This work has six exten- Meeting on Pastoral Care field of pastoral care in health. sive chapters: 1) the world of in Health (2003) At this level, which lasted suffering and Christian faith; four weeks of intensive work, 2) suffering in the Bible; 3) The Fourth Latin American the following experts offered salvific pain (the Magisterium and Caribbean Meeting on their contribution: Rev. Arnal- of the Church on suffering); 4) Pastoral Care in Health was do Pancrazi, on the subject ‘the pastoral care in health, a jour- held in San Paolo, Brazil, on 5- identity and meaning of reli- ney towards life; 5) the priestly 8 April 2003. The central ob- gious service in a health insti- ministry in pastoral care in jectives of this fourth meeting tution’ (30 hours); Rev. Leo health; 6) specialised pastoral were: 1) the establishment of Pessini, on the subject ‘ethics care in health. general lines of action that and bioethics’ (30 hours); Rev. would make possible commu- Luciano Sandrin, on the sub- nion for solidarity as regards ject ‘the Church, a healing Conclusion pastoral care in health in the community’ (30 hours); and new times; 2) to strengthen and Fra. José Carlos Bermelo, on The short journey that pas- consolidate the process of the subject ‘the pastoral care toral care in health has had as a structuring and organisation of relationship’. field connected with the De- pastoral care in health in Latin The second level. The year partment of Social Pastoral America and the Caribbean. 2001: the sociology of the Care (DEPAS) of the CELAM world of health and health is a journey that has been fruit- care: the care relationship II; ful and promising. 7. Training Programmes health, illness and suffering in During the meeting held in the light of biblical theology; Bogotá in 1999 certain ques- Both the Latin American the spirituality of service to the tions connected with ethics and meetings held in Santo Domin- sick. the humanisation of health and go and San Paolo, like the The third level. The year health care were examined. It OPS-CELAM meeting, adopt- 2002: ethics and bioethics II; was as though a whole range of

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realities and concerns experi- cally through the exchange of vice to sick poor people; union, enced at the present time in the lecturers, materials and publi- peace and concord between the world of health and health care cations. It is urgently necessary brothers and fathers of the or- had been opened up. to create a network of training der; and ascetic spirituality and A qualitative leap was made in pastoral care in health at a the acquisition of knowledge by the meeting in Quito (1994) Latin American level and or- that is useful and necessary. when, in addition to examining ganised by the Bishops’ Con- This is the challenge of the the situation of health and ferences. next years that the Church health care, certain shared In San Paolo (2003) the must meet with generosity and guidelines were formulated for structural and situational fac- courage. the direction of evangelisation tors that influence the trends in this specific field of pastoral and levels of health in Latin H.E. Msgr. JORGE ENRIQUE care. America and the Caribbean JIMÉNEZ CARVAJAL, In Santo Domingo (1998) a were examined, and emphasis Co-adjutant Archbishop of Cartagena, step was taken towards the was placed on promotion, pre- Colombia. construction of qualified areas vention, care and rehabilitation for the training of pastoral in the field of health, and upon workers so that they could en- overall care in relation to the gage in pastoral service in a illnesses that are prevalent in professional way and meet the Latin America and the needs of the world of health Caribbean. Notes and health care. It is important The best contribution that 1 The proceedings of the meeting were to strengthen the training of ecclesial groups and religious published in the volume Evangelización workers at different levels and communities that are dedicated de la Salud in the series containing the 61 in different contexts, from ini- to pastoral care in health in documents of the CELAM (n. 125, June 1993). tial training to specialised Latin America and the 2 The work document was published training, and from basic train- Caribbean can make is to in the DEPAS Bulletin (n. 10, March- ing in communities that pro- choose in favour of the training April 1994). 3 The final document of the meeting mote the health of their mem- of pastoral workers, moving was published as an issue of the CELAM bers to training at parish, from a paradigm of protection Bulletin n. 264 in November 1994. Some countries, for example Brazil, published diocesan, national and regional to a paradigm of prevention. It it and disseminated it widely in the com- levels. is moving to read the testamen- missions and basic groups concerned The study centres that are es- tary letter of San Camillo de with this field of pastoral care. This document, enriched by the contributions of tablished with this intention Lellis of 10 June 1614. Very experts of the episcopal commissions on must offer programmes that are near to death, he addressed the pastoral care in health, and especially by suited to the circumstances of brothers and fathers of his reli- the third Latin American and Caribbean meeting, was published in the current every country or region and at gious order in order to remind edition of the review Medellín under the the same time they must them of what was essential: title ‘A Guide for Pastoral Care in Health strengthen each other recipro- poverty and fundamental ser- for Latin America and the Caribbean’.

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XIX International Conference XIX International Conference Presentation Vatican City, 11-12-13 november 2004 Palliative care In the Pontifical Council for Health tion to such care should be. The Pastoral Care we strive at the time of presence of the mystery of the death our international conferences to and the resurrection of the Lord is Thursday, 11 November choose subjects that are not only of made contemporary today through interest but also need to receive spe- the sacraments and thus we want to 9.00 GREETING cial direction from the Holy Father. study this presence through the Today, given the great development sacrament of the anointing of the PROLUSION: The Christian Meaning in the life sciences, it is not strange sick. It is certainly the case that our of Pain. A Theological –Pastoral Reading of Salvifici Doloris that the application of such research approach is contradicted, or at least His Eminence Cardinal to the final stage of human life is in- not taken into strong consideration, Javier Lozano Barragán creasing and that questions are aris- by contemporary Western culture be- President of the Pontifical Council for ing that give rise to increasing con- cause of its secularisation. And thus Health Pastoral Care, the Holy See cern. it will be relevant, before going fur- This is the reason why we are ther, to consider the impact of secu- 10.00 Chairperson: dedicating our nineteenth interna- larisation on the final stage of life. Dr. Jean Paul Mundama tional conference to the study of pal- Lastly, in this stage of our conference Professor of Medical Ethics at the Catholic University of Graben-Butembo liative care and to receiving, thereby, on illumination, we will come to a (Democratic Republic of Congo) the indications of the Holy Father on practical point: what is exaggerated this burning question. treatment? The illumination will be fi- An International Survey Indeed, we will begin our confer- nally completed by an inter-religious of Palliative Care ence by investigating the Christian dialogue about palliative care in the Dr. Cecilia Sepulveda meaning of pain, given that palliative great religious traditions outside Coordinator Programme on Cancer care exists specifically to alleviate Christianity – Judaism, Islam, Hin- Control, World Health Organisation, pain. We will then enter to the full in- duism, Buddhism, and Post-Moder- Geneva (Switzerland) to our subject. nity. Following previous practice, our In the third part of the conference Break method has three well-defined we will ask what should be done. In The Contemporary Situation stages: after obtaining a general vi- this perspective we will speak about: sion of our position in relation to the the renewal of the sacraments for 11.00 1. The Problems and Questions of the subject, which we will offer with the the sick – the Viaticum, the anointing End of Life in the Mass Media Magisterium-based conference on of the sick, and reconciliation; the di- Rev. Vincent Arackal the Christian meaning of pain, we rection of contemporary medical in- Official of the Pontifical Council for Health want to observe the question in itself quiry and research; the role of the Pastoral Care, the Holy See according to the way in which it pre- psychological sciences in palliative 2. The Results of an Inquiry on sents itself today. We want to touch care; a new cultural approach to the Palliative Care the very reality that is experienced end of life; the training of palliative Dr. Fiorenza Deriu today. Thus we will begin this first care workers: the end of life in the Social Researcher, Rome (Italy) part with an international survey of mass media; the approach of med- Consultor of the Pontifical Council for palliative care. This survey will exam- ical doctors, priests, nurses, reli- Health Pastoral Care, the Holy See ine palliative care as it is presented gious, the patient’s family relatives, by the mass media in daily life. We psychologists and social workers, 3. Pain: The Scientific Data will also refer to an inquiry that has and finally volunteers, in palliative Dr. Simona Castellano Physiatrist at the Paraplegics Centre of been carried out into palliative care. care. Ostia, Rome (Italy) We will then study the scientific data As has already been observed, the on pain and its treatment before go- Holy Father will guide us in this diffi- 12.00 4. The Treatment of Pain ing on to ask ourselves about what cult field with his authoritative words. Prof. Pierluigi Zucchi palliative care is and what it is in All those giving papers at, or mak- Director of the Institute for the Study and practical terms in today’s world. We ing a contribution to, our conference, Therapy of Pain, Florence (Italy) will then emphasis the juridical as- have been chosen with great care, Consultor of the Pontifical Council for pect of palliative care and we will re- and they are amongst the best in this Health Pastoral Care, the Holy See fer to euthanasia, seeing this as sector in the world, as can be appre- 5. What is Palliative Care? something that is closely connected ciated from the names in the pro- Dr. Maurizio Evangelista to such care. gramme. Researcher at the Institute of We will then move to the second We would be very honoured if you Anaesthesia, Reanimation and Pain part of our conference in order to il- could accept our invitation to take Treatment, Catholic University of the luminate the realities that we have part in these days of study, which, in Sacred Hearth, (Italy) discovered about palliative care. The definitive terms, wish to provide an first illumination will be sought by us answer to the ultimate questions 13.00 End of the Session with reference to the history of such about our existence. Many thanks! care in the Catholic Church. Then, 16.00 Chairperson: Dr. Franco de Conno beginning with the central fact of His Eminence Cardinal Javier Director of the Department of Christianity, namely the death and Lozano Barragán Rehabilitation and Palliative Care at the resurrection of Christ, we will ask President of the Pontifical Council National Institute for Cancer Study and what the Christian orientation in rela- for Health Pastoral Care Treatment, Milan (Italy) DH n.56 ing 1-64 1-09-2004 17:24 Pagina 63

6. What are the Principal Palliative 11.00 Break 5. The Training of Workers who Treatments in the Contemporary Administer Palliative Care World? 11,30 Inter-religious Dialogue: Palliative Rev. Angelo Brusco, M.I. Dr. Stein Børge Husebø Care in the other Great Religions: Professor at the “Camillianum”, Head of Department Geriatrics and International Institute of the Theology of Palliative Care, Bergen-Sandviken Judaism: Pastoral Care in Health, Rome (Norway) Prof. Abramo Alberto Piattelli Member of the Pontifical Council for Visiting Professor at the IFF of Vienna and Rabbi of the Jewish Community of Rome Health Pastoral Care, the Holy See Head of the European Intervention Project Professor of Post-Biblical Judaism, on Palliative Care for all. Pontifical Lateran University, Rome 18.45 6. The End of Human Life in the Mass Media 7. Euthanasia: What it is and What it Islam: H.E. Msgr. John Patrick Foley is not (Biological Aspects) Prof. Iehia-El- Rakhawi President of the Pontifical Council for The Baroness Prof. Ilora Finlay of Professor of Psychiatry at the University Social Communications, the Holy See Llandaff of Cairo Dean of Palliative Medicine Department, Head Physician of University Hospital – End of the Session Velindre Hospital Whitchurch, Cairo University Cardiff, United Kingdom Hinduism: 17.00 8. The Juridical Aspects Dr. Rajeev Agarwal Saturday, 13 November Senior Consultant and Chairman in of Palliative Care 9.00 Chairperson: Dr. Fernando Antezana Surgical Oncology at Sir Ganga Ram Hospital, New Delhi (India) Mrs. Lillian Fanjul de Azqueta Minister of Health of the Republic Founder and Director of the “New Hope” of Bolivia, Buddhism: Foundation, Palm Beach (U.S.A.) Consultor of the Pontifical Council Rev. Masahiro Tanaka, M.D. for Health Pastoral Care, the Holy See Physician at “Medical Clinic Fumon-it”, 7. The Up-dating of Health Workers Chief Priest at “Buddhist Temple in the Pastoral Aspects Break Saimyou-ji, Mashiko (Japan) of Palliative Care

Illumination New Age - Post Modernity - Priests Rev. Fr. Jan Daçok, S.I. H.E. Msgr. Jacinto Guerrero Torres 18.00 1. The History of Palliative Care Professor of Moral Theology and Ethics at Bishop of Tlaxcala and Bishop Rev. Jesús Conde the Faculty of Theology of the University in Charge of Health Pastoral Care, Director of the Diocesan Health Pastoral of Trnava (Slovakia) México; Care, Madrid (Spain) Member of the Pontifical Council for 12,45 End of the Session Health Pastoral Care, the Holy See 2. Palliative Care, the Death and Resurrection of Our Lord 16.00 III. What Should Be done? 9.15 - Medical Doctors His Eminence Cardinal Rodolfo Prof. Miroslav Kalinowski, Ph.D. Quezada Toruño Chairperson: Director of the Chair of Social, Palliative Metropolitan Archbishop of Guatemala Fr. Pascual Piles Ferrando, O.H. and Hospice Care at the Institute for (Guatemala) Superior General of the Order of St. John Family Studies, Catholic University of of God, Rome Lublin, Poland 19.15 End of the Session Member of the Pontifical Council for Health Pastoral Care, the Holy See 9.30 - Nurses Ms. An Verlinde 1. Renewal of the Sacraments President of C.I.C.I.A.M.S. Friday, 12 November for the Sick: Penance, (International Catholic Committee of Anointing and the Viaticum Nurses and Medico-Social Assistants), 9.00 Chairperson: His Eminence Cardinal Carlos Amigo Belgium Rev. Anthony Frank Monks, M.I. Vallejo Consultant of the Pontifical Council for Superior General of the Camillians, Rome Archbishop of Seville (Spain) Health Pastoral Care, the Holy See Member of the Pontifical Council for Member of the Pontifical Council for Health Pastoral Care, the Holy See Health Pastoral Care, the Holy See 9.45 - Members of Religious Orders Sr. Marie-Sylvie Richard 3. The Sacraments of the Anointing 16.30 2. The Direction of Medical Director of the Hospice “Jeanne Garnier” of the Sick and the Viaticum Investigation for Palliative Care, Paris (France) Rev. Eugenio Sapori, M.I. Dr. Vittorina Zagonel Professor of Liturgy at the “Camillianum”, Specialist in Oncology and Hematology, 10.00 - Family Relatives International Institute of Theology of Director of the Operational Unit of Ms. Cristina Calabresi Pastoral Care in Health, Rome Oncology, Fatebenefratelli Hospital, Rome President of the “Federico Calabresi” Foundation, Rome 4. Faith and Secularisation 17.00 3. The Role of the Psychological in the last Stage of Life Sciences in Palliative Cure 10.15 - Psychologists and Social Workers Rev. Bonifacio Honings, O.C.D. Rev. Tony Anatrella Dr. Vito Ferri Professor Emeritus of Moral Theology at Psychoanalyst and Specialist in Social Psychologist at the “Gigi Ghirotti” the Pontifical Lateran University, Rome, Psychiatry, Paris (France) Foundation, Milan (Italy) Consultant of the Pontifical Council for Consultor of the Pontifical Council for Health Pastoral Care, the Holy See Health Pastoral Care, the Holy See 10.30 - Voluntary Workers Rev. Raymond Zambelli 10.15 5. Proportionate and Break Rector of the Basilica of Our Lady of Disproportionate Lourdes, France Palliative Treatments, 17.45 4. A New Cultural Approach Exaggerated Treatment to the End of Life 10.45 End of the Session Prof. Richard Horton His Eminence Cardinal Paul Poupard Publisher and Editor of “The Lancet”, President of the Pontifical Council for London (United Kingdom) Culture, the Holy See DH n.56 ing 1-64 1-09-2004 17:24 Pagina 64