DOLENTIUM HOMINUM No. 85 – year XXIX – No. 2, 2014

Journal of the pontifical council for health care workers (for health pastoral care)

Editor-in-Chief Archbishop Zygmunt Zimowski Executive Editor Jean-Marie Mupendawatu

Editorial Board Dr. Antonino Bagnato Don Marco Belladelli Dr. Daniel A. Cabezas Gómez Sr. Anna Antida Casolino Professor Maurizio Evangelista Rev. Bonifacio Honings Dr. Beatrice Luccardi Dr. Rosa Merola Mr. Luigi Nardelli Monsignor Jacques Suaudeau

Editorial and Business Offices: Pontifical Council for Health Care Workers (for Health Pastoral Care) 00120 Vatican City; Tel. 06.698.83138, 06.698.84720, 06.698.84799 - Fax: 06.698.83139 e-mail: [email protected] www.holyseeforhealth.net

Published three times a year. Subscription rate: 32 € postage included Printed by Editrice VELAR, Gorle (BG) 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

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Contents

3 Saturday, 22 November 2014 21 Report on the Activity the Lord Called to Himself of the Pontifical Council Cardinal Fiorenzo Angelini for Health Care Workers: 2009-2014

5 Fiorenzo Angelini 30 Presentation of the ‘Good Samaritan’ Msgr. Jean-Marie Mupendawatu Foundation Msgr. Jean-Marie Mupendawatu 6 He Lived Intensely and he Died ‘Living’ H.E. Msgr. José L. Redrado, OH 33 The World Days of the Sick Msgr. Jean-Marie Mupendawatu 7 Cardinal Fiorenzo Angelini Father Felice Ruffini, M.I. 41 The International Committee of Catholic Health-Care Institutions (CIISAC): 8 Words that Sound out, Genesis and Prospects Actions that Shine Dr. Antonino Bagnato Third International Conference 9 A Testimony in Memory of His Eminence Organised by the Network Cardinal Fiorenzo Angelini of Pastoral Care in Health Prof. Bonifacio Honings, O.C.D. of the Ecumenical Patriarchate of Constantinople 10 Spirituality – Humanity – Charity and Rhodes, 8-12 october 2014 Action: the Great Virtues of a Painful and Joyous Journey Prof. Filippo M. Boscia 44 Report Msgr. Dariusz Giers

VIII Plenary Assembly of the Pontifical Council 45 Intervention of the Pontifical Council for Health Care Workers for Health Care Workers ‘Do good with your suffering and Msgr. Dariusz Giers do good to those who suffer’ (Salvifici doloris, 30) 24-26 March 2014 TOPICS

14 Address of the Holy Father Francis 48 Childhood and the Anthropology of Pain Prof. Le Breton 15 Report 52 Pain in the Elderly: Anthropological, 16 Homily of the Secretary of State Clinical and Theological Aspects. Cardinal Parolin A New Classification Prof. Pierluigi Zucchi, S.O. 18 From the Encounter with the Living God Prof. Bonifacio Honings, O.C.D. to the Journey Towards Man who is in Need and Suffering, the ‘Triptych’ of Mary, Mother of Life H.E. Msgr. Zygmunt Zimowski

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Saturday, 22 November 2014 the Lord Called to Himself Cardinal Fiorenzo Angelini

Cardinal Fiorenzo Angelini

• Born in on 1 August 1916 • National Ecclesiastical Assi- the fight against tuberculosis, • Ordained a on 3 February stant of the Association of Ita- 1961 1940 lian Catholic Doctors, 1959- • Gold medal for blood donation, • Consecrated a Bishop on 29 1999 1966 July 1956 • Baccelliere in philosophy • Extraordinary Professor of Me- • Created a Cardinal of the Holy • Doctor in theology dical Deontology at the El Sal- Roman Church at the consistory • Extraordinary reader at the St. vador University of Buenos Ai- of 28 June 1991 Thomas University of Manila res, 1969 • President of the Pontifical • Gold medal for merit for public • Gold medal of the World He- Council for Health Care Wor- health care in , 1961 alth Organisation for studies kers, 1985-1996 • Gold medal for social merit in and activities against social di-

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seases especially in developing • Honoris causa degree in human Review “Dolentium Homi- countries, 1973 sciences of the ‘Madre y Mae- num: Church and Health in the • Member of the Academy of stra’ Pontifical Catholic Univer- World” Sciences of New York, 1983 sity, Santo Domingo, the Domi- • Organiser and director of twen- • The ‘Humanisation of Medici- nican Republic, July 1992 ty annual courses on ‘medicine ne’ Prize of Georgetown Uni- • Honoris causa degree in medi- and morality’ of an international versity in Washington, the Uni- cine from the Catholic Univer- character in Rome at the State ted States of America, 1986 sity of Santiago, Chile, Septem- University and the National Re- • The Sasakawa Prize of the ber 1992 search Council World Health Organisation, • Honoris causa degree in phar- • Organiser and director of va- 1990 macy at the University of Urbi- rious international conferen- • Honoris causa degree in medi- no, October 1992 ces in the Vatican on various cine from the Jagellonic Uni- • Gold medal of health of the subjects connected with medi- versity of Krakow, 1990, by World Health Organisation, No- cine and morality wish of the John Paul II vember 1992 • Founder and President since 25 • Honoris causa degree in medi- • Commendator of Holy Spirit in March 1997 of the International cine from the Medical College Sassia Institute of Research on the Fa- of Walhalla, New York, 1991 • Knight of the Grand Cross of ce of Christ – sixteen internatio- • Estrella Kennedy of the John F. the Equestrian Order of the nal congresses Kennedy University, Argentina, Holy Sepulchre of Jerusalem, • President of the Ethical Com- 1991 1993 mittee of the Santa Lucia • Humanitarian Prize of the • Honoris causa degree in medi- Foundation, Rome Advanced Studies in Immuno- cine from the Santa Maria Ca- • Founder of the ‘Friends of Fa- logy and Aging of Washington, tholic University of Argentina, ther Ildebrando Gregori ON- the United States of America, Buenos Aires, 1996 LUS’ Association, 21 June 1992 • Founder and Director of the 2006.

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Fiorenzo Angelini

Msgr. Jean-Marie by aerial bombing by the Allies. who was canonised on 27 April Mupendawatu One can from time to time see the 2014, he found himself in admira- Secretary of the Pontifical film of that visit and the young ble harmony, and from this arose Council for Health Care workers Don Fiorenzo opening a gap in documents, projects and institu- the crowd for the Supreme Pontiff tional initiatives. It was, in fact, to pass through. through the reform Pastor Bonus man of his times and of our He became a key figure in the that the Pontifical Commission A times, aware of the respon- health care of the capital city and for Pastoral Assistance to Health sibilities, strong and determined subsequently at an internation- Care Workers became a Pontifical but humble in dedicating himself al level as well, already engag- Council. to mission ad gentes as a work ing in initiatives that were appar- Tireless in his ecclesial activi- of justice and charity. Such is ently ‘revolutionary’ as President ty, in the evening he left the Pon- the image of Fiorenzo Angelini of the Pontifical Commission tifical Council with a briefcase who was born on 1 August 1916 for Pastoral Assistance to Health full of work which by the next and became during his more than care Workers, which would later morning had already been dealt 98 years of life and 75 years as become a Pontifical Council in with; he was an able creator of a priest: Don Fiorenzo (1940), 1988. He spoke French and had international relationships which Monsignor Angelini (1956) and, a good knowledge of English and were designed to promote Salus lastly, Cardinal Angelini (1991). was born in Rome, the son of a throughout the world. In many of He was, and will remain, a per- couple who originally came from his initiatives, of his projects, he sonality who was decidedly unu- Carsòli, a commune located along was able to express the ‘catholic- sual in the multiplicity of his as- the boundary that separates Lazio ity’ of the well pects and also in his longevity. from Abruzzo. They had emigrat- before the so-called phenomenon He passed away on 22 Novem- ed to the United States of America of globalisation arrived. ber of last year, a few hours be- and then returned to Italy. After reaching the ‘pensionable’ fore the audience granted by the It was perhaps from his family age he could have rested without Pope to people with autism spec- history that he drew his propen- any difficulty. He was famous, he trum disorders and to those taking sity for travelling, to meet people had honours and awards, together part in the twenty-ninth interna- of different languages, cultures with economic ease. However, at tional conference of the Pontifical and also faiths. How can one for- the age of 75 he wanted to give Council for Health Care Work- get his journeys, for example, to himself to Zaire, to India, to Po- ers, an institution of which he had Russia, where he subsequently land and to Romania. In order to been the first president. managed to have a children’s hos- establish care and evangelising He now rests at the side of his pital built with the gifts he had re- works in these countries, he even spiritual father, Fa- ceived on becoming a Cardinal, gave away everything he had ther Ildebrando Gregori, a Sylves- and also to Cuba, both of which that was valuable, even the gold trine Benedictine and the founder he engaged in before the political jewellery of his mother. He even of the Benedictine Sisters Repair- and ideological walls that divided risked his own life when cross- ers of the Holy Face, in the con- international politics had weak- ing or visiting areas that were vent of that institute which is ened and then collapsed? marked by major insecurity, such located in Bassano Romano. Faithful in his friendships, he as in Congo Kinshasa in August Fiorenzo Angelini, who together never hesitated to show himself 1998 when he was fortunate to with an imposing physique de- in public with Giulio Andreot- avoid armies that had gone back cidedly had an appearance that in ti, even during the most debated to fighting each other. Rome is defined as that of ‘Mark moments of the life of the former His last work on earth, the Cit- Anthony’, possessed great intelli- Prime Minister. adel of Charity, bears witness to gence and impressive farsighted- In the ecclesial world he was an this great love and it was located ness, as though from his height, effective implementer of the Sec- in Butembo which is to be found like the giraffe in the African im- ond Vatican Council, in which, in the east of the Democratic Re- agination, he could really see fur- indeed, he had taken part, and he public of the Congo. This work ther than many other people. knew how to make people recog- has not been completely finished The vice- priest of the nise the importance of the world but it certainly will be because Roman neighbourhood of S. Lor- of suffering and illness, and the it is a great initiative, one want- enzo, he was the guide for Pius needs of those who take care of ed and promoted by a Cardinal XII when the latter went in July sick people, of family relatives, who was a great personality of 1943 to visit the local population of professionals and of volun- the Church and the twentieth cen- which had been severely bombed teers. With Pope John Paul II, tury.

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He Lived Intensely and he Died ‘Living’ In Memory of Cardinal Fiorenzo Angelini

H.E. Msgr. starting with life. We thus began great generosity, with evangelical José L. Redrado, OH to travel. We went on numerous charity. All of this is not some- Secretary Emeritus journeys and engaged in many thing that is seen from an office of the Pontifical Council activities away from our central – it is seen by taking part in jour- for Health Care Workers offices in order, ‘in situ’, to learn neys of many miles where one has about the field of health and of ill- an opportunity to speak, to pro- ness, about the health-care world, pose, to verify, to observe and to have been asked to write a very and about an army of technicians know more deeply. Cardinal An- Ishort account of my memories and Samaritans. While accompa- gelini was a ‘personage’, feared of Cardinal Fiorenzo Angelini, nying Msgr. Angelini on all those by some, loved by others. a short testimony amongst very journeys for eleven years, I had At the moment of his retire- many others, bringing together an opportunity to observe his cre- ment, the man who left the Pon- what I remember about him. ative and animating capacities. tifical Council was a sower who I was called by Pope John Paul He was a teacher, an inventor who had given us a seed to cultivate. II to be a part – as its Secretary never spared himself, who taught, He himself, for the next eighteen – of the then ‘Pontifical Commis- who gave and gave of himself. years until his death, struggled and sion for Pastoral Assistance for Always present, competent and invented, as a tireless and active Health Care Workers’. The day enthusiastic, he believed in what traveller, from another platform. was 19 January 1986. Msgr. An- he was doing and he loved it; I During this final stage I had al- gelini was the Pro-President of learned from him ‘to dream’ and so seen him engage, at the same that new ‘Ministry’, and Fr. Fe- to transform dreams into reality. time, in an important journey lice Ruffini, a Camillian religious, Was the person I encountered a of spiritual maturity, a journey was its Under-Secretary. person with a strong, dominating where a person acquires greater We began our work starting and powerful character? To many riches and depth in what is es- from scratch. We had not been al- such appeared to be the case, but sential. His death brought back to located our central offices: there one had to know him more deeply me unforgettable memories: a life was only a founding decree of the at a real level, in his interiority. It lived with passion, deep thinking Pope and the experience that each was there that his authentic riches about frailty, on the one hand, and one of us brought to this new mis- appeared, his capacity to impress the God of love, on the other. Sin- sion. There was, however, a great and to illustrate; his piety, his cerely, although I was deeply sad- deal of enthusiasm and a great de- ability to be in many places and dened, at the same time I was joy- sire to work, to invent, to create, to reach very many people, to be ful on his death, when he was full and to open up new roadways. a man who was effective; his love in years: it was above all a death And it was there that I encoun- for the Church, for the health-care that was awaited, prepared for, tered a great personality with world; his friendships with very accompanied and prayed for. He whom I immediately felt in har- many people, who were very dif- died ‘living’. A finale that makes mony. I saw this as a privilege ferent; his capacity to work and to one reflect. In this, as well, he was since we began to work not only create ‘resources’, to invent, to re- for me a spiritual teacher. May he starting with our offices but also ceive abundantly and to give with rest in peace!

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Cardinal Fiorenzo Angelini

Father Felice Ruffini, M.I. as regards certain specific activi- Yes, indeed: the person who Under-Secretary Emeritus, ties a relationship of a certain re- coined the headline of the article in the Pontifical Council sponsibility with a number of other L’Avvenire (‘A Missionary of Life for Health Care Workers religious. and Health’) should be congratu- This is neither the place nor the lated because there are many wit- time to provide a detailed history. nesses to the fact that his increas- do not know whether the jour- Instead, I will offer some brief ref- ing devotion to the ‘Holy Face’, I nalist who wrote on Cardinal erences and some short paragraphs which, indeed, was disseminated Fiorenzo Angelini in the daily so as ‘not to forget’ the revolution wherever he went, was not for that newspaper L’Avvenire had or did that he achieved in ‘pastoral ser- little medallion, even though it was not have his ‘piece’, accompanied vice’ in the field of Roman health precious because of the holy effigy by a title, ready for some time, or care, prefiguring and ‘running in’ engraved upon it, but because he whether this was the work of the what years later, with the fraternal saw in the face of every sick and editorial board. Whatever the case, and friendship that had been es- suffering person ‘the face of man, amongst the obituaries that I have tablished with St. Pope John Paul of the Son of God, of the suffering, read hitherto it seems to me that II, led to the creation of the ‘Pon- of the Resurrected Christ’ and I can this is the one that most understood tifical Council for Pastoral Care in well say that he was famous for to the full the life journey of His Health’: this pastoral care was then pointing out often in his homilies Eminence with the Cardinal’s hat: promoted throughout the Church. and speeches that he was pursuing ‘A Missionary of Life and Health’. I believe that it is incumbent up- that face. I saw him on a number With admirable synthesis this on me to emphasise his daily tes- of occasions with tears in his eyes went to the heart of the life journey timony, wherever he went and in when he was near to patients in of this exceptional priest, which, whatever circumstances he found Roman hospitals, and in the hospi- indeed, the would himself, to the fact that he felt in tals of poor countries that he visit- discover with the passing of time. his heart the constant inspiration ed, or when near to the wounded of He wrote pages of history which of the wellspring of the ‘charism the agonising war of the Balkans to should be entrusted to the ‘Mem- that the crucified Christ gave to which St. John Paul II had sent him ory’ of the clergy of the Roman St. Camillus’ and what under the as his representative. Church. spiritual guidance of the Venerable The news of recent days has told The various steps that then led Abbot Ildebrando Gregori became us that he was born in August 1916 him to be made a bishop and after- a constant of his speech and be- in the neighbourhood of Campo wards an Archbishop and a Cardi- haviour. His devotion to the Holy Marzio...a few hundred yards from nal, we can see as ‘signs’ of the es- Face became an imperative of his the tomb of St. Camuillus – is this teem and trust that the who action as a pastor who was sent out a coincidence? Let me say so – I followed one another during his into the world of suffering and of think I can see in this fact, as well, life felt towards him, but a ‘corner pain, such as to deserve from St. a certain ‘premonitory sign’. He headline’ remains there, the fact John Paul II this passage of most will want to remind us that he was that he proclaimed that he was just excellent definition on the occa- the last ‘Commander of the Holy a ‘Roman priest of the Bishop of sion of the ‘Second Congress’: ‘To Spirit’…yes, the last…but the one the See of St. Peter’, faithful until know and contemplate the face of who gave greatest honour to this his death to his involvement in that God has been a human aspiration ancient title of a splendid living Primate of the ‘Chair of Peter, who in every age. The difficulty, wari- monument to the charity of the Ro- presides over the universal com- ness or prohibition of portraying man Pontiffs in an area near to the munion of charity’ (St. Ignatius M, the divinity stems from the aware- See of St. Peter. Ad Romanos). ness that every attempt to apply an In his study near to him he al- This was an approach to life that image to God is inadequate. Nev- ways kept prominent and in a posi- began in a decided way what was ertheless, the ancient invocation of tion of honour two important relics a more visible and authoritative the Psalm: “O Lord, let the light of – of St. Camillus and St. John of pathway when the Venerable Pius your countenance shine upon us” God – in two valuable reliquaries. XII in 1956 appointed him to be (4:7) prophetically introduced the These were the two inspir- the Delegate of the Cardinal Vicar revelation of Christ, because the ers of his ‘life consecrated’ to the for ‘pastoral care in health’ in the God of the Covenant revealed his sick, in whom – and this is not ba- hospitals and places of health care nature as a personal Being, indeed nal rhetoric – he saw and beheld of the diocese of Rome, and which as the Father, who in the Incarna- the ‘suffering Face of Christ’, as led we Camillians, who in those tion would assume, in Christ, a his two saints had. years were involved in pastoral face both human and divine. It is I saw them at his bedside where service as chaplains in what were Jesus himself who declares this to he had fallen asleep ‘in the sleep considerable numbers, to thereby the Apostle Philip: “He who has of the just’ in the early hours of establish a rather intense relation- seen me has seen the Father” (Jn Saturday morning, 22 November ship of cooperation with him, and 14:9)’. 2014.

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Words that Sound out, Actions that Shine

DR. Antonino Bagnato tensified, my eyes darkened with under his skin, and from that mo- Medical Doctor held-back tears which speed- ment onwards being a parish priest ily flowed down my cheeks – the was no longer enough for him. Reflections brought together by comforting caress of someone who A single and adamantine thought Francesca Cipriani Bianchini was no longer there for a person permeated his work from that day who was astonished and stunned onwards: to help everyone in all by life, for one who had seen the possible ways, beyond his strength, am a medical doctor. I have stud- abyss of the impossible pass near- unceasingly and without tiredness, Iied the human organism all my by and take away a person dear to and if tiredness arrived to close it life, I have learnt to recognise the his heart. up inside himself. symptoms of its illness, I have One was not fully aware that one He experienced the devastating learnt the ways it can be treated, so would no longer hear his voice, feeling of powerlessness that often as to be able to relieve suffering. that the air would no longer re- pervades the work of those who You put all of this and all of your- echo with his happiness and his de- are called to help, to provide aid. self at the service of those who are cisiveness, with his words, with his The loneliness of those who every in need, without any holding back. warnings and his projects. day try to combat and defeat suf- It sometimes happens that a pa- The days went by, everything fering, illness and death. tient dies and then a part of your was done, those who stayed behind Jesus said ‘I was sick and you heart suffers unspeakably. You went back to their usual activity, visited me’. He decided to help hope, with the dawn of the next but when one evening my thoughts those who were called to relieve day, to have the instruments to en- were turning over quickly, a world the suffering of people. sure that this does not happen again of memories opened up, of shared Always in the front line at the and your prayer to God is that the days, and of teachings which at side of health-care workers, he patient will be welcomed and that first were lighthouses in the night was appointed a bishop and the you will be helped in your mission. and then brilliant light by which to head of pastoral care in health for My meeting His Eminence Car- govern the rudder of my behaviour the diocese of Rome, as well as the dinal Fiorenzo Angelini almost as a man, as a medical doctor and national ecclesiastical assistant to thirty years ago was a matter of as a Catholic. the Association of Italian Medical chance. The initial esteem and re- His choice to be a priest amongst Doctors. spect, and then the understanding people, a parish priest at the ser- With modesty and generosity and affection that followed imme- vice of the community, was born but always with tenacity, he took diately afterwards, created over the early in this young Roman semi- up the missionary vocation of his years a very strong tie of sincere narian who was willing and gen- spiritual father, the Venerable Fa- friendship. erous. Then the war arrived and ther Ildebrando Gregori. He be- At times the hardship of the bombs fell on Rome. He was in came the active promoter of the passing of the years and the de- the rubble of San Lorenzo to com- missionary initiatives of the Ben- cline of a person’s body touches fort families, to help the wounded, edictine Sisters Repairers of the those who are near. We look after to give the last rites to friends...to- Holy Face in three continents of him unceasingly, we reassure him, day if you go to the area around the world for the protection of chil- we try to protect him from suffer- San Lorenzo everything has been dren, the right to education and the ing, we hope, but perhaps in vain, rebuilt, there are no ruins, no evi- defence of the elderly. to protect him from knowing what dent trace of what happened in that This was an extraordinary is happening. far off 1943, only a marble plaque friendship that led him to face up During the days that preceded which one even has to look for… to journeys that were often tiring, his departure from this earthly life, I am sure that that was a decisive in order to visit, help and comfort I knew the real situation of His moment which changed his way populations that were afflicted by Eminence but I did not want to of being a priest. Up to that mo- war and by poverty but popula- accept it, I repeated to myself ment his life has been quite calm, tions that were courageous in their that very little was needed for his certainly marked by the difficul- daily struggle for survival. body to recover, I knew that this ties of the war which had wounded From his encounter with St. had happened a number of times the population, brought the coun- John Paul II was born an incred- before, perhaps this could be the try to its knees, but that day the ible project which was shared in umpteenth time, but I realised that cruelty of man against man, the the intentions of these two great each time the recovery had been brutality of the bombs that ripped men who had grown up in very more arduous and that the irrevers- apart houses, bodies and hearts, different realities but ones that had ible crisis was going to arrive. was devastating for him. The air both been tormented by the Second He died in the night of 21-22 that could not be breathed in of World War. This project began the November 2014. smoke and dust, filled with desper- Pontifical Council for Pastoral As- When this took place the air ate cries, full of the acrid smell of sistance to Health Care Workers: filled with amazement, silence in- death, got into his lungs, his cells, To permeate one’s vocation to

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help with the most authentic Chris- sick person Jesus suffering on the hearts and tomorrow we will per- tian message, even though this is cross, always trying to do one’s ut- form our duties with renewed vig- not only a Christian and Catholic most without ever holding back. our. We are certain that we have question but, rather. possesses a Not to be afraid to go to the most not lost him and we are sure that universal meaning of human char- inaccessible parts of the world be- we will continue to be guided, in ity towards those who are in need. cause suffering and death have no our fleeting earthly pilgrimage, To always and whatever the case geographical borders and have no as people, as health-care workers put the sick person at the centre of scruples in striking where pover- and as Catholics, by his valuable one’s care, especially in those in- ty and hopelessness have already spirit. creasingly advanced technologi- wounded the lives of people. He has not left us, he has gone to cal realities where often machin- To welcome everybody without the house of God and he is in each ery helps in achieving survival but holding back, being aware of the one of us, in our deeds, which are where it can never take the place of sacredness of life in all its forms permeated with mercy and com- a smile, of words of comfort, and and ages. And when medical sci- passion – as he taught us. of gestures of being near. ence can no longer do anything, to …unfortunately he is no longer To carry out one’s ministry as a ensure that hurry or distraction do with us, he is no longer at our side health-care worker always looking not allow death to find loneliness, to spur us on, to guide us, to stew- into the eyes of the patient, without as well, at the bedside of the pa- ard us, to give us courage, but his allowing oneself to be distracted tient. words sound out like thunder, his by modern idols. To see in every His message is engraved in our actions shine like stars.

A Testimony in Memory of His Eminence Cardinal Fiorenzo Angelini

Prof. Bonifacio was a priest of the Lord at the ser- Prime Minister and life Senator, Honings, OCD vice of the Church and humanity. . During these Professor Emeritus of Moral In this priestly service I was above very spontaneous meetings, and Theology at the Pontifical all struck by the fact that for him this was an aspect of his humani- Lateran University and every hospital was a church and tarian character, he also willingly the Pontifical Urban University every bed was an altar. Thus with listened to some contributions of of Rome, great humility he entered hospitals ours. This brings me to my final Consultor of the and comforted and visited the sick. memory of him that I want to re- Pontifical Council In addition to this humble priest- cord: my personal friendship with for Health Care Workers, ly service of his – which the Lord him. For very many years, until the , employed for almost seventy-five two days before his death, I had Ordinary Member ad vitam of years – (indeed on 3 and 7 Febru- the privilege to go and visit him the Pontifical academy for Life, ary we will celebrate this event), I when I wanted and I was always the Holy See was struck by his deep and acute welcomed with great benevolence. intelligence and his tenacious will. Most of the time we spoke about The Pontifical Council of which he the conferences on the Face of Fac- congratulate the Pontifical Coun- was the President for many years es. He was the great creator not on- I cil for Health Care Workers on was able to take broad advantage ly of the truly important topics and thinking of dedicating space to of these attributes for many years. subjects but also of the precious the figure of Cardinal Angelini in But also those who worked most iconography which with great the review Dolentium Hominum. closely with him. And this allows regularity was published before I thank the Secretary Msgr. Jean- me a testimony as regards his hu- Christmas. To end this testimony Marie Mupendawatu for wanting manitarian character. Very often, of mine, I can affirm that with the to involve me in remembering His together with His Excellency Ms- death of His Eminence I lost – and Eminence, to whom the Church gr. Redrado, the first Secretary, and I was not alone – from many points and the health-care world owe a Father Felice Rufini, the first Un- of view, a great friend. His home great deal. I had the grace to know der-Secretary, we spent time with had become mine. My heartfelt His Eminence Cardinal Fioren- him to listen to his very many en- thanks go to his dear Mother Gen- zo Angelini for more than forty lightening experiences as a young eral, Sr. Maria Maurizia Biancucci, years. Therefore I have very many priest, a mature bishop and a wise because she said to me: Father, this memories of, but I will relate on- Cardinal. We were at those mo- is always your home. Most Rever- ly a few which particularly strike ments struck above all by his great end Eminence, my heartfelt thanks me. First of all his belief that he friendship with the seven-times and let us meet again in heaven.

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Spirituality – Humanity – Charity and Action: the Great Virtues of a Painful and Joyous Journey In Memory of Cardinal Fiorenzo Angelini

Professor tamination, were welcomed and nal influenced my maturation and Filippo M. Boscia looked after in groups of 60 in formation as well as the growth of National President of the AMCI Puglia, in the diocese of Bari-Bi- my personal motivations means (Association of Italian Catholic tonto, at the San Giuseppe di Mo- to range through innumerable Doctors) dugno Institute which was run by experiences, contacts, works of the Benedictine Sisters Repairers cooperation and participation in of the Holy Face of Christ. events of a notable ethical and so- he death of a ‘person who is The task was to look after them cial value. Tvery near and loved’ can lead with love and expertise in the It was in this way that I came one, when remembering him, to Catholic and non-Catholic health- to know and appreciate his reso- an excessive affective involve- care institutions in Bari and its luteness in the defence of non- ment, to exaggerate his talents Province, offering them for ten negotiable values but also that I and qualities, or as the Latins sug- consecutive years, from May to took part together with him in hu- gested to speak well about those September, a period of relaxa- manitarian projects at an interna- who have preceded us ‘de mor- tion and heliotherapy at welcom- tional level: in Russia, in India, in tuis nisi bene’. In the case of the ing seaside centres on the Adriatic Poland, in the Congo (Butembo unforgettable Cardinal Fiorenzo and Ionian coasts. Beni), in the Lebanon, in the Ivo- Angelini this is not the case in the Those were demanding and ry Coast and in Mexico. I remem- least. very intense years when, involv- ber many unreported and special Anybody who knew him or ing state and private agencies, episodes which in a precise way simply met him, could only have associations, Church groups and envisaged visits to, and support been struck by his unusual quali- very many friends, I strove with for, care institutions, meetings ties as a great man, a true giant of all my strength to meet the wishes with the poor and the sick and faith; meek, ready to help, frank, of the Cardinal who commended with the associations which pro- with a steady temperament, at to me ‘his sons, his children’. vided assistance, but also visits to times intransigent, a prelate of no- These ‘children of God’ did not Heads of State in the sumptuous table learning, who was ready to lack anything, not least because residences that were made availa- provide advice which was always the cooperation, the readiness to ble for the institutional audiences thoughtful and wise. help, the generosity, the solidari- envisaged for the pontifical dele- I had the joy and the privilege ty, the subsidiarity and the unlim- gation to which I belonged. to live at his side for very many ited support of very many of my The Cardinal dialogued with years, first as a Councillor, then faithful and dear friends of Bari the powerful of the earth, was as the Vice-President and lastly and Puglia were truly exemplary. concerned about social questions, as the National President of the This was a happy and fertile pe- reduced tensions, healed disa- AMCI, the Association of Italian riod, still present in the hearts and greements, sensitised conscienc- Catholic Doctors. the memories of everyone, which es, brought the voice of the Holy In truth, during the years be- was experienced with pride by the Father everywhere, and contrib- fore my experience as a national ACMI of Bari. uted to all forms of social devel- director of the association I had With an exemplary charge of opment with practical activities the pleasant opportunity of work- spirituality, balance, common of faith, hope and economic co- ing with him as president of the sense and affability, this demand- operation. diocesan AMCI of Bari for a pro- ing project developed in the mem- The missionary activity and ject of international solidarity for bers of the AMCI of the diocese fervour of this great Cardinal of children in Byelorussia, a nation of Bari feelings of fraternity, shar- the Church of Rome had their that had been struck by the dra- ing and cooperation which char- roots in the gospel of Charity. matic explosion of the nuclear re- acterised the whole of the long With extraordinary humility in actor of Chernobyl in the then far period of my diocesan presidency various parts of the world he bent away April 1986. in Bari when various family asso- down in front of so much frailty, Thanks to his humanitarian ciations were created to welcome of every ‘wounded creature’, to work in the world, 600 children the children of Chernobyl – these, care with love for every wound of from the area of Chernobyl, all indeed, are still operational. their bodies, minds and souls, that with pathologies of nuclear con- To say how much the Cardi- is to say in order to take care, as

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he used to say, of the ‘global sick- by his example, joined the AM- of care and mercy; and to be a fol- ness’ of each person. CI and based themselves on his lower of Christ the physician, giv- Cardinal Angelini, a Good Sa- great wisdom, his solid faith, his ing space to the word of God for maritan, made himself a neigh- illuminated teaching and his pro- the wellbeing of man. He inspired bour to very many marginalised found spirituality. the Charter for Health Care Work- and thrown-away people, promot- Cardinal Angelini always com- ers, inaugurating in pastoral care ing throughout the world overall mended us to nourish with prayer in health a season of an authen- pastoral care for suffering, health and a spirit of self-denial every tic ‘pedagogic art’ which leads to and salvation. He did this by sen- action we engaged in, to work a beholding of the face of Christ sitising men from everywhere – with coherent intellectual hones- which is reflected in every man the powerful and those who were ty, to bear witness without osten- and above all in those who suf- not powerful, the frail or the alone tation, so as to be salt or yeast in fer. The Charter for Health Care – with that love and that Christian the multitude. Workers remains today a docu- spirit that asked us Humanity, spirituality, charity ment which beholds the ‘incom- to bear witness to when he re- and action were his great virtues. mensurable dignity of the human ceived Catholic medical doctors His life, although it was full of being and his transcendent nature, for the seventieth anniversary of difficulties and sufferings, was a a nature that faith and reason see the foundation of our association. hymn to the dignity and the invio- as absolutely inviolable’. Very many of us are grateful to lability of the person which was What a great legacy he left to us the Cardinal for having proposed a part of his great commitment to Catholic medical doctors! to us new forms of work and ac- doing good well. In order to make our mission tion which enabled us to achieve For as many as thirty years in even more generative, the Cardi- important cultural and pastoral re- the AMCI, living at the side of nal outlined guidelines to be fol- sults in our lay and religious vol- Cardinal Fiorenzo Angelini, who lowed: prayer, self-denial, a lack untary work for sick people. was the ecclesiastical assistant to of interest in careerism, intellec- I personally shared with him the AMCI from 1959 to 1998, we tual humility, trusting openness very beautiful experiences and explored aspects connected with towards other people, compassion also cooperated in his role in theology, pastoral care in health, and sharing. acknowledging and maintain- spirituality, psychology and soci- Today, in open contrast with ing steady and strong the role of ology. the dehumanising negative ten- Italian Catholic doctors in the We lived with him that long dencies, we can argue that illness, FEAMC and the FIAMC, em- period of contemporary history pain and suffering do not manifest phasising the tasks that were con- when those great bioethical prob- the absence of God in the histo- tained in their respective statutes; lems emerged which are still dis- ry of man but, vice versa, express defending with steady intransi- cussed today: abortion, cloning, His full sharing in, and taking up- gence positions relating to respect euthanasia, brain death, trans- on Himself, our frail condition. for life from conception until its plants, the vegetative state, life From being a young priest on- natural end; valuing the interior- testament, biological patents, the wards, Cardinal Angelini had the ity of the person; defending fami- use of stem cells, heterologous merit of knowing how to under- lies; and promoting respect for the gametes for assisted fertilisa- stand the signs of the times, re- human person, above all if frail, tion, with transfers into surrogate sponding promptly to the new defenceless and sick, even if of- wombs as well. needs that presented themselves. ten incurable but always treatable. We live in an epoch when an Still not very much known, he ac- He openly supported the posi- attempt is being made to elimi- companied Pius XII in the streets tions of the AMCI without any nate conscientious objection; im- of wounded Rome. The white holding back and stated with con- portant laws are emerging as re- clothes of the Pope were stained viction that being Catholic is not gards the ethics of transplants; with blood, and from that mo- something to be reduced to a label and assisted human reproduction ment onwards Fiorenzo Angelini or a badge but, instead, require is opening up endless and poly- committed himself in a totalising deep and clear witness to the morphous questions about theo- way to transmitting that heritage faith and values that characterise ries of gender which are generat- of faith and life that had been in- Christianity, all of which are sol- ing great uncertainties about what herited from the apostles and mar- idly expressed in the ‘C of Catho- the family is, the truth of paternity tyrs, Peter and Paul. lics’ of our emblem. and maternity, and the meaning of Specifically in those years of He reminded us that daily ac- being parents. social confusion, when cooperat- tion had to be carried out without During this long period which ing with Pope Pius XII his priest- too much noise, without personal was characterised by the innova- ly passion was directed towards exaltations, without forms of self- tive methods of a strongly tech- the sick, the poor, the lay faith- advancement and forms of trium- nological medicine, the Cardinal ful, medical doctors and health- phalism: ‘A tree that falls makes always invited us to rediscover care workers in trying to reorgan- more noise than a forest that our role and to teach young medi- ise care in the city of Rome which grows’, he used to say! cal doctors to protect and support had been devastated by war. He Very many medical doctors, life at every one of its stages with established prayer groups but also young ones as well, attracted practical actions, to live the gospel associations of men and women

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from all ethnic groups, of Chris- (‘My Road’) published by Rizzo- mosaic depicting the whole of hu- tians who were strongly involved li is very much worthy of atten- manity until a ‘reductio ad unum’ in society in order to uphold hu- tion. In this work he outlined in a was achieved. man and civil rights. clear way his capacity to take de- One of his goals was to strength- As a priest, as a bishop and as a cisions, his patience, but also his en the structure of the AMCI in Cardinal, he always taught to eve- constructive impatience, his com- order to place it within Italian so- ryone the high value of the Chris- plete and disinterested generosity, ciety which at that time was un- tian message which requires the his strength and constancy in eve- dergoing in a state constant fer- utmost commitment to removing ry action of his, albeit in difficult ment, and this at a time when the the causes that bring about exclu- epochs and situations. world of associations was grow- sion and the urgent need to take Endowed with great physical ing weaker because of the rise of part to the full in the political and and moral strength, he ventured new approaches which had been social life of the country. into the complex and arduous outlined by the Second Vatican His pedagogic activity directed pathways of the missionary apos- Council. He infused new lymph towards Catholic medical doctors tolate in the world, in Russia, In- into Italian society and in particu- for more than fifty years of impas- dia, Romania, the Congo and the lar into the AMCI so that it could sioned formation was experienced Philippines, making everything understand to the full the spirit of by him as a precise duty, provok- that he possessed available, every the and ing in many generations of young personal memory, every pectoral the ecumenical approach. doctors an ability to discern what cross, every watch, gifts, paint- Moved by a sincere desire to is essential from what is not. He ings, sculptures by prestigious offer a loyal and disinterested filled with a new spirit students, painters and artists. I was an eye- contribution to the unity of Cath- medical doctors, professors and witness to his most complete and olic forces, he wove positive re- paramedical staff so that they disinterested generosity. lationships with politicians in the could understand with sensitivity He served the Church and the strong belief that Catholics could every beat of hope, of faith and of Roman Pontiffs, giving them his identify their field of action in or- enthusiasm. His total dedication is utmost cooperation and loyalty. der to renew the family, profes- today the most valuable gift that Indeed he worked with as many sional, social and political life of he could have left us, after calling as eight Popes: from Pius XI to the country. us to the fullness of Christian life Pius XII, from John XXIII to He kept high in front of us an and the perfection of charity. Paul VI, from John Paul I to John essential approach to life which In thanking the Lord, we are Paul II, and from Benedict XVI to was pure, sensitive and without today able to give our society a Francis, establishing a close rela- selfishness. Personally, having more human face in conformity tionship between the laity and the had the privilege to be very near with the image of Christ the Sav- hierarchies, at times acting as a to him, I owe a great deal to him iour and obedient in everything to mediator where there were cultur- when it comes to what I am today. the will of the Father. al and doctrinal divergences. All of us together, we Catholic The life of the Cardinal, which In him thinking, wanting, act- medical doctors, in expressing our was limpidly and solidly inter- ing and feeling worked in unison greatest gratitude to the Cardinal, twined with the life of the Church in permanent harmony, directed certain of the Resurrection, be- and the AMCI, was and always towards constructing unthinkable lieve that the Lord has welcomed will be a model of reference for ties which were sources of great him to His merciful arms, grant- the whole of our national associa- riches. ing him the price of eternal life, as tion. His thought was always di- is promised to us and we can read He obtained honours and cred- rected towards God, as a result of in Matthew chapter XXV. ibility for our association in the which every action of his, guid- Now the witness is in our hands national and international field, ed by learning and wisdom, was so that each one of us may know promoting, supporting and en- directed towards all frail people, how to live with faithfulness and couraging our member who had whom he saw as the privileged consistency the gospel message previously been our national sec- children of God. on which he based himself during retary as the head of the interna- He carried out many contem- his life, and also to live the torch tional federation. plative studies on the face of God of charity, of hope and of forti- The volume ‘La mia strada’ made up of a myriad of pieces of tude.

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VIII Plenary Assembly of the Pontifical Council for Health Care Workers on the Occasion of the XXX Anniversary of the Apostolic Letter Salvifici Doloris

‘Do good with your suffering and do good to those who suffer’ (Salvifici doloris, 30)

24-26 March 2014 Vatican City

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Address of Holy Father Francis

Clementine Hall, Monday, 24 March 2014

Dear Brothers and Sisters,

I welcome you on the occasion of your Plenary Session and I thank Archbishop Zimowski for his words. The Bishop of Rome is grateful to each of you for your commitment to the many brothers and sisters who bear the burden of sickness, disability, and difficult old age. Your work in these days is inspired by what John Paul II said of suffering, 30 years ago, in the Apostolic Letter Salvifici Doloris: “to do good by one’s suffering and to do good to those who suf- fer” (n. 30). John Paul II lived and witnessed to these words in an exemplary way. His was a living magisterium, which the People of God reciprocated with so much affection and veneration, recog- nizing that God was with him. It is true, in fact, that also in suffering no one is ever alone because God — in his merciful love for man and for the world — embraces even the most inhumane situations, in which the image of the Creator, present in everyone, is blurred or disfigured. Thus it was for Jesus in his Passion. In Him every human pain, every anxiety, every suffering was taken on out of love, out of pure desire to be close to us, to be with us. And here, in Jesus’ Passion, is the greatest lesson for anyone who wants to dedicate him-herself to serving our sick and suffering brothers. The experience of fraternal sharing with those who suffer opens us to the true beauty of human life which includes its frailty. In protecting and promoting life, at any stage or condition, we can recognize the dignity and value of every single human being, from conception until death. Tomorrow we will celebrate the Solemnity of the Annunciation of the Lord. “The one who ac- cepted ‘Life’ in the name of all and for the sake of all was Mary, the Mother; she is thus most closely and personally associated with the Gospel of life” (John Paul II, Encyclical Letter Evangelium Vitae, n. 102). Mary offered up her own existence, she made her whole self available to the will of God, becoming a “place” of his presence, a “place” in which the Son of God dwells. Dear friends, in exercising your daily service, let us keep ever present the flesh of Christ present in the poor, in those suffering, in children, also in the unwanted, in those with physical or mental disabilities and in the elderly. Thus I invoke upon each of you, upon all those who are sick and suffering together with their families, as well as upon all those who take care of them, the maternal protection of Mary, Salus infirmorum, so that she may illumine your reflection and your action in defending and promoting life and in health pastoral care. May the Lord bless you.

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Report

o good with your suffering brief greetings of the President of so the Delegate for the Founda- ‘Dand do good to those who the Pontifical Council, the Holy tion. Amongst the most important suffer’: these words of the Holy Father expressed his gratitude to projects of the Foundation, refer- Father John Paul II, taken from all those who take care of the sick ence was made to the following: his apostolic letter Salvifici do- and the suffering: ‘To each one of the fight against HIV/AIDS – the loris (n. 30), became the central you’, he said, ‘goes the gratitude model project in Tanzania; the theme of the eighth plenary as- of the Bishop of Rome for your network of the Faculties of Medi- sembly of the Pontifical Council commitment to so many broth- cine of seven Catholic universities for Health Care Workers which ers and sisters who bear the bur- in Africa; the fight against malar- was held on 24-26 March 2014 den of illness, of disability, of a ia; the fight against blindness; the in the Vatican at the great hall of difficult old age’. Then referring donation of medical products; a Palazzo San Pio X. to the title of the plenary assem- centre for medical products; food The plenary assembly was bly, he emphasised: ‘Your work education for children; and study opened with the celebration of a over these days takes its point of grants for , religious and Holy Mass in the grottos of the departure from what the Blessed lay people. Vatican basilica at the altar of John Paul II about thirty years ago The morning session of the sec- the tomb of St. Peter, which was stated as regards suffering in his ond day of the plenary assem- presided over by His Eminence apostolic letter Salvifici doloris: bly, 25 March, was preceded by Cardinal Pietro Parolin, the Sec- ‘Do good with your suffering and a Holy Mass on the occasion of retary of State, who on behalf of do good to those who suffer’ (n. the feast day of the Annunciation the Holy Father Francis thanked 30). He experienced these words, in the Church of the Holy Spirit those taking part in the plenary he bore witness to them in an ex- in Sassia. This was presided over assembly for their presence and emplary way. His was a living by Archbishop Zimowski and their daily activity in favour of magisterium which the People of concelebrated with all the those sick people, the disabled and the God corresponded with very great bishops and priests who were tak- suffering, and pointed out how affection and very great venera- ing part in the plenary assembly. important it is to have not only tion, recognising that God was The President of the Pontifical the professionalism of health-care with him’. Council gave a homily with the workers but also the presence of The deliberations in the assem- title: ‘From the Encounter with religious and spiritual assistance bly hall continued in the afternoon the Living God to the Journey to- at the side of patients with a discussion about report wards Needy and Suffering Man. The morning session of Mon- that had been given by the Presi- The ‘Triptych’ of Mary, Mother day 24 March was begun by the dent of the Pontifical Council in of Life’. President of the Pontifical Coun- the morning. The Members and Msgr. Jean-Marie Mupendawa- cil with a broad presentation of the Consultors appreciated the tu introduced the deliberations of the activities engaged in by the breadth of the work of the Pon- this day by giving a paper on ‘The dicastery during the years 2009- tifical Council over the previous Institution and Actuation of the 2014. Citing article 152 of the ap- five-year period and provided a World Days of the Sick. The Pre- ostolic constitution Pastor Bonus positive assessment, in particular, sent Situation and the Prospects of John Paul II, Archbishop Zi- of the two meetings of a pastoral for the Solemn World Day of the mowski emphasised that the Pon- and scientific character which are Sick in the Holy Land, 2016’. In tifical Council ‘shows the solici- celebrated respectively every year his paper, the Secretary referred tude of the Church for the sick by in the months of November and to the document by John Paul II helping those who serve the sick May. Reference was also made to which had instituted the World and suffering, so that their apos- the need for a greater effort on the Day of the Sick and he then sum- tolate of mercy may ever more part of the Pontifical Council as marised all the editions of this effectively respond to people’s regards the promotion of Catholic World Day from 1993 to 2014. needs’, and then continued by associations of health-care work- The Secretary of the Pontifical describing the many actions en- ers which are encountering dif- Council devoted the last part of gaged in by the dicastery, associ- ficulties in attracting new mem- his paper to a description of the ating each one with a specific task bers, especially young members. next World Day of the Sick at a indicated in the four sections of The final contribution of this continental level, a World Day article 152 of that constitution. rich day was a paper on ‘The that will take place in Nazareth After this paper, those taking ‘Good Samaritan’ Foundation – in the Holy Land and will try to part in the plenary session went to Activities and Projects’ which involve in a special way all the the Apostolic Palace where they was given by the Secretary of the heads of pastoral care in health of were received in private audience Pontifical Council, Msgr. Jean- the local Churches in the Middle by the Pope Francis. After the Marie Mupendawatu, who is al- East.

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The Secretary of the Pontifical medical sciences and their applica- mowski with a paper on possible Council, after receiving a short tions, of specific pronouncements projects of the Pontifical Coun- feedback on his first paper, con- of the Magisterium after 1995 dur- cil for Health Care Workers, and tinued with the second subject of ing the pontificates, respectively, more specifically: the Index of the session: ‘The International of St. John Paul II, Benedict XVI Catholic Health-care Institutions Committee of Catholic Health- and Pope Francis, and of new (po- which should outline the current Care Institutions (CIISAC): Gen- litical-legislative and political- situation of Catholic health care; esis and Prospects’. This is a new economic) aspects of the subject the international conference on body which has taken the place of that affect the health-care world. autism (20-22 November 2014); the AISAC (the International As- During the debate that followed proposals for the subjects of the sociation of Catholic Health-care this paper, it was pointed out that subsequent international confer- Institutions) and is one which the the Charter does not seek to cov- ences; and the institution of the Pontifical Council supports and er all the problems and questions ‘Pius XII International Prize for promotes with the aim of carrying that arise in the field of health and the Treatment of Pain’ for the best out a new evangelisation of hospi- illness, almost as though it was contributions made by young re- tal institutions. an ‘ethical handbook’, but, rather, searchers. During the afternoon session seeks to offer the clearest possible The deliberations of the eighth Rev. Fr. Augusto Chendi, M.I., guidelines on moral judgement for plenary assembly were brought the Under-Secretary of the Pon- individuals, as well as the most ev- to an end by the President of the tifical Council, illustrated what ident ethical problems which have Pontifical Council for Health had been done as regards the revi- to be addressed in the professional Care Workers who made the pro- sion and updating of the Charter practice of various figures in the posal to draw up the draft of a for Health-Care Workers, which world of health in general, where, pontifical document for the thir- was originally published in 1994. for that matter, such responses re- tieth anniversary of the apostolic In particular, the Under-Secretary ceive the consensus achieved by letter Salvifici Doloris. The gener- gave a detailed description of what the doctrine and the Magisterium al features of this document were had been done by the study group of the Church. described by H.E. Msgr. Sergio since June 2010, pointing out the The last session of the plena- Pintor, the Bishop Emeritus of additions and the changes that had ry assembly, which was held on Ozieri (Italy) and a Consultor of been made to the original text in Wednesday 26 March, was be- the Pontifical Council for Health the light of the advance of the bio- gun by Archbishop Zygmunt Zi- Care Workers.

Homily of the Secretary of State Cardinal Parolin

24 March 2014

Your Eminences oris of the Blessed John Paul II, God (cf. Lk 9:2). On this subject Dear Bishops and Priests my thirty years after its promulga- the Holy Father, in his apostolic religious brothers, tion: ‘do good by suffering and… exhortation Evangelii gaudium, Dear Brothers and sisters, do good to those who suffer’ (n. observed: ‘Jesus, the evangelizer 30). This highlights the power par excellence and the Gospel in I am happy to celebrate with of evangelisation which also ad- person, identifies especially with you this Holy Mass which opens vances thanks to those who expe- the little ones (cf. Mt 25:40). This the eighth plenary assembly of the rience suffering themselves and reminds us Christians that we are Pontifical Council for Health Care those who, through their profes- called to care for the vulnerable of Workers, an institution of the Ho- sionalism and concern, assist the the earth’ (n. 209). Thus the pre- ly See which is called to manifest sick un charity. ferred gaze of the disciples of Je- the solicitude of the Church to- The Church has always seen sus can only be addressed to the wards those who suffer and those service to the sick and the suf- marginalised, to the physical and who take care of them. You took fering as an integral part of the existential outskirts of the world. the theme of your meeting from mission entrusted to her by Je- This mission, however, can be the apostolic letter Salvifici dol- sus to proclaim the Kingdom of obfuscated by shadows, by weak-

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ness and by tiredness, which we not allowed to “pass by on the health-care workers, families and are called to overcome through other side” indifferently; we must volunteers for the valuable ser- clear witness and a personal and “stop” beside him. Everyone who vice that they offer in relieving communal pathway of conver- stops beside the suffering of an- the suffering of their neighbours. sion, especially during the Lent- other person, whatever form it Down the centuries very many en time of grace. As we were re- may take, is a Good Samaritan. Catholic – religious and lay – as- minded by the first reading with This stopping does not mean cu- sociations have arisen which have the example of Naaman the leper, riosity but availability’ (John Paul been involved in providing pas- we, being conscious of our limits II, apostolic letter Salvifici dolo- toral care for the sick, as well as and our weaknesses, feel the need ris, n. 28). very many organisations of Cath- to be healed, to be purified, and Health-care workers are called olic medical doctors, associations we know that to achieve this we to be neighbours to the sick, al- of nurses, of pharmacists, and of must entrust ourselves to God. ways trying to place care and volunteers, and national and in- But for this to take place we need concern at the side of their pro- ternational diocesan organisa- to come down off our pedestals, fessionalism. This is what St. tions, which have been created to lower ourselves and allow our- Camillus de Lellis asked of his respond to the problems of medi- selves to be reached by the grace religious when he used the phrase cine and health. The task entrust- of the humility of Christ who ‘more heart in those hands!’ The ed by the Blessed John Paul II to made himself poor in order to en- tandem of professionalism and your Pontifical Council consists rich us with his poverty. charity applies to all those who of coordinating these complex Only starting from this ex- draw near to the suffering of oth- realities and fostering an ongo- perience of Love that emanates er people, recognising in the face ing ethical-religious formation, in from the Cross and the Redemp- of every person the features of a the face of the new scenarios of- tion of the Lord can we turn our brother and a sister and, in essen- fered by the biomedical sciences gaze towards others, recognising tial terms, of Christ himself. as well. them in their dignity as persons, This gospel parable also points This plenary assembly consti- in particular when they suffer, as to the pathway by which we can tutes a valuable opportunity for an we were reminded by Pope Fran- achieve an authentically human assessment of the work that has cis in his Message for this Lent: civilisation which today is con- been done and for engaging in di- ‘we Christians are called to con- fronted by, and clashes with, cul- alogue about how the Church can front the poverty of our brothers tural models that are based on respond in a better way to her task and sisters, to touch it, to make success, efficiency and the exag- of evangelisation in the world of it our own and to take practical geratedly private dimension of health and health care. steps to alleviate it. Destitution life. What Pope Benedict XVI ob- It is my hope that all of you, is not the same as poverty: des- served in his encyclical Spe salvi dear brothers and sisters, will be titution is poverty without faith, is of as much contemporary rel- animated by the same spirit as without support, without hope… evance as it has ever been: ‘The Christ, the Good Samaritan. I en- In response to this destitution, the true measure of humanity is essen- trust this intention to the interces- Church offers her help, her diako- tially determined in relationship to sion of Mary, Salus infirmorum, nia, in meeting these needs and suffering and to the sufferer. This to all the men and women saints binding these wounds which dis- holds true both for the individual of charity who spangle the history figure the face of humanity. In the and for society. A society unable to of the Church, and to the Bless- poor, the sick and suffering, and accept its suffering members and ed John Paul II. May his witness, in the last we see Christ’s face’. incapable of helping to share their especially during his last years The Gospel that we have lis- suffering and to bear it inwardly when he experienced in his own tened to with the paradigmat- through ‘com-passion’ is a cruel flesh the burden and the difficul- ic figure of the Good Samaritan and inhuman society’ (n. 38). ties of infirmity, always be for makes us understand the infinite The service of the Pontifical your Pontifical Council for Health love that God has for every hu- Council for Health Pastoral Care Care Workers and for everyone man being, especially when they is located in this approach and it an admonition and an encourage- are afflicted by illness and pain, should be thanked for the work ment to do good to those who suf- and points out to us what the at- that it has carried out on behalf fer and to demonstrate that one titude of each one of us towards and by the mandate of the Holy can do good through one’s own our neighbour must be. ‘We are Father. My thanks also go to all suffering as well. Amen.

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From the Encounter with the Living God to the Journey Towards Man who is in Need and Suffering, the ‘Triptych’ of Mary, Mother of Life Homily by H.E. Msgr. Zygmunt Zimowski, the President of the Pontifical Council for Health Care Workers, Tuesday 25 March 2014, Church of the Holy Spirit in Sassia

ost Reverend Excellen- the moment of holy Christmas, in though she was holy and free of Mcies, distinguished members reality the decisive act for our sal- original sin. Behold the humil- and consultors of the Pontifical vation by Jesus Christ had already ity of God which is expressed in Council for Health Care Work- begun at the moment when he was obedience to Mary who from that ers (Health Pastoral Care), dear conceived in the womb of Mary, moment became his Mother and brothers and sisters, and this took place thanks to the whom he, although he was God, We have just listened to the pas- willingness of Mary and her co- had to obey. Let us, therefore, to- sage from the Gospel according to operation with divine grace. It is day thank the Father who sent His St. Luke (Lk 1:26-38) which de- specifically for this reason that the Son so that he could become our scribes the mystery of the solem- Blessed John Paul II, in his encyc- Brother and Redeemer. This mys- nity that we are experiencing to- lical Redemptoris Mater, empha- tery also demonstrates the trust day: the Annunciation of the Lord. sised the exceptional character of that God placed in Our Most Holy Behold, the young woman of Naz- that moment which is unique in Lady! areth is visited by the Messenger the history of salvation and of hu- The solemnity of today makes of God – the manity. Pope John Paul II wrote: us understand how great God’s – who announces to her amazing ‘Mary is definitively introduced love is for humanity: He not only and unexpected news: ‘“Hail, full into the mystery of Christ through created us, not only does he take of grace, the Lord is with you”’, this event: the Annunciation by care of us ‘from afar’ in heaven, the Archangel said to Mary, who the angel. This takes place at Naz- but He also enters our lives. was listening to him, certainly as- areth, within the concrete circum- As Pope Benedict XVI ob- tounded and astonished but also stances of the history of Israel, the served: ‘In the present crisis af- immediately ready to answer his people which first received God’s fecting not only the economy call: ‘“Do not be afraid, Mary, for promises’ (RM, n. 8). but also many sectors of socie- you have found favour with God. We are experiencing today the ty, the Incarnation of the Son of Behold, you will conceive in your mystery of the incarnation of the God speaks to us of how impor- womb and bear a son, and you Son of God who took on the hu- tant man is to God, and God to shall name him Jesus. He will be man conditions. As the Apostle man. Without God, man ultimate- great and will be called Son of the of the Nations writes: ‘He has al- ly chooses selfishness over soli- Most High, and the Lord God will ways had the nature of God, but darity and love, material things give him the throne of David his he did not think that by force he over values, having over being. father, and he will rule over the should try to remain equal with We must return to God, so that house of forever, and of his God. Instead of this, of his own man may return to being man. kingdom there will be no end”’. free will he gave up all he had, With God, even in difficult times Mary, trusting in the will of God, and took the nature of a serv- or moments of crisis, there is al- after the dialogue with the Arch- ant. He became like a human be- ways a horizon of hope: the Incar- angel answers: ‘“Behold, I am ing and appeared in human like- nation tells us that we are never the handmaid of the Lord. May it ness. He was humble and walked alone, that God has come to hu- be done to me according to your the path of obedience all the way manity and that he accompanies word”’ (Lk 1:36). to death – his death on the cross’ us’ (‘Homily in Loreto’, 4 Octo- Dear brothers and sisters, as (Phil 2:6-8). The Annunciation, ber 2012). we all know, today’s solemnity is indeed, signifies the entrance of We should also emphasise, very important for our faith! God God into human history, but also dearest brothers and sisters, that directly entered human history. It His debasement and His humilia- the mystery of the Incarnation was specifically that ‘fullness of tion. Behold the Son of God who was possible because of this ‘Yes’ time’ to which St. Paul referred – we can say – had enjoyed ce- of Mary; because of her full read- in his Letter to the Galatians (Gal lestial happiness and then took iness to implement the will of 4:4): God took upon Himself hu- upon himself the body of a man, God. ‘“Behold, I am the hand- man flesh and became one of us. of a little baby, who even al- maid of the Lord. May it be done Even though in a tangible sense lowed himself to be ‘closed up’ to me according to your word”’ He would make Himself seen at in the womb of a creature, even (Lk 1:36), and that today’s feast

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day must also be an occasion to Dear brothers and sisters, the can find Jesus. As the Holy Father express our gratitude to the Bless- Most Holy Mary wants, there- Francis often says, we can even ed Virgin Mary who became the fore, to teach us today that daily ‘touch’ Jesus by bending down Mother of God and our Mother. encounter with God must lead us before the poor and the suffer- It was specifically she who made to find our neighbour, to go out ing, the sick, who for him are the possible the plan of salvation of our homes and seek those who real flesh of Christ, as he remind- willed by God. The Blessed John are in a state of need, any need, ed us yesterday as well, during Paul II went on to write: ‘Mary is as Mary did by going to Elizabeth his address. On this point we can “full of grace,” because it is pre- to help her, to be near to her dur- also read in the apostolic exhor- cisely in her that the Incarnation ing the moment of her pregnancy tation Evangelii gaudium: ‘The of the Word, the hypostatic un- (all the more so because Eliza- Church’s closeness to Jesus is part ion of the Son of God with human beth was not very young!), and of a common journey; “commu- nature, is accomplished and ful- to serve unborn life. This action nion and mission are profoundly filled’ (RM, n. 9). certainly cost Mary a great deal interconnected”. In fidelity to the However, it should also be said of work. Certainly it would have example of the Master, it is vitally that the announcement that the been much easier and more com- important for the Church today to Archangel Gabriel made to Mary fortable for her to have stayed at go forth and preach the Gospel to was only the beginning of her home. But she was full of grace all: to all places, on all occasions, mission, even though it was fun- and thus she wanted to share this without hesitation, reluctance or damental for the further unfolding grace and this joy with other peo- fear. The joy of the Gospel is for of the history of salvation. Indeed, ple. She did this both with words all people: no one can be exclud- the encounter with the Messen- and with practical deeds of char- ed’ (Evangelii gaudium, 23). And ger of God called on Mary to go ity. This is what we should learn Pope Francis goes on: ‘An evan- out, to go out to find another per- from Mary today: first, to en- gelizing community gets involved son. As we are told by St. Luke, counter God sincerely, to unite by word and deed in people’s dai- Mary, as soon she learnt from the ourselves to Jesus through prayer ly lives; it bridges distances, it Archangel (cf. Lk 1:36) that her and the sacraments, and in par- is willing to abase itself if nec- cousin Elizabeth was expecting a ticular the Eucharist, so as then essary, and it embraces human child, although she was already to take him to other people. In life, touching the suffering flesh of an advanced age, immediately doing this we become authentic of Christ in others. Evangeliz- hurried to see her. She went to a apostles of Christ and we put in- ers thus take on the “smell of the town which according to scholars to practice his words: ‘You have sheep” and the sheep are willing is today’s Ain-Karim, not far from received without paying, so give to hear their voice’ (EG, n. 24). Jerusalem but rather distant from without being paid’ (Mt 10:8). It To go out, therefore, means Nazareth. However for Mary the is said that the Blessed Ozanam to bear witness. But this witness distance was not important. What after every Holy Mass in which cannot be limited to words alone. mattered was her wish to meet the he had taken part used to visit the We can well see that Mary not on- woman that the Archangel had sick. Faith grows in us and leads ly tells Elizabeth about the ‘great spoken to her about: Elizabeth, to charity when we share it with things’ (Lk 1:49) that the Lord has her relative. It is interesting to ob- others. Our love for Christ is mul- done for her but also makes her- serve that Our Lady, after her en- tiplied when we bear witness to self available to help her in prac- counter with the Archangel, after that love to our neighbour. We tical terms, trying to make easier that is to say accepting the mys- cannot keep the gift of the grace the difficult period of waiting be- tery of the incarnation, did not go of God within ourselves! We are fore the birth of her child. Mary to the temple or the synagogue called to give it to other people, thus teaches us that to evangelise to thank the Lord for the gift that even though this means at times means above all else to serve. She had been received, but, rather, she hard work and sacrifice! How thus shows us that she is a hum- wanted to share the joy of that can we not now refer to the very ble handmaid of the Lord who is encounter of divine reality with many appeals of Pope Francis ready to serve God in the human human reality, almost as though who is untiring in reminding us person! Thus first of all she puts she wanted to take the Annuncia- of this need to go out, to go to the into practice the words that her tion outwards. After her greetings outskirts of existence, to bring the Son would later say – ‘whenever and the mutual enthusiasm of be- Kingdom of God precisely there you did this for one of the least ing with her cousin Elizabeth, where there are marginalised important of my family, you did it Mary pronounced the hymn that people who are forgotten by the for me’ (Mt 25:40). is known as the Magnificat which world, people who are sick and In this way we have seen – so to is an authentic act of praise and suffering? speak – two wings of the triptych exultance for God. Thus can we This going towards other peo- of Mary and of each one of us: an- come to speak about a certain trip- ple must, however, be preceded nunciation and visitation; encoun- tych: the encounter of Mary with by encounter with God. We can- tering God, uniting oneself to Him God – annunciation; the encoun- not go towards others, empty and so as to then encounter our neigh- ter of Mary with another person – without divine power! On the oth- bour: sharing with our neighbour visitation; and the exultance of her er hand, it should also be said that the joy of the Gospel and being soul in the Lord – adoration. in encountering others, we, too, filled with this joy that emanates

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from others. There thus remains We are gathered here together whole of his or her life. In some the third part of this special ‘trip- in the Church of the Holy Spirit countries, such as Poland, the Day tych’, the central part that is ex- in Sassia and of Divine Mercy. for Life for the defence of life is pressed in adoration and giving We should thus remember that specifically organised today. Let praise to the Lord as Our Lady the key by which to understand us, therefore, pray to Mary, the did by exalting God in the hymn the faith of the Most Holy Mary Mother of life, for all women who called the Magnificat. Those who is the Person of the Holy Spirit. are expecting a baby, that they have really found God and then St. Luke tells us that Mary was may have the right conditions to have then found Jesus in their full of the Spirit of God. It was bring their pregnancies to a hap- neighbour can but praise God be- the Holy Spirit who had the Child py conclusion; let us pray for all cause their hearts are full of that Jesus conceived in her womb. It defenders of life, that their efforts happiness that derives from the was then the Holy Spirit who con- may achieve the construction fact that the Kingdom of God is vinced her to visit Elizabeth. And of the so-named ‘culture of life’ growing, that the earth is becom- Elizabeth perceived the presence against the ‘civilisation of death’, ing a ‘corner of heaven’, and that of God in her home. St. Luke the to which the Blessed John Paul II God has defeated the darkness of Evangelist communicates this often referred. the Evil One. Mary thus teaches with the following words: ‘When At the end of this homily let us us how to praise the Lord. First Elizabeth heard Mary’s greeting, turn our eyes to Mary, the Moth- of all she does this in a spontane- the infant leaped in her womb, er of life, with the words of John ous way but at the same time by and Elizabeth, filled with the ho- Paul II: basing herself on her knowledge ly Spirit, cried out in a loud voice ‘O Mary, of the word of God. Indeed, Mary and said, “Most blessed are you bright dawn of the new world, uses the model of ‘praise’ which among women, and blessed is the Mother of the living, had existed for centuries in the fruit of your womb. And how does to you do we entrust the cause psalms. Thus we can evince that this happen to me, that the mother of life her faith was deep and mature, of my Lord should come to me? Look down, O Mother, even though simple and sincere. For at the moment the sound of upon the vast numbers Mary’s faith was built upon lis- your greeting reached my ears, of babies not allowed to be born, tening to the word of God, medi- the infant in my womb leaped for of the poor whose lives are made tation and prayer. The echo of this joy. Blessed are you who believed difficult, ‘encounter’ of hers with God we that what was spoken to you by of men and women find in the text of the Magnificat. the Lord would be fulfilled”’ (Lk who are victims of brutal To praise God, to exalt the Lord, 1:41-45). In a few words, the joy- violence, one first needs silence, meditation ous meeting of Mary and Eliza- of the elderly and the sick killed and at times also the hard work of beth was the work of the Holy by indifference or out of deepening one’s close relation- Spirit. Both were women of faith, misguided mercy. ship with God, the one and triune full of the Holy Spirit. From the Grant that all who believe God. Holy Spirit they obtained the hap- in your Son The important thing is that one piness of encounter with God and may proclaim the Gospel of life has the wish to praise God. As fear of God, remembering His with honesty and love Pope Francis often reminds us, mercy. to the people of our time. we Christians usually confine Lastly, I would like to empha- Obtain for them the grace ourselves to asking God to grant sise that today’s solemnity must to accept that Gospel us a grace, to listen to our prayers. also be seen as the ‘Feast Day of as a gift ever new, We thank him much more rarely Life’. This aspect is very impor- the joy of celebrating it and we almost never praise Him. tant for us. Mary, indeed, is the with gratitude Instead, as the Holy Father re- Mother of life. This meeting of throughout their lives minded us a short time ago in one two expectant women makes us and the courage to bear of his morning sermons at the Ca- reflect upon the gift of life which witness to it sa Santa Marta, to praise God is already begins at conception and resolutely, in order to build, an obligation for us and it is the which should be supported and together with all people first act that we must repeat every protected not only in a physical of good will, day. It is precisely God who gave way but also in a spiritual way. the civilization of truth and love, us our lives and conserves them. That is to say: every father and to the praise and glory of God, Everything that we have, we pos- mother should pray for their un- the Creator and lover of life’ sess thanks to Him! This is some- born child and invite the Lord (EV, 105). thing that we should never forget! to accompany that child for the Amen!

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Report on the Activity of the Pontifical Council for Health Care Workers: 2009-2014

he apostolic Constitution Pas- 2.4 Celebration of the World a renewed and involving pastoral Ttor Bonus defines the mission Day of the Sick care in health. of our Pontifical Council in the fol- 2.5 Journeys and Pastoral Visits Our dicastery was called to con- lowing way: ‘Art. 152. The Pontifi- 2.6 Contacts with Chaplains and stant renewal and updating by its cal Council for Pastoral Assistance their Pastoral Assistants in Health founder the Blessed – and in a to Health Care Workers shows the Care and with Associations of Sick short time the – John Paul II. solicitude of the Church for the sick People and Volunteers In the apostolic Constitution Pas- by helping those who serve the sick 2.7 Pilgrimages and Moments of tor Bonus of 28 June 1988 he stat- and suffering, so that their aposto- Prayers with Health-Care Workers, ed in article 152 that the Pontifical late of mercy may ever more effec- Spiritual Assistants and Sick Peo- Council ‘shows the solicitude of tively respond to people’s needs’. ple the Church for the sick by helping those who serve the sick and suf- ‘§ 3. The Council fosters stud- fering, so that their apostolate of The tasks of the Pontifical ies and actions which interna- mercy may ever more effectively Council according to art. 153 tional Catholic organizations or respond to people’s needs’. In the of the same document are other institutions undertake in following article 153 the tasks of described in the following way: this field’. the Pontifical Council were then 3.1 The ‘Good Samaritan’ Foun- described by the Supreme Pontiff. ‘§ 1. The Council is to spread dation This report on the activities the Church’s teaching on the 3.2 The International Federation that were engaged in from 2009 spiritual and moral aspects of of Catholic Medical Associations to 2014 under the presidency of illness as well as the meaning of (FIAMC) Archbishop Zygmunt Zimowski is human suffering’. 3.3 The Catholic International organised into four parts based up- 1.1 Messages of the Holy Father Committee of Nurses and Medico- on the four sections of article 153 for the World Day of the Sick Social Assistants (CICIAMS) of Pastor Bonus where the tasks 1.2 Messages of the President of 3.4 The International Federation of the dicastery are outlined. The the Pontifical Council of Catholic Pharmacists (FIPC) initiatives of the Pontifical Coun- 1.3 International Conferences of 3.5 The International Commit- cil are described with reference to the Pontifical Council for Health tee of Health-Care Institutions of each of these sections. Care Workers the Church (CIISAC) 1.4 International Study Meetings 3.6 Institutes of Consecrated Life 1.5 The Review Dolentium hom- 3.7 Contacts with Catholic and Art. 153 § 1: ‘The Council inum and other Publications of the non-Catholic Associations, Insti- is to spread the Church’s Pontifical Council tutes and Organisations Active in teaching on the spiritual and 1.6 Communication: Press Con- the World of Health moral aspects of illness as well as ferences, Presence in the Mass the meaning of human suffering’ Media, the Web Site of the Pontifi- ‘§ 4. With keen interest it fol- cal Council. lows new health care develop- To perform this task the Pontifi- 1.7 Participation in Congresses, ments in law and science so that cal Council draws up and dissemi- Conferences and Meetings these may be duly taken into ac- nates the Messages of the Holy Fa- 1.8 Cooperation with the Dicast- count in the pastoral work of the ther for the World Day of the Sick; eries of the Church’. publishes the Messages of the Pres- 4.1 Cooperation with the Pontif- ident of the dicastery; organises in- ‘§ 2. It lends its assistance to ical Academy for Life ternational conferences and study the particular Churches to en- 4.2 Cooperation with Catholic meetings; publishes the review Do- sure that health care workers Universities and Other Universi- lentium hominum and other pub- receive spiritual help in carry- ties, Research Centres and Insti- lications; organises and takes part ing out their work according to tutes in press conferences and is present Christian teachings, and espe- 4.3 Study Activities within the mass media; manages cially that in turn the pastoral its own web site; takes part in con- workers in this field may never gresses, conferences and meetings; lack the help they need to carry Introduction and cooperates with the other di- out their work’. casteries of the Roman Curia. 2.1 Synods of Bishops This eighth plenary session of 2.2 Visits ad limina and other the Pontifical Council for Health 1.1 Messages of the Holy Father Visits to the Pontifical Council Care workers (for Health Pasto- for the World Day of the Sick 2.3 The Offices for Pastoral Care ral Care) wishes to be first of all in Health of Local Churches a stimulus and encouragement for Every year the Pontifical Coun-

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cil writes a draft of this Message Conference on Conscientious Ob- are 600-650 people from 60-65 which is then submitted to the Holy jection held at the Catholic Univer- countries. The speakers, who are Father. The themes of these Mes- sity of Lublin. on the whole Catholics, are chosen sages correspond to the themes from amongst the greatest experts chosen for the World Day of the In addition, in 2009, on the occa- in the field and represent variegat- Sick. The Message is disseminated, sion of the Year of Priests, the Pres- ed geographical, cultural and reli- translated, and put on the web sites ident of the Pontifical Academy gious realities. One session is de- of the Holy See and our own dicas- published a ‘Letter to the Sick and voted to an inter-religious vision of tery. The President writes a theo- the Suffering in the World’. This the subject addressed. logical comment which is availa- was translated into many languag- The international conferences ble to everyone. We like to ensure es, disseminated through Bishops’ are open to everyone and generate that the Messages are published as Conferences and bishops responsi- great interest, on the part of civil quickly as possible so that they can ble for pastoral care in health, as- authorities as well, for example be used as soon as possible in the sociations of sick people and also Ministers for Health, ambassadors, pastoral work of local Churches. widely through the mass media. and representatives of the World Since 2011 these Messages have Health Organisation and other in- had a title based on a text from Ho- 1.3 International Conferences ternational institutions. ly Scripture: of the Pontifical Council The culminating moments of the – in 2011: ‘By his wounds you international conferences are the have been healed’ (1Pt 2:24); The international conferences, moving meetings with the Holy – in 2012: ‘Stand up and go, your which are organised each year in Father. These are strong moments faith has saved you’ (Lk 17:19); the month of November, consti- not only from a doctrinal point of – in 2013 ‘Go and do likewise’ tute one of the most important ini- view but also at an emotional level, (Lk 10:37). tiatives designed to meet the new in particular for those who have an The first Message of Pope Fran- needs and issues that emerge in opportunity to greet the Pope indi- cis, of this year, had as its theme: the field of health care and which vidually. Since the year 2012, in or- ‘Faith and charity: “We too must health-care workers and pastoral der to take part in these meetings at give our lives for our brethren”’(1 workers in health care have to ad- a deeper level, they have been pre- Jn 3:16). dress. Through them the doctrine ceded by moments of reflection and of the Church on various aspects of prayer in the Paul VI Hall, alternat- 1.2 Messages of the President illness and human suffering is dis- ed with moving testimonies of life of the Pontifical Council seminated. The subjects that have and songs by choirs. In addition been addressed since 2009 are as to those taking part in these inter- The Messages of the President follows: national conferences, sick people, of the Pontifical Council are on 2009 - ‘Ephphatha! The Hear- associations of socio-health-care events such as: ing-impaired Person in the Life of volunteers, medical students and The World Leprosy Day. the Church’ student nurses also take part. The World Day against AIDS. 2010 - ‘Caritas in veritate. We would like to point to the The World Autism Awareness Towards Equitable and Human special features of the internation- Day. Health Care’ al conference of 2009 which was The International Day of Older 2011 - ‘Pastoral Care in Health on hearing-impaired people. The Persons. at the Service of Life in the Light large numbers of these people in The World Diabetes Day. of the Magisterium of the Blessed the hall meant that major efforts at The World Day of the Disabled. John Paul II’ the level of organisation were re- The World Day for the Collec- 2012 - ‘Hospitals as a Setting quired. At the end of the deliber- tion of Medicines. for Evangelisation: their Human ations, and in the light of the ad- and Spiritual Mission’ dress of the Holy Father, a text There are also Messages for var- 2013 – The Church at the Ser- containing ‘Final Recommenda- ious ecclesiastical associations and vice of Sick Elderly people: Care tions’ was drawn up in which it institutions in which the Magisteri- for People with Neurodegenerative was stated that people with hearing um of the Church on questions re- Diseases’. impediments should be integrated lating to the promotion of life and into the life of the ecclesial com- the protection of health is empha- Before every international con- munity. These ‘Recommendations’ sised. Last year alone the follow- ference of the Pontifical Council were translated into various lan- ing Messages were disseminated: a press conference is held in the guages and sent to all the Bishops’ – To those taking part in the Vatican press hall of the Vatican to Conferences of the world. Sixth International Colloquium of give greater publicity to the event. the International Association of The deliberations of the interna- 1.4 International Study Meetings Catholic Bioethicists. tional conferences take place in – To the President of the Catho- the Vatican City in the New Hall of These have been a new initia- lic Health Association of India on the Synod. These meetings bring tive for the Pontifical Council and the seventieth anniversary of its together hundreds of participants were begun in the year 2010 with foundation. and numerous speakers from all the idea of organising study meet- – To those taking part in the over the world. On average there ings of a more contained nature

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than the international conferences. ecclesial and civil, organisations to for Health Care Workers has con- These meetings are organised to- achieve one of the priority objec- tinued the publication of its review gether with the ‘Good Samaritan’ tives of the fight against blindness: Dolentium Hominum – Church Foundation which works inside the universal and free access to treat- and Health in the World. This is Pontifical Council. Hitherto four ment. The Christian Blind Mission a four-monthly publication and is such meetings have taken place in Italy cooperated with this event. printed in four languages: Italian, the Vatican. To facilitate the utilisation of the French, English and Spanish. One The first meeting of June 2010 whole initiative by people with im- of its editions contains the pro- – ‘Ephphatha! The Deaf Person: paired sight, various aids were en- ceedings of the international con- a Herald and Witness to the Evan- visaged, amongst which the publi- ference that is held every year in gelical Message’ – was a contin- cation in Braille of the programme November; another contains the uation of the international confer- and the showing in the form of a proceedings of the study meeting ence of 2009 on hearing-impaired reproduction in bas-relief of two which usually takes place in May people in the Church. A large num- works from the diocesan museum or June; and in the third is to be ber of Italian dioceses under the of Mantua, enriched by a guide found, starting with the Message guidance of the Bishops’ Confer- written in Braille and an audio ex- of the Holy Father, texts connected ence of Italy cooperated with this planation. with the annual celebration of the event which was designed to elimi- One outcome of this meeting World Day of the Sick. This edi- nate ‘the barriers of physical deaf- was a project of the diocese of Co- tion is completed by other texts, ness but above all those of spiritu- roico in Bolivia for the prevention for example papers given at con- al deafness’. A major contribution and treatment of visual disability ferences or texts of a pastoral or was made by the representatives of designed to avoid children leaving scientific character. the American, Spanish, Irish and school because of difficulties with In preparation for the World Day German Churches. their sight. of the Sick of 2013 and 2014, sup- The second meeting of May The fourth meeting of May 2013 porting material of a theological- 2011 – ‘The Centrality of Care for – on the theme ‘The Child as a Per- pastoral-liturgical character was the Person in the Prevention and son and a Patient: Therapeutic Ap- published on subjects indicated by Treatment of Illnesses Connected proaches Compared’ – took place the Holy Father for the World Day with HIV/AIDS’ – sought to pro- as a preparation for the Day of of the Sick. These support materi- mote information and discussion Evangelium vitae which was cele- als sought to offer patients, health- about therapies in this area with brated in the Vatican on 15-16 June care workers, pastoral workers, a view to a ‘holistic’ approach to last year within the framework of families, parishes and volunteers illness and its prevention. The ob- the Year of Faith. More than 200 points for theological reflection, jective was to achieve a synthesis participants came from over thirty studies in pastoral care, and for- of new strategies for action able to countries of all the continents of the mulas for prayers. conjoin scientific discoveries with world. The papers were given by In 2012 the Pontifical Council the defence of life and the dignity 41 speakers, amongst whom were published the volume ‘God has of the human person. psychologists, psychiatrists, theo- Visited His people. On the Way of Ecclesial institutions, organi- logians, philosophers, bioethicists, Suffering Man’. The texts in this sations and movements, as well pharmacists, researchers and econ- collections come from speeches or as bodies not connected with the omists, who were supported by the papers given by the President of Church, that are involved in assis- experiences offered by representa- the dicastery on public occasions tance and care for people with HIV/ tives of the local Churches of Afri- which varied in terms of their con- AIDS cooperated with this event. ca, North America, South America, text and their importance. This is a One outcome of the meeting was Asia, Oceania and Europe. publication rich in pastoral experi- the Test and Treatment Project for The Day of Evangelium vitae, ence as regards the field of health people with HIV/AIDS in the dio- which was organised by the Pon- and illness. cese of Shinyanga in Tanzania. tifical Council for the New Evan- In 2013 a short book was pub- The third meeting of May 2014 gelisation in cooperation with our lished entitled ‘Pastoral Care in – ‘The Unsighted Person: Rab- Pontifical Council, was an impor- Health and the New Evangelisation bi, Restore my Sight (Mk 10:51)’ tant moment to emphasise pastoral for the Transmission of the Faith’. – sought to explore the subjects action in favour of love and service This is a contribution to the debate of the prevention and treatment of for life from conception to its natu- about the new evangelisation and blindness and impaired sight ac- ral sunset. seeks to respond to the recommen- cording to the new approaches of dations made at the end of the thir- study and research in the field, also 1.5 The Review Dolentium teenth Ordinary general Assembly bearing in mind the experience ac- Hominum and Other of Bishops and the Twenty-Sev- cumulated in traditional approach- Publications of the Pontifical enth International Conference or- es. In addition, this meeting was an Council ganised by our Pontifical Council opportunity to promote above all on 15-17 November 2012 whose else the pastoral dimension to help- During the years 2009-2014, in subject was ‘Hospitals as Settings ing people without the faculty of disseminating the thought of the for Evangelisation: their Human sight, but ut was also to encourage Church in the field of health and and Spiritual Mission’. all the national and international, health care, the Pontifical Council Two important volumes are be-

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ing prepared: the new version of the Popes to the entire collections hundred occasions in the form of the Charter for Health Care Work- of the review Dolentium Hominum. keynote lectures, prolusions and ers and the Index of the health- The web site of the dicastery, shorter papers. Some of the sub- care institutions of the Catholic holyseeforhealth.net, is rich in ma- jects addressed were: Church. There will be two separate terial and potentially very produc- ‘The Value of Human Life in articles on these two projects. tive from the point of view of dis- the Light of the Teaching of the semination. It clearly deserves to Church’ 1.6 Communication: Press be further encouraged and devel- ‘The Institution and Activities of Conferences, Presence in the oped. the Pontifical Council for Health Mass Media, and the Web Site Care Workers from the Perspective of the Pontifical Council 1.7 Participation in Congresses, of its Twenty-Fifth Anniversary’ Conferences and Meetings ‘Humanae Vitae and the Chal- Starting at the end of Septem- lenge to Health-Care Workers’ ber 2009, the presence of the di- Each year the Pontifical Coun- ‘Priests and the Mass Media castery in the mass media has been cil receives numerous invitations from the Point of View of Human decidedly increased in line with a to take part in various scientific, Suffering’ specific strategy and offering the cultural and religious events which ‘The Frail Person: the Spiritual greatest possible cooperation to deal with subjects connected with Dimension’ the Vatican Press Office which has life, health and illness. These are ‘The Theology of the Body and worked prodigiously for our ini- congresses, conferences and meet- Pastoral Care in Health’ tiatives as well. Carrying out re- ings organised by various ecclesial ‘The Blessed John Paul II: a search on Internet, for example and lay institutions. The President, Marian Pope and an Intrepid De- using Google, and using as a key the Secretary and the Under-Secre- fender of Life’ the name of our dicastery in Ital- tary, as well as the Officials and the ian, about 60,000 results appear; Consultors of the dicastery, travel Over the last five years, the di- in English there are about 90,000. in Italy and abroad to take part in castery has given about 160 lec- These facts constitute an excellent these events. We may cite here by tures and talks of this kind. indication of the quantity of ser- way of examples: vices, news and citations that have 1.8 Cooperation with the appeared in the various parts of the • The conferences held in Rome: Dicasteries of the Roman mass media. By the ‘Don Giuseppe Dossetti’ Curia This was obtained during a peri- Associations and the Art and Life od that was far from being easy for Association at the Chamber of Relations have continued with the Church which in recent years Deputies. the various dicasteries of the Ro- has far too often been the subject By the Health Care and Health man Curia and these have wit- of criticisms and attacks, notwith- Observatory at the Senate of Italy. nessed the involvement of the su- standing the immense amount of By the Politics and charity Inter- periors and the officials of our positive work that has been en- national Association. Pontifical Council. gaged in. This result was also By the ‘Camillianum’ Interna- First of all reference should be obtained thanks to the industri- tional Institute of the Theology of made to cooperation with the Sec- ousness of the dicastery and to ma- Pastoral Care at the beginning of retariat of State in the drafting of terial produced beforehand ad hoc, its academic year. reports on the conventions on: to targeted interviews, to press re- By Matercare International, The Rights of Children; leases, and to Messages that were Against Torture or other Cruel, disseminated everywhere, as well • The conferences held in Italy: Inhuman or Degrading Punish- as to a careful management of con- By the Gaslini Scientific Insti- ments or Treatment (CAT); tacts with people who work in the tute of Genoa. For the Elimination of all Forms mass media. By various associations and in- of Racial Discrimination (CERD). The press conferences that have stitutions of Verona. been held over the last five-year By the Magna Græcia Univer- There have also been many oth- period have numbered seven, and sity in Catanzaro. er meetings on various subjects of all of them were organised by the common interest with dicasteries Vatican Press Office. There were • The conferences held abroad: and institutions of the Holy See, six which launched the same num- By the National Catholic Bio- and in particular: the Congregation ber of international conferences ethics Center in cooperation with for the Doctrine of the Faith; the and two connected with the World the Knights of Columbus in the Congregation for Institutes of Con- Days of the Sick which were cel- USA. secrated Life and Societies of Ap- ebrated in a solemn way, that is to By the Catholic University of ostolic Life; the Pontifical Council say those of 2010 and 2013. Lublin in Poland. for Justice and Peace; the Adminis- The photographic archive of the By the diocese of Vitebsk in tration of the Patrimony of the Ap- Pontifical Council was digitalised. Byelorussia. ostolic See (APSA); the Prefecture A DVD was produced containing for the Economic Affairs of the Ho- all the documents of use to pastoral The President of the Pontifi- ly See; the Pontifical Academy for care in health, from documents of cal Council has spoken on about a Life; and the Governorate.

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Art. 153 § 2: ‘It lends its which highlighted the need for the sector of health and pastoral care assistance to the particular defence and the valuing of life; the in health. Churches to ensure that health importance of inter-religious co- care workers receive spiritual operation in combating the most 2.3 Cooperation with the Offices help in carrying out their widespread illnesses; and support for Pastoral Care in Health in work according to Christian for the health-care services of the Local Churches teachings, and especially that Church which often are the only in turn the pastoral workers points of reference in vast territo- This cooperation has continued in this field may never lack the ries, such Africa, Asia and South first and foremost through corre- help they need to carry out their America. spondence. The offices for pas- work’. During the Synod for Africa 275 toral care in health of all the lo- health-care kits for first aid were cal Churches have been informed The Pontifical Council performs donated by the Pontifical Council about the more important initia- this task through: taking part in in cooperation with the embassy of tives of the dicastery. Amongst Synods of Bishops; visits of bish- Taiwan to the Holy See, to the Ho- other things, we sent them the ops ad limina and other visits; con- ly Father and the Synodal Fathers. Recommendations published after tacts with the offices for pastoral the international conferences and care in health of local Churches; 2.2 Visits ad limina and Other meetings. pastoral journeys and visits; con- Visits to the Pontifical Council The Pontifical Council has or- tacts with chaplains and their pas- ganised various initiatives to in- toral assistants in health care; co- These are moments of strong form bishops responsible for pas- operation with associations of sick fraternal communion and the ex- toral care in health about the people and volunteers; the celebra- change of experiences in the field cooperation between the Church tion of the World Day of the Sick; of health care and pastoral care and States in the field of health care and pilgrimages and moments of in health in order to have greater and the ideologies of gender and prayer with health-care workers, knowledge of activities, initiatives reproductive health. In this field, spiritual assistants and sick people. and projects in the sector of the ac- a notable initiative was the Meet- tivity of the local Churches. ing of Bishops Responsible for 2.1 Synods of Bishops To encourage visits to our di- Pastoral Care in Health and their castery, as soon as the annual list Delegates which was held in the These are fundamental mo- of the Bishops’ Conferences that Vatican in 2011, before the twenty- ments of cooperation with the local will make visits ad limina is issued sixth international conference. 42 Churches. Before a specific syn- by the Prefecture of the Pontifical prelates from 39 countries, as well od, the Pontifical Council studies Household, the dicastery sends a as experts and invited guests, came the relevant questions and issues letter of invitation to their respec- to Rome. The meeting was useful and draws up a suitable contribu- tive Presidents. In preparation for in assessing together the planning tion which is then presented by the a visit, the Officials of the Pontif- and operational forms for a better president of the dicastery – who is ical Council study the five-yearly coordination of action and forma- a member by right of the synod – reports that the bishops are obliged tion in a field that is as delicate as to the synodal assembly. to submit to the Holy Father and it is complex, namely the field of During the Thirteenth Ordinary draw up reports in order to facili- health. General Assembly of the Synod of tate shared deliberations. Usually Another example of cooperation Bishops on ‘The New Evangelisa- we are visited by delegations led is the journeys and visits by mem- tion for the Transmission of Chris- by the bishop responsible for pas- bers of the Pontifical Council in or- tian Faith’, Archbishop Zygmunt toral care in health. At times an en- der to take part in various meetings Zimowski summed up the relat- tire Bishops’ Conference comes organised by national and diocesan ed observations of the Pontifical to visit us; at times, unfortunately, offices for pastoral care in health. Council in his speech entitled ‘The nobody comes. These are lost op- Diakonia of Charity for the Sick’. portunities for knowing about each 2.4 Celebration of the Word Day He observed amongst other things other and for growth! of the Sick that during the course of her his- Despite the great amount of tory the Church has always seen work involved, we are happy about By his letter of 23 November service to the sick as ‘an integral the long list of visits ad limina of 2006, the Holy Father Benedict part of her evangelising mission’. the year now underway. One is XVI decided that the World Day of Thus the tandem of mission and dealing here, indeed, with twen- the Sick would be celebrated in sol- service for the sick is an integral ty-six bishops’ conferences which emn form once every three years in part of overall pastoral care of the represent the whole world. order to conform to similar World sick without which the apostolate We also receive at the Pontifical Days, for example the World Youth becomes mutilated. Council a large number of visits Day and the World Family Day. At the Special Assembly for Afri- from prelates, major superiors, ac- Because of this decision, the first ca of the Synod of Bishops of 2009, ademics and professionals, as well solemn celebration of the Eight- as well, the observations of the as ambassadors and politicians in- eenth World Day of the Sick took Pontifical Council were summa- volved in various national and in- place in the year 2010 in Rome in rised in a speech by the President ternational organisations in the concomitance with the fifteenth

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anniversary of the institution of the The next solemn celebration take part in congresses and meet- Pontifical Council for Health Care of the World Day of the Sick will ings and also to promote the Foun- Workers. On that occasion, on 9-11 take place in Nazareth in the Holy dation: in Italy, Byelorussia, Slo- February, the symposium on ‘The Land in 2016 and its theme will be vakia, France, Portugal, Taiwan, Church at the Service of Love for ‘Entrusting Oneself to Jesus like Indonesia, the Democratic Repub- the Suffering’ was held, with the Mary: “Do what I tell you!” (Jn lic of the Congo, the United Re- participation of 600 people from 2:5)’, as was decided by the Holy public of Tanzania, Zambia, Ugan- 47 countries. Father Francis. da and South Africa. The Holy Mass of 11 February As regards the celebration of the The Under-Secretary of the di- was presided over by the Holy Fa- World Day in ordinary form, that castery, Fr. Augusto Chendi MI, ther Benedict XVI and concele- is to say at a local level, one can engaged in a number of journeys brated with a large number of Car- state that this is by now a usual in Italy. In addition he accompa- dinals, bishops and priests. In the and consolidated practice in all the nied the ninth national pilgrim- afternoon, along Via della Concil- local Churches. 2014 witnessed age of the Italian National Union iazione, there was a torchlight pro- the twenty-second edition of this for the Transport of Sick People to cession led by the relic of St. Ber- World Day. Lourdes and International Sanctu- nadette and the statue of our Lady Msgr. Jean-Marie Mupendawa- aries (UNITALSI) to Barcelona, of Lourdes which had come for the tu, the Secretary of the Pontifical in which 900 people took part, in- occasion from France. Sick people Council, will speak in more detail cluding about 160 disabled chil- accompanied by nurses and vol- about the meaning of the World dren. unteers, as well as the superiors of Day of the Sick. the dicastery, took part. The event 2.6 Contacts with Chaplains ended with a blessing by Benedict 2.5 Pastoral Journeys and Visits and their Pastoral Assistants XVI from the window of his pri- in Health Care and with vate study. These are a tangible sign of co- Associations of Sick People Following tradition, on the oc- operation with local Churches in and Volunteers casion of the ‘World Day’, visits the field of pastoral care in health. were made to a number of places Numerous invitations to the dicast- Chaplaincies in health care are of care, for example, the Hospital ery come from Roman institutions: not a homogenous reality inside the of the Holy Spirit in Sassia. hospitals, private clinics, nursing Church. In order to learn about the The Twenty-First World Day of homes and various health-care in- profile of this reality, at the present the Sick, which was celebrated in stitutions. time we want to organise an inter- a solemn way, took place on 7-11 In addition, over the last five national meeting. To this end we February 2013 in three dioceses of years the President and the Secre- sent three questions to all the Bish- Bavaria in Germany, the birthplace tary of the Pontifical Council have ops’ Conferences of the world: 1. of the Holy Father Benedict XVI. engaged in many pastoral journeys does an organisation or association For the event the Pope appointed in Italy in response to invitations of hospital chaplains exist within as his special envoy Archbishop from various dioceses and institu- the Bishops’ Conference, in the di- Zygmunt Zimowski, the Presi- tions. oceses and in the parishes? 2. What dent of the Pontifical Council. The Other journeys, always in re- are the questions, the problems and programme for the celebrations sponse to invitations, have been the challenges that this organisa- in Bavaria followed the model of undertaken in Europe: Poland, tion faces? 3. Does a protocol of the previous solemn editions of Switzerland, Germany, France, understanding between the Church the World Day, namely they were Spain, Austria, Croatia, Slovakia, and the State as regards the organi- sub-divided into three moments – a Lithuania and Byelorussia. But sation of chaplaincies in places of theological one, with a conference there have also been longer jour- health care and the juridical status at the Catholic University of Eich- neys, such as those in the United of the personnel of chaplaincies? stätt-Ingolstadt; a pastoral one, States of America, Taipei, Mexico, From the answers that we re- with visits to various health-care the Island of Moloki, Reunion Is- ceived it emerges that in some institutions, such as, for example, land and Australia. countries chaplaincies are well the Hospital of Grosshadern which All these journeys have includ- organised whereas in others they has the clinic of the University of ed moments of prayer, meetings still function in an informal way. Munich; and a liturgical one, with with Church hierarchies and local All those who were questioned as- a solemn celebration of the Eucha- dignitaries, visits to health-care in- sured us that there pastoral care rist on 11 February at the Marian stitutions of the Church but also for the sick was provided but that sanctuary of Altötting. The sol- to public health-care institutions, a specific organisation for chap- emn liturgy took place in the large and meetings with sick people, lains did not exist. For this reason, church behind the Chapel of Our with health-care workers and with the Pontifical Council is working Lady of Graces. A large number of chaplains. to help the local Churches to cre- German and foreign bishops and Other journeys were engaged in ate a network of chaplaincies and priests concelebrated with the spe- by Msgr. Jean-Marie Mupendawa- the conference for this purpose cial envoy of the Pope. The sacra- tu as Secretary of the Pontifical should be held in the year 2015. ment of the sick was administered Council and as the delegate of the But before managing to create this to a large number of sick people. ‘Good Samaritan’ Foundation to international network it would be

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advisable for there to be organisa- 2.7 Pilgrimages and Moments who is one of the greatest promot- tions of some form of this sector of Prayer with Health-Care ers of charity and mercy towards at the level of dioceses and Bish- Workers, Spiritual Assistants the sick. ops’ Conferences. We are in con- and Sick people tact with a large number of interna- tional and national associations in In April 2010, on the occasion Art. 153 § 3: ‘The Council order to follow how this situations of the Year of Priests, the Inter- fosters studies and actions develops. national Pilgrimage of Hospi- which international Catholic We can point out that an institute tal Chaplains to Lourdes and Ars organizations or other for the formation of those working took place. This was organised by institutions undertake in this in chaplaincies in health care has the Pontifical Council and led by field’. been created in Krakow, Poland, its President, assisted by the then and its name is ‘The School for Secretary, H.E. Msgr. José L. Re- To carry out this task the Pon- Pastoral Care in Health of St. John drado OH. About fifty chaplains, tifical Council avails itself of the of God’. The Pontifical Council both religious and diocesan, from ‘Good Samaritan’ Foundation; has done a great deal as regards thirteen countries and four conti- works with the three most impor- this institution. nents of the world took part in this tant international associations of As regards associations of sick pilgrimage. During the five days of Catholic health-care workers: the people, during this five-year pe- pilgrimage, the prayers, the meet- International Federation of Catho- riod of 2009-2014 we have coop- ings with the sick and the liturgi- lic Medical associations (FIAMC), erated to a greater extent with as- cal celebrations helped to revive in the Catholic International Commit- sociations of the hearing impaired these priests the meaning of their tee of Nurses and Medico-Social and the sight impaired in preparing priestly vocations and their dedica- Assistants (CICIAMS), and the a conference and two internation- tion to the sick and the suffering. International Federation of Cath- al meetings. The relations with the In October 2013, before the olic Pharmacists (FIPC); cooper- International Association of the Si- closing of the Year of Faith, the ates with institutes of consecrated lent Workers of the Cross intensi- Pontifical Council organised a Pil- life; and works with associations, fied before the of their grimage to Israel and the Pales- institutes and organisations, both founder, Msgr. Luigi Novarese. tinian Territories. This group of Catholic and otherwise, active in In the year 2009, on the occasion about eighty people, made up of the world of health and health care. of the Year of Priests, the Presi- religious and health-care person- dent of the Pontifical Council sent nel under the guidance of the Sec- 3.1 The ‘Good Samaritan’ to all associations of sick people a retary of the dicastery, Msgr. Jean- Foundation Pastoral Letter in which he asked Marie Mupendawatu, helped by them to pray and to offer up their the Under-Secretary, Fr. Augusto This Foundation was instituted sufferings for the sanctification of Chendi MI, had an opportunity to by the Blessed John Paul II on 12 priests. visit the holy places. This pilgrim- September 2004 to give econom- As regards associations of Cath- age included a visit to a number ic support to sick people most in olic volunteers in health care, of important Catholic health-care need, and in particular AIDS pa- these have been of great help in the institutions in the Holy Land. On tients. Over time, the activity of preparation of our initiatives. We the final day the pilgrims took part the Foundation has steadily in- are especially grateful to the Ital- in a solemn Eucharistic liturgy in creased and today it is engaged ian National Union for the Trans- honour of the Virgin Mary, the in theoretical-practical initiatives port of Sick People to Lourdes and Queen of Palestine, during which such as the organisation of inter- International Sanctuaries (UNI- Archbishop Zygmunt Zimowski national study meetings; the fight TALSI), to the Military Sovereign officially announced that the next against HIV/AIDS; the donation Order of Malta (SMOM), and to celebration in solemn form of the of medical products; food educa- the ‘Misericordie’ of Italy. World Day of the Sick of 2016 tion for children; and scholarships. Last year UNITALSI celebrated would take place in Nazareth. The At a more detailed level, the the one hundred and tenth anni- news was received with great joy activity of the ‘Good Samari- versary of its foundation. It is very and expressions of gratitude to the tan’ Foundation will be discussed active in the preparations for the Lord by the over two thousand by the Secretary of the Pontifical World Day of the Sick, in audienc- faithful. Council, Msgr. Jean-Marie Mu- es with the Holy Father and during Another pilgrimage of the Pon- pendawatu, who is the delegate for moments of prayers in Rome and tifical Council took place during the Foundation. Lourdes. the Year of Faith and thus at the In various ways, through the ap- same time as the Camillian jubilee 3.2 The International Federation ostolic nuncios as well, we exhort year, which was held on the occa- of Catholic Medical the pastors of the Church to foster sion of the four hundredth anni- Associations (FIAMC) this kind of voluntary work, in par- versary of the death of St. Camil- ticular in hospices and in parishes, lus de Lellis. All the personnel This Federation has always been providing care to sick people who of the Pontifical Council went to invited to take part in the activi- are on their own, poor and aban- Bucchianico, which is near to Chi- ties of the Pontifical Council. The doned. eto, the birthplace of St. Camillus, current President, Dr. José Ma-

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ría Simón Castellví, has been in- International (MMI), the Univer- tifical Council. In addition, there formed about, and involved in, all sity College for Aspirant Mission- have been numerous meetings with of our more important initiatives. ary Doctors – Doctors with Africa the Noble Pharmaceutical Chemi- The President of the Pontifical (CUAMM), and the Association of cal College of Rome. Council was invited: in 2010 to Italian Catholic Doctors (AMCI). Furthermore, the President of the twenty-third world congress of the Pontifical Council took part the FIAMC whose theme was ‘Our 3.3 The CICIAMS (Catholic in September 2009 in the Federal Faith as Physicians’ and which was International Committee of Days of the FIPC whose subject held in Lourdes; and in 2012 to the Nurses and Medico-Social was ‘The Safety of Medical Prod- twenty-fifth congress on ‘Bioeth- Assistants) ucts: Ethics and the Conscience ics and Christian Europe’ organ- for Pharmacists’, which was held ised by the European Federation of Cooperation with the CICIAMS in Poland. He gave a prolusion en- Catholic Medical Associations, to- is very important because this is titled ‘The World Economic Cri- gether with the Association of Ital- the organisation that has the most sis and Access to Medicine for the ian Medical Doctors (AMCI), and members as regards internation- Poorest, Especially Children’. held at the Catholic University of al associations of Catholic health- In September in Paris, France, the Sacred Heart in Rome. In 2012 care workers. In addition, the CI- the Secretary of the Pontifical Msgr. Jean-Marie Mupendawatu CIAMS is the only Catholic body Council took part, with an opening went to Bali in Indonesia to take accredited with the World Health paper, in the international congress part in the fifteenth conference Organisation and it is thus strongly of the FIPC whose subject was: of the Federation of Associations encouraged by the Pontifical Coun- ‘Pharmacists Today: What Work, of Catholic Doctors of Asia, the cil to work for the culture of life. What Future and What Hope?’ theme of which was ‘The Chal- This association has always been The dicastery strongly supports lenges of Catholic Doctors in the involved in the initiatives of the di- the right of pharmacists to consci- Changing World’. The Secretary of castery through its President, Mrs entious objection. In this field the the dicastery gave a prolusion on Marylee J. Meehan, and through President of the Pontifical Coun- ‘The Mission of the Catholic Doc- her successor, the Reverend Sister cil has spoken on a number of oc- tor Today’. In February 2014, on Anne John RJM,who was elected casions and commented on re- the occasion of the twenty-second in 2012. Sister Anne John visited cent European legislation in this World Day of the Sick, the Presi- the Pontifical Council on the occa- field – for example his ‘Letter’ to dent of the Pontifical Council met sion of the meeting of the executive those taking part in the symposium the members of the Federation of committee of the CICIAMS which on conscientious objection which Polish Catholic Doctors, who were was held in Rome in January 2013. was held in November 2013 at the celebrating the twentieth anniver- On 26-29 May 2012, in Lusaka, Catholic University of Lublin. sary of their creation, in Czesto- Zambia, the Secretary of the Pon- The latest initiative to be di- chowa in Poland. tifical Council took part in the na- rected to all pharmacists was the It has to be observed, unfortu- tional congress of the CICIAMS of ‘Letter’ of the President of 8 Feb- nately, that membership of Catho- Anglophone countries on the sub- ruary last on the occasion of the lic medical associations has drasti- ject ‘Catholic Nurses: Instruments fourteenth Day for the Collection cally declined, and this is especially of Healing’. 300 Catholic nurses of Medical Products which in Ita- true as regards young medical doc- from all over the world took part in ly involves over 3,400 pharmacies tors. The Pontifical Council has this congress. to help people in a state of poverty constantly called on those respon- This year the CICIAMS will throughout the nation. sible for pastoral care in health to organise on 23-26 September in greater commitment to producing Dublin, Ireland, its nineteenth 3.5 The International Committee ‘new members’ for the associations world congress on the subject of Catholic Health-Care of Catholic medical doctors in their ‘Protecting Family Life: the Role Institutions (CIISAC) respective countries. and Responsibilities of Nurses and In 2011, within the context of Midwives’. This meaning will be The new International Commit- the nineteenth World Day of the a further opportunity to strengthen tee of Catholic Health-Care In- Sick, the dicastery organised a our contacts. The Secretary of the stitutions (CIISAC) has taken the seminar on the subject of ‘Catholic Pontifical Council will give an in- place of the International Asso- Health-Care Associations and the troductory lecture to those taking ciation of Catholic Health-Care Culture of Life’. One part was on part. Institutions (AISAC) which was Catholic international federations created in 1984 to coordinate the involved in the field of health and 3.4 The International Federation Catholic health-care institutions of health care, such as those for med- of Catholic Pharmacists the Church at an international lev- ical doctors, nurses and pharma- (FIPC) el. This is a body that promotes a cists, all of which were represented new network which connects the by their respective Presidents. Our contacts have been very fre- various Catholic health-care asso- The Pontifical Council has also quent with Dr. Piero Uroda, the ciations in the world. The members maintained good relations involv- President of the FIPC. The FIPC of the governing council of the CI- ing cooperation with other medi- has always taken part most will- ISAC, who represent the largest cal associations: Medicus Mundi ingly in the initiatives of the Pon- associations of Catholic health-

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care institutions of the five conti- policies. To this end, the dicastery Within the framework of this co- nents of the world, met in Novem- takes part every year in the execu- operation, the Holy See has signed ber 2013 in the Vatican to draw up tive committee of the WHO which two Conventions of the United Na- the new statutes of the committee is held in January in , in tions: the Single Convention on and these will be presented shortly. preparation for the World Health Narcotic Drugs, 1961, amended in The Secretary of the Pontifical Assembly. This assembly, in which 1972, and the Convention on Psy- Council, Msgr. Jean-Marie Mu- the ministers of health of the mem- chotropic Substances of 1971. pendawatu, who is the coordina- ber States take part, takes place For the United Nations the com- tor of the committee, will speak in every year in Geneva in the month petent authorities in this field of greater detail about the CIISAC. of May. On this occasion the Presi- the Holy See, as well as the guar- dent of the Pontifical Council leads antors of the Pontifical Council for 3.6 Institutes of Consecrated the delegation of the Holy See and Health Care Workers and the Gen- Life speaks on the subjects which are eral Secretariat of the Governorate debated, expressing the stance of of the Vatican City. First of all one should empha- the Church and its concerns re- As regards this task, the Pontifi- sise the excellent cooperation with garding the programmes proposed cal Council has organised in the institutes of consecrated life (re- to the member States. Amongst the past an international conference ligious institutes and secular in- subjects addressed by Archbishop on drugs which was followed by stitutes), and in particular with: Zimowski, reference may be made a handbook on drugs entitled ‘The the Hospital Order of St. John of to the reduction of child mortali- Church, Drugs and Drug Addic- God, the Fatebenefratelli; the Reg- ty; access to antiretroviral medical tion’. The dicastery has continued ular Clerics Ministers of the Sick, products for HIV/AIDS patients; to disseminate this handbook on the Camillians; the Brothers of the counterfeiting and falsification various occasions. Charity; the Silvestrine Benedic- of medical products; access to pri- On 28 January 2014 Archbishop tine Sisters Repairers of the Holy mary care for all citizens and above Zimowski met the President of the Face; the Sisters of St. Francesca all poor and disadvantaged people; International Committee for Drug Cabrini; the Sisters of Charity of education in ‘healthy’ lifestyles in Control to discuss the imminent re- of Calcutta; and the the fight against non-transmissible vision of these Conventions by the Camillian Sisters. diseases; and recognition and sup- member countries which envisaged Some Superior Generals are port on the part of States for faith for the year 2016, given the risk of members of the Pontifical Council organisations and the health-care a move towards liberalisation. for Health Care Workers. institutions of the Catholic Church. Ever since the creation of the The Pontifical Council also dicastery, many institutes of con- works with the various institutions Art. 153 § 4: ‘With keen secrated life have offered some of the organisations of the United interest it follows new health of their members to work as vol- Nations involved in the struggle care developments in law and unteers. At the moment we have against drug addiction and crimi- science so that these may be two religious working in this ca- nality connected with it: the Of- duly taken into account in the pacity for us: Sister Anna Antida fice of the United Nations for the pastoral work of the Church’ Casolino of the Sisters of Charity Control of Drugs and the Preven- of St. Joan Antida Thouret offers tion of Crime (UNODC); the Inter- In performing this task the Pon- her generous and effective service national Committee fir the Control tifical Council works with: the in the protocol and archives sec- of Drugs; and the Commission on Pontifical Academy for Life (PAV), tions; Frà Jaime Buitrago Gómez Drugs and Narcotics. This is a mat- with Catholic and non-Catholic of the Fatebenefratelli, acts as a ter of being near to these agencies universities, and research centres trait d’union with the Church of in order to dialogue and cooperate and institutes. In addition, it en- Latin America. for life and the dignity of the per- gages in various study activities. The Pontifical Council express- son. The World Health Organisa- es its sincere gratitude to those in- tion promotes programmes to com- 4.1 Cooperation with the stitutes of consecrated life which bat illnesses and drug addiction. Pontifical Academy for Life freely make available volunteers The Church is called to work both to the Pontifical Council and the in the planning and in the imple- The Pontifical Academy for life Holy See. mentation of these programmes. In (PAV) was created by the Blessed very many countries, the Church John Paul II on 11 February 1994 3.7 Contacts with Catholic through its various institutions, is by his Motu Proprio ‘Vitae Mys- Associations, Institutes and one of the principal actors for the terium’ and bringing together the Associations, and Others, State in the implementation of recommendations expressed by Involved in the World of these programmes. The Pontifical the most important heads of pasto- Health and Health Care Council has the precise task of fol- ral care in health. lowing the initiatives of all inter- Although independent accord- The Pontifical Council carefully national organisations in the field ing to its statutes, the PAV is ‘con- follows the work and the initiatives of health care and to denounce nected and works in a close re- of the World Health Organisation everything that is against the doc- lationship’ with the Pontifical (WHO) in relation to health-care trine of the Catholic Church. Council for Health Care Workers

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in the study of questions and issues The most frequent contacts have olic university of Australia and the connected with life that have a sci- been in Rome and more specifical- Catholic University of Louvain- entific and bioethical relevance, in ly with the Catholic University of la-Neuve also take part in this net- order to help local Churches to re- the Sacred heart, Tor Vergata Uni- work. spond in a better way to the new versity and the Higher Institute of challenges to the sacredness and Health Care. 4.3 Study Activities the defence of life. The dicastery also follows the The Secretary of the Pontifical conferences organised in Rome The activity of this kind which Council, Msgr. Jean-Marie Mu- by the pontifical universities: the has most involved the Pontifical pendawatu, is a member of the Gregorian University, the Seraphic Council has been the revision and governing council of the Academy University, the Urban University, the updating of the Charter for and takes part in the meetings and the University of the Holy Cross Health Care Workers. The work all the important initiatives of the and the Regina Apostolorum Uni- that has been done will be de- PAV. versity. scribed by the Under-Secretary Fr. On the occasion of the tenth an- Abroad there has been coopera- Augusto Chendi. niversary of the Pontifical Acade- tion with the Catholic University A number of study groups made my for Life which was celebrated of Lublin and the Catholic Uni- up of experts in bioethics, medi- last February, a general assembly versity of Warsaw in Poland; the cine, pastoral care in health and re- was held on the subject of ‘Ageing Catholic University of Eichstätt- lated disciplines have been created and Disability’. The President of Ingolstadt in Germany; and the within the framework of the activi- the Pontifical Council gave a paper National Catholic Bioetics Center ties of the Pontifical Council. which ended the deliberations of in the United States of America. In cooperation with the Institute the assembly and this was on ‘The In addition there has been coop- for the Treatment of Infertility of Church and the Sick Elderly’ eration with seven African Catho- the Agostino Gemelli University lic universities within the context Polyclinic, one group has studied 4.2 Cooperation with Catholic of the project called ‘Africae Mu- natural medicine and fair access to and Non-Catholic Universities nus’. This is a network of seven medical products and one has stud- and Research Centres and medical schools of the following ied perinatal medicine. Institutes countries: the Democratic Repub- A great deal of attention has reg- lic of the Congo, Uganda, Tanza- ularly been paid to dossiers and The Pontifical Council works nia, Burkina Faso, Chad and Mo- other documents sent in to the di- with universities and in particular zambique. It was created to foster castery by papal representatives with faculties and colleges of med- mutual and productive coopera- and Bishops’ Conferences. icine, pharmacy and nursing. But tion between these universities and Many cases are sent to members, not only ones that belong to the Catholic institutions and universi- consultors and experts of the Pon- Church – secular such institutions ties in the world through the ‘Good tifical Council to be studied and to are also involved. Samaritan’ Foundation. The Cath- obtain their opinions.

Presentation of the ‘Good Samaritan’ Foundation

Msgr. Jean-Marie Care Workers (for Health Pastoral helps is seen not as a humiliating Mupendawatu Care) in order to provide economic handout but as a sharing between Secretary of the Pontifical support to those sick people most brothers and sisters’. Council for Health Care Workers, in need, and in particular AIDS pa- With the intention of fully meet- Delegate for the ‘Good tients, who ask for an act of sup- ing this mandate, ever since its Samaritan’ Foundation portive love from the Church. For constitution the ‘Good Samaritan’ the occasion the Holy Father in- foundation has provided assistance vited ‘all men of good will, in to hundreds of thousands of people ood morning and thank you particular those of the most eco- in need in the various continents of Gfor being here today, nomically advanced countries, to the world, giving economic sup- I am happy to present here the contribute to this end’, proposing port to variegated projects which ‘Good Samaritan’ Foundation and anew what he had already written have been principally implemented describe its activities and its pro- in his apostolic letter Novo Millen- in the sectors of health care. This jects which are now underway. nio Ineunte: ‘Now is the time for a has been an undertaking founded The Blessed John Paul II on 12 new “creativity” in charity, not on- on awareness that missionary co- September 2004 established the ly by ensuring that help is effective operation starts with Jesus and its ‘Good Samaritan’ Foundation at but also by “getting close” to those recipient is the sick person, who the Pontifical Council for Health who suffer, so that the hand that has the very face of Jesus. In this

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approach, therefore, the ‘Good patients, of whom many are chil- dicasteries of the Roman Curia Samaritan’ Foundation intends to dren, the intention being to give were asked to do something, each serve Christ in the suffering other them antiretroviral treatment fro in their own field and according to and to do good as he did. all of their lives. Amongst the oth- their own fields of competence, in There are therefore many hospi- er objectives, reference should al- order to help local pastors to imple- tal and care-providing institutions so be made to the wish to counter ment the recommendations of the that have been able to carry on the transmission of the virus from Holy Father. In order to respond their worthy activities thanks to the mother to child; to create and/or to the request of the Holy Father Foundation in Africa, in Asia, in supplement activities in labora- to offer a concrete contribution in Latin America and in Europe. This tories and clinics for the preven- this direction, the ‘Good Samari- support has been directed in a spe- tion and treatment of infection by tan’ Foundation decided to pro- cial way to patients with the HIV/ HIV; to promote the training of mote the creation of a network of AIDS pathology who, in addition health-care workers and managers the faculties of medicine of the sev- to physical malady, also experi- through suitable study plans and en Catholic universities of Africa: ence human suffering, humiliation work placements; and to sensitise the Catholic University of Bukavu and loneliness – the consequences the local population to the subject (UCB), in the Democratic Repub- of the blindness of a society that of HIV/AIDS, through the support lic of the Congo; the University of marginalises them, abandons them, of the local mass media as well. Ugandan Martyrs (UMU), in Kam- denigrates them and makes them In November 2013 the ‘Good pala in Uganda; the Catholic Uni- doubly victims. This is a form of Samaritan’ Foundation and Gile- versity for Health and Associated social exclusion that obstructs and ad as the sponsoring agencies Sciences, in Mwanza in Tanzania; at times totally impedes access to signed an agreement of intent (the the St. Univer- treatment, delaying taking care of ‘Memorandum of Understanding’) sity (USTA), in Ouagadougou in patients and also the possibility of which allowed the setting in mo- Burkina Faso; the Catholic Univer- relieving their physical, psycho- tion of the Project Agreement and sity of Graban (UCG), in Butembo logical and spiritual sufferings. the Action Plan 2014-2015 which in the Democratic Republic of the At the present time the action of will both be signed shortly. Congo; the Catholic University of the ‘Good Samaritan’ Foundation In February 2014, in concomi- Mozambique (UCM) in Beira; and is expressed in variegated initia- tance with the celebrations for the ‘Le Bon Samaritain’ University tives: the World Day of the Sick, which Polyclinic of N’Djaména in Chad. The struggle against HIV/AIDS was instituted by the Blessed Pope The project entitled ‘the Africae – the model project in Tanzania. John Paul II and which takes place Munus Project’ was established in In 2013 there began to the full the on 11 February of each year, some order to foster cooperation between project for the struggle against representatives of the ‘Good Sa- universities and other Church bod- HIV/AIDS promoted by the ‘Good maritan’ Foundation and Gilead ies and institutions involved in the Samaritan’ Foundation in the dio- visited Shinyanga and Dar Es Sa- world of medical education and re- cese of Shinyanga, in Tanzania, laam with the aim of collecting in- search in order to develop more ef- in conjunction with the same dio- formation in order to organise the fective programmes of training, as- cese and the Bishops’ Conference project at a detailed level, to plan sistance, treatment and research in of Tanazania, in cooperation with its various stages, and to clarify line with the Magisterium of the Gilead Sciences – a world lead- the roles and tasks of the different Church. At the level of detail, the er in the production of antiretro- parties involved. This visit was, in initiative seeks to promote scien- viral medical products – and with addition, a valuable opportunity to tific-cultural exchanges between the Catholic University of Health encounter the local referents of the these connected faculties of medi- and Allied Sciences of Mwan- project, the heads of the Bishops’ cine; the promotion of the train- za. This project is called ‘Test & Conference of Tanzania, medical ing of health-care workers, lectur- Treatment’. Created in response doctors and university lecturers ers and managers, with especial to a request for help from the local who work at the Catholic Universi- reference to ethics, bioethics and Church, this project involves four ty of Health and Allied Sciences of Christian anthropology; improve- diocesan health-care centres – the Mwanza and the Bugando Medical ment in the supply of teaching and Bugisi Dispensary, the Ngokolo Centre, representatives of the gov- research; and the development and Health Centre, the Buhangija Dis- ernment and of local institutions, the sharing of knowledge that can pensary and the Mipa Dispensary and the representative of the World increase in a notable way the ca- – which are used by about 300,000 Health Organisation in Tanzania. pacity to make reliable diagnoses. people and which deal, amongst The network of Catholic uni- In November 2013, a year af- other things, with the prevention versities of Africa. After the visit ter the launching of the project, an and treatment of AIDS. The action of Benedict XVI to Benin in No- international study and planning plan envisages the free and volun- vember 2011 – when he took with meeting sought to assess the state tary administration of tests for the him the post-synodal apostolic ex- of advance of the activities, devel- diagnosis of HIV/AIDS to about hortation Africae Munus and gave op the pathways that had already 120,000 people (from those who to the pastors of the continent the been followed, and identify new go to these four health-care cen- document containing pastoral rec- possible synergies. The rectors of tres) and free antiretroviral treat- ommendations for the Church in the African universities involved ment for five years to about 20,000 Africa over the next decades – the in the network and the heads of

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their respective faculties of medi- 2012 an international study con- The donation of medical prod- cine, together with university lec- ference was held on ‘The Unsight- ucts. The ‘Good Samaritan’ Foun- turers and rectors of universities ed Person: Teacher, that I may see dation is also involved in a project in other continents of the world, Again’ which witnessed in-depth for the donation of medical prod- took part in this meeting in order study and discussion on the sub- ucts and equipment to health-care to foster dialogue about the possi- jects of the prevention and treat- institutions of the Catholic Church ble creation of a system of univer- ment of blindness and bad sight, in the world. The methodology of sity twining. During the course of with the objective of promoting the action envisages the involvement 2013 a pathway of specialisation engagement of all national and in- in every country of apostolic nun- of medical/health-care disciplines ternational, ecclesial and govern- cios, national Bishops’ Confer- for four Congolese medical doc- mental, bodies so as to foster the ences, dioceses and religious Con- tors was planned and set in motion fight against pathologies of sight gregations that promote initiatives at the University of Ugandan Mar- and to facilitate access to care and involving assistance and care in the tyrs (UCB). Amongst these medi- treatment. In response to this need, health-care field. Launched in June cal doctors there was a woman re- and in cooperation with CBM Ita- 2010, this project is operative in ligious. Similar pathways will be lia Onlus, the ‘Good Samaritan’ thirteen countries of the continent begun in the year 2014 for other Foundation launched a project di- of Africa. It has been implement- African medical doctors involved rected towards the distribution of ed in cooperation with the Catholic in the Africae Munus Network. high-quality glasses of a very low Medical Mission Board (CMMB), The fight against malaria. Obey- cost to poor patients in Africa. a no-profit non-governmental or- ing its mission to provide assis- This project also envisages a plan ganisation with its headquarters in tance and care to sick poor people, for the prevention and treatment the United States of America in- the ‘Good Samaritan’ Foundation of pathologies of sight through a volved in providing high-quality works to counter the spread of ma- programme of health-care exami- health-care services, health-care laria in developing countries, with nations and check-ups in particu- material and pharmaceutical prod- special attention being paid to Afri- lar for children, to be carried out in ucts, without any form of discrim- ca, and to disseminate the principle parishes and schools. ination based on race, politics or of universal and free access to care To this field also belongs the pro- religion, to sick people and peo- and treatment. According to the ject that will shortly be launched in ple in need throughout the world. WHO there were about 207 mil- Bolivia, in the district of La Paz, The CMMB works in coordina- lion ascertained cases of malaria where the intention is to provide tion with the Social and Economic in 2012 and about 627,000 deaths support for the creation of an eye Council of the United Nations and caused by this disease, of which department at the ‘Las Yungas’ with its programmes. 90% took place in south Saharan Hospital of Coroico. The aim of A centre for medical products. Africa and 77% involved children the initiative – implemented in co- The ‘Good Samaritan’ Founda- under the age of 5. In the year 2012 operation with CBM Italia Onlus tion in the year 2013 launched malaria killed about 483,000 chil- and the University of Padua, with the creation of its own centre for dren from 0-5 years of age, that is the support of the Rotary Club – is medical products for the collec- to say 1,300 children every year or to foster the prevention and treat- tion and storage for short periods almost one child every minute. In ment of visual disability through of time of pharmaceutical products addition, it is calculated that there a number of activities. A training and health-care equipment. This are 3.4 billion people who run plan is envisaged for local spe- is material – produced by dona- the risk of contracting the infec- cialised personnel, Bolivian spe- tions – which is sent to Churches tion. And yet malaria can be pre- cialist oculists, workers in Boliv- in developing countries to be in- vented and treated. To this end, ian communities and paramedical struments of support for initiatives the ‘Good Samaritan’ Foundation personnel. A screening of the pop- involving assistance and care for – in cooperation with medical doc- ulation will follow for the identifi- very poor patients who are helped tors, institutions and experts in the cation of refractive defects which in hospitals and health centres field – works to foster access to a will involve in particular a group promoted and managed by local new medical product of tested ef- of 400 pre-school children (4-5 Churches. In donating such medi- fectiveness and a cost that is very years) and a second group of adults cal products, the ‘Good Samaritan’ much lower than the medical prod- made up of 300 people with long Foundation responds to explicit re- ucts that are currently available, sight(40-50 years). In line with the quests from bishops and religious and is studying a research project needs brought out by these exami- Congregations. In 2013 the ‘Good designed to reduce the incidence nations, children and adults will at Samaritan’ Foundation was able to of malaria in children through in- last be able to have access to per- meet the request for support from novative forms of prevention and sonalised glasses of a low cost pro- the bishops of Congo Brazzaville treatment. In 2013 this project was duced locally. and sent a container with medical launched in Burkina Faso and in Amongst its other initiatives, the products and equipment for Cath- Ghana. Foundation has also carried out olic health-care centres managed The fight against blindness. The a census of projects for the fight by the local Church, together with Foundation is also involved in the against blindness that have been publications, books, support ma- fight against blindness in the poor- promoted by the Catholic Church terials and documentation of great est countries in the world. In May in the world. relevance to the training of work-

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ers in the field of pastoral care in motion of a healthy food culture Scholarships. The ‘Good Sa- health. The material that was do- in children in the certainty that the maritan’ Foundation is involved in nated was divided between about prevention of the most widespread fostering the educational and train- forty Catholic health-care centres pathologies in so-called under-de- ing pathways of priests and men distributed between the seven dio- veloped countries must begin at an and women religious involved in ceses into which the country is di- early age in family and school con- the world of health and health care vided. A second container is ready texts and aim above all else at the in order to enable them to acquire to be sent very shortly to Mada- promotion of healthy and correct knowledge and skills that can be gascar to help patients of the 157 habits and behaviour in relation of help in the practice of the medi- health-care centres supported by to food. In this area the Founda- cal and nursing professions, some- the Catholic Church of Madagas- tion has created at its headquarters thing that is of fundamental im- car in the twenty-one dioceses into a work table that brings together portance in developing countries which the country is divided. experts in the disciplines of human where there is widespread shortage Food education for children. nutrition, teachers, and associa- of qualified health-care workers. The ‘Good Samaritan’ Foundation tions with recognised experience Thank you for your attention is studying a project for the pro- in this field. and I wish you successful work.

The World Days of the Sick

Msgr. Jean-Marie ter Addressed to Cardinal Fioren- to help those who are sick and to Mupendawatu zo Angelini First President of the value suffering at a human lev- Secretary of the Pontifical Pontifical Council for Pastoral As- el and above all else a supernatu- Council for Health Care sistance to Health Care Workers’. ral level; to involve in a particular Workers In this letter, dated 13 May – way dioceses, Christian communi- the day when the first Apparition ties and religious families in pas- of Our Lady of Fatima in 1917 is toral care in health; to foster the Mary, Immaculate Virgin, remembered – the Pope indicated valuable role of voluntary work- OWoman of suffering and hope, as a date for the celebrations that ers; to stress the importance of the be kind to every suffering person, of 11 February, the liturgical me- spiritual and moral formation of obtain fullness of life for each one. morial of the Blessed Virgin of health-care workers; and, lastly, Turn your maternal gaze Lourdes, explaining that ‘Lourdes, to make priests and those who live especially upon those in Africa one of the Marian sanctuaries most and work at the side of those suffer whose need is extreme, loved by the Christian people, is a understand the importance of reli- struck down by AIDS place and at the same time a sym- gious assistance for the sick’. or other mortal illness. bol of hope and grace under the Starting in the year 1993 the Look upon the mothers who are sign of the acceptance and offering World Days of the Sick have de- mourning their children; up of salvific suffering’. veloped according to a recurrent Look upon the grandparents who In his letter the Pope observed approach made up of three days. lack the resources that the Church, following the ex- Firstly, to open the celebrations in to support their orphaned ample of Christ, feels that the duty a place chosen by the Holy Father grandchildren. of service to the sick and the suffer- because it is especially significant Embrace them all, keep them ing – and the loving and generous given the nature of the event – in close to your Mother’s heart. welcoming of every human life, general one is dealing here with Queen of Africa and of the above all of weak and sick people some of the most important Mar- whole world, – is an ‘integral part of her mission’ ian sanctuaries in the world – a Virgin Most Holy, pray for us! and that in this solicitude towards conference is held of a theologi- the sick the Church emphasises cal-pastoral character on the sub- From the Vatican, the ‘salvific character of the offer- jects of pastoral care in health. 8 September 2004 ing up of suffering which, lived in This is organised in cooperation communion with Christ, belongs to with the local ecclesiastical institu- This prayer to the Virgin Mary the very essence of redemption’. tions and universities. This is fol- ended the Message of Pope John Pope John Paul thus explained lowed by visits to sick people and Paul II to the Thirteenth World that the celebration of the World health-care institutions of the local Day of the Sick (the last such Mes- Day of the Sick ‘has the purpose Church. Then to end the days there sage of his) which had the theme of sensitising the People of God is a celebration of the Eucharist in ‘Jesus, Hope for Africa’. This was and Catholic health-care institu- the chosen sanctuary during which an event that the Holy Father had tions and civil society to the need a reading of the Message of the established in 1992 with his ‘Let- to assure the best care for the sick; Pope and the administration of the

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sacrament of the anointing of the Paul II went back to emphasising called attention to the subject of sick are envisaged. Each year the the meaning of the celebration that ‘salvific pain’, that is to say to the Message of the Pope is disseminat- he himself had instituted: ‘This Christian meaning of suffering, ed a few months before the event to day…seeks to be “a special time quoting the Apostolic Letter Salvi- help the local Church and churches of prayer and sharing, of offering fici doloris, which he himself had on the ground in their preparations one’s suffering for the good of the published. ‘In Christ’, wrote the for the World Day itself. Church and of reminding everyone Holy Father, ‘even pain is taken up Whereas at the outset the cel- to see in his sick brother or sister into the mystery of infinite charity, ebrations of the World Day of the the face of Christ who, by suffer- which radiates out from God the Sick took place every year in a ing, dying and rising, achieved the Trinity and becomes an expression solemn way. with the presence of salvation of mankind”…Illness, of love and instrument of redemp- a delegate of the Pope in the cho- which in everyday experience is tion – that is, it becomes salvific sen place, subsequently the Pope perceived as a frustration of the pain. It is in fact the Father who decided that only one celebration natural life force, for believers be- chooses the total gift of the Son as every three years should have a comes an appeal to “read” the new, the way to restore the alliance with solemn character, with the others difficult situation in the perspec- men rendered ineffective by sin’. having ‘minor’ celebrations in in- tive which is proper to faith. Out- In addition, Pope John Paul II dividual countries. From the insti- side of faith, moreover, how can continued, ‘A perfect revelation tution of the World Day of the Sick we discover in the moment of tri- of the salvific value of pain is the until today, in carrying the Mes- al the constructive contribution of passion of the Lord: “In the cross sage of the Holy Father to the local pain? How can we give meaning of Christ not only has redemption and particular Churches the Pontif- and value to the anguish, unease, been fulfilled through suffering, ical Council for Health Care Work- and physical and psychic ills ac- but suffering itself has also been ers has reached all the continents companying our mortal condition? redeemed”. Christ “opened his suf- of the world. What justification can we find for fering to man”, and in him man re- On the occasion of the last two the decline of old age and the final discovers his sufferings “enriched World Days of the Sick, the Pon- goal of death…Yes, only in Christ, with a new content and a new tifical Council for Health Care the incarnate Word, Redeemer of meaning”. All of the tribulations of Workers (for Health Pastoral Care) mankind and victor over death, is life can become signs and founda- published a support document it possible to find satisfactory an- tions of future glory… a prolonga- translated into various languages swers to such fundamental ques- tion of the mystery of the Redemp- (French, English, German, Portu- tions. In the light of Christ’s death tion, which, though complete in guese and Polish) and useful for and resurrection illness no longer Christ, “constantly remains open the whole of the liturgical year, appears as an exclusively negative to all love which is expressed in arranged around three fundamen- event; rather, it is seen as a “visit human suffering”’. tal times (Advent-Christmas, the by God”, an opportunity “to release World Day of the Sick on the Litur- love, in order to give birth to works 1995. The Third World Day of gical Memorial of the Blessed Vir- of love towards neighbour”’. the Sick, the Sanctuary of Mary gin of Lourdes, Lent-Easter), with With the celebration of the World Queen of Peace of Yamoussoukro, at its end a Via Crucis to offer to Day of the Sick the Pope also called the Ivory Coast the sick, to health-care workers and for a renewed commitment in par- to pastoral workers, to families, to ticular to the populations of devel- In his Message for the Third parishes and to volunteers points oping countries ‘to wipe out the World Day of the Sick, the Pope for theological reflection, pastoral injustice existing today by devot- remembered the institution on 11 analyses and formulas for prayers. ing greater human, spiritual, and February 1985, by his Motu pro- The texts were written on the ba- material resources to their needs’ prio ‘Dolentium hominum’, of the sis of the themes entrusted by the and affirmed that ‘To make health Pontifical Commission, which Holy Father for this Day and were care more humane and adequate it would later become Pontifical made available free by the Pontif- is, however, essential to draw on a Council, for Pastoral Assistance to ical Council for the various Bish- transcendent vision of man which Health Care Workers. For the oc- ops’ Conferences that requested it stresses the value and sacredness of casion the Holy Father reaffirmed so that they could publish it in their life in the sick person as the image the aims of this Pontifical Coun- respective languages and through and child of God. Illness and pain cil which ‘through multiple ini- local publishing houses. affect every human being: love for tiatives, “manifests the Church’s the suffering is the sign and meas- concern for the ill by helping those ure of the degree of civilization and engaged in serving the sick and the Themes of the World Days progress of a people’. suffering so that the apostolate of of the Sick mercy to which they are devoted 1994. The Second World Day will meet the new demands with 1993. The First World Day of the Sick, the Marian Sanctuary increasing effectiveness” (Apos- of the Sick of Czestochowa, Poland tolic Constitution Pastor Bonus, art. 152)’. In his Message for the first On the occasion of the Second The official celebrations of the World Day of the Sick, Pope John World Day of the Sick, the Pope Third World Day of the sick were

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held in the Ivory Coast at the Sanc- In addition the Pope exhorted continued to repeat – and in a spe- tuary of Mary Queen of Peace of the Church, in carrying out her cial way in our time – the words Yamoussoukro on the occasion of missionary task and in the expres- “Do whatever He tells you”’ the centenary of the arrival of the sion of her solicitude towards the first missionaries. In this circum- sick and the suffering, to follow 1998. The Sixth World Day stance the Pope invited people to the model of the Most Holy Mary, of the Sick, the Sanctuary reflect on the relationship between ‘who continues today, as she did at of Loreto, Italy pain and peace. This is a very pro- the dawn of the Church, to be “the found relationship: when there model of that motherly love with In his Message for the Seventh is no peace suffering spreads and which all who join in the Church’s World Day of the Sick, John Paul death expands its power among apostolic mission for the regenera- II dwelt upon the mystery of the men. In the social, as well as in the tion of mankind should be animat- Incarnation of the Word. The Pope familial, community, the decline of ed” (Lumen gentium, n. 65)’. observed that: ‘Within the walls peaceful understanding translates of the Holy House, in an especial- into a proliferation of attacks on 1997. The Fifth World Day of the ly forceful manner Jesus Christ, life, whereas serving, advancing Sick, the Sanctuary of Our Lady of “God with us,” speaks to us of the and defending life, even at the cost Fatima, Portugal Father’s love (cf. Jn 3:16), which of personal sacrifice, constitute the in the redemptive Incarnation was indispensable premise for authen- For the Fifth World Day of the manifested in the loftiest way. God tically building individual and so- Sick the Pope chose the Sanctuary Himself, in search of man, became cial peace. of Our Lady of Fatima in Portu- man, building a bridge between di- The Pope then exhorted all sick gal. This was a place, his Message vine transcendence and the human people and believers to offer up proclaimed, that was ‘particularly condition’. to God their own suffering in the significant for me. I in fact wished ‘Christ’, he went on, ‘did not name of peace on ‘the altar of dai- to go there on the anniversary of come to remove our afflictions, ly, ardent prayer, together with the the assassination attempt I suffered but to share in them and, in tak- sick all over the world, to present in St. Peter’s Square, in order to ing them on, to confer upon them the offering of suffering which thank Divine Providence, accord- a salvific value: by becoming a Christ has accepted as a means to ing to whose inscrutable design the partaker in the human condition, redeem mankind and save it’. dramatic event had mysteriously with its limits and its sorrows, coincided with the anniversary of He redeemed it. The salvation ac- 1996. The Fourth World Day the first appearance of the Mother complished by Him, already pre- of the Sick, the sanctuary of Our of Jesus on May 13, 1917, at the figured in the healings of the sick, Lady of Guadalupe, Mexico City Cave of Iria’. opens up horizons of hope for all For the occasion the Pope stat- who find themselves in the difficult In his Message for the Fourth ed that at Fatima Mary became time of suffering’. World Day of the Sick, Pope John the spokesman of the invitation of In addition the Pope empha- Paul II pointed to the figure of Christ: ‘Come to me all you who sised that ‘The mystery of the In- Mary as ‘Salus Infirmorum’ and labour and are overburdened, and I carnation is the work of the Spirit’ her role as a mediator between will give you rest’ (Mt 11:28), and and that ‘It is the Spirit who gives God and men: ‘The Mother of Je- that ‘And in Fatima this relief is the human heart the strength to sus is the model and guide of this found: sometimes it is physical re- face difficult situations and over- effective proclamation, since she lief, when, in his providence, God come them’. ‘Poured forth into “places herself between her Son grants healing from illness; more our hearts, the Holy Spirit brings and mankind in the reality of their often it is spiritual relief, when the us to perceive ineffably the “near- wants, needs and sufferings. She soul, pervaded by the inner light of by God”…He is the true guardian puts herself ?in the middle’, that is grace, finds the strength to accept of the hope of all human creatures, to say, she acts as a mediatrix not the painful weight of infirmity, and especially of those who “pos- as an outsider, but in her position as transforming it, through commun- sess the first fruits of the Spirit” mother. She knows that as such she ion with Christ, the suffering serv- and “await the redemption of their can point out to her Son the needs ant, into an instrument of redemp- bodies” (cf. Rm 8:23). In man’s of mankind, and in fact, she ‘has tion and salvation for oneself and heart the Holy Spirit…becomes the right’ to do so. Her mediation is one’s brothers and sisters’. the…giver of gifts,” and “light of thus in the nature of intercession: The Pope observed that ‘it is hearts”; He becomes the “sweet Mary ‘intercedes’ for mankind. the suffering who feel attracted by guest of the soul” who brings “re- And that is not all. As a mother she the perspective of “relief” which pose” in weariness, “shelter” in the also wishes the messianic power of the Divine Physician is able to of- “heat” of the day, and “comfort” her Son to be manifested, that salv- fer those who turn to Him with in the midst of the preoccupations, ific power of his which is meant to trust’, and for them he pointed out struggles, and dangers in every pe- help man in his misfortunes, to free the path to follow: ‘The direction riod’. him from the evil which in various to move in, on this hard road, is A spirit to whom one should be forms and degrees weighs heavily pointed out to us by the motherly meek, as Mary was, who ‘must be upon his life” (Redemptoris Mater, voice of Mary, who, in the history contemplated and imitated above n. 21)’. and life of the Church, has always all, as the woman docile to the

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voice of the Spirit, the woman of families and entire societies’. The spiritual and social dimensions, silence and listening, the woman Pope observed the ‘suffering in- ends by jeopardizing his true good. of hope, who, like , was flicted by the mistakes of individ- Precisely because health is not lim- able to accept God’s will, ‘hoping uals and of States’ and referred to ited to biological perfection, life against all hope’’. ‘the wars that have caused so much lived in suffering also offers room bloodshed in this century’ and ‘the for growth and self-fulfillment, 1999. The Seventh World Day types of disease that are prevalent and opens the way to discovering of the Sick, the Sanctuary of Our in society such as drug dependen- new values. This vision of health, Lady of Harissa, Beirut, cy, AIDS, illnesses caused by the based on an anthropology that re- the Lebanon deterioration of the big cities and spects the whole person, far from the environment’, organised crime, being identified with the mere ab- The Seventh World Day of the ‘the proposals of euthanasia’, but sence of illness, strives to achieve Sick had its solemn celebrations also ‘the serious social inequalities a fuller harmony and healthy bal- in the Lebanon, a land, wrote the in access to health-care resources, ance on the physical, psychologi- Pope in his Message, which ‘more which are still present in vast ar- cal, spiritual and social level’. than a country is a message and an eas of the world, especially in the Lastly, the Pope invited us ‘to example for the East and the West’. countries of the South’. contemplate the face of Jesus, the ‘What place on earth could be bet- In addition the Pope observed divine Samaritan of souls and bod- ter than the Lebanon’, asked John that ‘in many cases, the econom- ies. The example of Christ, the Paul II, ‘to symbolize unity among ic, scientific and technological good Samaritan, must inspire the Christians and the encounter for all breakthroughs have not brought believer’s attitude, prompting him human beings in the communion real progress that is focused on the to be “close” to his brothers and of love?’ person and the inviolable dignity sisters who are suffering, through Specifically in that land where of every human being. Even the respect, understanding, accept- different ethnic groups, cultures achievements in the field of genet- ance, tenderness, compassion and and religions live together often ics… can become an opportunity gratuitousness’. in peace and in dialogue, the Pope for inadmissible choices, callous spoke about the need to promote manipulation and interests that 2001. The Ninth World Day an ‘ecumenism of works’ which contradict real development…On of the sick, the Cathedral in care for the sick, the suffering, the one hand remarkable efforts of Sydney, Australia the poor and those without any- are being made to prolong life and thing was the most urgent, and at even to procreate it artificially; but In his Message for the Ninth the same time the least arduous, of on the other, birth is not permit- World Day of the Sick on the theme the pathways of ecumenism. On ted to those who have already been ‘The New Evangelisation and the this way, he explained, it would be conceived, and the death of those Dignity of the Suffering Person’, possible not only to search for the no longer considered to be of use is the Pope exhorted us to evangelise ‘full unity’ of those who profess to hastened…we are reduced to con- the world of health care in a re- be Christian ‘but also to be open to sidering life as a mere consumer newed way, ‘as a place particularly inter-religious dialogue in a place good, setting a new scale of mar- suited to becoming a valuable lab- like the Lebanon where different ginalization for the disabled, the oratory for the civilization of love’ religious beliefs have in common elderly and the terminally ill’. in order to ‘encourage its orienta- a certain number of indisputable In the face of such a scenario the tion to the overall well-being of the human and spiritual values’ which Holy Father expressed the hope person and the progress of all peo- could spur people ‘beyond the im- that ‘“the purification of memo- ple in every part of the world’. portant differences between the re- ry” would also be promoted in John Paul II declared in his Mes- ligions’ to discern first and fore- the world of suffering and health, sage that: ‘Hospitals, centres for most what unites them. which would lead to “recogniz- the sick or the elderly and every ing the wrongs done by those who institution which cares for the suf- 2000. The Eighth World Day of have borne or bear the name of fering are privileged areas for the the Sick, the Year of the Great Christian”’. In particular the Pope new evangelization, which must be Jubilee reminded Christians of two duties: committed to making the Gospel the defence of life and the promo- message of hope heard precisely in With the drawing near of the tion of health worthy of man. these places. Only Jesus the divine Seventh Word Day of the Sick of The Pope thus outlined the fea- Samaritan is the fully satisfying 11 February 2000, the Holy Father tures of the Christian approach answer to the deepest expectations in his Message which had been to illness: integral care for the of every human being in search of written for the occasion looked person. John Paul II wrote: ‘The peace and salvation. Christ is the at the journey hitherto travelled Christian vision of the human be- Saviour of every person and of the by humanity and declared: ‘at the ing opposes a notion of health re- whole person. For this reason the end of the second millennium duced to pure, exuberant vitality Church never tires of proclaiming we cannot say that humanity has and satisfaction with one’s own him, so that the world of illness done all that is necessary to allevi- physical fitness, far removed from and the search for health may be ate the immense burden of suffer- any real consideration of suffering. enlivened by his light’. ing which weighs on individuals, This view, ignoring the person’s On this occasion, as well, the

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Pope returned to emphasising takes on a redemptive meaning’. ly in the field of biotechnology, the need to promote the integral In other words, ‘Faith teaches us to must never disregard fundamen- health of the person: ‘In this per- seek the ultimate meaning of suf- tal ethical requirements by invok- spective, there is increasing dis- fering in Christ’s Passion, Death ing a questionable solidarity which cussion of “holistic” care, that is, and Resurrection’. Lastly, the Ho- eventually leads to discriminating care that pays attention to the bio- ly Father observed that ‘The Chris- between one life and another and logical, psychological, social and tian response to pain and suffering ignoring the dignity which belongs spiritual needs of the sick and of is never one of passivity. Urged on to every human being’. those around them…with regard to by Christian charity… the Church ‘The Church’, one reads in the medicines, treatments and surgical goes out to meet the sick and suf- Message, ‘which is open to gen- operations, for clinical experimen- fering, bringing them comfort and uine scientific and technologi- tation to be conducted with abso- hope’. cal progress, values the effort and lute respect for the individual and sacrifice of those who with dedi- with a clear awareness of the risks 2003. The Eleventh World Day cation and professionalism help and, consequently, of the limits in- of the Sick, the Basilica of to improve the quality of the ser- volved. In this area Christian pro- the , vice rendered to the sick, respect- fessionals are called to bear wit- Washington D.C., the United ing their inviolable dignity… And ness to their ethical convictions States of America while palliative treatment in the and to be constantly enlightened final stage of life can be encour- by faith’. Lastly the Pope em- In his Message for the Eleventh aged, avoiding a “treatment at all phasised the urgent need top pro- World Day of the Sick, the solemn costs” mentality, it will never be mote ‘the equitable distribution of celebrations for which took place permissible to resort to actions or goods, desired by the Creator’ in in the United States of America, omissions which by their nature or order to combat ‘the persistent in- the Pope addressed with concern a in the intention of the person act- justice that deprives a large part of model of society where the power- ing are designed to bring about the population of the treatment in- ful dominate to the detriment of the death…it remains a fundamental dispensable to health’. marginalised, a model which un- precept that life is to protected and fortunately is widespread in parts defended, from its conception to its 2002. The Tenth World Day of the of the world: ‘I am thinking here of natural end’. Sick, the Sanctuary of ‘Our Lady unborn children, helpless victims of Health’ in Vailankanny, India of abortion; the elderly and incur- 2004. The Twelfth World Day able ill, subjected at times to eutha- of the Sick, the Marian Sanctuary The Tenth World Day of the Sick nasia; and the many other people of Lourdes, France had its official celebrations in In- relegated to the margins of socie- dia, in the Sanctuary of ‘Our Lady ty by consumerism and material- For the Twelfth World Day of of Health’ in Vailankanny which ism. Nor can I fail to mention the the Sick the Pope, the Pope chose the Pope defined as ‘a meeting- unnecessary recourse to the death the sanctuary of Lourdes in France point for members of different re- penalty . . . This model of socie- on the occasion of the one hun- ligions, and an outstanding exam- ty bears the stamp of the culture of dred and fiftieth anniversary of ple of interreligious harmony and death, and is therefore in opposi- the proclamation of the Immacu- exchange’. In this context the Ho- tion to the Gospel message’. late Conception. At Lourdes Mary ly Father observed that ‘The vari- In the face of such a reality, the said: ‘I am the Immaculate Con- ous religions of humanity have Pope went on, ‘Catholics working ception’ and it is specifically this always sought to answer the ques- in the field of health care have the theme that constitutes the heart of tion of the meaning of suffering’, urgent task of doing all they can to the Message of the Pope. but ‘Even though the Church finds defend life when it is most serious- ‘At Lourdes’ wrote John Paul much that is valid and noble in ly threatened and to act with a con- II, ‘it is not difficult to understand non-Christian interpretations of science correctly formed accord- Mary’s unique participation in the suffering, her own understand- ing to the teaching of the Church… salvific role of Christ’. Precisely ing of this great human mystery is Catholic hospitals should be cen- ‘with the Immaculate Conception unique’. tres of life and hope which pro- of Mary began the great work of The Pope then declared that mote – together with chaplaincies Redemption that was brought to the answer to the question of the – ethics committees, training pro- fulfilment in the precious blood of meaning of suffering has been grammes for lay health workers, Christ…The Immaculate Concep- “given by God to man in the Cross personal and compassionate care tion is, therefore, the promising of Jesus Christ”…Through his of the sick, attention to the needs dawn of the radiant day of Christ’. suffering on the Cross, Christ has of their families and a particular Furthermore, observed the Pope, prevailed over evil and enables us sensitivity to the poor and the mar- ‘If Jesus is the source of life that too to overcome it. Our sufferings ginalized’. conquers death, Mary is the atten- become meaningful and precious The Pope then quoted his apos- tive mother who comes to meet the when united with his. As God and tolic letter Novo millennio ineunte: needs of her children, obtaining for man, Christ has taken upon him- ‘The service of humanity leads us them the health of soul and body… self the sufferings of humanity, to insist…that those using the lat- This is also the meaning behind the and in him human suffering itself est advances of science, especial- healings of body and spirit that take

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place at the grotto of Massabielle’. responsible conduct and the obser- people are given access to neces- ‘On that site’, continued the Pope, vance of the virtue of chastity’. sary forms of care and treatment’. ‘since the day of the apparition to When addressing the bishops of Indeed, he observed with concern, , Mary has the Bishops’ Conferences of other ‘in many parts of the world, servic- “healed” pain and sickness, also continents of the world, John Paul es for these sick people are lack- restoring many of her sons and II exhorted them to a shared com- ing, inadequate or in a state of de- daughters to health of body. She mitment to support for the Pas- cay. The social context does not has worked much more surprising tors of Africa in order to face up always accept the mentally ill with miracles, however, in the souls of to these and other emergencies in their limitations, and this is anoth- believers, preparing them for the an effective way. In addition, he re- er reason difficulties are encoun- encounter with her Son Jesus, the ferred to the role of the Pontifical tered in securing the human and fi- authentic answer to the deepest ex- Council for Health Care Workers nancial resources that are needed’. pectations of the human heart’. The which is called to ‘make its own gift of the conversion of the heart, contribution to coordinating and 2007. The Fifteenth World Day a source of peace and interior joy promoting such cooperation, ask- of the Sick, Seoul, Korea ‘gift transforms their existence and ing every Bishops’ Conference for makes them apostles of the Cross its effective contribution’. In his Message for the Fifteenth of Christ, standard of hope, even World Day of the Sick, Pope Ben- amid the hardest and most difficult BENEDICT XVI edict XVI called attention to the trials’. condition of the incurably ill, who Lastly, the Holy Father declared 2006. The Fourteenth World are present in every continent of that: ‘The prodigy of the Immacu- Day of the Sick, the Cathedral the world and in particular in plac- late Conception reminds believers of St. , Adelaide, es where poverty and difficulties of a fundamental truth: it is possi- Australia cause immense misery and pain. ble to reach salvation only through ‘Despite the advances of sci- docile participation in the project In his first Message for a World ence, a cure cannot be found for of the Father, who wanted to re- Day of the Sick, which was the every illness, and thus, in hospi- deem the world through the death fourteenth edition of the event, tals, hospices and homes through- and Resurrection of his only-be- Pope Benedict XVI placed empha- out the world we encounter the gotten Son’. sis on the subject of mental distur- sufferings of our many brothers bance, inviting Church communi- and sisters who are incurably and 2005. The Thirteenth World Day ties ‘to bear witness to the tender often terminally ill. In addition, of the Sick, the Sanctuary of mercy of the Lord’. many millions of people in our Mary the Queen of the Apostles, ‘In many countries’, observed the world still experience insanitary in Yaoundé, Cameroon. Theme: Pope, ‘legislation in this field does living conditions and lack access Christ, Hope for Africa not yet exist and in others, there is to much-needed medical resourc- no definite mental-health policy. es, often of the most basic kind, As I said at the beginning of this It should then be noted that pro- with the result that the number of paper, the Pope wanted to dedi- longed armed conflicts in various human beings considered “incur- cate the Thirteenth World Day of regions of the world, the succes- able” is greatly increased’. the Sick in particular to Africa. Re- sion of terrible natural catastrophes The Holy Father then empha- membering the numerous wounds and the spread of terrorism, in ad- sised that: ‘The Church wishes to that scourge the continent, from dition to causing a shocking num- support the incurably and terminal- armed conflicts to inequalities, ber of deaths, has triggered psycho- ly ill by calling for just social poli- from poverty to the shortage of logical traumas that are sometimes cies which can help to eliminate food and medical products and on difficult to cure in many survivors. the causes of many diseases and by to diseases, the Holy Father dwelt In the economically highly-devel- urging improved care for the dy- upon the drama of AIDS which he oped countries, experts then recog- ing and those for whom no medi- defined as being a ‘pathology of nize that at the origin of new forms cal remedy is available. There is a the spirit’. of mental disease we may also find need to promote policies which cre- ‘To fight it responsibly’, Pope the negative impact of the crisis of ate conditions where human beings John Paul II wrote in his Mes- moral values. This increases the can bear even incurable illnesses sage, ‘it is necessary to increase feeling of loneliness, undermin- and death in a dignified manner’. its prevention by teaching respect ing and even breaking up tradition- The Pope then stressed the need for the sacred value of life and the al forms of social cohesion, start- to promote ‘palliative care centres correct approach to sexuality. In- ing with the family institution, and which provide integral care, offer- deed, if there are many contagious marginalizing the sick, particularly ing the sick the human assistance infections passed on through the the mentally ill who are all too of- and spiritual accompaniment they blood especially during pregnan- ten considered as a burden on the need’. Addressing those who suffer cy - infections that must be com- family and community’. from incurable illnesses, the Holy bated with every possible means Faced with this socio/health- Father said ‘your sufferings, united - those contracted through sexual care emergency, the Holy Father to those of Christ, will prove fruit- intercourse are by far the most nu- encouraged an intensification of ef- ful for the needs of the Church and merous and can only be avoided by forts ‘to ensure that all mentally ill the world’.

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2008. The Sixteenth World Day signs of the passion of the Lord. also feel duty-bound to help fami- of the Sick, theme ‘The Eucharist, Mary suffers with those people lies afflicted by the illness of a son Lourdes and Pastoral Care who are in tribulation, with them or daughter’. In these contexts, for the Sick’ she hopes and she is their comfort, ‘the acceptance and sharing of suf- supporting them with her maternal fering is expressed in the practical The Sixteenth World Day of the help. support of sick children’s families, Sick was held in concomitance Jesus Christ present in the sac- creating in them an atmosphere with two events that are important rament of the altar, wrote Benedict of serenity and hope and making for the life of the Church: the one XVI, is that ‘Hope that does not them feel that they are in the midst hundred and fiftieth anniversary of disappoint…that medicine of im- of a larger family of brothers and the apparitions of the Virgin Mary mortality which heals the body and sisters in Christ’. in Lourdes and the celebration of the spirit’. His sacrifice is for eve- Lastly, the Pope emphasised the International Eucharistic Con- ryone and thus the Eucharist leads that: ‘The daily devotion and con- gress in Quebec in Canada. Indeed, every believer in him to become tinuous commitment to serving the theme of this World Day was ‘broken bread’ for other people. sick children is an eloquent testi- ‘The Eucharist, Lourdes and Pas- We are thus encouraged to become mony of love for human life, par- toral Care for the Sick’. personally involved in serving our ticularly for the life of those who In his Message the Pope sought brethren and in particular those are weak and dependant on others to highlight the close connection who are in difficulty because the in all things and for all things’. that exists between the mystery of vocation of every Christian is tru- the Eucharist, the role of Mary in ly that of being, together with Je- 2010. The Eighteenth World Day the project of salvation and the re- sus, broken bread for the life of the of the Sick ality of the suffering of man. world. In the sacrament of the Eucha- The Eighteenth World Day of rist, observed Benedict XVI, one 2009. The Seventeenth World Day the Sick was on the same date as can see the ‘indissoluble link be- of the Sick the twenty-fifth anniversary of the tween the Mother and the Son gen- institution of the Pontifical Coun- erated in her womb by the work of The Seventeenth World Day of cil for Health Care Workers. the Holy Spirit’: ‘The flesh born the Sick was dedicated principally For the occasion the Pope want- of Mary, coming from the Holy to sick and suffering children, to ed to raise ‘the ecclesial communi- Spirit, is bread descended from all those children – one can read ty’s awareness to the importance of heaven’. Quoting St. Peter Dami- in the Message of Benedict XVI pastoral service in the vast world ani, the Pope explained again that for that occasion – who ‘bear in of health care’ and emphasised that ‘That body that the Most Blessed their bodies the consequences of such service is an integral part of Virgin generated…we now receive incapacitating diseases, and others the mission of the Church ‘since it from the sacred altar, and we drink who are fighting illnesses’; those is engraved in Christ’s saving mis- its blood as a sacrament of our re- who struggle against illnesses ‘that sion itself. He, the divine Doctor, demption’. are still incurable today’; and those “went about doing good and heal- In addition Benedict XVI de- ‘injured in body and in mind, sub- ing all that were oppressed by the clared that ‘Mary is a model of sequent to conflicts and wars, and devil”’. total self-abandonment to God’s other innocent victims of the in- The Pope explained that at the will: she received in her heart the sensate hatred of adults’. And there Last Supper, with the gesture of eternal Word and she conceived it are also those ‘who are deprived the washing of feet, Jesus ‘invit- in her virginal womb; she trusted of the warmth of a family and left ed his disciples to enter into the in God and, with her soul pierced to themselves, and minors defiled same logic of love that is given by a sword (cf. Lk 2: 35), she did by degenerate people who violate especially to the lowliest and to not hesitate to share the Passion of their innocence…Then we can- the needy. Following his example, her Son, renewing on Calvary at not forget the incalculable number every Christian is called to relive, the foot of the Cross her “yes” of of minors who die of thirst, hun- in different and ever new contexts, the Annunciation’. The Holy Fa- ger and the lack of medical help, the Parable of the Good Samaritan ther thus stressed the need ‘to al- as well as the small exiles and ref- who, passing by a man whom rob- low oneself to be taken and led ugees who flee from their coun- bers had left half-dead by the road- by her hand to pronounce in one’s tries together with their parents in side, “saw him and had compas- turn “fiat” to the will of God, with search of a better life’. ‘A silent cry sion, and went to him and bound all one’s existence interwoven with of pain’, declared Benedict XVI, up his wounds”’. With the words joys and sadness, hopes and disap- ‘rises from all these children which that ended this parable ‘Go and do pointments’. questions our consciences as hu- likewise’, the Pope wrote, ‘he is Associated with the sacrifice of man beings and believers’. also addressing us. Jesus exhorts Christ, Mary, the sorrowful Moth- The Holy Father then empha- us to bend over the physical and er, who at the foot of the Cross suf- sised that ‘Since the sick child be- mental wounds of so many of our fered with her divine Son, is felt to longs to a family that frequently brothers and sisters’. be especially near to the Christian shares in his or her suffering with When looking at the commit- community which gathers around serious hardship and difficulties, ment of the Church to service to its suffering members who bear the Christian communities cannot but the sick, Benedict XVI observed

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that ‘The ecclesial community’s even the incredulous Thomas ex- God”’. But the Garden of Olives, humanitarian and spiritual action pressed a moving profession of Benedict XVI went on, ‘is also for the sick and the suffering has faith: ‘My Lord and my God’. the place from which he ascended been expressed down the centu- With the drawing near of the to the Father, and is therefore the ries in many forms and health-care World Youth Day, which took place of redemption’. Thus, ‘In the structures, also of an institutional place in August 2011, Benedict Anointing of the Sick, the sacra- character…It is a precious “patri- XVI directed special thoughts to mental matter of the oil is offered mony” that corresponds with the sick young people: ‘Often the Pas- to us, so to speak, “as God’s med- fact that “love... needs to be organ- sion, the Cross of Jesus, generate icine … which now assures us of ized if it is to be an ordered service fear because they seem to be the his goodness, offering us strength to the community”. Thus, he went negation of life. In reality, it is ex- and consolation, yet at the same on, ‘The creation of the Pontifical actly the contrary! The Cross is time points beyond the moment of Council for Health-Care Work- God’s ‘yes’ to mankind, the high- the illness towards the definitive ers 25 years ago complies with the est and most intense expression of healing, the resurrection’. Church’s solicitude for the world his love and the source from which Together with these two sacra- of health care’. flows eternal life.’ ments, the Pope also emphasised At the current historical-cultur- the importance of the Eucharist: re- al time, the Pope ended, one per- 2012. The Twentieth World Day of ceived at a time of illness, it asso- ceives even more ‘the need for an the Sick, on the Theme ‘Stand up ciates ‘the person who partakes of attentive and far-reaching ecclesial and go; your Faith has Saved you’ the Body and Blood of Christ to the presence beside the sick, as well as offering that he made of himself to a presence in society that can ef- At the centre of the Twentieth the Father for the salvation of all’. fectively pass on the Gospel values World Day of the Sick Pope Ben- that safeguard human life in all its edict XVI placed emphasis on the 2013. The Twenty-First World Day phases, from its conception to its ‘sacraments of healing’, that is to of the Sick, Solemn Celebrations natural end’. say the sacrament of penance, the at the Marian Sanctuary of sacrament of reconciliation and Altötting, Germany 2011. The Nineteenth World Day the sacrament of the anointing of of the Sick, on the Theme ‘by his the sick. In his Message for the Twenty- Wounds you Have Been Healed’ The value of penance, the Holy First Word Day of the Sick, Ben- Father wrote, ‘consists in restoring edict XVI directed attention to In his Message for the Nine- us to God’s grace, and joining with the figure of the Good Samaritan, teenth World Day of the Sick, Ben- him in an intimate friendship…Je- spoken about by the Gospel of edict XVI remembered his pasto- sus, during his life, proclaimed and St Luke, and referred to the final ral visit to Turin and in particular made present the mercy of the Fa- words of the parable: ‘Go and do his remaining in prayer in front of ther. He came not to condemn but likewise’. the Turin Shroud. To contemplate to forgive and to save, to give hope In that gospel passage, observed the suffering face of he who took in the deepest darkness of suffer- the Pope, ‘the Lord also indicates upon himself the passion of men of ing and sin, and to give eternal the attitude that each of his dis- all epochs and all places, and also life’. Merciful God ‘does not close ciples should have towards oth- our sufferings, our difficulties, and his heart to any of his children, but ers, especially those in need. We our sins, wrote Benedict XVI, was waits for them, looks for them, need to draw from the infinite love an invitation to reflect upon what reaches them where their rejection of God, through an intense rela- St. Peter wrote: ‘by his wounds you of communion imprisons them in tionship with him in prayer, the have been healed’. isolation and division’. Thus it is strength to live day by day with ‘The Son of God suffered, died, that confession may be defined as concrete concern, like that of the but rose again, and precisely be- a ‘medicine’ for the soul, thanks to Good Samaritan, for those suffer- cause of this those wounds become which ‘the experience of sin does ing in body and spirit who ask for the sign of our redemption, of for- not degenerate into despair but en- our help, whether or not we know giveness and reconciliation with counters the Love that forgives and them and however poor they may the Father; however they also be- transforms’. be’. come a test for the faith of the dis- On the other hand the sacrament ‘Various Fathers of the Church’, ciples and our faith… For them, as of the anointing of the sick ‘leads the Holy Father explained, ‘saw for us, suffering is always charged us to contemplate the double mys- Jesus himself in the Good Samari- with mystery, difficult to accept and tery of the Mount of Olives, where tan; and in the man who fell among to bear’. ‘It is precisely through the Jesus found himself dramatically thieves they saw , our very wounds of Christ that we are able confronted by the path indicated to humanity wounded and disorient- to see, with eyes of hope, all the him by the Father, that of his Pas- ed on account of its sins…But Je- evils that afflict humanity. In ris- sion, the supreme act of love; and sus is also the one who sheds the ing again, the Lord did not remove he accepted it. In that hour of trib- garment of his divinity, who leaves suffering and evil from the world, ulation, he is the mediator, “bear- his divine condition to assume the but he defeated them at their root’. ing in himself, taking upon himself likeness of men…in order to bring Thus it is, therefore, that in front of the sufferings and passion of the hope and light. He does not jeal- Christ who displayed his wounds, world, transforming it into a cry to ously guard his equality with God

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but, filled with compassion, he herself and hurries from Galilee to tion, a meeting with bishops of the looks into the abyss of human suf- Judea to meet and help her cousin region who are responsible for pas- fering so as to pour out the oil of Elizabeth; she intercedes with her toral care in health will be organ- consolation and the wine of hope’. Son at the wedding feast of Cana, ised. when she sees that there is a short- During the pilgrimage to the Ho- POPE FRANCIS age of wine at the party; he carries ly Land organised by the Pontifi- in her heart, during the pilgrimage cal Council for Health Care Work- 2014. The Twenty-Second World of her life, the words of the old Si- ers on the occasion of the Year of Day of the Sick, on the theme mon who tells her beforehand of Faith, a Holy Mass was celebrated ‘Faith and Charity: ‘We too must a sword that will pierce her soul, in honour of the Virgin Mary, the Give our Lives for the Brethren’’ and with fortitude she remains at Queen of Palestine, in Deir Rafat, the foot of the Cross of Jesus. She at the end of which it was officially The figure of the Good Samari- knows how this road is followed announced by H.E. Msgr. Zygmunt tan come to the fore again in the and for this reason she is the Moth- Zimowski, the President of the Message for the Twenty-Second er of all sick people and suffering Pontifical Council for Health Care World Day of the Sick of Pope people’. Workers, that the Twenty-Fourth Francis. ‘By virtue of baptism World Day of the Sick would be and confirmation’, wrote the Holy 2016. The Twenty-Fourth celebrated in the Holy Land. Father, ‘we are called to be con- World Day of the Sick, Solemn formed to Christ, the Good Samar- Celebrations in Nazareth itan of all the afflicted’. Thus, he in the Holy Land The Fruits of these World Days observed, ‘When we approach with tenderness those who are in need In 2016 the Pontifical Council Over the years, the celebration of care , we bring hope and a smile for Health Care Workers will cel- of the World Days of the Sick of God amid the contradictions of ebrate in a solemn form the Twen- in the various continents of the the world. When dedication and ty-Fourth World Day of the Sick world has allowed a dissemina- generosity towards others becomes which will take place in Nazareth tion of the contents of the Mag- the of our actions, we make in the Holy Land on 11 February isterium of the Church in the field space for the Heart of Christ and with the theme: ‘Trust in Jesus like of health amongst sick people and we are warmed by it, thus offering Mary – ‘Do whatever he tells you!’ health-care workers; a fostering our contribution to the advent of (Jn 2:5). of the implementation of pastoral the Kingdom of God’. Following tradition, the local care in health; a greater awareness In this charitable approach to our Churches will be involved in the of the need to place the dignity of suffering neighbour, the model for Twenty-Fourth World Day of the the human person and the protec- tenderness and charity to which we Sick not only in the celebration of tion of life in all its forms from should look is Mary, the Mother of the Day itself but also in the organ- conception until its natural end at Jesus and our mother, attentive to isation of the theological-pastoral the centre of things; and the pro- the voice of God and to the needs conference, the subject of which motion of a concept of ‘integral and difficulties of His children. will reflect the specific questions care’ which unites the medical/ ‘Mary’, the Pope wrote, ‘moved and issues of the Middle East and health-care aspect with the psy- by the divine mercy which in her will thus be connected with peace, chological, social, spiritual and has become flesh, forgets about reconciliation and health. In addi- pastoral aspects.

The International Committee of Catholic Health-Care Institutions (CIISAC): Genesis and Prospects

• The International Committee • The AISAC was founded in stitutions of the Church at an in- of Catholic Health-Care Institu- 1986 by the Pontifical Commis- ternational level. tions (CIISAC) is the new organi- sion for Pastoral Assistance to • In 1986 the first draft of the sation which has taken the place Health Care Workers, following statutes was drawn up by the Pro- of the International Association of the encouragement given by Pope visional Committee. In July 1990 Catholic Health-Care Institutions John Paul II, in order to coordi- a second draft was drawn up and (AISAC). nate the Catholic health-care in- this was sent by the then Arch-

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bishop Fiorenzo Angelini to the – The keeping of informa- – Cooperation with Bish- Secretariat of State, which in Jan- tion/documentation on Catholic ops’ Conferences so that the as- uary 1991 sent back its observa- health care in order to support the sociations that already exist are tions. work of the Pontifical Council for strengthened and are encouraged • In January 1998 the last draft Health Care Workers and the in- to join the CIISAC. of the statutes was drawn up and ternational association. • Initiatives designed to foster in April 1998 the Secretariat of • It was thus necessary to make shared awareness of various ex- State sent in its observations on it. the activity involving manage- periences in the field of health- • In July 1999 the delegates of ment that had been previously en- care administration and manage- the twenty-five nations decided trusted to the AISAC up-to-date ment at an international level. on the creation of a Governing and effective, taking into account: – The creation of a suitable Council made up of various con- – The increasing organisational structure in order to provide tinental delegates who could help complexities of modern health- members with appropriate tech- the Pontifical Council for Health care institutions. nical, professional and moral as- Care Workers in the process of the – The need to maintain and/or sistance, with especial reference growth of the AISAC. promote the humanisation of care to areas that have specific critical • The President had indicated and treatment. situations. two principal objectives: – The need to obtain new hu- – Publications or other instru- – The economic problems to man and financial resources. ments of communication, with be solved as regards the manage- • The CIISAC wants, therefore, programmes that will be decided ment of Catholic hospitals. to be an international committee upon. – The need to establish guide- made up of Catholic health-care • To this end, this institution in- lines for a new evangelisation of institutions or bodies represent- tends to organise conferences on Catholic health-care institutions. ed by their administrators, whose subjects involving health-care ad- • It was suggested that the mission is the actuation of a new ministration and formation on the AISAC, although continuing to evangelisation of hospital institu- basis of Catholic teaching. be under the Pontifical Council tions. • On 23 November 2013, at the for Health Care Workers, should • To match this mission, the CI- end of the twenty-eighth interna- become a Federation of Catho- ISAC intends to promote contacts, tional conference on ‘Hospitals lic Health-Care Institutions in exchanges and solidarity amongst as Settings for Evangelisation: order to stimulate the creation its members, providing to heads their Human and Spiritual Mis- of new national associations and and administrators of Catho- sion’, organised by the Pontifical strengthen the initiatives of those lic health-care institutions con- Council for Health Care Workers, that already existed. tributions involving theological a meeting took place of the mem- • From 2000 to 2011 the meet- and spiritual formation, research bers of the Governing Council of ings involving planning took at the level of pastoral care, and the Committee. place once a year in order to up- moral and technical-professional Invited representatives of the date the Pontifical Council on the assistance, with special reference most important associations of situation of Catholic health-care to those who work in areas of es- Catholic health-care institutions institutions. They witnessed the pecial difficulty. of the world from various coun- participation of: the Superiors of • The CIISAC, connected with tries (amongst which Brazil, Isra- the Pontifical Council, bishops re- the Pontifical Council for Health el, the USA) were present at this sponsible for pastoral care in the Care Workers, amongst its tasks meeting. various continents of the world, seeks to promote: • The central point of the agen- Superiors of various religious In- – The theological education and da of this meeting was a discus- stitutes, and representatives of the spiritual formation of those sion of the draft of the new stat- Catholic health-care associations. who are involved in the work of utes of the CIISAC, whose final • At the various meetings the the member institutions. version will have to be presented following objectives emerged: – The implementation of so- to the Secretariat of State for due – The strengthening of the iden- cio/health-care programmes that approval. tity of Catholic health care. respect actual socio-political re- • Here, amongst the various – The exchange of information alities, as well as the teaching of projects proposed for insertion about the condition of Catholic the Magisterium and the recom- into the planning of activity for health care in the world and the mendations at the level of pasto- 2014-2015, we find: challenges that it has to address. ral care of the Pontifical Council – The up-dating of the Index of – The encouragement of the for Health Care Workers. Catholic health-care institutions. formation of Catholic health-care – The birth of new socio/health- – The creation of a web site and workers, especially in relation to care associations and institutions a news bulletin of the new Com- questions connected with ethics in all those regions where they do mittee of Catholic Health-Care and pastoral care in health. not yet exist. Institutions.

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Third International Conference Organised by the Network of Pastoral Care in Health of the Ecumenical Patriarchate of Constantinople

8-12 October 2014 Rhodes, Greece

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Report

Msgr. Dariusz Giers context in which contemporary posed to various kinds of trau- Official of the Pontifical Council humanity finds itself. Modern mas during every stage of their for Health Care Workers man is living the illusion of the lives, and in particular when past and the impasse of today physical illness, ill-treatment, and these cause within him an- natural disasters, calamities, vi- n 8-12 October 2014 the ger, disappointment, discomfort, olence and terrorist attacks enter Othird edition of the interna- hopelessness and depression. their existence. A special trauma tional conference organised by Faced with increasingly broad is generated by war which in- the Network of Pastoral Care in bands of society who are afflict- volves all imaginable forms of Health of the Ecumenical Patri- ed by these woes, the Church of suffering such as the loss of life, archate of Constantinople was Christ cannot be indifferent. It of health, of one’s family and of held in Rhodes, Greece. Over possesses the grace of God that one’s home. A moving testimo- two-hundred people took part in springs from the love of Christ ny was provided on this subject the event as representatives of and it has the strength to heal all by Rev. Fr. Bassam Nassif, a lec- the Metropolises – those people human wounds. turer at the Theological univer- who belong in an administrative Other distinguished speakers, sity of Ballam in the Lebanon, or spiritual sense to the Ecumen- who came exclusively from the where the refugee camps for ical Patriarchate in the world, Orthodox Greek world, were en- Palestinian refugees are by now of the Orthodox autocephalous trusted with the task of identify- on the point of collapse because Churches, of Orthodox theo- ing the wounds of the men of to- of the massive inflow of Syrians logical schools in Greece and day, of classifying them and of that has taken place over recent abroad, of health-care workers pointing to the instruments by months. and of pastoral workers in the which they can be healed. The The conference was rich in re- field of health. problem was analysed from the flections and ideas which offered Amongst those non-Orthodox point of view of various disci- a vast survey of the subject that invited to the conference by Rev. plines such as medicine, psy- was addressed. The traumas ex- Fr. Stavros Kofinas, the coordi- chology and sociology, but al- perienced by the categories of nator of this network, reference so in theological and spiritual most vulnerable people, such as may be made to: a representative terms. women and children exposed to of the World Council of Church- The introductory paper en- violence and physical and men- es and an Official of the Pon- titled ‘A Great Wound – Man’ tal maltreatment, were identi- tifical Council for Health Care was given by the Archimandrite fied. The traumas to which medi- Workers, Rev. Msgr. Dariusz Theodoseos Martzouchos, the cal doctors, therapists and even Giers. The presence of the Pon- Metropolitan of Nicopolis and medical students who experience tifical Council for Health Care Preveza, who sought to provide stress and pressure generated by Workers at the conferences that the theological and philosophical demanding and tiring study were have been held in Rhodes goes bases of the subject that was be- pointed out. The penultimate pa- back to the year 2008 and has ing addressed. per, which was given by His Em- helped to strengthen the relations Over the subsequent twelve inence Paul the Metropolitan of of the Catholic Church with its sessions various subjects were Sisanios and Siatista, was on the sister Orthodox Church in this addressed, such as: the psycho- wounds of the clergy which quite very important field of the apos- logical meaning of trauma, the frequently lead ministers of God tolate of mercy. wounds derived from eros and to situations of interior crisis, a The aim of the third conference complex human relationships, lack of confidence and burnout. of Rhodes, in addition to that of the traumas provoked by an in- In the programme of the meet- fostering increasingly deep com- correct religious education, the ing moments of prayer were en- munion between the Orthodox traumas of adolescence, the visaged both in the hall and in Churches, was to examine the traumas following surgical op- the Cathedral of the Annuncia- subject that is expressed by the erations, and the traumas pro- tion of Rhodes as well as in a lo- Greek term ‘trauma’. The choice duced by the ill-treatment of cal sanctuary where the prayers of this subject – explained Rev. women and children and those of the ‘great vespers’ are offered Fr. Kofinas when opening the connected with road accidents. up for the sick and for health- conference – arose from the It emerged that people are ex- care workers.

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Intervention of the Pontifical Council for Health Care Workers

Msgr. Dariusz Giers ties in her pastoral action, Pope In suffering that torments what Official of the Pontifical Council Francis, in a broad-ranging in- counts is the essential: presence, for Health Care Workers terview with the director of the being there for others. We can Italian Jesuit Magazine Civilità speak about the ministry of be- Cattolica, stressed that “what the ing there for others, which needs Your Eminence, the Metropol- Church needs today is the abil- to recuperated. The presence of a itan of Rhodes Kirill and Presi- ity to heal wounds and the hearts priest, a sister, a volunteer, fam- dent of this Conference, of the faithful, it needs to be by ily members, health profession- Your Excellences, Representatives their side. I see - he explained - als; all can become good Samari- of the Metropolises belonging to the the Church as a field hospital af- tans and take care of many of our Ecumenical Patriarchate, ter a battle. It’s pointless to ask a wounded bodies and souls (Cf. Dear Father Stavros Kofinas, seriously injured patient wheth- Benedict XVI, Jesus of Naza- Coordinator of the Network and er his cholesterol or blood sugar reth, chap. VII). Organizing Committee, levels are high! It is his wounds We have to keep before our All you Distinguished Partici- that need to be healed. The rest minds the example of our Lord pants at this Conference, Care we can talk about later. Now we and Master, Jesus the Good Sa- Providers in the area of health, must think about treating those maritan per excellence, who shed wounds. And we need to start the garment of his divinity, left It is a great joy and honour from the bottom.” (19,23,29 Au- his divine condition to assume for me, once again, to represent gust 2013) the likeness of men (Phil 2:6-8) the Pontifical Council for Health First of all, according to the and drew near to human suffer- Care Workers at this Third In- Pope, we have to come back to ing, even to the point of descend- ternational Conference of the proclamation of the Gospel “in ing into the underworld, in order Network of the Ecumenical Pa- a missionary style focusing on to bring hope and light. He does triarchate of Constantinople for the essentials, on the necessary not jealously guard his equality Pastoral Health Care. I bring to things: this is also what fasci- with God (cf. Phil 2:6) but, filled you the greetings and blessings nates and attracts more, what with compassion, he looks into of the President, Archbishop makes the heart burn, as it did the abyss of human suffering so Zygmunt Zimowski, who is very for the disciples at Emmaus.” as to pour out the oil of consola- grateful for this invitation and He pointed out in the same in- tion and the wine of hope on the convinced about the necessity of terview: “the ministers of the wounds of human suffering (cf. the collaboration of our two Sis- Church must be ministers of Benedict XVI, Message for the ter Churches in the field of health mercy above all.” XXI World Day of the Sick, Go pastoral care, as we carry on the A perennial example of this and do likewise, 11.02.2013). mission of caring and healing in ministry of mercy is offered to Finally I wish to reaffirm the the name of Christ, all those who us in the Parable of the Good Sa- commitment of Pontifical Coun- suffer and feel pain. maritan (Lk 10:25-37), which cil to the collaboration with the The topic of this Conference shows us in the perfect way Network of the Ecumenical Pa- “The Wound” and the explicating what kind of approach we should triarchate for Pastoral Health words of the Ecumenical Patri- have towards wounded man. The Care. In this spirit I invited the arch Bartholomew “to minster to good Samaritan does not ask for representatives of the Ecumeni- the ‘great wound’ and the ‘great anything, the suffering of the cal Patriarchate to take part in miracle’ – man”, are very central neighbor breaks his heart and he the 29th International Confer- to our mission. It is true that man shows compassion. Seeing man ence of the Pontifical Council created in the image and likeness in those conditions moves him for Health Care Workers, which of God is a great miracle of di- viscerally with feelings of com- will be held in the Vatican this vine creation and occupies a spe- passion, he is deeply touched. coming November 20-22, on the cial position in the created real- In the behavior of the good Sa- topic: “The Person with Autism ity. He thus demands respect for maritan the injured and suffer- Spectrum Disorders: Animating his dignity and life, and ought to ing are not addressed by socio- Hope”. be taken care of with love and logical or ideological criteria, Prompted by the Holy Spir- compassion. but with a personal approach. In- it, let us learn from one another Speaking about the role of jured people are in need of close- how to cure the wounded bod- the Church today and the priori- ness, compassion and support. ies and souls of our contempo-

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raries and “our path will be even to the Delegation of the Ecumen- ry on the ministry to our sick straighter and our cooperation all ical Patriarchate of Constantino- brothers and sisters during the the more easy in the many areas ple, 28.06.2014). delicate moments of their lives. of daily life which already hap- I wish you all God’s blessings, Thank you for your attention. pily unite us” (Francis, Address so that you may assiduously car-

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topics

Childhood and the Anthropology of Pain

Pain in the Elderly: Anthropological, Clinical and Theological Aspects. A New Classification

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Childhood and the Anthropology of Pain

Prof. David Le Breton the question of meaning; it is al- case that babies cried and waves Professor of Sociology so perception, that is to say activ- their arms, being for a long time at the University of Strasburg, ity involving a reading of oneself marked by their experience, but member of the Institute of and not the copy of a somatic al- in the name of science a medi- Advanced Studies of the teration (Le Breton, 2004; 2010). cal doctor could not be wrong. University of Strasburg, In this sense, forms of care and Innumerable testimonies attest member of the treatment cannot be satisfied with to the trauma created by pain or University Institute of France a purely technical action applied unthinkable violence for these to the patient, above all in the case children, with the addition of be- of a child. Accompanying, there- trayal by their parents. The event fore, imposes itself; a quality in was seen as a nameless violence the relationship with him or her in which induced a lasting suffering The Tolerance of Pain Depends order to allay his or her fears but not expressed by the parents or on the Meaning that it has for also to strengthen the therapy that the medical doctor. the Suffering Person is applied. However, in the ordinary cir- cumstances of existence, the re- For anthropology, pain is not actions of the environment to the only a biological fact. There is The Pain of a Child is Marked pain of a child begin to shape his another dimension which perma- by the Relationship with or her sensitivity. The actions, the nently bears upon how it is tol- his or her Mother and the words of comfort that are given, erated and that is the meaning Surrounding Environment the forms of treatment that are ap- that pervades it, that is to say, the plied or indifference towards him meaning of it which comes from A study by Lancet on women or her, the perceived meanings of the individual as a singular be- with pregnancies of between 20 the discourses that are applied to ing, from the social, from the cul- and 34 weeks demonstrated the him or her, and the affective envi- tural, from the context, from the suffering of foetuses when they ronment in which he or she lives: unconscious and above all from were subjected to aggressive all these impress an original seal his or her life history…Pain, in- forms of treatment. Two-hundred on his or her relationship with deed, does not concern only the samples of foetal blood had bio- pain. The manner in which an in- body: it relates to the whole per- chemical substances linked to dividual reacts to pain is rooted, son. When it strikes, it does not stress. Psychoanalysis has said in large measure, in the first years bear upon only the organism and this from the outset, in particu- of life and in the quality of the it is not limited to a fraction of the lar Otto Rank, G. Groddeck, and attention that is paid by the par- body or a nerve pathway: it al- more recently Françoise Dolto. ents to the wounds or illnesses of so marks an individual, the con- In incubators children subjected childhood. sequences for his or her relation- to aggressive forms of treatment The family is an intense place of ship with the world, and it is not cry, have facial grimaces or be- socialisation where the relation- conceived without a moral reper- come agitated. A neonate suffers, ship of the child with his or her cussion. It is, therefore, suffer- as is borne witness to by his or body and with the world is con- ing, even in the case of a child. her cries, crying, refusal of con- structed. Whether the intentions Although a neuro-physiological tact, inability to play, agitation or are or are not educative, during phenomenon, it is not only this prostration. Words do not exist to the course of time familial inter- because there is always an indi- give a precise meaning to what he actions define the field of percep- vidual who experiences it and or she experiences. Experience of tions and emotions, they educate modulates its impact through the intense pain, experience as a vi- and ritualise its expression for the meaning that it has for him or her olation of the self, impregnates child or for other people (Le Bre- and the instruments that he or she personal sensitivity like a wound ton, 2010). The tone of voice and employs to control it, whether that never completely closes. All the quality of presence, first and these are medical doctors or come pain imposed by violence, or foremost of the mother, conjoin from his or her own interior re- which is incomprehensible for the their respective influences and sources. Pain, therefore, is not the child, leaves a scar in his or her lead the child gradually to shape pure physiological consequence memory. For a long time Western his or her experience into a lan- of an alteration of the organism. medicine engaged in operations guage. The mother gives a name It is perceived according to a grid on the tonsils or adenoids of chil- to pain and helps to inscribe it in- of interpretations inherent in the dren without using any kind of to a fabric of symbols; she allays individual. Pain is not only a sen- pain-killer and this with the pre- fears or increases them with a fit- sation. It is also emotion and al- text that their neurological system ting approach, on the one hand, or lows, therefore, the emergence of was incomplete. It is certainly the indifference, on the other. Her ap-

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proach encourages or dissuades, the second, in contrary fashion, 29 used their mental imaginations calms or nourishes, the pain of the affectivity. Comfort was the rule or relaxation in order to maintain child. The point should be made in in the face of pain of a girl who their control over the situation. If clear way: the mother is not alone was invited to abandon herself to the declarations of the children because the family environment her pain. Where sensitivity was were taken into account, the oth- or the medical and nursing team attributed to female seduction, ers had no resource by which to help to give to the child the instru- a boy was ordered to ‘show that oppose pain (Ross, Ross, 1984). ments by which to understand and he was a man’ and not to dero- A study carried out on adoles- fight against pain. When growing, gate the values upheld by adults. cents afflicted by chronic benign the child multiplies his or her ex- It was a rule that a man clenched pain stressed the relationship of periences of pain and develops his teeth more in the face of pain their approaches with those of his or her awareness of them: the in order not to be seen as a ‘little their mothers. Those mothers who first teeth, falls, illnesses, wounds girl’. But this schema was never adopted an approach of fighting etc. He or she learns to coordinate completely univocal, if only be- without ceasing to encourage movements, to prevent the risks cause of influences of upbringing their children, tirelessly support- of doing harm to himself or her- and education that combated each ing them, strengthened their will self, and addresses pain by turn- other. to face up to and to show them- ing to an interlocutor who under- selves up to the trial (Dunn Gaier stands him or her. The child thus et al., 1986). Engaged in an ac- explores his or her environment The Absence of Preparing a tive struggle against pain, they and defines his or her sovereign- Child for Pain felt less inclined than their com- ty over the world whose peaceful panions to passivity and were less appearances conceal mortal traps In the face of experience of ad- accompanied by a mother with a and require precautions at the lev- versity, the contemporary indi- resigned approach who joined her el of use. vidual is often naked. Rarely do laments to those of their children. Access to language authorises adults prepare a child for the af- These last rarely ended the exer- the child to refine his or her sub- firming of his or her personal de- cises prescribed by their doctors jective experience; to organise his fences. He or she learns in an in- to speed up the relief. The abili- or her knowledge so as to commu- formal way that things are not ty for restraint on the part of the nicate it to other people. For that always pleasant and that is there- mother was a decisive fact in un- matter, words of pain are amongst fore better to address them. How- derstanding the combativeness of the first to enter into the vocabu- ever, the more a child is defence- the child. lary of a child. Being the object less in this respect, the more pain There is another decisive fact of attention on the part of his or will have a hold on him or her, which is mixed in part with per- her environment when he or she if only because of an increasing ception, above all as regards vul- suffers, or a witness to the pain of anxiety. Less than 1% of parents nerability to pain, and that is the other people, his or her relation- of 994 children in the North of affective conditions of the child. ship with pain acquires, with the California who underwent surgi- One study demonstrated that one passing of time, the relatively pre- cal operations or a painful episode French person in every three de- dictable form of cultural models. that required hospitalisation pre- clared that they had addressed Interactions with the other mem- pared the child for the tribulations constant affective difficulties bers of the community and the that were then experienced. A very during childhood. After becom- neighbourhood, in particular of low number of them received sug- ing adults, these adults declared his or her generation, strengthens gestions or active support so as to illnesses 43% more than those these kinds of forms of behaviour, be helped in bearing pain where adults who had not had such accompanying them with a sort of pain-killers or forms of treatment problems. Inequality in suffering natural evidence. But such orien- were insufficient to eliminate it. and illness during adulthood was tations leave a margin of variation Out of sixty-eight parents who also rooted in inequalities in the which is connected with the sin- were interviewed, not one wanted affective climates that governed gularity of individual pathways; to address the question. Removed childhood. By comparison, and in the child interacts with these in- from their concerns, pain was al- a surprising way, social inequali- fluences and they do not affect so removed from their upbringing ties in relation to health appeared him or her in a mechanical way. of their children, even though in to be of lesser importance. This In our societies, the upbringing an informal way. No special in- study identified various affective of children was for long marked tention was implemented in or- problems that in the long term (and this is probably still the der to educate the child to mobi- weighed upon individuals. A lack case today) by the various imag- lise his or her interior resources as of affection was translated sta- es associated with a boy as a fu- well. Only 213 children worked tistically into 49% more supple- ture head of a family, and with a through their fight against pain mentary illnesses, 57% of which girl as a future wife. Family and in a creative way: 93 used diver- affected the respiratory and or school upbringing and education sion (thinking of something else, digestive apparatuses, and 76% privileged, in the case of the first, thinking of the alphabet back- more disturbances in mental ex- steadiness in the face of pain and wards, etc.); 91 clenched their pression. Conflict between par- encouraged, and, in the case of fists or were tense physically; and ents corresponded with 45% of

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the declarations of further illness- of pain of the child during his or children during their stay in hos- es. Their somewhat prolonged ab- her stay in hospital. pital was distributed to the nurses sence produced a figure of 36%. It is presumed that whether a (who did not know the composi- A grave illness, a disability or a mother is calm or troubled has the tion of the two groups). The results mother or father having an acci- effect of moderating or increas- were significant. The mothers dent provided an average of 26% ing the stress of her child. Dai- who had benefited from detailed of supplementary declarations in ly experience demonstrates this explanations were markedly less the first case and 23% in the sec- abundantly. The organisation of anxious than the mothers of the ond. An early experience of the the hospital care and treatment other group. Relaxed and confi- death of a parent or their sepa- fosters anxiety by subjecting the dent, they controlled their appre- ration reduced this vulnerabil- user to a routine where his or her hension, and their calm and their ity. The number of illnesses de- singularity is cancelled and his words of comfort had a relieving clared by these individuals was or he anxiety is rarely taken into effect on their children. Incontest- equivalent in approximate terms consideration. With some excep- able physical signs indicated the to that of the population in gen- tions, it does not provide explana- lower levels of stress experienced eral. Workers or employees had tions that allow a taming in a pro- by these children: their tempera- a marked sensitivity to the prob- pitious way of the person’s pain tures and blood pressure did not lems of childhood and related fur- or treatment. diverge from the normal; their ther health difficulties. In statisti- In order to test the influence of sleep patterns were better; they cal terms, these people who were the affection of mothers on their did not have nightmares and they more marked than others by the children, two groups were isolat- quickly regained regular sleep; affective conditions of childhood ed. Children who had already had they cried and complained less were also those people who con- an experience of being admitted during and after the stay in hos- sulted their medical doctors less to hospital or ran the risk of medi- pital, and they stayed in hospital and were less attentive to their cal complications were excluded. for less time. On the other hand, own health (Menahem, 1994). An optimal conformity between in the other group, the anxiety of An American study reached the the two groups was looked for. mothers who did not have infor- same conclusion. Of 63 patients The survey involved a total of mation available to them how the with chronic pain, 40% experi- eighty children. In the first group hospitalisation of their children enced the separation of their par- a woman nurse welcomed the was going, doubled the anxiety ents during childhood, while 23% mothers and tried to create from of their children: high heartbeats, were abandoned. 82% admitted a the outset a climate of truth with temperatures, bad sleep quality, grave affective lack during their them while their children pro- and more keenly-felt pain. The childhood, 63% a clear rejection, ceeded to have a series of medical trauma of a badly assimilated ex- and 19% indifference and the lack examinations. They were provid- perience was translated into fre- of readiness to help of their par- ed with the information needed quent nightmares. ents. 33% had been beaten (Vi- for a good understanding of the The study was worrying as re- olin, 1982). Naturally enough, conditions of the stay in hospi- gards the services that imple- what matters is not so much the tal and had described to them mented routine care and treat- affective conditions but more the sequences of the surgical op- ment, leaving patients in a state what people do with them during eration and convalescence. They of uncertainty about their condi- the course of their natural histo- were invited to express their fears tion or the medical products that ries. and to formulate those questions they would receive. The ethical that concerned them. The wom- and practical applications of this an nurse answered each question observation command our atten- Accompanying a Child During with care. During these conver- tion (Skipper, Leonard, 1968). Painful Treatment sations the children were present The study also demonstrated how without being asked questions di- much the children suffered above The accompanying of a child rectly. In the other group, on the all because of how their mothers by his or he parents or loved ones other hand, the mothers and chil- looked at them when these last, during treatment or a stay in hos- dren were subjected to the hos- unknowingly, modulated the re- pital, like the quality of the pres- pital routine without a particular lationships of their children with ence of the care team, are of rel- attempt at communication being pain through their own emotions. evance in attenuating suffering. attempted. The first defence against pain (or A classic study, which has the Over the following days the illness) lay in the meaning that a value of a paradigm, highlighted mothers filled in a questionnaire person, in our case a child, gave the perception of pain and post- in which they assessed the level it. When there was nothing that operation reactions of children of stress before and after the op- made the child involved enter in- who had been admitted to hospi- eration, described the attitudes of to a framework of meaning or val- tal to have their tonsils removed. their children and, above all, de- ue, it was experienced in a naked The research concentrated on the scribed the convalescence of their way, it lacerated and it often pro- symbolism of the body and meas- children once they had returned to voked discouragement or depres- ured the influence of the approach the family home. A second ques- sion. of the mother on the perceptions tionnaire on the behaviour of the In alleviating pain, a judicious

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use of pain-killers goes hand in ters difficulties in translating his David Le Breton Author in particular of: Anthropologie du hand with listening to complaints, or her pain into words. The task corps et modernité (PUF); Expériences de with an accompanying and a qual- of health-care workers is to pro- la douleur. Entre destruction et renaissance ity of presence at the bedside of vide care and treatment without (Métailié); Eclats de voix. Une anthropolo- gie des voix (Métailié); La chair à vif. De the patient. The relief of anxiety projecting their own values and la leçon d’anatomie aux greffes d’organes connected with all pain and the behaviour in order to judge his (Métailié); and En souffrance. Adolescence development of an illness, the es- or her behaviour. A great deal of et entrée dans la vie (Métailié). tablishment of trust between the research indicates, indeed, a fre- child and the medical team, the quent underestimation of pain involvement of the parents and in by health-care workers, in par- particular of the mother, all work ticular in the case of children or together to strengthen the efficacy elderly people, that is to say the Bibliography of the pain-killers. Medical and most vulnerable people and those Dunn-Geier B.J. et al., ‘Adolescent nursing care call attention to the less inclined to complain or make chronic pain: the ability to cope’, Pain, n. specificity of a patient who alone demands (Le Breton, 2010). A 26, 1986. Le Breton D., Expériences de la dou- is able to testify to what he or she health-care worker in good health leur. Entre destruction et renaissance (Pa- is experiencing. The effective re- and who is active is not able to ris, Métailié, 2010). lief of pain requires medicine judge the suffering of another per- Le Breton D., Anthropologie de la dou- leur (Paris, Métailié, 2004). centred around the person and no son and also runs the risk of pro- Menahem G., Problèmes de l’enfance, longer around biological parame- jecting his or her own psychology statut social et santé des adultes (Paris, ters. Recognising that the patient to the detriment of that of the pa- CREDES, 1994). Ross D. M. and Ross S. A., ‘Childhood is a subject is a pre-condition for tient. One should care for a man pain: the school-aged child’s view point’, the total efficacy of the treatment qua man, in his singularity. The Pain, n. 20, 1984. and care that is received. patient is always right about his or Skipper Jr J.K. and Leonard R. C., ‘Children, stress, and hospitalization: a field The pain of the child is not al- her pain. As René Leriche wrote, experiment’, Journal of health social behav- ways expressed in words but, the only pain that can be borne is ior, n. 9, 1968. rather, it is often translated in- that of other people. In relieving Violin A., ‘The process involved in be- to immobility, into a refusal to coming a chronic pain patient’, in R. Roy pain it is not enough to provide and E. Tunks (eds.), Chronic Pain: Psy- play. One should decipher the care and treatment: one should chosocial Factors in Rehabilitation, (Balti- body language. A child encoun- above all take care of pain. more, Williams and Wiltkin, 1982).

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Pain in the Elderly: Anthropological, Clinical and Theological Aspects. A New Classification

Prof. Pierluigi vi founded the ‘Niccolò Stenone’ starting with the age of five, re- Zucchi, S.O. Help Centre). ferring for the periods prior to this Lecturer in physiatry and 5) Provide hospitality (Msgr. age to the data of the literature in illnesses of the locomotive Li­vi founded the Casa-Famiglia of the field. apparatus at the Faculty of via Faenza at Florence); In the section of the anthropol- Medicine and Surgery of the 6) Help elderly people (Msgr. ogy of pain which examines pain University of Florence and Li­vi founded the Centre for the El- in relation to cultures, it is high- lecturer in the physiopathology derly in Taybet-Jerusalem). lighted how important motivation- and treatment of pain and 7) Have the right quality of life al conditions (the phenomenon headaches at the Faculty of and being in constant dialogue of ‘couvade’, the initiation rite of Medicine and Surgery at the with God, through prayer, in order tribal chiefs) can create within the Università Campus Bio-Medico to receive the light of the journey organism moments when pain is of Rome to be followed. perceived with a higher threshold. 8) Follow a balanced diet as a In the section on the neurogen- Prof. Bonifacio principal form of therapy. esis of the brain in the elderly it Honings, O.C.D. 9) Follow appropriate treatment is understood why an elderly per- Emeritus Professor of Moral at the right moment, that is to say son, who, obviously, is not affect- Theology at the Pontifical do not follow therapies that have ed by encephalic, neurological or Lateran University and the been recently acquired and are he- vascular pathologies, can be lucid Pontifical Urban University, roic. and serene until the last moment Rome; Consultor to the 10) Choose a good doctor, that before departure because of a con- Pontifical Council for Health is say a trained physician with an stant, albeit slow, regeneration of Care Workers; and Ordinary ethical physiognomy and of great the neurons which is facilitated Member ad vitam of the humility and faith. by an ethically directed quality of Pontifical Academy for Life, life. the Holy See In the phenomenon of the mem- Preface ory of pain reference is made to how a traumatic episode that is I am very happy to introduce distant in time can create – follow- the work ‘Pain in the Elderly: An- ing a repetition of the noxa, and thropological, Clinical and Theo- in that part of the body that was Dedication logical Aspects. A New Classifica- previously struck – a very impor- tion’ by the distinguished scholars tant pain condition comparable to To the Most Reverend Monsig- Pierluigi Zucchi and Bonifacio an equivalent trauma that can take nor Angiolo Livi, (Florence, 31 Honings. As regards the gener- place in the same area of the brain March 1914 - Florence, 28 Dicem- al part, I was favourably struck on the other side. ber 2014) Prelate Prior of the Fa- by the definition of ageing which The authors of this work also mous Basilica of St. Laurence of these two eminent researchers address the question of empathetic Florence, who is a valuable exam- give of it and which makes a com- pain and empathetic pleasure and ple of values and hope for all those pletely new contribution to the lit- offer an original classification of people who have had the privilege erature in the field; ageing, indeed, empathy. of meeting him, the authors, in- begins at birth and continues until In the phenomenon of mirror spired by him, dedicate this work. the obitus. neurons and the elderly it is sci- Fragmenta Paradigmatica Another interesting fact is the entifically highlighted how an im- Bonae Vitae. From the absolutely analysis that they provide of pain, provement in quality of life is ob- honest life of Monsignor Angiolo the perception of which, accord- tained when an elderly person is Livi guidance for the well-being ing to the studies reported, can be surrounded by friends and pleas- of the body (soma), of the mind present from the seventh week of ant environments. (psyche) and of the soul (pneuma): pregnancy when in the oral cavity I would also like to point out 1) Have a capacity to listen. and the soles of the feet the first that it is emphasised that an eth- 2) Immerge oneself empatheti- pain receivers appear. ical-spiritual approach conditions cally in the condition of others. These two researchers highlight the body and, therefore, illnesses 3) Help the least and the unde- that from the foetal-neonatal peri- and the perception of pain as well. fended (Msgr. Livi founded the od until the sixty-fifth year of life, As a medical doctor and a mor- ‘Cristina Ogier’ Centre for Help in the perception of pain is the same, alist theologian, I would like to Life). even if the studies that they have observe that all the medical-theo- 4) Help the poorest (Msgr. Li- carried out examine individuals logical explanations given about

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pain in the elderly by the distin- Introduction 3. How there did not exist a var- guished authors of this work em- iability in pain due to sex within phasise once again how the Ordo The authors have divided their the group of patients examined. Creationis always has a continu- work into two parts: a general part 4. How the ageing of the organ- ous relationship with the Ordo and a special part. ism and the pain receiving system Redemptionis. These are entities The general part describes the both begin at birth. that constitute in a strict way the historical, ethno-anthropological, 5. How the perception of pain constituent elements of the human anatomical, physio-pathological and quality of life can be clearly being and in which the advanced and ethical aspects of pain. A spe- improved by lifestyle, for exam- chronological age of the body does cial examination is engaged in of ple following rest and/or listening not in the least condition the soul the aspects inherent in neurogen- to music in a systematic way, or but, instead, can be elevated by it. esis and the plasticity of the cen- when ethical parameters are tak- I would also like to highlight the tral and peripheral nervous sys- en into account which refer to re- definitions and the physio-path- tem: these last two conditions are ligious practices such as engaging ological interpretations that are facilitated above all else by envi- in a thoughtful reading of a pas- given of pain, of the elderly, of the ronments and by people that are sage from the gospels. faith-effect, of the prayer-effect, of pleasing to the elderly. the placebo effect, of the nocebo- The special part describes: effect, of the caress-effect, of the 1. the new classification of the music-effect (or new Mozart ef- three levels of elderly people, with General Part fect) and of ethical therapy, all of the most frequent various typolo- which are also described and em- gies of pain by level according to ‘I love more than anything else phasised with reference to statis- different age bands. At the first the faces of people who have tical studies to be found in other level is placed the perception of grown old without doing vio- works published previously. pain (intensity) starting with the lence to customs, allowing them- In the special part the phenom- foetal-neonatal period until the selves to go with the laws of time’. enon of presbialgia is described age of sixty-five. As regards the This eponym of Paul Cézanne with an original classification in- ontogenesis and phylogenesis of (the impressionist painter, Aix en volving three levels in which is pain starting with the foetus until Provence 1839-1906) emphasises highlighted the intensity and the the age of five, we took advantage the coherence of a balanced man frequency of the various types of of the data that appeared recently in accepting time. pain for each age band. in the literature in the field (Bel- I hope for the authors that this lieni, Anand). important work, which enriches At the first level the pain with A Definition of the Process the medical and theological liter- greatest frequency and intensity is of Ageing According to the ature in the field above all in the vascular pain (40%) compared to Literature in the Field field of the neurosciences and neu- the other three kinds of pain which ro-theology, will be learnt about in by frequency and intensity in de- In the literature in the field one a capillary way at an international creasing order are central pain finds that ageing begins when the level, as for that matter it truly de- (25%), oncological pain (20%) individual has ended the period of serves. and somatic pain (15%). his or her physical development At the second level (68-85 years) which is held to take place at the His Eminence Cardinal the pain of greatest frequency and age of twenty-five. This is fol- Willem Jacobus Eijk intensity is that of the group of pa- lowed by a period of the full devel- Archbishop of Utrecht, tients with oncological pain (40%) opment of youth (25-40 years), af- Primate of Holland, compared to patients with the oth- ter which comes adulthood (40-50 President of the Bishops’ er three types of pain which in de- years) and maturity (50-65 years). Conference of Holland. creasing order are vascular pain At the end of maturity old age or (30%), somatic pain (20%) and senility begins which characteris- neurological pain (10%). es the class of young elderly, indi- Key Words and Phrases At the third level (86 to over viduals who are between the ages 100 years) the pain with greatest of 65 and 75, which is followed Elderly, pain, breakthrough pain frequency and intensity is that of by the class of elderly people – of (or intense episodic pain), empa- the group of patients with somatic 76-85 years, which in turn is fol- thetic pain, empathetic pleasure, pain (70%) compared to patients lowed by the class of the very old: classification of pain in the el- with the three other types of pain 86-100; 120 years with the physi- derly, classification of empathy, which in decreasing order are vas- ological obitus. the faith effect, the prayer effect, cular pain (155), neurological pain However, according to con- the placebo effect, the nocebo ef- (8%) and oncological pain (7%). ventional parameters ageing be- fect, the stroking effect, the mu- 2. How from the first to the third gins at the sixty-fifth year of life sic effect (or new Mozart effect), level the intensity of pain in its (the Committee of Experts of the memory of pain, mirror neurons, various types tends to decrease in WHO, 9, 1990). neurogenesis (birth of neurons), a directly proportional way to the pharmacological therapy, ethical increase in the age of the individu- therapy. al involved (cf. VAS).

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The Definition bands (this is the phenomenon of the perception of which different of the Process of Ageing presbialgia). individual, cultural and religious of Zucchi and Honings causes are at work and in the con- textualisation of which take part Ageing is a gradual natural phe- The ISTAT classification of not only the disciplines of medicine nomenon (Ordo Creationis) which various types of elderly person of and biology but also those of the begins with the neonate and pro- and over the age of 65 human sciences (philosophy and ceeds until the obitus for organs, psychology)’ (P.L. Zucchi, Algolo- including the nervous system, even Young elderly people: individuals gia, 1 (1983), pp. 41-82). though, above all in the nervous for whom age is a mere fact of birth system itself, there is a reproduc- certificates. They make up 30% of tion of cells (neurogenesis) which the part of the population that is A Medical Definition of Pain tends to compensate, to a decidedly over the age of 65. Active elderly lesser extent, the physiological loss people: individuals who say they The Committee for the Taxon- of neurons. have some aches and pains but who omy of the International Associa- take part in social life. They consti- tion for the Study of Pain (IASP) tute 32% of the part of the popula- defines pain as an ‘unpleasant sen- A Definition of Being Elderly tion over the age of 65. Withdrawn sorial and emotional experience and Old Age from a Clinical elderly people: individuals who see associated with a real or potential Point of View themselves as ‘old’ and exclude damage to the tissue or described themselves from the social context. in terms that refer to such damage’ Being elderly and old age are They make up 19% of the part of (Sub-committee of IASP for the phrases that are used as synonyms, the population over the age of 65. Taxonomy, 1979, 1982). even though the first is used above Marginalised elderly people: indi- This definition is partial because all in the human field (for example: viduals who are isolated from the it does not take into consideration an elderly man), whereas the sec- social and family context, are often the person who cannot express ond is used in the animal world (for disabled, and have limited econom- himself or herself or who does not example: an old dog). When the ic means. They make up 19% of the remember (the phenomenon of term ‘old’ is used in the human field part of the population over the age memory) clinical conditions which it acquires a negative meaning. of 65. are so present above all else in the Being elderly (old age) is a uni- elderly. versal phenomenon, one that is nat- ural to existence, and where there is An Anthropological-Theological a more frequent incidence of path- Definition of an Elderly Person A Theological Definition of Pain ological situations which are fos- tered by advanced age because of An elderly person is a paradigm Pain is a value entity in whose a decrease in a capacity to adapt to of semantic and cultural commu- physiognomy jointly penetrate, solicitations and modifications of nication. He or she constitutes a both in the Order of the Creation an exogenous character. The ap- resource, a gift, human and social and in the Order of Redemption, of pearance of pathological situations riches, the value of free giving, of necessity, the constitutive elements can more easily interrupt health and history, of the identity of belonging, of man: soma (the body), psyche create states of suffering and of ill- of experience, and of interdepend- (the soul), and pneuma (the spirit) ness. ence (because all people need each (Zucchi-Honings, 2013). It is also advisable to bear in other). He or she provides within This definition seeks to empha- mind that at times being elderly the context of daily life a funda- sise the meanings of pain from the in a physical (or biological) sense mental ethical and anthropological anthropological point of view in a and being elderly in a psychologi- direction, emphasising the impor- holistic approach. cal sense do not coincide. Indeed, tance of being as compared to ac- A human being, indeed, is not a one can frequently observe elderly tion and activity, pointing to silence separated dualistic entity but, rath- people who are lucid but who at the as a form of empathetic dialogue er, a unitary dual entity. His or her same time have illnesses, usually of with the other. constituent elements are the body their joints, which are very impor- The development and the quality and the soul; man does not have a tant. of life of a society is highlighted by body and a soul but a body and a its level of respect for the elderly soul together. The French philoso- who become in this way a diagnos- pher Merleau Ponty (1908-1961) A Medical Definition (Clinical tic index of health of the society it- says on this point, ‘le corps c’est and Algological) of an Elderly self. moi’, ‘my body is me’. In order to Person distinguish man in essential terms from the other creatures of the An elderly person is a person An Anthropological Definition earth, plants, and animals, God the where the physical threshold (al- of Pain Creator willed that man, both male gos) of various kinds of (somatic, and female, had a human body, a vascular, neurological and oncolog- The algological school of Flor- body that is to say animated by a ical) pain tends to increase gradu- ence defines ‘pain as mental-physi- spiritual and immortal soul. This is ally according to the various age cal entity, with universal values, in what is taught explicitly by the Fa-

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thers of the Second Vatican Council serene martyrdom, with the bequest the work that was performed with (cf. GS, 14). of a noble example to the young, a different evaluation according to For this reason they stated that ‘preferring a glorious death to an the various ethnic groups that were the three elements – the body (so- ignominious life’ (see Eleazar, 2 belonged to. ma), the soul (psyche) and the Mac 6:23-28). In some groups, indeed, the in- spirit (pneuma) – are necessarily In a passage from the Book of dividual was well seen as long as connected with each other. This Wisdom (Wis 4:7-16) the wise he could work and be productive, connection, however, can make man identifies longevity with spir- but for those who belonged to the man carnal or spiritual. Indeed, itual maturity: ‘Righteous people, non-working band they were not it makes him carnal if the sensual even if they die young, will find well seen and they waited for their movements of his body – the pas- rest. We honour old age, but not deaths, having been abandoned sions – dominate in his life and de- just because a person has lived a by everyone. Before this event, in termine the style of his behaviour long time. Wisdom and righteous- some populations, above all in Afri- and his way of living. The connec- ness are signs of the maturity that ca and India, propitiatory rites were tion between the soma, the psiche should come with old age’. The celebrated and the elderly person and the pneuma make him, instead, honour that is to be rendered to the was then left to die of hunger or a spiritual man if the movements of elderly is closely connected with was even buried alive. the soul – the thoughts of his mind the fourth commandment: ‘Hon- In other groups, on the other and the effects of his will – are rea- our your father and mother’. In Le- hand, knowledge about hunting or sonable and virtuous. Now, if we viticus (Lv 19:92) we read: ‘Show farming methods, and learning ac- apply this theological anthropology respect for old people and honour quired over the years, which, in- to pain, corporeal, mental and spir- them. Reverently obey me; I am the deed, constituted a fundamental itual pain become value entities in Lord’. The Apostle Paul prescribes bridge between one generation the order of the redemption: the or- to Timothy: ‘Do not rebuke an el- and another, as held by the elder- der of the pain, of the death and of der man, but appeal to him as if he ly was thought to be valuable. In the resurrection of man. were your father. Treat the young- such groups the elderly were loved, er men as your brothers, the older esteemed and followed with ven- women as mothers, and the young- eration until their exitus. This ap- Historical Aspects er women as sisters, with all purity’ proach of especial care for the el- (1 Tm 5:1-2). In the Book of Sirach derly was present above all else in The elderly in Holy Scripture we read (8:6): ‘Never think less of Eastern populations. someone because he is old, some of Not only in primitive societies Elderly people have had differ- us are growing old, too’. but also in ancient Greece, at Ath- ent positions in families and soci- In order to emphasise the respect ens and Sparta, different attitudes ety during the course of history. In that is due to the elderly, the East- existed in relation to the elderly. all of Holy Scripture elderly people ern peoples, to refer to the family The declining condition of the el- are said to deserve great respect: in to which they belong, make an im- derly was not accepted in Athens the book of the Prophet Daniel God mediate reference to their parent – and the preference was that they Himself is called the ‘venerable old the son of Abraham – differ- should not be present in the various man’. In Israelite society the elderly ently to the Western peoples who contexts of social life. In Sparta, on played a pre-eminent role and had use the surname of their family. the other hand, an elderly person to take important decisions in polit- In the Bible, which is a textbook had a privileged position and this ical and social life. In Deuteronomy for prayer to the utmost, it is em- was so much the case that the Geru- their juridical function, which was phasised that only those who have sia was created, that is to say the as- of primary importance, is stressed learnt to establish suitable spaces in sembly of elderly people which had (Deut 19). Old age is defined as solitude and silence will not experi- the highest powers in the field of the ‘crown of the just’ (Pr 10:27). ence tedium during their old age if law and education, performing the In the Psalms (Ps 92:15) we read: they happen to live alone. role of judge in controversies and ‘The righteous…still bear fruit in In Holy Scripture, unfortunate- disputes. old age and are always green and ly, there are also some negative Homer (perhaps the ninth centu- strong’. The righteous die of a ‘ripe examples of the elderly and these ry BC) in his Iliad and The Odys- old age’ (Gen 25:8), aware that become emblems of wickedness, sey, epic poems that were written their lives have been full (Sir 44: dissoluteness and impiety. These in hexameters in twenty-four books 14-15). An example is Tobit who negative features are present in the between the tenth and eighth cen- died at the age of 112 and who be- story of Susanna (Dn 13) and in the turies BC, believed that an elderly came blind when he was 62: after episode of the adulterous woman person had to be highly regarded, he was cured he lived in happiness, (Jn 8:1-11). above all because of his wisdom. gave alms and always continued The two great philosophers Ar- to bless God and to celebrate His Elderly People in Different istotle and Plato had different ap- greatness (Tb 14:2). Death is ex- Societies and Cultures proaches to the elderly. Aristotle perienced with a grateful blessing, (a Greek philosopher, a surrounded by children and grand- In primitive societies there was of Plato, Stagira 384 - Calcide 322 children, for whom an example is no distinction between individu- BC) excluded the presence of el- set even in dying (see Jacob, Gen als according to age bands. The derly people from the government 49). Death is also experienced as distinction operated according to of the polis, whereas Plato (a Greek

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philosopher, a disciple of Socrates, er, on the wisdom and the wealth of to address. He emphasises the phys- Athens 428-347 BC), in his The Re- the spirit of the same time of life. ical decline that man has to undergo public argued that only elderly men In comedy in the Latin world as he grows old and he expressed should express the final judgement old age was portrayed with all the himself in his ‘Moral Letters to Lu- in difficult situations. The differ- physical and mental failings that cilius’ in the following way: ‘But ence between these two thinkers as accompanied it. if the body no longer performs its regards their philosophical idea of Marcus Tullius Cicero (Arpi- functions, is it not better to free the man formed the basis of their dif- no 106 – Formia 43 BC) in his De soul from its sufferings? And per- ferent approaches. Senectute, in which he examined haps one should act a little before For Aristotle, man had a soul and the art of knowing how to grow old, the due moment because, when the a body which were united and in- wrote that an elderly person should moment arrives, one may find it divisible and as a consequence the not become downcast because of impossible to act: the danger of liv- deterioration of one involved the the weight of years because he ing badly is greater than the danger decline of the other. Plato, on the is the custodian of a heritage of of dying early’ (Epistulae Morales other hand, did not take into con- knowledge that is indispensable ad Lucilium). sideration the decline of the body to future generations; however, he Publius Terentius Afer, Terence because he believed that the virtues tends to bring out the negative as- (a Roman poet, c. 190 to c. 160 were in the soul and that the body pects of old age. BC) fed prejudices about old age was a mere container. Indeed he wrote: ‘in reality, when and said that senectus ipsa morbus. Mimnermus, the Greek poet, I examine the problems in all its In the medieval period (the his- Smirne seventh century BC – first aspects, I find four reasons which torical epoch that goes from an- half sixth century BC, defined old make old age appear unhappy. tiquity to the modern age), whose age in a negative way and stated First: it distances a person from ac- beginning according to traditional that he would have preferred to die tivity. Second: it weakens the body. chronology is seen as the fall of the rather than grow old. Third: it deprives a person of all the Roman Empire of the West (476 Sappho (a Greek poetess, Les- pleasures: Fourth: it is a step from AD) and whose end is seen as the bos, end of the seventh century- death’ (De Senectute). year of the discovery of America in first half of the sixth century BC) Cicero adopts a critical stance in 1492, the elderly person was well addressed the female side of grow- relation to old age as a chronologi- regarded. ing old, which was almost never cal period of human existence, but Dante Alighieri (Florence 1265– taken into consideration, and stat- certainly not towards the elderly Ravenna 1321) in his Convivio ed that old age was a wound to the whom he invites to take part in po- (1304–1307) described the stages physiognomy of the image of a litical life, observing: ‘great things of life and observed that maturity is woman who was undergoing dete- are not done with force or speed the period that goes from the age of rioration. or with the agility of the body, but 25 to the age of 45, and that after Solon (Athenia legislator and po- with wisdom, with authority, with that age old age begins. et, c. 630-560 BC) had an ambig- prestige, of whose virtues old age Roger Bacon (Ilchester 1214 – uous attitude towards old age. In- is not only not without but is indeed Oxford 1292), a Franciscan monk, deed, he defined it as a period when enriched’ (De Senectute). theologian and English scientist, man still has the wish to act and to In De Senectute Cicero also sug- believed that old age was connect- learn and thus death was to be wel- gests the style of life that should be ed with the lifestyle that had been comed around the age of eighty. To appropriate for an elderly person, adopted in youth. the term ‘death’, however, he gave that is to say dedicating himself to In the fifteenth and sixteenth cen- contrasting and differing attributes: intellectual and political activities, turies elderly people, especially if bent, wrinkly, breathless, pale and including rural activities such as they belonged to the upper class- sick. These adjectives concern- looking after an estate. This style of es, had an important role at a social ing death with meanings that were life, in the Latin world, was chosen and political level. clearly negative were opposed by by many aristocrats and middle- During the seventeenth century others which had a positive mean- class people in their old age. power was wielded by the young ing, such as white, candid and ven- Publius Ovidus Nason, Ovid and elderly people, especially if erable. (born in Sulmona on 20 March 43 they belonged to the upper classes, Phocylides of Miletus (born Mi- BC and died in Tomi-Costanza, on were seen as the bearers of learn- letus 560 BC) in Maxims, Book the black Sea in what is now Ro- ing and experience and were seen XLII, admonished: ‘Respect white mania, 17 AD, in Fasti, bk. V, v. as useful to those who came after. hair, render the same tribute to a 57) stated that ‘At one time there Treatment marked by abandonment wise old man as you give to your was reverence for the white-haired and marginalisation was meted out father’. Also original was his idea head’. to elderly people who belonged to of the physiognomy of each kind Lucius Annaeus Seneca (Lat- the lower classes and were inactive. of woman which he derived from in philosopher, Córdoba c. 4 BC During the eighteenth century a particular animal: the beauty of a – Rome 65AD) believed that man the Church, which was especial- horse, the indifference of a pig and should commit suicide when as an ly sensitive to the problems of the the industrious of a bee. In Greek old man he has to experience a life poor, and especially the elderly tragedy emphasis was laid, on the that is not worthy of being lived, poor, created the first poor people’s one hand, on the physical and men- and this because of the physical homes. During this century the first tal decay of old age, and, on the oth- pain or moral suffering that he has industries came into being with an

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improvement in health-care condi- It is obvious that in our society cording to which a hopelessly im- tions and people’s diets. However, and culture ‘having’ is seen as a paired life no longer has any value’ the advantages derived from eco- foundation for ‘existing’: power, (Evangelium Vitae, n. 64). nomic development benefited only pleasure, impressing; a person is John Paul II emphasised that the privileged classes and the poor assessed not for what he is but for ‘Man is understood in a more com- could use only the poor people’s what he has, what he does, what plete way when he is situated with- homes and charitable associations. he produces. The physiognomy of in the sphere of culture through his During the nineteenth century in such a society and culture places language, history, and the position Europe there was a notable increase the elderly in a position of clear he takes towards the fundamental in the population which rose from marginalisation, thereby creating events of life, such as birth, love, 187 million at the beginning of the the bases for the temptation of eu- work and death. At the heart of eve- century to 300 million in 1870, a thanasia. ry culture lies the attitude man takes period when the figure of the elder- In section 64 of his encyclical to the greatest mystery: the mystery ly person was re-assessed. Evangelium Vitae John Paul II ob- of God’ (Centesimus Annus, n. 24). During the twentieth centu- served: ‘Today, as a result of ad- In contrary fashion, ‘Where God is ry there was a return to a utilitar- vances in medicine and in a cul- denied and people live as though he ian idea of the individual who was tural context frequently closed to did not exist, or his commandments valued only according to his pro- the transcendent, the experience of are not taken into account, the dig- ductivity and utility both for soci- dying is marked by new features. nity of the human person and the ety and, unfortunately, for families, When the prevailing tendency is inviolability of human life also end which tended to rid themselves of to value life only to the extent that up being rejected or compromised’ their elderly members and put them it brings pleasure and well-being, (Evangelium Vitae, n. 96). in old people’s homes until their suffering seems like an unbearable From the statistical data that have deaths, thereby injuring their dig- setback, something from which one emerged in various studies, it is ad- nity and tending to create in actual must be freed at all costs. Death is visable to observe that whereas the terms their marginalisation. considered “senseless” if it sud- twentieth century was the century The term ‘third age’ (troisiemme denly interrupts a life still open to of demographic growth, the twen- age) was coined in France to re- a future of new and interesting ex- ty-first century is the century of the move from the definition of the el- periences. But it becomes a “right- ageing of populations. derly all negative connotations and ful liberation” once life is held to those elderly people who were au- be no longer meaningful because it tonomous could attend the univer- is filled with pain and inexorably Epidemiological Aspects sities for elderly people that arose doomed to even greater suffering. in that period. Furthermore, when he denies or ne- Our society is undergoing a sort In 1999 John Paul II, Wadowice glects his fundamental relationship of ‘demographic revolution’. In 18 May 1920 – Vatican City 2 April to God, man thinks he is his own 2000 there were in the world about 2005, emphasised that the elderly rule and measure, with the right to 600 million people over the age of constitute an important presence demand that society should guar- sixty. In 2025 there will be 1 bil- and an important force for values in antee him the ways and means of lion and 200 million and 2 billion the Church and in society and in sec- deciding what to do with his life in in 2050. In addition, women live tion 9 of his Letter to the Elderly (1 full and complete autonomy. It is more than men in all societies. October 1999) he made the follow- especially people in the developed As a consequence within the very ing statements: ‘In the past, great countries who act in this way… In elderly age band (85-100 years) the respect was shown to the elderly… this context the temptation grows to ratio of women to men is 2 to 1. In And what of today? If we stop to have recourse to euthanasia, that is, Europe, as in other rich parts of the consider the current situation, we to take control of death and bring it planet, 1 person in every 5 is over see that among some peoples old about before its time, “gently” end- the age of sixty. This ratio falls to age is esteemed and valued, while ing one’s own life or the life of oth- 1 in 20 in Africa and, as is the case among others this is much less the ers. In reality, what might seem log- with other developing areas, the case, due to a mentality which gives ical and humane, when looked at process of the ageing of the popu- priority to immediate human useful- more closely is seen to be senseless lation is more rapid than in ‘devel- ness and productivity. Such an atti- and inhumane. Here we are faced oped’ countries. tude frequently leads to contempt with one of the more alarming The ageing of the population is for the later years of life, while symptoms of the “culture of death”, typically accompanied by an in- older people themselves are led to which is advancing above all in crease in the burden of non-trans- wonder whether their lives are still prosperous societies, marked by missible illnesses, such as car- worthwhile. It has come to the point an attitude of excessive preoccupa- diovascular diseases, diabetes, where euthanasia is increasingly put tion with efficiency and which sees Alzheimer’s disease and other neu- forward as a solution for difficult the growing number of elderly and rodegenerative diseases, tumours, situations. Unfortunately, in recent disabled people as intolerable and chronic obstructive pulmonary dis- years the idea of euthanasia has lost too burdensome. These people are eases, and pathologies of the skel- for many people the sense of horror very often isolated by their families eton and muscles. As a logical which it naturally awakens in those and by society, which are organized consequence the pressure on the who have a sense of respect for life’ almost exclusively on the basis of world’s health-care system is in- (Letter to the Elderly, n. 9). criteria of productive efficiency, ac- creasing. Chronic illnesses impose

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on the elderly part of the population Latin America and Central Afri- Aspects of Clinical a heavy burden in terms of health ca and amongst the inhabitants of Neurophysiology and economics because of the long the Basque Country, women who Neurogenesis in the (elderly) duration of these illness, of the de- are about to give birth continue to adult brain crease in quality of life and of the work in the fields until a short time costs of care and treatment. before the birth of their children, The brain and in particular the whereas their husbands take to bed human brain has been tradition- and begin to complain during the ally seen as an organ that cannot The Prevention of Illness childbirth of their wives as though be renewed. Differently from the in Elderly People they themselves were really feeling other cells of the human body, the pain (empathy pain). After child- neurons that make up the brain Although the risk of illness in- birth, the women go back to work- are seen as perennial cells that are creases with age, the problems of ing in the fields and the men look born and die with the individual health are not an inevitable conse- after the new-born children. to whom they belong. The princi- quence of ageing. Indeed, where- ple that ‘in the adult brain the nerve as in the case of many pathologies pathways are finite and immutable, effective preventive measures are The initiation ceremonies each of which can die and none of not known about, in the case of of tribal chiefs which can be regenerated’, which others they are already well known was introduced by Ramon y Cajal about. Amongst these there is the The initiation ceremonies of (Santiago 1852-1934) at the end adoption of a healthy lifestyle tribal chiefs are another example of the nineteenth century, consti- which involves regular physical that demonstrates how cultural tra- tuted the central axis of neurobiol- activity, a healthy diet and cutting ditions and the acquisition of an ogy and medicine until the exper- out smoking. important role can influence the imental data that were obtained at Measures of prevention include perception of pain in individuals. the beginning of the twenty-first clinical examinations to achieve In some populations of India and century, even though the first stud- an early diagnosis, as in the case Latin America, indeed, the man ies go back to the 1960s. Howev- of screening for breast cancer, of who is chosen from the members er, many studies carried out in the uterine cancer and of cancer of the of the tribe as a bearer of the pow- 1960s were not listened to even in colon and rectum, of diabetes and er of the gods has iron hooks put the face of experimental data which its connected complications, and of in the muscles of both sides of his demonstrated that in the brains of depression. back. To these are attached ropes small mammals, birds and amphib- with which the individual who has ians new neurons can be generated. been chosen is raised to the top of The dominant concept in medical Ethnic-Anthropological Aspects a pole on a cart, from which he science emphasised that a perma- Culture and nature. Pain and blesses the populations of various nent population of neurons was the cultures. The pain threshold. places to which he is then taken. indispensable basis for the learning Pain in elderly men and women Man in these conditions not on- of new information, on whose sta- ly does not appear to feel pain but, bility depended the survival of an The cultural-anthropological fac- after the hooks are removed from individual. tor as a biological-environmen- the back the wounds rapidly cica- In the 1990s it was demonstrated tal factor has an influence on the trise. that in phylogenetically ancient and perception of pain. Indeed, in our These two examples highlight non-cognitive areas of the brain, study it was shown that: 1. social- how emotional, motivational and such as the olfactory bulb, and not ly poorer and less educated people affective factors can stimulate parts in higher cerebral areas, there exists feel pain less than compared to so- of the brain (the hypothalamus, a renewable population of neurons cially and culturally more evolved the limbic system, the nucleus ac- and their circuits. people. 2. The pain threshold is the cumbens, the amygdule) which, In 1998 Eriksson (1959-2007), same in people from different rac- through impulses from the cor- a neurologist from Goteborg, dem- es. 3. The difference between men tex to the cerebellum, are able to onstrated that what had been seen and women is only located in sex- prevent the transmission of pain- in animals also took place in man. ual identity and is not to be found receiving impulses in the dorsal This distinguished researcher car- in the pain threshold. However, the horns and in different levels of the ried out post-mortem analyses of way in which problems and com- neuraxis, thereby raising the thresh- the brains of five patients with can- munication are addressed in rela- old of pain. cer to whom, while they were still tion to pain and illness exalt the These two examples also offer alive, he had administered bromo- values of different cultural tradi- a very important anthropological deossiuridina (brdu) for diagnostic tions, as is the case in the phenom- teaching because, when translated purposes. This analogue of thymi- enon of couvade and the initiation into the medical field, and above all dine, which is incorporated into the rites of tribal chiefs. the geriatric sphere, they suggest DNA of dividing cells, offered the to us that the sick person should be definitive demonstration that new placed at the centre of things and neurons were generated at the lev- The phenomenon of couvade that his or role should be motivated el of the hippocampus and the sub- as a person, to which all attention ventricular area of the lateral ven- Amongst the Indian tribes of should be paid. tricles in the human brain as well.

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A negligible quantity is involved gene areas into areas that are neu- Neurogenesis is significantly when compared to the 100 billion rogenically active. higher in the first category than neurons that make up the enceph- in the second. The separation of a alon. However, this phenomenon, young individual from the moth- which lasts throughout life, implies Neurogenesis and the Plasticity er for prolonged periods can also constant and gradual structural of the Nervous System create a reduction in neurogenesis, changes. whereas brief periods of such sepa- One must therefore state that the The capacity of the adult brain ration do not bear upon neurogen- brain, from the foetal period un- to generate new nerve cells is not esis. til the pre-death period, is a high- only a mechanism to which the The separation of a neonate from ly plastic organ which is subject to brain has resort in order to repair its mother for prolonged periods of continuous molecular and cellular wear and tare in the tissue. It is al- time is used as a model for depres- modifications, and this neurogene- so the most solid basis for the con- sion once the individual has be- sis constitutes a further instrument cept of the plasticity of the nerv- come an adult. of the adoptive response of the in- ous system. This means that the With ageing, neurogenesis, above dividual to the external and internal final number and the real destina- all the level of the hippocampus environment, above all when he or tion of the newly formed cells is and the sub-ventricular area, under- she grows old. not fixed but connected at any mo- goes a drastic reduction which is re- ment to physiological and patho- sponsible, it is presumed, for cog- logical factors. nitive decline and can be improved Anatomical Areas Involved in through physical exercise and inter- Neurogenesis at the Level of the action with stimuli from the envi- Encephalon Neurogenesis in the brain ronment. from birth to senescence: the The generation of a new neurons environment and lifestyle in the brain of an adult mammal Neurogenetic areas at the level takes place in two areas (fig. 1): Interaction with the environ- of the spinal cord 1) The sub-ventricular area of the ment (and with our fellows), as lateral ventricles. well as a balanced lifestyle (phys- The greater slowness in the re- 2) The syb-granular areas of the ical exercise, cultural involve- production of neurons that takes dentate gyrus of the hippocampus. ment and ethical and spiritual val- place in the age band of 86-100 (level 3) leads to a diminished Dorsal-medial nucleus Neurogenetic areas plasticity which brings about a Septum of the thalamus at the level of physiological raising of the pain nuclei the encephalon: threshold in line with the im- the sub-ventricular pact on areas innervated by those area of the lateral cells of the posterior horn of the ventricles and the spine that correspond to the head Fornix (the seat of exteroceptive centres: Septum area sub-granular area of the dentate gyrus skin); of the neck (the seat of pro- of the hippocampus. prioceptive centres: muscle); and of the base (seat of interoceptive centres: viscera) (fig. 2). This ex- plains why diminished neurogene- sis in some areas of the encephalon Hippocampus Amygdala (lateral ventricles, hippocampus) and the spinal cord can give rise Fig. 1. Anatomical areas involved in neurogenesis at the level to pain symptoms that are mod- of the encephalon est or even absent in important pa- thologies such as: 1. grave injuries However, it has been demon- ues of reference) are the basis of (through reduction of the cells of strated that areas that are normal- the physical, mental and spiritual the head of the posterior horn, the ly not neurogenetic, for example wellbeing of every individual and sear of the exteroceptive centres: the cortex and the striatum, in re- constitute the physiological stimu- skin); 2, traumas (through reduc- sponse to certain stimuli, such as li that are most incisive as regards tion of the neurogenesis of cells neurodegeneration and the death neurogenesis. of the neck of the posterior horn, of cells, can modify their micro- In a neonate neurogenesis is the seat of proprioceptive centres: environment and be induced to quantitatively different according muscles, joints); and 3. myocardi- become neurogenetic. We also to the quality of life that is expe- al heart attack or the perforation of believe that in the (elderly) adult rienced. Indeed, in rats, as in man, the abdominal viscera (through re- brain, in addition to the two areas there are young individuals who are duction of the neurogenesis of the of so-termed constitutive neuro- raised by mothers who spend most base of the posterior corn, the seat genesis, there exist non-neuroge- of their time looking after them and of the interoceptive centres). netic areas that respond to stimuli there are those who are only spo- The neurogenesis of the neurons that transform these silent neuro- radically taken care of. of the anterior horn is very much

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slower and is of an inferior level and can significantly influence is pain or even fear, the amygdale compared to that of the neurons of the perception of a new pain stim- (fig. 3) is also activated. This last the posterior horn. This condition ulus in that area of the brain that is called this because of the fact explains in case of the very elderly was previously damaged (the phe- that it has the shape of an almond (86-100 years, and over) the late nomenon of hyperalgesia); 3. can and it provokes corporeal respons- occurrence of very grave patholo- cause a painful experience in the es (tachycardia, tachypnea) and gies of the joints (neuro-arthropa- presence of stimuli that normally behavioural responses (flight, de- thies). do not have this effect (the phe- fence, aggression).

Amygdala Hippocampus

Fig. 3. The amygdale, the seat of the brain that works through fear, aggressiveness and pain.

Fig. 2 - Schematic depiction of the sense centers (exteroceptive in the head, proprioceptive in the neck, interoceptive at the base) The ablation of the amygdale of the posterior horn and the motor centers (viscermotor centers reduces fear and aggressiveness, at the base, somatomotor centers at the top) ot the anterior horn whereas its stimulation can lead to of the grey substance of the spinal cord. a state of increased vigilance and attention. Current research is directed to- The Phenomenon nomenon of physical allodynia); wards modulating or blocking the of Memory of Pain and 4. does not exist in biology activity of the amygdale, seeking only at a encephalic level – it is al- in this way to eliminate the mem- Traumatic events, which can al- so at a spinal level. ory of an unpleasant experience so occur when a person is young, The phenomenon of memory and thereby inhibiting the conse- create an injury which gives rise has a positive impact not only in quence response reactions. to a hyperalgesic area which is the sphere of painful pathologies, The modulation of the amyg- projected at the level of the cor- because it creates the conditions of dale, according to studies that responding cerebral circuits. This early warning of pain, but also is are underway, could be achieved central and peripheral condition, of great utility in the neurological through pleasurable stimuli (mu- even after many years, can be ac- field. Indeed, a patient can even sic) that are able to free neuro- tivated by solicitations of noxae come out of certain forms of coma chemical substances that are even varie in a very rapid way through through listening to certain kinds able to bring patients out of certain the phenomenon of memory of of music that he or she liked when kinds of coma. pain. This situation explains the he was well. It has also been observed exper- lowering of the pain threshold imentally that in acting at the level (hyperalgesia) in specific areas of of the amygdale of mice it is pos- our organism, compared to nor- The Physiopathological sible to eliminate the fear that they mal contra-lateral counterparts, Mechanisms behind the have of anaesthetised cats, lead- through subliminal stimuli as well Phenomenon of Memory ing them to draw near to them in (the phenomenon of allodynia). In a calm way. schematic form one can state that Unpleasant memories or ones These scientific data inevitably memory of pain: 1. is influenced connected to a feeling of pain felt lead to very important observa- by the intensity of the perceived previously can activate specif- tions of an ethical character be- stimulus and by its consequenc- ic areas of the brain if there is a cause although, on the one hand, es; 2. on its own can act as a pain new physical or mental traumatic there can exist an improvement in stimulus and cause a painful expe- event, and in a way that is not pro- the quality of life of a patient by rience even when there is an ab- portional to the size of the noxa acting on unpleasant memories (a sence of painful stimuli (the phe- but much greater. In specific con- previous painful episode) or pleas- nomenon of mental alloydynia) ditions of mental pain, where there ant ones (listening to pleasant mu-

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sic), on the other, research could Level of empathy according which evokes painful events (em- become an instrument for the au- to age pathetic pain) or painful events thentic manipulation of individu- (empathetic pleasure); als, especially elderly ones. Different levels of empathy ex- 4. assessment of the high (+; ist according to age (fig. 4). positive empathy; placebo effect) This graph shows that the high- or low (-; negative empathy, an- Elderly People, Mirror est level of empathy is established tipathy; nocebo effect) of the lan- Neurons, Pain, Empathy in individuals of the first and sec- guage; and Prayer ond levels of the classification (fig. 5. assessment of stroking with 15). Indeed, it is specifically in the result of the stroking effect The sharing of moments in life childhood-youth (5-15 years) and (positive: +) or the allodynic ef- with people who are truly friends during maturity (86-100 years) fect (negative: -) with the with- creates the conditions for an acti- that this phenomenon takes place. drawal of the part of the body that vation of parts of the brain involv- has been stroked. ing the perception of the emotions 6. The quotient of empathy of other people, expressed through Measurement of the quotient (QE) is obtained from the number movements of the face and with of empathy (Q E): of plus signs or negative signs. A gestures in what is authentic em- low, average, high plus sign creates a low QE; 2 +++ pathetic participation. More spe- an average QE; and from 3+++ cifically, the same neurons located To achieve the measurement of and more a high QE. near to the Broca area which are the quotient of empathy (positive: activated by the executor during +, or negative: -) certain clinical- an action are also activated in the semeiological parameters have to Cerebral areas that are observer of the same action (mir- be followed: interconnected and activated ror neurons). It is a good thing, 1. assessment of the emotion of during an empathetic therefore, to pass time with people the meeting as pleasurable (posi- relationship who are ethically correct and well tive empathy: +) or unpleasant grounded because a large part of (negative empathy: -); Brain radiologists, through func- our behaviour and learning takes 2. assessment of the satisfied tional magnetic resonance imaging place through the imitation and (+) or suffering (-) expression of (fMRI), have been able to dem- stimulation of the behaviour of the face, which represent the vis- onstrate the activation of cerebral other people. ible form of the indissoluble union areas during an empathetic rela- These data have been highlight- with the soul, which is apparently tionship. They are: 1. the medial ed with very sophisticated instru- invisibile (Il dolore e la semiolo- prefrontal cortex, which is sub-di- mental examinations: positron gia del volto, Zucchi-Honings, in vided into a dorso-medial prefron- emission tomography (PET), func- press); tal cortex and into a ventral part tional magnetic resonance (fMRI), 3. assessment of the fluidity, (the ventro-medial prefrontal cor- transcranial magnetic stimulation abundant (+) or scarce (-), lan- tex); 2) the inferior frontal gyrus); (TMS), and magnetoenchephalog- guage of the anamnestic inquiry 3) the caudal anterior cingolate cor- raphy (MEG) (Singer, 2004). With the same examinations it Empathy (%) has been shown that during prayer addressed to God as well the same 10 cerebral areas are activated, espe- cially the prefrontal areas, which are activated during a normal con- versation with another person, be- cause the mystical dimension is a dialogic dimension, inherent in every human being, including ag- nostics who, nonetheless, are peo- ple made in the image and likeness of God and in whom, obviously enough, different constitutive con- ditions do not exist when com- pared to believers. It is advisable, however, to ob- Age serve that these radiological ex- 0 plorations which demonstrate the 5-15 15-50 50-65 66-75 75-85 86-100 (years) activation of cerebral areas during prayer obviously do not demon- 1st level 2nd level 3rd level strate that it is the brain that cre- (5-65 years) (66-85 years) (86-100 years ates faith. and over) Fig. 4. Distribution of percentage of empathy according to age.

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tex); 4) the anterior insula; 5) the whom he or she sees as not correct pathetic pleasure, establishing a right temporo-parietal junction); or unpleasant suffer. close connection between the Ordo 6) the posterior superior temporal An analogous nerve mechanism Creationis and the Ordo Redemp- sulcus); 7) and the somatosensorial has been observed in animals by the tionis and stressing how in an in- cortex); the amygdale (fig. 5). research group of Professor Riz- timate (empathetic) relationship with the Creator through prayer, or Right parietal-temporal junction in referring to entities of value, the conditions area created for a rais- ing of the pain threshold ( (Zucchi, Parietal lobe Central scissure Frontal lobe Honings, 1996, 2001, 2004, 2005, 2008, 2011, 2013).

Empathy and the Elderly. A New Classification of Empathy: Biological (Somatic), Medical (Mental) and Theological (Pneumatic)

In any field, whether somatic, mental or pneumatic, the relation- Occipital lobe Lower frontal gyrus ship of a subject – elaborated sub- Lateral scissure ject-person, doctor-patient, Crea- Temporal lobe tor-creature – becomes important Lateral surface of the encephalon if it develops as an empathetic re- lationship. This relationship, in all age bands, is important above all Anterior cingulate area Central scissure Parietal lobe else in elderly patients. On this point we offer a new clas- Pre-frontal dorsal-medial cortex sification of empathy: biological, medical and theological. Biologi- Pre-frontal medial cal (somatic, aesthetic) empathy is cortex Occipital lobe that condition that arises in a per- Frontal lobe son faced with an event of extraor- dinary beauty in which the person- subject identifies with the acquired Ventral-medial subject (a work of art, music, scen- pre-frontal cortex ery) without, however, reaching Hippocampus phenomena involving hallucina- Temporal lobe Amygdala tion, as occurs with the Stendhal ef- Limbic system fect, as described by the physician and psychiatrist of Florence, Magh- Medial surface of the encephalon erini (1989), but, rather, experienc- ing the work of art as an interior Fig. 5. Cerebral areas that are interconnected and activated during an neuro-aesthetic identification that empathic relationship. Lateral and medial surface of the encephalon. leads to a condition of the new sub- ject elaborated through the libera- Tania Singer and her collabora- zolatti of the Parma School which, tion of endorphins and the raising tors of Zurich have demonstrated when introducing electrodes into of the pain threshold. through functional magnetic reso- the parts of the brain cited above, Within the context of a painful nance that when a person has re- recorded the activation of neurons condition (an earthquake, learn- ceived a painful stimulus on their (mirror neurons) in the these areas ing about the death of a loved one, own hand, or the hand of a loved not only when the animal carried an economic collapse), exactly the person has received such a stimu- out an action but also when it ob- same phenomenon occurs, experi- lus, the same cerebral areas are ac- served another animal carry out the enced, however, in an opposite way, tivated both when the pain is expe- same action. that is to say with negative mean- rienced personally and when it is One can, therefore, assert that the ings, which lead within the organ- experienced by the loved person. neurons activated in an empathetic ism to a situation of pain with the These cerebral areas are also acti- relationship are mirror neurons. release of pain-inducing substances vated in the observer when he or Zucchi and Honings in the clas- and the lowering of the pain thresh- she sees someone – the whom he sification that they have wanted old (fig. 6). or she considers to be correct and to offer of biological, medical and Medical (mental) empathy is agreeable – suffer. These nerve ar- theological empathy allocate to that condition of an identifica- eas are activated to a lesser extent theological empathy the explana- tion of the pain-pleasure of anoth- when the observer sees someone tion for empathetic pain and em- er person which, if experienced

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and shared (sym-pathy) in a nega- tive way (anti-pathy) leads to de- SUBJECT-PERSON pression (negative empathy; em- pathetic pain-pleasure; window identification pain-pleasure) and if experienced and shared in a positive way (cin- modulation estesis) leads to cinestesis (positive PAIN.PLEASURE OF ANOTHER NEW PERSONAL ENTITY empathy; empathetic (sublimated) ACQUIRED SUBJECT INTERIOR ELABORATED SUBJECT pain-pleasure (joy, felicitas); (win- dow) pain-pleasure or a state of Fig. 6. Biological empathy. A person (the subject) identifies with a pneumatic-physical-mental well- condition of pain or pleasure of another person (acquired subject) being. Sympathy creates the con- which modulates into a new personal entity (interior elaborated ditions for the entity of empathy subject). to move from a binomial relation- ship between two people to a cho- ral relationship shared by a number NEGATIVE EMPATHY of people. In this hermeneutics was actuated the neurophenomenologi- Em-pathy Sym-pathy Anti-pathy (Burn-Out) cal synthesis between Max Scheler Identification Sharing Empathetic pain-pleasure; and (fig. 7). with the pain-pleasure of pain-pleasure Mirror pain-pleasure Theological (pneumatic, ecstat- of others of others ic) empathy has as its goal the in- (Algos)-(Voluptas) (Depression) terpretation of the empathetic pain of the man-God and the empathetic pain (joy-felicitas) of the man-God. POSITIVE EMPATHY From a theological point of view, therefore, we can state that God, Em-pathy Sym-pathy Cin-estesis (cinestesis) who became a man like us, made Identification Sharing Empathetic pain-pleasure Himself ‘empathiable’ in Jesus of Nazareth and in each man. From with pain-pleasure in the pain-pleasure Mirror pain-pleasure a clinical point of view, this empa- of others of others thetic relation of God in Christ the (Pathos)-(Felicitas) (State of psycho-physical wellbeing) man and in suffering-praying man creates the conditions for a raising Fig. 7. Medical empathy: positive and negative of the total (physical, mental and spiritual) pain threshold. In Christ in the Garden of Gethsemane, EMPATHETIC PAIN OF THE MAN-GOD through a (direct) immediate empa- immediate empathy mediated thetic relationship with God the Fa- empathy through prayer ther and in highly suffering every- (direct) man through prayer (mediated indirect empathy). are created the Equivalence of pain conditions for the identification of God with the pain of His son Christ Pain of Pain of the man and the pain of everyman of the man-Christ everyman (fig. 8). Just as in the dying Christ the Fig. 8. Theological Empathy. Interpretation of the empathetic pain conditions were created for a more of the man-God. Empathiability of God in the Pain of the Man- serene passage to the Father, so in Christ and in the pain of everyman. everyman the conditions for the more dignified bearing of pain, above all when this takes place at EMPATHETIC PLEASURE (FELICITAS) THE MAN-GOD (Creator) the end of life, are also created. In the condition of the empa- Present Grace Empathiability thetic pleasure (joy-felicitas) of the man God, the joy of the crea- ture becomes empathiable with the Happiness of his Creator. Indeed God, through contemporary Grace, transforms pleasure of the senses SENSE PLEASURE SPIRITUAL JOY into spiritual Joy in man, who be- of man of man (Creature) comes a creature empathiable with the Happiness of his Creator, like Fig. 9. Theological Empathy. Interpretation of empathetic Jesus in the Father at the day of the pleasure. The empathiability of the joy of the creature (ecstatic Resurrection-Ascension (fig. 9). empathy) with the Happiness of his own Creator.

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In man these three forms of em- Clinical aspects effect) is the result of that clinical pathy – the biological (somatic), The faith effect; the prayer effect, condition in which patients with the medical (mental) and theologi- the music effect or new Mozart pain syndromes manifest a lower cal (pneumatic) – are experienced effect, the placebo effect, the perception of pain and a strength- in different ways according to the nocebo effect, the stroking effect, ening of the result obtained from different age bands, different op- ethical therapy and pain in the anti-pain therapy, joining prayer to portunities and above all different elderly listening to pleasant music, which ethical-spiritual formations and we is usually of a classical or reli- can find in these three empathetic Ethically correct lifestyles and gious character (Zucchi, Honings, entities a physiological approach ones which refer to spiritual mo- Voegelin, 2005). that interacts between the soma, ments lived with joy not only cre- A placebo is a pharmaceutical the mind and the pneuma (fig. 10). ate conditions for a longer life but product without active principles that contains only inert substances. ORDO REDEMPTIONIS It is prescribed for psychological reasons or to assess in a compara- PNEUMA THEOLOGICAl (PNEUMATICAL) EMPATHY tive way the real action of medi- cal products used with the same form as a placebo with which they are alternated without the patient knowing this (blind trial). ORDO CREATIONIS The placebo effect is the posi- tive result produced by an inert bi- MIND MIND MEDICAL (MENTAL) PAIN omedical substance in relation to the perception of pain which is di- minished in a way that is similar to what takes place with the admin- istration of the authentic medical SOMA BIOLOGICAL (SOMATIC) EMPATHY product. The placebo effect is im- portant in the field of the study of Fig. 10. The physiological interactive process of empathy: pain, above all in elderly people, from the soma to the mind to the pneuma. in long-term therapies and has a reduced effect compared to a med- itated reading of a passage from The Perception of Pain in also influence the nociceptive sys- the gospels (Zucchi, Honings, Elderly People tem, improving the perception of Voegelin, 2008). Placebo and the pain in each individual, above all placebo effect constitute an au- The data presented in the litera- if they are elderly. thentic oxymoron, that is to say ture in the field on the perception On this point the authors wish to that semantic condition in which of pain in elderly people do not in- offer the following definitions of two words with opposing mean- volve a univocal interpretation. On the faith effect, the prayer effect, ings are placed together. the basis of clinical studies carried the new Mozart effect, the placebo A nocebo is an inert substance out by our study group we believe effect, the nocebo effect, the stroke with a negative reaction with- that an elderly person has a higher effect and ethical therapy. in the organism. The nocebo ef- pain threshold in relation to differ- The faith effect is the result of fect (which hitherto has not taken ent kinds of pain, above all as re- that condition in which patients place in our case studies) is the gards pain from (radiant) heat. who are believers, compared to negative result that an individual In an elderly person the decrease patients who are agnostics, have manifests following the adminis- in the perception of pain (presby- a lower perception of pain and re- tration of a medical product of a algia) is not only an expression spond better to pharmacological completely inert nature but which of receptor damage as in the case treatment (Zucchi-Honings, 1996; is perceived by the patient as be- of presbyacusia (présbus=old; Zucchi, Honings, Voegelin, 2001). ing harmful. Usually, it takes place akoùein=to hear), or of an al- The prayer effect is the result of because of a bad relationship be- tered accommodation of the stim- that condition in which both pa- tween the medical doctor and his ulus as in the case of presbyopia tients who are believers and pa- or her patient (Zucchi, Honings, (présbus=old; òpsis=sight), but, tients who are agnostics who free- Voegelin, 2008). rather, it is the consequence of a ly agreed to carry out a meditated The stroking effect is the result more complex process which in- reading of a passage from the gos- of an act that is ethical for the per- volves: 1. the nerve pathways for pels manifest a better therapeu- son who engages in it and thera- the transmission and modulation tic response to (pharmacological) peutic for the person who receives of the nociceptive input; 2. the treatment as compared to patients it. It diminishes the perception of cortical and sub-cortical integrat- (both believers and agnostics) who pain. It is advisable to stress that ing centres; and 3. the ethical for- did not agree to a meditated read- skin, which covers the whole of mation of the subject; the history ing of passage from the gospels the human body, does not only of pain of that individual; and 4. (Zucchi, Honings, Voegelin, 2001). have an external function involv- the socio-cultural context. The new Mozart effect (music ing microbiological defence. It al-

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so constitutes a complex interface the syndromes of immunodeficien- Tab. II. Conditions of a with the nervous system. Indeed, cy (zoster herpes) which usually ac- deterioration of quality of in embryological terms, the skin company neoplasms. life in elderly people with derives from the same (embryo) untreated pain. sheet called the ectoderm from which the central nervous system Quality of Life 1) Reduction in social and the peripheral nervous system in the Elderly with Pain. relationships. derive. Stroking, on the basis of The Ethical-Religious Iter 2) Depression. our studies, specifically because 3) Anxiety. of the very embryological origins Tab. I. Positive conditions 4) Low/malnutrition. of the skin and the brain, which that are obtained through a 5) Sleep disturbance we define as ectodermic twins, di- meditated reading of a passage 6) Increase in disability minishes the perception of pain (a from the gospels in painful and 7) Greater resort to health-care higher pain threshold), fostering cardiovascular pathologies, and social services. the release of endorphins and neu- including ones treated rogenesis. In the paediatric sphere pharmacologically. it fosters the growth of the child; in the geriatric sphere it fosters From this study one can state that a meditated reading of a passage cinestesis in the elderly person. from the gospels offers in elderly people with painful pathologies (5-65 Ethical therapy is the result of years: level 1; 66-85 years: level 2; 86-100 years, level 3), the following that condition characterised by the positive conditions: strengthening of therapeutic treat- 1) Strengthening of the action of pain-killing medical products that are ment, usually of a pharmacologi- taken (Zucchi, Honings, Voegelin, 2001. cal character, both in believers and in agnostics who freely agreed to 2) Reduction of the quantity of medical products which have to be engage in a meditated reading of a taken (Zucchi, Honings, Voegelin, 2001). passage from the gospels (Zucchi, 3) Reduction of the perception of physical and medical pain (raising of Honings, 1996, 2001, 2005, 2008, the physical and mental pain threshold, Zucchi, Honings, Voegelin, 2011). 2001). 4) Improvement of the quality of life and therefore of the state of health (Zucchi, Honings, Voegelin, 2001). Different Frequency of Acute 5) Improvement of the interior conditions of assessments of others and and Chronic Pain with Age one’s own ways of behaving (Zucchi, Honings, Voegelin, 2001). 6) Greater satisfaction as regards one’s life. Greater self-esteem, ‘Growing old is a privilege and greater optimism, better prospects (Zucchi, Honings, Voegelin, a goal of society, it is also a chal- 2001). lenge which has an impact on all 7) A 20% increase in life expectation compared to those who do not aspects of twenty-first century so- engage in religious practices (Zucchi, Honings, Voegelin, 2001). ciety’ (WHO). 8) Reduction in the cystic and diastolic blood pressure levels in A different frequency of acute individuals with hypertension (Lagi et al. 2001). and chronic pain exists with the 9) Reduced risk of death caused by cardiovascular or pulmonary advance of age. Acute pain of re- diseases (Lagi et al. 2001). cent irruption diminishes with the 10) More incisive health-inducing effects as compared to the music advance of age whereas chronic effect (Zucchi-Honings, 2005). pain increases. The use of health- 11) More effective health-inducing effects compared to the placebo care measures for acute pain reach effect (Zucchi-Honings, 2008). a peak between the first and sec- ond halves of the fifth decade of life whereas resort to a medical Non-Treated Pain Myths and facts about pain in doctor for chronic pain increases elderly people in a linear way until the age of 65, Pain, however, even if per- Myths: ‘if they do not complain to then decrease from the age of ceived by an elderly person as be- it means that they do not have 66 onwards, even though the real ing lower compared to individuals pain’ decrease takes place after the age who are younger, must, whatever Facts: there are a large number of 86 (cf. fig. 15. Classification of the case, be treated. Instead, often of reasons why elderly people are pain in the elderly at three levels). it is underestimated and thus un- reluctant to admit that they are in It is interesting to observe how der-treated. pain, even though pain significant- the clinical conditions that most fre- As a consequence untreated ly reduces good mood and their quently cause pain in young adults pain, in individuals who entrust functional state. (migraine, chronic headaches, pep- themselves to prayer as well, caus- tic ulcers, abdominal pain, heart es a worsening of quality of life in Reasons why Elderly People do pain) diminish at an advanced age, patients ands brings about the fol- not Speak about their Pain whereas painful clinical conditions lowing conditions: (tab. II). 1) Fear of being subjected to di- increase as regards the joint appa- agnostic examinations. ratus, the respiratory apparatus, and 2) Fear of medical products.

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3) Fear of the cause of pain. neonates and in adults (men, wom- the four types of first-level pain 4) Perception of the fact that the en) has received great attention examined in the classification we medical doctor is too busy. over the last thirty years. In contra- have proposed (somatic pain, neu- 5) Believing that nothing can be ry fashion, pain in elderly patients rological pain, vascular-visceral done or will be done. has been very little studied. pain, oncologic pain), BO is more The points to be borne in mind frequent in patients with neuro- However, the most reliable in- as regards geriatric pain: morbid- logical cancer (40%; migraine), dicator of pain and its seriousness ity (the set of illnesses that afflict oncological cancer (30%), gastric is the description provided of it by an individual) and co-morbidity or tumour, tumour of the genital-uri- the patient himself or herself. co-morbosity (associated patholo- nary apparatus, tumour of the ear, Objectives of a medical doctor gies). nose and throat area; vascular can- when faced with an elderly patient 1) An increase in life expectan- cer (20%); and, to a lesser extent, who is in pain: cy means the possibility of an in- somatic cancer (10%). 1) A careful anamnesis to iden- crease in morbidity. tify the causes (when this is pos- 2) Pain constitutes a parameter The Aetiology of BP sible, inquiries into previous ill- that can influence morbidity. nesses and the use of medical 3) Pain is the most feared com- BP can be caused: by move- products). plication of illness. ments, coughs and changes in po- 2) An ethno-anthropological 4) Pain is the first symptom that sition (predictable intense episod- and social assessment. is referred to a medical doctor. ic pain) or by: distension of the 3) A psychological assessment 5) Often pain is under-diagnosed urinary or intestinal tracts (unpre- with psychometric tests. and undertreated. dictable intense episodic pain). In 4) A clinical-physical assess- 6) Pain modifies mood, the some cases a real cause is not rec- ment with the focus of somatic functional state and quality of life. ognised (idiopathic BP) pain (the skeletal-muscular sys- 7) Pain increases the use of tem, with special attention paid to health-care services. The Characteristics of BP the palpation of trigger points). 5) An instrumental assessment: BP is characterised by sudden algometric tests (VAS; hyperal- Breakthrough Pain (BP) or pain of notable intensity which is gesia; telethermography; accept- Intense Episodic Pain (IEP) in piercing and burning. The seat is ance; algogenic substances: free Elderly People often that of basic pain, is preva- radicals: d-roms-test; bap-test; lently nocturnal and of short dura- lactic acid; ascorbic acid; PCT; By the phrases ‘intense episodic tion (from 10 to 30 minutes). The homocysteine; hydroxyproline; pain’ (IEP) or ‘breakthrough pain’ treatment of BP must be seen as a PTH). (BP) we mean a sudden increase, clinical and ethical priority because 6) Identification of the qualita- and as a rule not predictable, in- it is a type of pain that undermines tive and quantitative aspects of crease in the pain of a patient who quality of life. The management pain control. is having well controlled basic of BP can be achieved in an opti- pain treatment. mal way with the adjustment of the In the cases that we have exam- therapy underway, but overcoming Assessment of Geriatric Pain ined BP is most frequent in pa- cultural attitudes that are not cor- tients of the first-level age band rect and rather widespread amongst ‘Geriatric pain is underestimated with a maximum incidence around patients who say they have to bear and undertreated’ (Bernabei, R., et the age of fifty. However, it is al- crises of acute pain after the basic al., Jama, 279 (1998) 237-249). so present in patients who belong therapy has been established. In to the other two levels, but with a the oncological field BP creates a The control of pain in a foetus, in much lower incidence. Amongst prognosis that is even worse.

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Special Part The Fundamental Parameters right to have free access to the Clinical Experimentation of the Study documentation relating to this re- search. The study examines the existing In addition I am aware that ac- Ethical-Religious Aspects relationships of five fundamental cording to respect for laws in force parameters: my personal data will be used ex- In this part of the paper we ex- 1) The faith effect (assessment clusively for the purposes of sci- amine how the transcendent ele- of the initial intensity of the pain entific research. ment of faith together with a medi- perceived V1 and the therapeutic tated reading of a passage from the result V2 in relation to the faith Date gospels can influence the thresh- parameter). old of the perception of pain and 2) The prayer effect (assessment ……………………………… the strengthening of pharmacolog- of therapeutic improvement VD in ical therapeutic responses in elder- relation to the parameter of a med- Signature of the Patient ly patients, whether believers or itated reading of a passage from agnostics, who have chronic pain- the gospels). ……………………………… ful pathologies. 3) V1 (initial intensity of pain before treatment). Date 4) VD (intensity of pain at the ……………………………… The Clinical-Statistical end of treatment). Approach to the Therapeutic 5) Correlation of VD/V1: the re- Signature of the Effectiveness of a ‘New’ Medical lationship between improvement medical doctor researcher Product tin the intensity of pain VD and the initial pain V1 in relation to ……………………………… In order to assess the efficacy the parameters of faith and prayer. of medical product ‘X’ (prayer) in relation to a given pathology, Clinical Experimentation a ‘G’ group of patients is selected Declaration of Informed who suffer from that pathology; Consent As regards prenatal, neonatal this group is divided into two sub- and paediatric pain, we based our- groups G1 and G2; G1 is treated I the undersigned selves on the data to be found in with medical product ‘F’ and G2 the literature in the field (Bellieni, is treated with medical product ……………………………… Anand, Phil, Hickey, Fisk) which ‘F’ and with medical product ‘X’ demonstrate that a foetus per- which is being studied. Declare that I have received ceives pain starting in the seventh The gravity of the pathology is from Dr. week of pregnancy, with the ap- assessed with an objective index pearance of sense receptors in the ‘P’ which is measured at the be- ……………………………… perioral area, in the palms of the ginning (P1) and at the end of the hand and in the souls of the feet therapy (P2) . Two P1 independent exhaustive explanations about (Gleiss, 1970). However, despite variables are obtained as an index the request for my participation in the evidence of the scientific da- of the gravity of the initial pathol- the Experimental Study described ta, some researchers (Enghelhardt, ogy and DP = P1-P2, as an index above. A copy of the present infor- Derbyshire) argue that a foetus on- of its improvement. mation sheet has been given to me. ly feels pain when it adopts the po- The statistical inquiry involves I declare that I have been able sition of a neonate. assessing whether there exists a to discuss these explanations, that On this point we would like to meaningful difference of the val- I have posed questions and that I stress what the Catechism of the ue of DP in the two sub-groups G1 have received answers to them Catholic Church says in section and G2, that is to say whether the that are satisfactory. 2274: ‘Since it must be treated new medical product ‘X’ strength- I also declare that I have had from conception as a person, the ens improvement. an opportunity to inform myself embryo must be defended in its A further exploration of the about the features of the study integrity, cared for, and healed, as characteristics of the medical with other person in whom I trust far as possible, like any other hu- product ‘X’ used involves assess- as well. man being’. Indeed, to recognise ing whether the improvement pro- I therefore freely agree to take that a foetus can feel pain is a step duced by this is greater when the part in the research, having per- forward in recognising that it is a gravity of the pathology is greater, fectly understood all the informa- person. Given that we believe that that is to say if there is a positive tion given above. a foetus and a neonate have the correlation between DP and P1. I am aware that my participation same perception of pain as adults All the patients have to sign a dec- in the research is voluntary and (5-65 years) because of a comple- laration of informed consent. that I have the option to withdraw tion of the pain-receiving system, at any moment without this preju- we also placed patients of a pae- dicing the medical treatment that I diatric age in the experimentation. might need. The data on pain relating to peo- I have been informed about my ple of a paediatric age start with

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observations of people of the age Tab. III. Sub-division by To both groups – the S (study) of five and above, a period when frequency of prevalent pain in group and the C (control) group it is possible assess the strength- decreasing order (vascular pain, – belonging to the three levels 1 ening of the efficacy of medical neurological pain, oncological (5-65 years), 2 (66-85 years) and 3 products through being accompa- pain, somatic pain) in the 120 (86-100 years), an ‘F’ pharmaco- nied by prayer. individuals belonging to level 1: logical therapy was administered The sample of individuals be- young-old (5-65 years). Within based on FANS. longing to the first level (5-65 the four types of pain the VAS The S group was also invited to years) was made up of 120 peo- level (10/9 –> 5/4) was the same. engage in a meditated reading of a ple, of whom a small part (1/6) be- passage from the gospels (prayer) longed to the age band of 5 to 10 Vascular pain: (40%): before the beginning of the treat- years. In those who belonged to 48 individuals (32 S and 16 C) ment, and this lasted ten days. the first level the most frequent pa- Neurological pain (25%): On the first, fifth and tenth days thologies involved vascular pain, 30 individuals (20 S and 10 C) the individuals of the two groups differently from what happened in Oncological pain (20%): (S and C) of the three levels 1, 2 level 2 individuals where oncolog- 24 individuals (20 S and 4 C) and 3, underwent a psycho-phys- ical pain was prevalent, and level Somatic pain (15%): ical assessment of their pain two 3 where somatic (bone, joint and 18 individuals (10 S and 8 C) hours before and after, the admin- muscular) pain was prevalent. istration of the treatment which in- The individuals who belonged volved the administration of the to the three levels (young-old, medical product F to the control 5-65 years, level 1; old-old, 66-85 Tab. IV. Sub-division by group and of the medical product years, level 2; oldest-old, 86 to 100 frequency of prevalent pain in F, together with a meditated read- and over, level 3) and had chronic a decreasing order (oncological ing of a passage from the gospels, painful pathologies, in part admit- pain, vascular pain, somatic to the study group. ted to the departments of internal pain, neurological pain) of the In the case of the younger indi- medicine and in part examined in 120 patients belonging to level 2: viduals prayers were often said in clinics of the specialist clinics of old-old (individuals between the the presence of an older adult, usu- Florence and the Biomedical uni- ages of 66 and 85. Within the 4 ally one of the parents of these in- versity Campus of Rome, were en- types of pain the VAS assessment dividuals. rolled in a blind study, that is to (8/7 –> 4/3) was the same in The assessment of pain was car- say without knowing beforehand each level. ried out using the analogical visu- the religious beliefs of the people al scale (VAS) (Zucchi, Honings, taking part in the project. Oncological pain (40%): Voegelin, 2008). When the patients entered a 48 individuals (20 S and 28 C) The initial VAS was the variable department or clinic an assess- Vascular pain (30%): VI, an index of the painful pathol- ment was made of the pathology 36 individuals (10 S and 26 C) ogy and the difference between the that was responsible for their al- Somatic pain (20%): indicator of initial VAS and that of gic state. The various painful pa- 24 individuals (14 S and 10 C) the final VAS made up the variable thologies were divided into four Neurological pain (10%): VD, an index of improvement. groups: a central kind (neurologi- 12 individuals (7 S and 5 C) At the end of the treatment, that cal); a somatic kind (joints–myo- is to say at the end of the tenth day fascial); of a vascular kind; and of of admission, the patients were an oncological kind. asked if they were believers or The patient were then sub-divid- Tab. V. Sub-division by otherwise, and in this way was ob- ed according to a random criterion frequency of prevalent pain tained, in each of the three levels, (chance allocation of patients) in- in a decreasing order (somatic two groups of individuals with dif- to two groups: an S group (study: pain, vascular pain, neurological ferent responses to the therapy, ac- treatment with medical products pain, oncological pain) of the cording to their own spiritual ap- and prayer) and a C group (con- 120 patients belonging to level 3: proaches as well. trol: treatment only with medical oldest-old (individuals between products). the ages of 86 and 100. Within All the patients were amply in- the 4 types of pain the VAS formed about the clinical experi- assessment (7/6 –> 3/2) was the mentation and consented to it. same. Prevalence of Pain Type in 120 Patients Belonging Somatic pain (70%): to Each Level 84 individuals (45 S and 39 C) AT LEVEL 1 (individuals Vascular pain (15%): between the ages of 5 and 18 individuals (10 S and 8 C) 65); at level 2 (individuals Neurological pain (8%): BETWEEN THE AGES OF 66 9,6 individuals (4 S and 5 C) and 85); and level 3 (indi- Oncological pain (7%): VIDUALS BETWEEN THE AG- 8,4 individuals (6 S and 2 C) es of 86 and 100 and over).

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Tab. VI. Sub-group of patients with neurological (or central) Central (neurological) pain pain. Level 1: 5-65 years. Level 1 (5-65 years) V. A. S. Examination of the Sub- groups at the End of the 10 Therapy 9 C1= 5 believers treated with 8 prayer and pharmacological 7 6 therapy A4 C3= 4 believers treated only 5 A2 with pharmacological therapy 4 C3 A2= 15 agnostics treated with 3 C1 prayer and pharmacological 2 therapy 1 A4= 6 agnostics treated only 0 with pharmacological therapy T0 T5 T10

Fig. 11 A. Central pain (acute headaches, migraine, trigeminal Tab. VI A. Sub-group of patients neuralgia, outcomes of ischemic or haemorrhage stroke, with neurological (or central) Alzheimer’s disease, multi-heart attack dementia, Parkinson’s pain. Level 2: 66-85 years. disease) in patients of the first level (5-65 years).

C1= 4 believers treated with V. A. S. Central (neurological) pain prayer and pharmacological Level 2 (66-85 years) therapy 10 C3= 3 believers treated only 9 with pharmacological therapy 8 A2= 3 agnostics treated with 7 prayer and pharmacological 6 A4 therapy 5 A2 A4= 2 agnostics treated only 4 C3 with pharmacological therapy 3 C1 2 1 Tab. VI B. Sub-group of patients 0 with neurological 8or central9 T0 T5 T10 pain. Level 3: 86-100 years. Fig. 11 B. Central pain (acute headaches, migraine, trigeminal C1= 2 believers treated with neuralgia, outcomes of ischemic or haemorrhage stroke, prayer and pharmacological Alzheimer’s disease, multi-heart attack dementia, Parkinson’s therapy disease) in patient of the second level (66-85 years). C3= 3 believers treated only with pharmacological therapy A2= 2 agnostics treated with V. A. S. Central (neurological) pain prayer and pharmacological Level 3 (86-100 years) therapy 10 A4= 2 agnostics treated only 9 with pharmacological therapy 8 7 6 5 4 A4 3 A2 2 C3 1 C1 0 T0 T5 T10

Fig. 11 C. Central pain (acute headaches, migraine, trigeminal neuralgia, outcomes of ischemic or haemorrhage stroke, Alzheimer’s disease, multi-heart attack dementia, Parkinson’s disease) in third-level patients (86-100 years).

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Tab. VII. Sub-group of patients with oncological pain. Level 1 Oncological pain (5-65 years). Level 1 (5-65 years) C1= 6 believers treated with V. A. S. prayer and pharmacological therapy 10 C3= 3 believers treated only 9 with pharmacological therapy 8 A2= 4 agnostics treated with 7 A4 prayer and pharmacological 6 A2 therapy 5 4 C3 A4= 11 agnostics treated only C1 with pharmacological therapy 3 2 1 0 Tab. VII A. Sub-group of T0 T5 T10 patients with oncological pain. Level 2 (66-85 years). Fig. 12 A. Oncological pain of patients of the first level (5-65 years). C1= 9 believers treated with prayer and pharmacological therapy Oncological pain C3= 12 believers treated only Level 2 (66-85 years) with pharmacological therapy V. A. S. A2= 11 agnostics treated with prayer and pharmacological 10 therapy 9 A4= 8 agnostics treated only 8 with pharmacological therapy 7 6 5 A4 Tab. VII B. sub-group of 4 A2 patients with oncological pain. 3 C3 Level 3 (86-100 years). 2 C1 1 C1= 3 believers treated with 0 prayer and pharmacological T0 T5 T10 therapy C3= 1 believer treated only with pharmacological therapy Fig. 12 B. Oncological pain in patients of the second level (66-85 years). A2= 3 agnostics treated with prayer and pharmacological therapy Oncological pain A4= 1 agnostic treated only Level 3 (86-100 years) with pharmacological therapy V. A. S.

10 9 8 7 6 5 A4 4 A2 3 C3 2 C1 1 0 T0 T5 T10

Fig. 12 C. Oncological pain in patients of the third level (86-100 years).

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Tab. VIII. Sub-group of patients with vascular pain. Vascular pain Level 1 (5-65 years). Level 1 (5-65 years) C1= 20 believers treated with V. A. S. prayer and pharmacological therapy 10 C3= 6 believers treated only 9 with pharmacological therapy 8 A2= 12 agnostics treated with 7 prayer and pharmacological 6 A4 therapy 5 A2 A4= 10 agnostics treated only 4 C3 with pharmacological therapy 3 C1 2 1 0 Tab. VIIIA. Sub-group of T0 T5 T10 patients with vascular pain. Level 2 (66-85 years). Fig. 13 A. Vascular pain in patients of level 1 (5-65 years). C1= 4 believers treated with prayer and pharmacological therapy Vascular pain C3= 10 believers treated only Level 2 (66-85 years) with pharmacological therapy A2= 6 agnostics treated with V. A. S. prayer and pharmacological therapy 10 A4= 16 agnostics treated only 9 with pharmacological therapy 8 7 6 5 A4 Tab. VIII B. Sub-group of 4 A2 C3 patients with vascular pain. 3 C1 Level 3 (86-100 years). 2 1 C1= 4 believers treated with 0 prayer and pharmacological T0 T5 T10 therapy C3= 3 believers treated only with pharmacological therapy Fig. 13 B. Vascular pain of level 2 (66-85 years). A2= 6 agnostics treated with prayer and pharmacological therapy Vascular pain A4= 5 agnostics treated only Level 3 (86-100 years) with pharmacological therapy V. A. S.

10 9 8 7 6 5 4 3 A4 2 A2 C3 1 C1 0 T0 T5 T10

Fig. 13 C. Vascular pain in patients of level 3 (86-100 years).

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Tab. IX. Sub-group of patients with somatic pain (joints/myo- Somatic pain fascial). Level 1 (5-65 years). V. A. S. Level 1 (5-65 years)

C1= 6 believers treated with 10 prayer and pharmacological 9 therapy 8 C3= believers treated only with 7 pharmacological therapy 6 A2= 4 agnostics treated with 5 A4 prayer and pharmacological 4 A2 therapy 3 C3 C1 A4= 3 agnostics treated only 2 with pharmacological therapy 1 0 T0 T5 T10 Tab. IX A. sub-group of patients with somatic pain (joints/myo- Fig. 14 A. Somatic pain (articular and joints/myo-fascial; arthritis, fascial). Level 2 (66-85 years). arthrosis; cervical pain; dorsal pain; lower back pain) in patients of level 1 (5-65 years). C1= 9 believers treated with prayer and pharmacological therapy Somatic pain (joints/myo-fascial) V. A. S. C3= 6 believers treated only Level 2 (66-85 years) with pharmacological therapy 10 A2= 5 agnostics treated with 9 prayer and pharmacological 8 therapy 7 A4= 4 agnostics treated only 6 with pharmacological therapy 5 A4 4 A2 C3 3 C1 Tab IX B. Sub-group of patients 2 with somatic pain (joints/myo- 1 fascial). Level 3 (86-100 years). 0 T0 T5 T10 C1= 30 believers treated with prayer and pharmacological therapy Fig. 14 B. Somatic pain (articular and joints/myo-fascial: arthritis, C3= 19 believers treated only arthrosis, cervical pain; dorsal pain; lower back pain) in patients with pharmacological therapy of level 2 (66-85 years). A2= 15 agnostics treated with prayer and pharmacological Somatic pain (joints/myo-fascial) therapy V. A. S. A4= 20 agnostics treated only Level 3 (86-100 years) with pharmacological therapy 10 9 8 7 6 5 4 A4 3 A2 2 C3 C1 1 0 T0 T5 T10

Fig. 14 C. Somatic pain (articular and joints/myo-fascial: arthritis, arthrosis, cervical pain, dorsal pain, lower back pain) in patients of level 3 (86-100 years).

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Results and Conclusions cular-visceral (silent myocardial 3. The patients in the study infarction and complicated ulcer group (S) and those of the control From the data examined in this illnesses) constitute pathologies group (C) of level 3 require lower study it has been shown that the with painful symptoms in minimal quantities of pain-killing medical variability of the intensity of pain intensity in patients of the geriat- products and opioids in the four correlates with: ric age of the third level (86-100 types of pain (somatic, vascular, 1) Age: the elderly people of years) as compared to the groups neurological, oncological) com- the third level (86-100 years) per- of patients of the first and second pared to the patients (S and C) of ceived less pain than those of the levels. the first and second levels. second level (65-85 years) and of In these pathologies vascular- 4. The instrument of a meditated the first level (5-65 years). visceral pain emerges when suf- reading of a passage from the gos- 2) The environmental pheno- ficient levels of afferent impuls- pels (prayer) strengthens the effect type factor: less comforted envi- es are reached and when there is of pain-killing medical products in ronments engendered a greater an appropriate activation of the all the levels of the patients sub- perception of pain. central ascendant pathways. In jected to examination, even though 3) Culture: classes with a low- asymptomatic elderly people there to a greater extent in those of the er culture and people with a more takes place an insufficient stimu- third level because of a physiolog- humble physiognomy tolerated lus of the tissues with a related de- ical condition of lesser perception pain better and responded better to creased spinal transmission and of pain due, as well, to the applica- therapies than more cultured and consequential lesser cortical inte- tion of more aware lifestyles. arrogant people. gration. It is advisable to emphasise, 4) As regards sex, there were no 2. At level 3 the clinical condi- therefore, that the intensity of the significant variations in the per- tions of vascular-visceral pain, to- different types of pain within the ception of pain in men and wom- gether with those of central pain different age bands of the individ- en, when elderly as well, as had and oncological pain, have lesser uals belonging to each of the three already been indicated in previous frequency, as an epidemiological levels tends to decrease from level studies (Zucchi-Honings, 2005). fact, compared to clinical forms 1 to level 2. of somatic pain (arthrosis, arthri- The Characteristics of Different tis, zoster herpes, injuries) which Types of Pain in the Three Levels are very well represented in the Classification (at Three levels) cases of medical services and ad- of Pain in the Elderly From this study it also emerged missions carried out in the emer- that: gency departments of hospitals in On the basis of the results ob- 1. Some clinical forms of vas- various cities. tained from this study we formu-

SOMATIC PAIN (70%) V. A. S. 7/6 –› 4/2 VASCULAR PAIN (15%) V. A. S. 7/6 –› 3/2 NEUROLOGICAL PAIN (8%) V. A. S. 7/6 –› 3/2 ONCOLOGICAL PAIN (7%) V. A. S. 7/6 –› 4/2 Level 3 OLDEST-OLD (PERSON: 86-100 years) V. A. S. 7/6 –› 3/2= men and women

ONCOLOGICAL PAIN (40%) V. A. S. 8/6 –› 5/3 VASCULAR PAIN (30%) V. A. S. 8/7 –› 5/4 Level 2 SOMATIC PAIN (20%) V. A. S. 7/6 –› 4/3 NEUROLOGICAL PAIN (10%) V. A. S. 7/6 –› 5/4

OLD-OLD (PERSON: 66-85 years) V. A. S. 8/7 –› 4/3= men and women

VASCULAR PAIN (40%) V. A. S. 10/8 –› 6/4 CENTRAL PAIN (NEUROLOGICAL) (25%) V. A. S. 10/8 –› 5/4 ONCOLOGICAL PAIN (20%) V. A. S. 10/9 –› 5/4 Level 1 SOMATIC PAIN (15%) V. A. S. 8/7 –› 5/4

YOUNG-OLD V. A. S. 10/9 –› 5/4= men and women (Foetus-PERSON: 5- 65 anni)

Fig.15. Classification at the three levels of the threshold of various types of pain according to age.

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lated a scale with three levels of ed to engage in a meditated read- Giovanni Paolo II, Lettera agli anziani, 1 October 1999. pain in the elderly in order to offer ing of a passage from the gospels Johnson, D. M., ‘L’uomo chiamato ca- a new classification that examines with a strengthening of the thera- vallo’, in G. Aristarco (ed.), Cinema Nuovo, the intensity and the frequency of peutic effects in the various types Sansoni, Florence, 1970, pp. 132-137. Kosambi, D. D., ‘Living prehistory in In- the various types of pain on the ba- of pain. dia’, Sci. Amer., 216 (1967), 105-120. sis of the age of the patient. This We wanted in this classification Kroeber, A. L., Essays in historical an- condition places the foetus (of the of pain in the elderly to provide an thropology of North America, Washington, seventh week of pregnancy) and overall view of man starting from (1940), pp. 1-58. Kroeber, A. L., ‘A cross-cultural survey the neonate at the same level as the the foetus in order to give this enti- of South American Indian tribes: esthetic adult person (65 years) because ty the dignity of a person who per- and recreational activities, in J. H. Steward with the same condition they pos- ceives all the signs of pain equiva- (ed.), Handbook of South American Indi- ans, Washington, V, 1940, pp. 411-492. ses the same nociceptive appara- lent to those in adults, emphasising Kroeber, A. L., ‘The Chibcha’, in J. H. tus and thus the same perception that the perception of human pain Steward (ed.), Handbook of South American of pain (minimal variability of the begins with man’s foetal being and Indians, Washington, V, 1940, pp. 887-909. Magherini, G., La Sindrome di Stend- VAS within the level). that man’s ageing begins with his hal. Il malessere del viaggiatore di fronte neonatal being. alla grandezza dell’arte, Ponte alle Grazie In this work we would like to Editore, Florence, 1989. Mukamel, D.G., Ekstrom, A. D., Ka- Frequency of the various types emphasise that the perception of plan, J., Iacoboni, M., Fried, I., ‘Single of pain (vascular, neurological, pain begins to decrease with the in- neuron responses in human during execu- oncological, somatic) and crease in age and that this param- tion and observation of actions’, Current Bi- average intensity (VAS) in the eter emerges with a clearer physi- ology, 20 (2010), 750-756. Newberg, A., Dio nel cervello, Monda- basis of the age of the individual ognomy in believers as compared dori, 2002. within each level. to agnostics in the various types of Reader, V. G., Fisk, N. M., ‘Fetal pain: pain examined in each level. This implications for research and practice’, In- ternational Journal of Obstetrics and Gy- The age examined in the first observation is important not only naecology, 9 (1999), 881-886. level on the basis of the percep- from a clinical point of view. 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