Dolentium Hominum N.47

DOLENTIUM HOMINUM N. 47 – Year XVI – No. 2, 2001

JOURNAL OF THE PONTIFICAL COUNCIL FOR HEALTH PASTORAL CARE

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

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MAGISTERIUM TESTIMONY 5 Addresses by the Holy Father 60 The Servant of God, Manuel Lozano Garrido: Paralytic, Blind Man, NINTH WORLD DAY OF THE SICK Journalist and Writer SYDNEY, 11 FEBRUARY 2001 Rev. Rafael Higueras Álamo 64 The Hospital of the Holy Spirit 12 The Holy Father’s Letter of Rome as an Example to the President of the Pontifical of the Apostolate of Compassion Council for Health Pastoral Care Prof. Marian Surdacki John Paul II 73 The Department of Pastoral Care 13 Do not Forget those at the Cardinal Tien Hospital who Lack Health Care in Taiwan John Paul II 75 Archdiocese of Philadelphia: 2 14 The Sick are a World Protocol for Evaluating of Hope and Joy Catholic Health Care John Paul II Collaborative Relationships 15 United to Christ the Suffering Become 77 The Paulinian Approach Ministers of the New Evangelisation to Nursing Education: A Response H.E. Card. Edward Bede Clancy to the Church’s Call for Compassionate Caring 18 The Celebration of the Sr. Rosamond Marie Abadesco Ninth World Day of the Sick ‘The New Evangelisation and the Dignity of the Suffering Person’ Rev. Krzysztof Nykiel

TOPICS

24 Physical Pain and Moral Suffering of Everyman and the Christ-man Prof. Pierluigi Zucchi Rev. Bonifacio Honings 34 The Spiritual Needs of the Sick Child and his Pastoral Care H.E. Mons. José L. Redrado 45 Philosophy, the Construction of a Profession Rev. Cecilio Eseverri Chaverri 52 Neurological Aspects of Death Dr. Purificacion de Castro Rev. Miguel Angel Monge 55 Fears and Hopes in the Face of Death Rev. Arnaldo Pangrazzi

The illustrations in this edition are taken from the book “Pittura e scultura nella Chiesa di San Domenico a San Miniato: studi e restauri” Antonia D’Aniello Pacini Editore - Ospedaletto (Pisa), 1998

Magisterium

Addresses by the Holy Father

DOLENTIUM HOMINUM N. 47-2001 We are Certain that Life will Triumph THE SPEECH OF JOHN PAUL II TO THOSE TAKING PART IN THE SEVENTH GENERAL ASSEMBLY OF THE PONTIFICAL ACADEMY FOR LIFE AT THE AUDIENCE GRANTED ON THE MORNING OF 3 MARCH IN THE SALA CLEMENTINA.

1. It is always a great pleasure for me to than ever is able to offer powerful means meet you, distinguished members of the that unfortunately are not always used for Pontifical Academy for Life. The reason to- man’s true good. On the contrary, at times day for this opportunity is your annual gen- research in many fields even seems to turn eral assembly, which has brought you to against man. Rome from various countries. I extend my cordial greetings to each of you, worthy 3. Therefore, it is appropriate that you friends who make up the family of this wished to clarify the foundations and di- Academy which is so dear to me. I extend a mensions of the culture of life. With this in particular and respectful greeting to your mind, you stressed the great themes of cre- President, Prof. Juan de Dios Vial Correa, ation, showing clearly how human life must whom I thank for his kind words expressing be seen as God’s gift. Man, created in the 5 your sentiments. I also greet the Vice-Presi- image and likeness of God, is called to be dent, Bishop Elio Sgreccia, the members of his free co-worker and, at the same time, to the Executive Council, the staff and bene- be responsible for the “stewardship” of cre- factors. ation. You have also wished to reaffirm the in- 2. You have chosen a topic of great inter- alienable value of the personal dignity of est as the theme for your assembly’s reflec- every individual from conception to natural tion: “The Culture of Life: Foundations and death; you revisited the theme of bodiliness Dimensions”. Its very formulation already and its personalistic meaning; you focused expresses your intention to focus on the pos- your attention on the family as a community itive and constructive aspect of the defence of love and life. You dwelt on the impor- of human life. During these days you have tance of the communications media for a been asking yourselves about the necessary far-reaching dissemination of the culture of foundations for promoting or revitalizing a culture of life, and with what elements to propose it to a society marked Ð as I recalled in my Encyclical Evangelium vitae Ð by an increasingly widespread and alarming culture of death (cf. nn. 7, 17). The best way to overcome and defeat the dangerous culture of death is to give firm foundations and clear content to a culture of life that will vigorously oppose it. Although right and necessary it is not enough merely to expose and denounce the lethal effects of the culture of death. Rather, the inner tissue of contemporary culture must be continually regenerated, culture being understood as a conscious mentality, as convictions and actions, as the social structures that support it. This reflection seems all the more valuable if we consider that culture influences not only the behaviour of individuals but also legislative and political decisions, which in turn facilitate cultural trends which, unfortunately, often impede the authentic renewal of society. Culture, moreover, orients the strategies of scientific research, which today more

DOLENTIUM HOMINUM N. 47-2001 life, and the need to be involved in a person- sonal, for it consists in the proclamation of al witness to it. You have also recalled how, the very person of Jesus. Jesus made himself in this area, everything that encourages dia- known to the Apostle Thomas, and in him to logue should be pursued, in the conviction every person, with the words: ‘I am the way, that the full truth about man supports life. and the truth, and the life’ (Jn 14:6)” (n. 29). The believer is sustained in this by an enthu- This. is a fundamental truth that the com- siasm rooted in the faith. Life will triumph: munity of believers is called, today more this is a sure hope for us. Yes, life will tri- than ever, to defend and promote. The umph because truth, goodness, joy and true Christian message about life, “written in the progress are on the side of life. God, who heart of every man and woman, has echoed loves life and gives it generously, is on the in every conscience “from the beginning”, side of life. from the time of creation itself, in such a way that, despite the negative consequences 4. As always happens in the relationship of sin, t can also be known in its essential between philosophical reflection and theo- traits by human reason” (Evangelium vitae, logical meditation, in this case too the word n. 29). and example of Jesus, who gave his life to The concept of creation is not only a conquer death and to give man a share in his splendid message of revelation, but also a resurrection, are also an indispensable help. sort of profound intuition of the human spir- Christ is the “resurrection and the life” (Jn it. Likewise, the dignity of the person is not 6 11:25). only an idea deducible from the biblical Reasoning from this perspective, I wrote statement that man was created “in the im- in the Encyclical Evangelium vitae: “The age and likeness” of the Creator, but a con- Gospel of life is not simply a reflection, cept rooted in his spiritual being, by which however new and profound, on human life. he shows that he is a being who transcends Nor is it merely a commandment aimed at the world around him. The body’s claim to raising awareness and bringing about signif- dignity as a “subject”, and not simply a ma- icant changes in society. Still less is it an il- terial “object”, is the logical consequence of lusory promise of a better future. The the biblical concept of the person. This is a Gospel of life is something concrete and per- unified concept of the human being, which has been taught by many currents of thought from medieval philosophy to our times.

5. The commitment to the dialogue between faith and reason can only strengthen the culture of life, combining the dignity and sacredness, freedom and responsibility of every person as indispensable components of his very existence. Along with the defence of personal life, the environment must also be protected: both have been created and ordered by God, as the natural structure of the visible world itself confirms. The great issues concerning the right to life of every human being from conception to death, the efforts to promote the family according to God’s original plan, and the urgent need, now felt by all, to protect the environment in which we live represent an area of common interest for ethics and law. Particularly in this field, which involves the fundamental rights of human society, what I wrote in the Encyclical Fides et ratio applies: “The Church remains profoundly convinced that faith and reason mutually support each other; each influences the other, as they offer to each other a purifying critique and a stimulus to pursue the search for deeper understanding” (n. 100). The radical nature of the challenges posed to humanity today by the progress of science 6. I pray that God will enlighten con- and technology, on the one hand; and by the sciences and guide everyone involved at progressive secularization of society, on the various levels in building the society of the other, demands an impassioned effort to re- future. May they always make the protection flect more deeply on man and on his exis- and defence of life their primary goal, tence in the world and in history. It is neces- I express my heartfelt and grateful appre- sary to show a great capacity for dialogue, ciation to you, distinguished members of the for listening and for proposing, so that con- Pontifical Academy for Life, who spend sciences may be formed. Only in this way your energies in serving such a noble and will it be possible to create, in a just and demanding goal. May the Lord support you united way, a culture based on hope and in your work and help you to fulfil the mis- open to the integral progress of every indi- sion entrusted to you. May the Blessed Vir- vidual in the various countries. Without a gin strengthen you with her motherly pro- culture that safeguards the right to life and tection. promotes the fundamental values of every The Church is grateful to you for your person, it is impossible to have a healthy so- lofty service to life. For my part, I would like ciety, nor can peace and justice be guaran- to accompany you with my constant encour- teed. agement, confirmed by a special Blessing.

A Handicap Invites us to Overcome all Forms of Selfishness FOR THE 30TH ANNIVERSARY OF THE FAITH AND LIFE MOVEMENT, WHICH OFFERS SUPPORT AND ASSISTANCE TO THE HANDICAPPED, THE HOLY FATHER SENT A MESSAGE TO ITS MEMBERS AS THEY GATHERED IN LOURDES TO CELEBRATE THEIR FOUNDATION

To my Sons and Daughters of the Faith and Light Movement

l. In this Holy Week of the first year of the new millennium, you have come to the Grotto of Massabielle on the occasion of the 30th anniversary of the foundation of your movement, and I greet you and the I greet you with affection and the assurance of my prayers. Mary herself invites you to rekindle your desire to “come and drink at the source”; she leads you, as she once led Bernadette, to the encounter with her Son. In Lourdes, the love of Jesus and Mary for the weakest appears with unique power, inviting you to give thanks to God for the marvels the Lord has wrought in you. I encourage you to renew and strengthen your

DOLENTIUM HOMINUM N. 47-2001 faith, and to live every day with a sense of mission.

2. Those of you who have handicaps are the very heart of the great family of Faith and Light. Your life is a gift from God and makes of you witnesses to the true life. If your handicap sometimes brings you difficult trials, you often live, in Claudel’s expression, with “enlarged souls in chained bodies”. Dear friends, you are a precious treasure of the Church, which is also your family, and you have a special place in the heart of Jesus.

3. For 30 years, with boldness, courage and perseverance, Faith and Light has not stopped reminding people of the eminent dignity of every human person. We can be grateful for the hope and confidence which 8 so many individuals and families have found in the movement. To those who assist the handicapped I give heartfelt thanks for the irreplaceable work they do every day in the service of those who are often forgotten by our society, and I thank them especially for the happiness they bring. In this way they bear witness to the fact that the joy of living is a hidden fountain which flows from trust in God and in Mary, his Mother. I wish to extend a special greeting to Jean Vanier and Marie-Hélène Mathieu, who for a long time have devoted themselves to improving truly ecumenical one. The presence together the lives of handicapped people and advanc- in Lourdes of different Christian confes- ing their cause. sions, Catholic, Orthodox, Anglican and Protestant, testifies, on the basis of your 4. Dear brothers and sisters, your presence common faith in the risen Christ, that every in Lourdes is also a call to Christians and to individual is a gift from God, with inalien- civic leaders to understand better that a able dignity and rights. It shows too that de- handicap, even when it calls for care, is spite a handicap, it is possible to live with above all an invitation to overcome all happiness. forms of selfishness and to commit ourselves to a new brotherhood and a new soli- 6. With affection I invoke upon you, upon darity. As I recalled, during their Jubilee in those accompanying you and upon those Rome, the handicapped call “into question who could not come, the strength of the understandings of life linked only to person- risen Lord; may he grant each one of you al satisfaction, appearances, efficiency” courage and joy to continue the mission of (Homily, 3 December 2000, n. 5). They call bearing witness to God’s love in the world. on all the members of society to give moral Following the example of Bernadette, may and material support to parents of handi- you be ever more receptive to the Good capped children. While there is an ever News, which humanity so greatly needs, and growing tendency to eliminate before birth a may you make it bear ever greater fruit. En- human being who may be handicapped, the trusting you to the maternal tenderness of activity of Faith and Light stands out as a Our Lady of Lourdes, I cordially impart to prophetic sign in favour of life and in favour you my Apostolic Blessing. of the priority due to the weakest members of society. From the Vatican, 2 April 2001

5. In your great diversity, coming as you do from 75 countries, your experience is a May the Step of those Called to Stoop down to Care for and to Treat the Wounded and Suffering Man, like the Good Samaritan, be Swifter THE ADDRESS OF THE POPE TO THE PARTICIPANTS AT THE MEETING PROMOTED BY THE NATIONAL OFFICE FOR PASTORAL CARE IN HEALTH OF THE ITALIAN BISHOPS’ CONFERENCE WHO WERE RECEIVED AT AN AUDIENCE ON SATURDAY MORNING, 12 MAY, IN THE PAUL VI HALL. THE MEETING, WHICH TOOK PLACE ON 10-12 MAY, ADDRESSED ITSELF TO THE SUBJECT: ‘THE ITALIAN CHURCH IN THE WORLD OF HEALTH: IDENTITY AND NEW PATHWAYS’.

1. I am very happy to extend my welcome pathways of apostolic penetration. to all of you, who during these days have re- It is useful in relation to this to remember, as flected on the presence of the Church in the I wrote in the apostolic letter Novo Millennio world of health, of illness, and of suffering. I Ineunte, that ‘this is not a matter of inventing a greet first of all Cardinal Camillo Ruini, Pres- new programme. There is already a pro- ident of the Italian Bishops’ Conference, and gramme: it is that which has always existed, Msgr. Javier Lozano Barragán, President of present in the Gospel and in the living Tradi- 9 the Pontifical Council for Health Pastoral tion. It is centred in the ultimate analysis on Care, and I thank them both for their cordial Christ himself’ (n. 29). words. I also greet the other Archbishops and And in the Message for the Eighth World Bishops present, especially Msgr. Alessandro Day of the Sick, held during the Great Jubilee Plotti, the Archbishop of Pisa and the of the year 2000, I observed: ‘Jesus did not on- Vice-President of the Italian Bishops’ Confer- ly take care of and heal the sick, he was also an ence, and Msgr. Benito Cocchi, the Bishop of untiring promoter of health through his salvif- Modena and the President of the Episcopal ic presence, his teaching, his action...In him Commission for the Service of Charity and the human condition demonstrated its redemp- Pastoral Care in Health of the Italian Bishops’ tive countenance, and the deepest human aspi- Conference. rations found realisation. He wants to commu- I also extend my greetings to all those peo- nicate this harmonious fullness of life to the ple who are ill and suffering, to their families, men of today’ (n. 10). Yes: Jesus came so that and to those who provide them with care and all men ‘may have life and have it more abun- treatment. As I wrote in my Message of this dantly’ (Jn 10:10). And which context, more year for the World Day of the Sick, ‘I really than that of health and suffering, awaits the wish in my mind, every day, to be at the side of patients, their family relatives, and health care staff’ (n. 3). This meeting of yours, significant for many reasons, is to be placed on the journey undertaken by the Italian Church to achieve an increasingly active promotion of pastoral care in health. I encourage you to follow on this path so that pastoral care in health may be recognised as having all its strength of evangelical witness, in full faithfulness to the mandate of Christ: ‘Go, preach the Kingdom of God and heal the sick’ (cf. Lk 5:1-2; Mt 10: 7-9; Mk 3:13-19).

2. You have gathered together to investigate the meaning and the ways in which this mandate of Christ can be implemented today. From a careful discernment of the present-day socio-cultural realities, there will certainly emerge concrete indications upon which must be based the presence of the Church in the field of caring for and looking after health, improving its quality and identifying for it new

DOLENTIUM HOMINUM N. 47-2001 preaching, the witness and the service of the mystery. The crucified Jesus, experiencing dis- Gospel of life? tance from the Father, shouts out to Him his Imitating Christ, who took upon himself the request for help, but in an act of love and filial ‘suffering’ countenance of man to make it trust he places himself in His hands. In the ‘glorious’, the Church is called to follow the Messiah crucified on Golgotha the Church way of man, especially if he is suffering (cf. contemplates humanity extending trustingly Redemptor Hominis, 7, 14, 21; Salvifici Do- its suffering arms to God. She draws near to loris, 3). Her action comes to the infirm person those who are in pain with compassion and so as to listen to him, take care of him, allevi- solidarity, making the feelings of divine mercy ate his trials, and open him to the understand- her own. This service to men afflicted by ill- ing of the meaning and the salvific value of ness postulates a close co-operation between pain. health care workers and pastoral workers, spir- Never can one insist enough, and you have itual assistants and health care voluntary done this during your meeting, on the need to workers. How valuable, from this point of place the person at the centre of things, both view, is the action of the various ecclesial as- the person of the sick man and the person of sociations of health care workers, both of a health care workers. professional kind Ð medical doctors, nurses, pharmacists Ð and of a more specifically pas- 3. The Church appreciates how much others toral and spiritual kind! work in this field and offers to public struc- 10 tures her contribution to respond to the needs 4. In this context, the religious institutions and requirements of an overall care and treat- which Ð loyal to their own charism Ð continue ment of the person. to play an important role in this sector, are de- In this the Church is moved and sustained serving of a special mention. I ask these insti- by a vision of health which is seen not as mere tutions to safeguard and to render increasingly absence of illness but as a tendency towards a recognisable their charisms in present situa- full harmony and a healthy equilibrium at a tions, whilst thanking them for the witness mental, spiritual and social level. The Church they offer with generosity and competence, al- proposes a model of health which is based up- beit amidst by no means few difficulties. on the ‘health-giving salvation’ offered by Theirs is a public service, and I strongly Christ: an offer of ‘overall’ and ‘integral’ wish and hope that it will never fail to have the health which heals the sick person in his en- right and due recognition from the civil au- tirety. The human experience of illness is illu- thorities. This is a service which requires, minated in this way by the light of the paschal moreover, strong and convinced investment in the field of the specific training of health care workers. These are ‘works of the Church’, the heritage and diaconate of the gospel of charity for those who are in need of care and treatment. The support of the whole ecclesial community for such works should never fail to be forthcoming. Dear brothers and sisters! Here is a privileged context in which the Church is called to bear witness to the presence of the resurrected Lord. To all those who are involved in it I would like to repeat what I wrote in the above-mentioned apostolic letter Novo Millen- nio Ineunte: ‘Let us go forward with hope! A new millennium opens up before the Church like a vast ocean on which to venture out, counting on the help of Christ’ (n. 58). At the beginning of this century may the step of those called to stoop down to care for and to treat the wounded and suffering man, like the Good Samaritan, be swifter. May Mary, who in heaven maternally guards over those who are afflicted by pain, be the constant support of those who dedicate themselves to its allevia- tion! With such feelings, I most willingly bestow upon all of you a special Apostolic Blessing. Ninth World Day of the Sick

Sydney 11 February 2001

DOLENTIUM HOMINUM N. 47-2001 The Holy Father’s Letter to the President of the Pontifical Council for Health Pastoral Care

To My Venerable Brother tions. This uncertainty can become a fatal Archbishop Javier Lozano Barragán confusion, manifested as a failure to under- President of the Pontifical Council stand that the essential purpose of health for Health Pastoral Care care is to promote and safeguard the well- being of those who need it, that medical re- In the peace which comes from God, I search and practice must always be tied to greet you and all who are gathered in Saint ethical imperatives, that the weak and those Mary’s Cathedral in Sydney for the Eu- who may seem unproductive in the eyes of charistic Sacrifice that is the very heart of a consumer society have an inviolable dig- the Ninth World Day of the Sick. I ask you nity that must always be respected, and that to convey to Cardinal Edward Clancy and health care should be available as a basic to the Church in Sydney and throughout right to all people without exception. Re- 12 Australia the assurance of my closeness in garding all of this I would apply to the work prayer as you meet to reflect on how the of the Pontifical Council and the discus- new evangelization needed at the beginning sions of your Conference what I said in my of the Third Christian Millennium must re- recent Apostolic Letter Novo Millennio Ine- spond to the many complex questions aris- unte at the close of the Jubilee Year: it has ing in the field of health care, always in the become increasingly important “to explain light of the Cross of Christ, in which human properly the reasons for the Church’s posi- suffering finds “its supreme and surest point tion, stressing that it is not a case of impos- of reference” (Salvifici Doloris, 3l). ing on non-believers a vision based on faith, Few areas of human concern are as sub- but of interpreting and defending the values ject to the profound social and cultural rooted in the very nature of the human per- changes affecting contemporary life as son” (n. 51). health care. This is one of the reasons why The World Day of the Sick has a vital in 1985 I established the body which has word to say, and the Pontifical Council has become the Pontifical Council for Health an indispensable role to play, in the Pastoral Care, over which you diligently Church’s mission of proclaiming the Gospel preside. Down the years, the Pontifical of life and love to the world. Council has rendered an invaluable service As you gather on this day dedicated to not only to those directly involved in Our Lady of Lourdes, in the Cathedral dedi- Catholic health care, but to the wider com- cated to Mary Help of Christians, I community as it grapples with the many issues mend you and Cardinal Clancy, the Pontifi- which have become still more pressing in cal Council for Health Pastoral Care and all the time since the Council was established. taking part in the World Day of the Sick, to For that service, I give fervent thanks to the loving intercession of Mary Most Holy, Almighty God. the Woman whom the Church invokes as At the dawn of the new millennium, it is “Health of the Sick”. As a pledge of joy and more urgent than ever that the Gospel of Je- peace in her Son, the Redeemer of the sus Christ should permeate every aspect of world, I gladly impart my Apostolic Bless- health care, and therefore I welcome the ing. choice of theme for this World Day of the Sick: “The New Evangelization and the From the Vatican, 18 January 2001 Dignity of the Suffering Person”. Evange- lization must be new Ð new in method and JOHN PAUL II new in ardour Ð because so much has changed and is changing in the care of the sick. Not only is health care facing unprece- dented economic pressures and legal com- plexities, but at times there is also an ethical uncertainty which tends to obscure what have always been its clear moral founda- Do not Forget those Who Lack Health Care THE SPEECH OF THE HOLY FATHER AT THE ANGELUS OF SUNDAY 11 FEBRUARY WHEN ADDRESSING THE FAITHFUL WHO THRONGED ST. PETER’S SQUARE FOR THE USUAL APPOINTMENT OF THE SAYING OF THE SUNDAY PRAYER.

Dear Brothers and Sister! Gospel message of hope. It is therefore important at the beginning of the third millen- 1. Today, the liturgical memorial of Our nium to give new energy to the Church’s Lady of Lourdes, the World Day of the Sick age-old involvement in the world of health is being celebrated. The place designated care, a genuine workshop for the civilization this year for the significant event is Sydney, of love. Australia, where Archbishop Javier Lozano Barragán, President of the Pontifical Council 2. Looking at the current world situation, I for Health Pastoral Care, went with his assis- cannot forget that many, too many, brothers 13 tants. Every diocesan community moreover, and sisters still lack necessary health care. is turning its attention to the sick and to This is a grave injustice which urgently de- health-care workers. In St Peter’s Basilica mands efforts on everyone’s part, starting the traditional Eucharistic celebration will especially with those have greater political also take place this afternoon, with Cardinal and economic responsibilities. Camillo Ruini presiding. At the end of Mass On this significant occasion, I would like I myself will come down to meet the sick to give credit to everyone, individuals, reli- and pilgrims attending. gious institutions and non-governmental or- In my message for this World Day, pub- ganizations, who devote themselves with lished on 22 August last year, I reflected on admirable care to the service of the sick and the theme: “The New Evangelization and the the suffering. I am thinking specifically of Dignity of the Suffering Person”. Hospitals, the host of men and women religious who centres for the sick or the elderly and every work along with many lay people at hospi- home where human suffering is present are tals and small health-care centres in the privileged settings for proclaiming the poorest countries amid problems and con- flicts, risking their lives to save those of their brethren. I encourage them all to perse- vere in this praiseworthy task, which in many nations is leading to a vast and providential sensitising of consciences.

3. Let us now turn our gaze to the Blessed Virgin. The cathedral of Sydney, where solemn Mass is being celebrated, with Car- dinal Edward Bede Clancy, Archbishop of that city, presiding in my name, is dedicated to St Mary Auxilium Christianorum, “Help of Christians”. For nine years, in various parts of the world, this appointment with suffering and hope has been renewed under the sign of Our Lady of Lourdes. Let us entrust to her the sick of the whole world and all who put their professional skill and sometimes their whole lives at their service.

DOLENTIUM HOMINUM N. 47-2001 The Sick are a World of Hope and Joy THE SPEECH OF JOHN PAUL II TO THE THOUSANDS OF SUFFERING PEOPLE GATHERED TOGETHER ON SUNDAY AFTERNOON, 11 FEBRUARY, IN THE VATICAN BASILICA FOR THE CONCELEBRATION OF THE EUCHARIST PRESIDED OVER IN THE NAME OF THE POPE BY THE CARDINAL VICAR, CAMILLO RUINI, ON THE OCCASION OF THE NINTH WORLD DAY OF THE SICK.

Dear Brothers and Sisters! 3. This evening, in the evocative setting of this gathering, we want to feel in communion 1. Today, 11 February, we have come to- with our brothers and sisters meeting in Syd- gether as we do every year for this customary ney, Australia, for the World Day of the Sick. gathering in the Vatican Basilica. My thoughts The theme chosen for the event, this year is: naturally turn to the grotto of Massabielle, “The New Evangelization and the Dignity of where every year so many people pause in the Suffering Person”. This is a theme on prayer at the foot of the statue of the Immacu- which it is important to reflect, because physi- late Conception. And, precisely in Mary’s cal and spiritual pain mark everyone’s life name, I greet all of you who have come for more or less deeply, and it is necessary that 14 the Eucharistic celebration and for the evoca- the light of the Gospel also illumines this as- tive candlelight procession which recreates pect of human existence. the characteristic atmosphere of Lourdes. I al- In the Apostolic Letter Novo millennio ine- so greet those who have promoted and orga- unte, which I signed on the closing day of the nized this always moving Marian event. Jubilee, I invited all believers to contemplate I first greet the Cardinal Vicar and the Bish- the face of Jesus. I wrote in that Letter that ops present; I also greet the directors of Opera “in contemplating Christ’s face, we confront Romana Pellegrinaggi and all the priests, reli- the most paradoxical aspect of his mystery, gious and lay people who are taking part in as it emerges in his last hour, on the Cross” the national pastoral-theological convention (n. 25). on the theme: “The Local Church, Pilgrimage You in particular, my sick friends, under- and Traditio Fidei”. stand how paradoxical the Cross is, because I greet you in particular, dear sick people, you are allowed to feel the mystery of pain in and with you, the organizers and volunteers of your own flesh. When your strength fails be- UNITALSI, a commendable association that cause of a serious illness, projects you have cares for you, especially on pilgrimages. long cherished in your heart are abandoned. In addition to physical suffering, there is often 2. Dear sick people and volunteers, your spiritual suffering due to a sense of loneliness presence has special meaning, since we are now celebrating the World Day of the Sick for the ninth time. I still remember last year’s celebration. We were in the intense spiritual atmosphere of the Great Jubilee, and the witness of faith given by those who took part made a deep impression. The generous acceptance of the Lord’s will by those who are suffering is always a great lesson of life. As I have said on other occasions, the Church re- lies heavily on the support of those who are tried by illness: their sacrifice is sometimes little understood, but, when combined with intense prayer, it has a mysterious efficacy for the propagation of the Gospel and the welfare of the whole People of God. Dear brothers and sisters, today I would like to express again my deep gratitude to you for your silent mission in the Church. May you be firmly convinced that it gives extraordinary power to the progress of the entire Ecclesial Community. which grips the individual. In contemporary altar on which I want to sacrifice myself by society a certain culture considers the sick dying for Jesus” (M. B. Soubirous, Carnet person a troublesome hindrance, failing to de notes intimes, p. 20). recognize that he makes a valuable spiritual contribution to the community. It is necessary 5. This is the message of Lourdes, which so and urgent to rediscover the value of the Cross many pilgrims, healthy and sick, have accept- we share with Christ. ed and made their own. May the Virgin’s words bring interior comfort to you, suffering 4. At Lourdes Our Lady said to Bernadette brothers and sisters, to whom I once again of- on 18 February 1858: “I do not promise you fer my fraternal solidarity. If you docilely ac- will be happy in this world, but in the next”. cept God’s’ will, in your illness you can be a During another apparition, she invited her to word of hope and even of joy for many peo- turn her gaze to heaven. Let us listen again to ple, since you tell our contemporaries, who these exhortations of our heavenly Mother as are often restless and unable to find meaning if they were addressed to us: they are an invi- in pain, that God has not abandoned them. In tation to evaluate earthly realities correctly, living your situation with faith, you bear wit- knowing that we are destined for eternal life. ness that God is near. You proclaim that the They help people patiently to bear adversity, Lord’s tender and loving closeness ensures sufferings, and sickness, in the perspective that there is no season of life that it not worth of paradise. At times some have thought of living. Illness and death are not realities to paradise as an escape from daily reality; on flee or criticize as useless, but both are stages 15 the contrary, the light of faith makes the on a journey. harsh experience of suffering better under- I also wish to encourage all who dedicate stood and thus more knowingly accepted. St themselves zealously to caring for the sick to Bernadette herself, harshly tested by physi- continue in their precious mission of love and cal illness, exclaimed one day: “Cross of my find in it the inner consolation which the Lord Saviour, holy Cross, adorable Cross, in you grants to those who become Good Samaritans alone I place my strength, my hope and my for their suffering neighbour. joy. You are the tree of life, the mysterious With these sentiments, I embrace you all in stairway that joins earth to heaven, and the the Lord and cordially bless you.

United to Christ the Suffering Become Ministers of the New Evangelisation THE HOMILY OF CARDINAL EDWARD BEDE CLANCY, SPECIAL ENVOY OF THE HOLY FATHER FOR THE WORLD DAY OF THE SICK, AT THE CONCLUSION OF THE CELEBRATIONS

We are still living in the gleam of the Great The Pope observes the request for forgive- Jubilee. But this is something which is now ness in the name of the whole of the Church mixed with the dawn of the new millennium. for the errors committed by her sons and her Pope John Paul II presented the blessings of daughters down the centuries Ð something he the year of the Great Jubilee in his Apostolic calls the purification of the memory of the Letter Novo Millennio Ineunte. In this Apos- Church. He observes the witness provided by tolic Letter he observes the great flowering of so many martyrs of our times; the pilgrimage Jubilee exercises and initiatives which has tak- character of the Jubilee year demonstrated by en place in the dioceses and parishes through- so many pilgrimages, in particular carried out out the world, but he dedicates his reflections by young people, to Rome and the tombs of and thoughts to events which have taken place the Apostles; the Eucharistic Congress; the ec- in Rome, or in which he has been personally umenical appointments and meetings; and his and immediately involved. These are events memorable pilgrimage to the Holy Land. He which naturally have a universal value. sees in the Holy Year and all its activities

DOLENTIUM HOMINUM N. 47-2001 throughout the world a vivid expression of the of Christ in the Gospel according to St. presence, the mystery, and the countenance of Matthew: “I will be with you for all time, until Christ. Remembering the words that certain the end of the world” (Mt 28:20). John Paul II Greek pilgrims addressed to the Apostle goes on: ‘this certainty, dear brothers and sis- Philip – “we want to see the Christ” – the ters, has accompanied the Church for two Holy Father raises the question: ‘is it not per- thousand years and has been renewed in our haps the task of the Church to reflect the light hearts by the celebration of the Jubilee. From of Christ in every historical period in order to it we draw a new impetus of Christian life, make his face shine forth to the generations of making it the force which inspires our journey the new millennium as well?’ Christ is every- of faith. Aware of the presence of the resur- thing for us, He is ‘our way, our truth and our rected Lord amongst us, we now ask the same life’, everything is captured in Him, all of us question which was addressed to Peter in are united with Him and united with each oth- Jerusalem after the speech of the Pentecost: er like organs of the same mystical body. “What should we do?” (Acts 2:37)’. This total assimilation and incorporation in The Holy Father observes that it is not a Christ by which he becomes our totality and matter of inventing a new project Ð in fact our end, our alpha and omega, is the constant there is only one project: that of the Gospels theme of the readings of today. In the first and the tradition of the Church, which finds reading the Prophet Isaiah lyrically describes its centre in Christ himself. ‘This is a project’, the saviour who is to come: ‘the people who he goes on, ‘which does not change with the 16 have walked in darkness have seen a great times and with cultures, even though it takes light; those who dwelt in a land of deep dark- time and culture into account so as to have a ness on them light has shined...For to us a ba- real dialogue with them and effective commu- by is born, to us a son is given...’(Is 9:1-6). nication. This project for every time is our The words of Isaiah are echoed by those of project for the third millennium’. What awaits St. Paul who writes to the Ephesians: ‘He has us ‘is a splendid work of revitalisation; a chosen us out, in Christ, before the foundation work which involves us all’. The Pope then of the world, to be saints, to be blameless in points out certain priorities such as holiness, his sight, for love of him; marking us out be- prayer, the sacraments of reconciliation and forehand (so his will decreed) to be his adopt- the Eucharist, grace, and the revealed Word of ed children through Jesus Christ. Thus he God. Special emphasis is placed upon charity, would manifest the splendour of that grace by and especially on koinonia or communion and which he has taken us into his favour in the on the teachings of Vatican Council II. Just as person of his beloved son’ (Eph 1:1-6). In the Christ invited Peter to throw the net in again, Gospels, Christ himself takes the opportunity even though he had worked all night without to confirm this truth when he speaks about his success, so the Holy Father invites us to en- mother and his relatives: “Whoever carries gage with faith and courage Ð without being out the will of God, is my brother, my sister, worried by the disappointments of the past Ð and my mother” (Mk 3:35). in this work of the revitalisation of the Church After bringing us, through his reflections on of the new millennium: it is the Christ of the the Jubilee, face to face with Christ, Pope Great Jubilee who is guiding us. John Paul II then invites us with Christ and in The Pope emphasises that all baptised peo- Christ to face the future and to answer the in- ple, without any kind of exception, are called vitations and the challenges which it presents upon to take part with zeal in this new and to us. Here the Holy Father quotes the words blessed initiative. In this way he directs our attention to the teaching of St. Paul regarding the unity and the diversity of the Church, a reality represented by the metaphor of the body Ð one head and many organs. ‘For this reason’, says the Pope, ‘the Church of the third millennium must encourage all baptised people and all people who have received first communion to be aware of their active responsibility within the life of the Church’. At this point the World Day of the Sick requires us to ask ourselves about the place of sick people and those who take care of them in this new initiative of revitalisation. By the words ‘sick’ and ‘afflicted’ we mean all those who suffer because of mental or physical illness and those who suffer because of the weaknesses and limitations brought about by advancing years. We mean both those who suffer periodically and those who suffer per- manently; those who suffer in a serious way and those whose afflictions are perhaps less heavy. One thing is certain: in the providential design the sick are not merely an unfortunate minority, the consequence of original sin and a burden on a Church which despite this fact tries to build up the Kingdom of God. We should not, that is to say, think of them as a negative factor in the mission of the Church. This could be also deduced solely from the number of people who are involved: in basic knowledge. In this technological age, howev- terms who is not sick for at least one moment er, it is above all else up to them to bring that in their lives? But even more it can be de- personal warmth and that love which em- duced from the importance of the sick and the braces every human being as a son of God and afflicted in the earthly mission of Jesus. A heir to the kingdom of heaven, and to recog- large part of his time was dedicated to healing nise Christ himself in the sick person: “I was 17 the sick: ‘His fame spread throughout Syria sick”, Jesus said, “and you visited me” (Mt and thus they brought to him all the sick, trou- 25:35). bled by various illnesses and pains, the pos- The suffering and care for those who suffer sessed epileptics and paralytics; and he healed are two parallel and interdependent aposto- them’ (Mt 4:24). lates. They draw their life force directly from The key to the meaning of the sick in the the Gospels and make Christ present in our work of redemption and salvation is to be world as few other things do. Both are for this found in suffering. The work of Christ in re- reason destined to play a central role in giving ducing suffering, indeed, was symbolic of his new life to the Church of the new millennium. forgiveness of sins: ‘He took on our suffering, The Australian Church can boast an envi- he took on our pain’ (Is 53:4). But even more, able past with respect to the apostolate of he chose suffering for himself as a means for health. Immediately after the European settle- our redemption. For this reason, those who ment and after the restrictions on the Catholic suffer patiently are united to Christ our Sav- Church had been removed, Catholic hospitals iour in a unique and privileged way: ‘I am sprang up in all the large inhabited centres, glad of my sufferings on your behalf, as, in above all as part of the work of religious con- this mortal frame of mine, I help to pay off the gregations. The high standard of the hospitals debt which the afflictions of the Christ still and the other facilities of the pastoral care in leave to be paid, for the sake of his body, the health of the Church has always been recog- Church’ (Col 1:24). In speaking to those who nised by the civil community, and Australian suffer in his message for this World Day, the medical doctors and nurses are still some of Holy Father says: ‘I invite them to contem- the best in the world. In recent years, howev- plate with faith the mystery of the crucified er, the structures of pastoral care in health of and risen Christ, so as to discover the loving the Church, as is the case with hospitals plan of God in their own experience of pain. throughout the world, have had to face up to Only in looking at Christ ‘man of sorrows increasing problems. There has been an amaz- well acquainted with grief’ (Is 53:3), is it in ing increase in costs; a reduced number of fact possible to find serenity and trust’. The young people taking up the nursing profession sick and the suffering, who are so intimately as a religious vocation; new illnesses which united to Christ, are through their suffering threaten human life and weigh upon the reactive and indeed key ministers of the new sources which are available; and lastly the evangelisation. Experience lived out with medical profession itself has every day to ad- faith is thereby sanctified. dress itself to complex problems of a med- And if those who suffer become one with ical-moral character. Such are the challenges Christ, the same is true of those who take care which we have discussed in these days. of them. They continue the mission of Christ With this Holy Mass, therefore, we address by bringing relief, understanding, recovery God in prayer and thank Him first of all for and encouragement to the sick and at times by the divine help which in the past has been our performing human miracles through their trust. We also pray that He will enlighten us,

DOLENTIUM HOMINUM N. 47-2001 give us strength, and guide us as we accept the sick and the afflicted in places such as the challenges and seize the opportunities Lourdes and Fatima. It naturally also follows which present themselves. In a special way that those who take care of sick people also we must pray for religious vocations dedicat- have a special place in her heart. For this rea- ed to pastoral care in health so that they will son, it is truly appropriate that the World Day always have a key role to play. The Holy Fa- of the Sick should also be associated with a ther, too, has emphasised the importance of Marian sanctuary, as is the case with today’s prayer in favour of a close union with Christ Holy Mass which we are celebrating in this as we enter in decisive fashion into the third beautiful mother church of Australia which is millennium. dedicated to Our Lady, the help of Christians. In the Catholic tradition, Mary has always Let it be remembered that this World Day is been seen as the friend and patron saint of the dedicated not only to the sick people of Aus- sick, in whom, in a special way, she sees the tralia but to sick people throughout the world, clear image of her divine son. Mother of us and on this feast of Our Lady of Lourdes we all, Mary has special compassion for her sick entrust all sick people, together with those sons and daughters. For this reason, we in- who take care of them, to her maternal heart. voke the ‘health of the infirm’ and the ‘comfort of the sick’ in the Loretan litanies. Mary H.Em. Cardinal EDWARD BEDE CLANCY herself has demonstrated her special care for Archbishop of Sydney

The Celebration of the Ninth World Day of the Sick ‘The New Evangelisation and the Dignity of the Suffering Person’ SYDNEY, 11 FEBRUARY 2001

The Ninth World Day of the The Pontifical Mission was World Day of the Sick was the Sick was solemnly celebrated led by H.Em. Cardinal Ed- involvement and role of the in St. Mary’s cathedral in Syd- ward Bede Clancy, the Special Pontifical Council for Health ney in Australia. As the Holy Envoy of the Holy Father to Pastoral Care, the Australian Father observed in his Mes- the Ninth World Day of the Episcopal Conference of sage for this World Day, ‘the Sick, and included Rev. Don Catholic Bishops, and the Aus- choice of the Australian conti- Krzystof Nykiel, an Official of tralian Episcopal Commission nent with its cultural and eth- the Pontifical Council for for Pastoral Care in Health. nic richness throws light on Health Pastoral Care, Dr. John This convergent co-operation the close bond of ecclesial Gallagher, and Judge John made possible not only a suit- communion: it overcomes dis- Slattery. able and successful preparation tances, and favours the en- Archbishop Javier Lozano and celebration of this World counter between different cul- Barragán, the President of the Day but also constituted a spe- tural identities which are made Pontifical Council for Health cial sensitising force in relation fertile by the unique preaching Pastoral Care, together with its to increasingly large areas of of salvation’. ‘The new evan- Bishop-Secretary, Msgr. José both the faithful and of reli- gelisation and the dignity of L. Redrado O.H., led the Dele- gious and secular institutions the suffering person’ was the gation which was made up of a which are involved in the field theme of this Ninth World Day group of sixteen people: Offi- of health, health care and suf- of the Sick, not least in order cials of the Ministry, ecclesias- fering. to place emphasis on the need tical dignitaries, priests, mem- to evangelise in a renewed bers of religious orders, and way this sphere of human ex- members of the laity Ð all of The Long-Term perience, to foster in relation whom are people who have al- Preparations to it a direction towards the ways been involved in pastoral for the World Day overall well-being of the per- care in health. son and the progress of all The salient characteristic of Announced and called for by people throughout the world. the celebration of the Ninth the Message of the Holy Fa- ther, the celebration of the a meeting was held with the dinal Edward Bede Clancy, the World Day was the subject of a hospital staff and personnel and Archbishop of Sydney and the very large number of prepara- visits were made to the various Special Envoy of the Pope for tory initiatives. It should be ob- wards of the hospital, where the Ninth World Day of the served that the Pontifical Coun- the sick were comforted and all Sick, as well as a number of cil for Health Pastoral Care the patients received the bless- bishops of the Australian Epis- was responsible for a capillary ing of the Holy Father. copal Conference and represen- diffusion of the Message of the In the morning of 9 February tatives of the episcopal com- Holy Father through the bish- the Vatican delegation, led by mission for pastoral care in ops responsible for pastoral are Archbishop President Javier health, also took part in this in health and through the obvi- Lozano Barragán, visited St. meeting. ous means of communications Vincent’s hospital, which is ad- (Internet, the Press, interviews ministered by the Sisters of 3. The conference on the new with Superiors etc.), as well as Charity of San Vincenzo de evangelisation and the dignity the preparation of the official Paoli. The immensity of this of the suffering person. On Sat- Manifesto of the Day and vari- hospital complex was very urday 10 February a confer- ous other kinds of supports. striking. The public hospital ence on the subject of ‘the new The Vatican Radio also made and the private hospital, the evangelisation and the suffer- live broadcasts of the principal clinic and the institute for re- ing person’ was held at the au- initiatives connected with the search into cancer and trans- ditorium of Mary Mackilop celebration of this World Day. plants, are all in the same build- Place in Sydney. This confer- ings. The delegation personally ence was chaired by Mr. Fran- met the staff and personnel of cis Sullivan, the Executive Di- The Celebration of the the hospital as well as its pa- rector of Catholic Health Aus- 19 Ninth World Day of the Sick tients. During this visit it could tralia. be observed that the institute About five hundred partici- The salient moments of the for research into cancer and pants were present who had celebration which marked the transplants of this complex was come from the whole of Aus- days from 8-11 February, really in the very forefront of tralia, and from Italy, Spain, the which culminated in the developments and research. Philippines, and other countries solemn concluding celebration of the Ninth World Day of the Sick on 11 February, were the following: visits to certain hospitals and clinics (8-9 Febru- ary); the meeting with the May- or of Sydney and the civil and ecclesiastical authorities (9 February); the celebration of the ‘new evangelisation and the dignity of the suffering person’ (10 February); and the solemn celebration which was held on 11 February.

1) The visits to certain hospitals and clinics. On Thursday 8 February H.E. Msgr. J. Lozano Barragán, the Presi- dent of the Pontifical Council for Health Pastoral Care, with the Secretary of the Ministry, H.E. Msgr. José L. Redrado 2) The meeting with the of Asia and Oceania. They fol- O.H., and a number of the Mayor of Sydney and certain lowed the papers and contribu- members of the Vatican Dele- civil and ecclesiastical authori- tions of the conference with gation, visited Burwood Hos- ties. On the afternoon of Friday keenly-felt interest. In addition pital, the Catholic hospital of 9 February, the President of the to the delegation led by the the Fatebenefratelli, which has Pontifical Council, H.E. Msgr. President of the Pontifical eighty-six beds. Here it was J. Lozano Barragán, and the Council, H.E. Msgr. Javier possible to observe how the Secretary, H.E. Msgr. Redrado, Lozano Barragán, there were world of health and suffering is together with other members of also present His Eminence Car- evangelised in Australia today. the delegation which had been dinal Edward Bede Clancey, The delegation was received by sent from Rome, met the May- the Archbishop of Sydney and the Provincial and the Director or of Sydney, Mr. Frank Sartor, the special envoy of the Pope to of the hospital, Peter Burke, in Sydney Town Hall. In addi- the celebration of the Ninth who explained what their mis- tion to a cordial speech of World Day of the Sick, the sion had been in Australia over greeting there was also an ex- Archbishop of Canberra and the last forty years. Afterwards change of presents. H.Em. Car- Goulburn, Msgr. Francis Car-

DOLENTIUM HOMINUM N. 47-2001 roll, the President of the person Ð with the evangelising to pastoral care in health as a Catholic bishops of the Episco- role and importance of these ‘ministry which touches upon pal Conference of Australia, bodies. the very essence of the H.E. Msgr. John Joseph Gerry, During his paper the Presi- Church’. In addressing them- the Auxiliary Bishop of Bris- dent stressed among other selves to the subject: ‘evange- bane, the President of the Epis- things that the idea of health ‘is lising in the health system: eth- copal Commission for Pastoral not only the absense of illness ical, legal and pastoral ques- Care in Health, and the Presi- but is a harmonious tendency tions’, the three speakers – dents and representatives of the towards physical, mental, so- Rev. Dr. Gerald Gleeson of the international Catholic associa- cial and spiritual well-being Catholic Institute of Sydney, tions and federations actives in which allows man to carry out Prof. Peter Dwyer of the Uni- the world of health and health the mission that God has des- versity of New South Wales, care Ð medical doctors, phar- tined him for, according to the and Ms. Janine Wilson, psy- macists, nurses, hospital chap- stage of life in which he finds chotherapist and lecturer in lains, male and female mem- himself’. With respect to the pastoral theology of the bers of religious orders, male origins of life, the basic princi- Catholic Institute of Sydney Ð and female nurses, and female ple continues to be that which it addressed themselves to the students from faculties of med- has always been: ‘human life is ‘way’ in which the health sys- icine. The presence of figures a gift from God and as such it tem can be evangelised today from the world of science and should be seen and approached. from an ethical, legal and pas- learning of the country was al- The way in which God wants toral point of view. so very marked. this gift to be transmitted is in In the afternoon of 10 Febru- The special envoy of the the highest form of love, that is ary workshops were held on 20 Pope, Cardinal Edward B. to say the conjugal love of the how to support and promote Clancy, H.E. Msgr. Francis marriage partners within a fam- ‘the Catholic identity in the Carroll, the Archbishop of Can- ily. Everything that contradicts world of health and health berra and Goulburn and the this principle, which also ap- care’, that is to say the Catholic President of the Episcopal Con- plies to euthanasia, is not ac- identity of medical doctors, fe- ference of Australia of Catholic ceptable from a moral point of male nurses, chaplains, and Bishops, and Mr. Francis Sulli- view’, continued this ecclesias- those providing pastoral care in van, the Executive Director of tical dignitary. health. Catholic Health Australia, ex- Other papers followed this On this subject papers were tended a greeting to the partici- address given by the President given by: Dr. Gian Luigi Gigli, pants. of the Pontifical Council for President of the International Federation of Catholic Doctors (FIAMC), Anne Verlinde, the General Secretary of the Inter- national Committee of Nurses and Catholic Medical-Social Assistants (CICIAMS), and Fa- ther David Ranson, the chaplain of St. Vincent’s hospital in Melbourne. The day of study and reflection finished with certain suggestions and proposals to be made to the Episcopal Confer- ence whose aims were to im- prove the presence of Good Samaritans of today in the vast field of health and suffering, which will remain for ever a special and favoured place for the new evangelisation.

4) The celebration of 11 Feb- ruary. On the morning of 11 The President of the Pontifi- Health Pastoral Care, all of February Archbishop Javier cal Council, H.E. Msgr. J. which were directed towards Lozano Barragán, the President Lozano Barragán, inaugurated making a valid contribution to of the Pontifical Council, ac- the deliberations and papers of the subject of the World Day. companied by the Secretary of the conference with an address Sister Annette Cunliffe the Pontifical Council, H.E. on ‘the episcopal, national and RSG, Director of the Catholic Msgr. José L. Redrado, Rev. parish bodies for pastoral care Association of Health Care in Gianfranco Grieco of the Os- in health’, and in this way he Australia, and Father Gerald A. servatore Romano, Don Anto- linked the subject of the confer- Arbuckle SM, Co-Director of nio Soto and Don Krzysztof ence Ð the new evangelisation ‘Refounding and Pastoral De- Nykiel, both Officials of the and the dignity of the suffering velopment’ of Sydney, referred Pontifical Council, began the World Day with visits to a fied, and 3,600 pilgrims took destined to play a determining number of patients at St. Vin- part in it, amongst whom were part in the new life of the cent’s hospital. The President patients and the people who ac- Church of the third millenni- and the Secretary of the Min- companied them. The Presi- um’. istry comforted these patients dents and representatives of the A very moving moment was and brought them the blessing international federations and the administration of the sacra- of the Holy Father; some pa- associations of the world of ment of the anointing of the tients were also given holy health and health care were al- sick to twenty-five sick people communion and provided with so present: medical doctors, by Cardinal Clancy, the special the sacrament of the anointing nurses, hospital chaplains, male envoy of the Pope, by the Pres- of the sick. Also in the morning and female members of reli- ident of the Pontifical Council, of the 11 February the Presi- gious orders, female students H.E. Msgr. Javier Lozano Bar- dent of the Pontifical Council, from faculties of medicine, as ragán, and by the other two ec- Archbishop Javier Lozano Bar- well as a representative of the clesiastical dignitaries of the ragán, presided over a Holy female religious of the FERS of local Church who were present. Mass which was held in St. Spain. The celebration of the Ninth Vincent’s hospital for those pa- At the beginning of the World Day of the Sick termi- tients and health care workers solemn celebration of the Eu- nated with the solemn blessing who were not able to go to the charist, from the altar of the of all the participants, and espe- cathedral. During this holy cathedral of Sydney which is cially of sick people. mass the Archbishop adminis- dedicated to the Virgin of Con- On 13 February, on the re- tered the sacrament of the solation, H.E. Msgr. Javier turn trip to Rome, in response anointing of the sick to a num- Lozano Barragán, President of to an invitation of the Episco- ber of patients. the Pontifical Council for pal Commission for Pastoral 21 The most important moment Health Pastoral Care, read in Care in Health of Thailand, the during the celebration was the English the Message of the President of the Pontifical solemn celebration of the Eu- Holy Father John Paul II which Council, H.E. Msgr. Javier charist, which took place on the Pope had sent to this special Lozano Barragán, accompa- Sunday 11 February and was occasion, and this was met by a nied by the Bishop-Secretary celebrated in the memory of long applause by the assembly Msgr. Redrado and the other the Blessed Virgin of Lourdes. which had gathered together in members of the Vatican delega- It was presided over by the prayer. Once again the word of tion, stopped at Bangkok and special envoy of the Holy Fa- the Holy Father touched peo- went to Rayong, a city some ther for this World Day, Cardi- ple’s hearts and projected into two hundred kilometers from nal Edward Bede Clancy, the the future this Church, called as Bangkok, to visit a centre for Archbishop of Sydney. Twen- she is to defend the value of life the care of AIDS victims run ty-five ecclesiastical digni- from conception until its natur- by the Camillian Fathers. A taries were next to Cardinal al end. meeting was held with the Clancy, amongst whom were Cardinal Edward Bede Clan- Commission for Pastoral Care archbishops and bishops of the cy, the Archbishop of Sydney in Health of the local Church continent of Oceania and the and the Special Envoy of the led by H.E. Msgr. Lawrence President of the Episcopal Con- Pope to the celebrations of the Khai Saen-Phon-On, Archbish- ference of Catholic Bishops of Ninth World Day of the Sick, in op of Thare and Nonseng, and Australia, H.E. Msgr. Francis his homily summarised the with those in charge of the cen- Carroll, the Archbishop of Can- whole of the Jubilee idea of the tre. During the meeting the sit- berra and Goulburn, Archbish- Holy Father as expressed in the uation of pastoral care in health op Francesco Canalini, the Apostolic Letter ‘Novo Mil- in Thailand was described, and Apostolic Nuncio to Australia, lenio Ineunte’ in order to stress the activities carried out in the Archbishop Javier Lozano Bar- once again the urgent need of centre were also illustrated. ragán, President of the Pontifi- beginning from Christ and with The President-Archbishop de- cal Council for Health Pastoral Christ to evangelise each and scribed certain guidelines for Care, the Bishop-Secretary of every field of apostolate and in pastoral care in health at the the same Pontifical Council, a special way that of health and level of the Episcopal Confer- Msgr. José L. Redrado, H.E. suffering. The Ninth World ence. The following also took Msgr. John Joseph Gerry, the Day of the Sick, observed Car- part in the meeting: H.E. Ms- Auxiliary Bishop of Brisbane, dinal Clancy, ‘obliges us to ask gr., Adriano Bernadini, the the President of the Episcopal ourselves the place of the sick Apostolic Nuncio in Thailand, Commission for Pastoral Care and those who care for them in H.E. Msgr. Lawrence Thien- in Health, and bishops from this new initiative of post-Ju- chai Samanchit, the Bishop of Papua New Guinea, New bilee revitalisation’. ‘Suffering Chanthaburi, Rev. Gianfranco Zealand, Malaysia and Ghana, and care for those who suffer’, Crieco of the Osservatore Ro- as well as Officials of the Pon- continued the Cardinal, ‘are mano, and Msgr. Jean Marie tifical Council for Health Pas- two parallel and interdependent Mpendawatu, Don Antonio So- toral Care and about a hundred apostolates. They draw their to, Rev. Bernard Grasser M.I, priests from the archdiocese of life force directly from the respectively Officials and col- Sydney. Gospels and make Christ pre- laborator of the Pontifical The celebration of the Eu- sent in the world as few things Council. charist was solemn and digni- do. Both for this reason are The visit was concluded

DOLENTIUM HOMINUM N. 47-2001 with a concelebration of the ments of the many-sided partic- Church. At the dawn of the new Eucharist accompanied by ipation of the delegation in the millennium it is more urgent songs and prayers and presided celebration held in Sydney and than ever before to proclaim over in the Thai language by the meeting in Bangkok were the Gospel of life and to reaf- Archbishop Lawrence Khai both comfortable and faultless. firm the dignity of the suffering Saen-Phon-On, who is respon- person. sible for pastoral care in health 6. The Message of the Holy in Thailand. In addition to the Conclusion Father, his love for the sick and members of the Vatican delega- the suffering, remain as an invi- tion, H.E. Msgr. Lawrence 1. The well organised prepa- tation to everybody and espe- Thienchai Samanchai and a ration of the World Day and its cially to all sick people of any number of Camillian fathers successful celebration should age or condition, to abandon from the centre also took part. be emphasised. themselves to the paternal arms This was really a joyful cele- 2. In participating in the days of God. It is also an invitation bration whose real protagonists of study and prayer it was pos- to be always the custodians and were the sick, both adults and sible to observe the openness, the Witnesses of the Gospel of children. the hospitality, and the wel- life, doing good to those who After the celebration of the come of the Australian Church. suffer and doing good with Eucharist, the delegation had 3. It was possible to observe one’s own suffering. The Ju- lunch with the directors of the that pastoral care in health in bilee idea of the Holy Father centre and all the sick people Australia is developing well. expressed in the Apostolic Let- present. 4. The participation of vari- ter ‘Novo Millennio Ineunte’ The Vatican delegation ous groups and their immediate was received with new enthusi- 22 reached Rome in the morning involvement in the unfolding of asm: to begin again from Christ of 14 February. the World Day was also a fact to evangelise every field of The logistical and transfer to be noted. apostolate and in particular the organisation, directed by the 5. There certainly remains field of health and suffering, Under-Secretary of the Pontifi- over from this World Day the which is the authentic labora- cal Council, Rev. Felice Ruffini spirit of the celebration which tory of the civilisation of love. M.I., with the active collabora- will lead to greater attention tion of the members of the gen- being paid to sick people and Rev. KRZYSZTOF NYKIEL, eral secretariat of the Ministry, the suffering, who are and will Official of the Pontifical Council meant that the various mo- always be the way for the for Health Pastoral Care. Topics

Physical Pain and Moral Suffering of Everyman and the Christ-man

The Spiritual Needs of the Sick Child and his Pastoral Care

Philosophy, the Construction of a Profession

Neurological Aspects of Death

Fears and Hopes in the Face of Death

DOLENTIUM HOMINUM N. 47-2001 Physical Pain and Moral Suffering of Everyman and the Christ-man A PHYSIOPATHOLOGICAL AND THEOLOGICAL INTERPRETATION: THE PHENOMENON OF HEMATOIDROSIS

PART I: Fig. 1. A theological-medical interpretation of pain and suffering. A Physiopathological Gate control: the gate which controls the nociperceptor afferencies. Endorphins: Interpretation of the Pain endogenous substances of a meconic nature which have an analgesic effect. and the Suffering of Everyman GUILT—EVIL We know that from the bio- (original sin) logical stage of physical pain (or algos) man matures an ethical stage involving the internali- sation of his own physical pain, which is moral pain, or suffering (pathos) which is a moment of 24 free and conscious reactivity of ALGOS or his own Self which involves the PHISICAL PAIN INCREASE will. This condition leads both (perception showing – – – IN PHYSICAL pure PASSIVITY: AND PSYCHIC everyman and the Christ-man to BIOLOGICAL PHASE) RESISTANCE greater knowledge of God, and thus to an increase in Faith, the fundamental moment which + gate tends to lead him as well to ac- + control – – – cept and bear really intense clin- + endorphins ical situations of pain both in clinical pathologies which af- flict everyman (Zucchi-Hon- PATHOS or ings, 1996) and in the dying sit- MORAL SUFFERING + + + + + + uation of the Crucifixion of the (man’s free and conscious KNOWLEDGE INCREASE RE-ACTIVITY involving his will: of GOD of FAITH Christ-man. ETHICAL PHASE) The raising of the threshold of pain (= the reduction in the perception of physical pain and

Fig. 2. A schematic representation of the principal stations Fig. 3. A schematic representation of anti-nociperception. of the sense receptors.

intralaminar and medial thalamic nuclei limbic Pacini’s PRESSURE system corpuscle postero-lateral ventral nucleus

posterior thalamic nuclei hypotalamus Meissner’s TOUCH corpuscle

Ruffini’s reticular periaqueductal gray m. HEAT formation corpuscle

gigantocellular nucleus Krause’s COLD corpuscle

spinal cord Free (I LAMINA) PAIN endings moral suffering) in the believer of the anti-nociperception path- with an antalgenic effect, which is due to an increase in the phys- ways (Fig. 2) made up of the de- are localised at various levels of ical and moral forms of resis- scendant inhibitor tracts which the central nervous system tance which the condition of determine the closure of the gate (CNS) (the medial and intralam- Faith is able to achieve in the or- to the pain receptor input, inal thalamic nuclei, the limbic ganism of each individual who caused by the algogenic noxa, system, the lateral postero ven- has a Higher Being as a point of which begins with the various tral nucleus, the posterior thala- reference (Fig. 1) (Zucchi-Hon- types of receptors (Fig. 3) and mic nuclei, the hypothalamus, ings, 1996). which follow the ascendant the reticular formation, the peri- tracts of nociperception (the acquaductal grey substance, and neospinothalamic tract and the the gigantocellular nucleus) The Physiopathological paleospinothalamic tract) (Fig. (Fig. 2). Mechanism of the Raising 4) at the level of the different of the Threshold of Pain stations (Fig. 5), as is also pro- pounded in the ‘gate theory’ of Systems of the Organism The physiopathological mech- Melzack and Wall (1965, cf. fig. which Interfere with Pain anism by which the condition of 6). b) Neuropharmacologically, faith in everyman and the in the release of encephalins Ð Pain is a very complex noxo- Christ-man manages to raise the endogenous substances which logical entity whose genesis and threshold of pain lies: (a) neuro- the organism itself produces Ð of typology involve the action of a physiologically, in the activation a meconic (morphinic) nature number of systems (Zucchi,

Fig. 4. Schematic representation of the Fig. 5. Schematic representation of the stations neospinothalamic tract and the of nociperception. (I neuron: receptor-column; 25 paleospinothalamic tract, pathways which lead II neuron: column-thalamus; and modulate pain to the higher centres. III neuron: thalamus-cortex.

CORTEX

III neuron

THALAMUS

MESENCEPHALON Reticular Neospinothalamic formation tract PONS Paleospinothalamic tract II neuron

BULB

Spinothalamic tract

I neuron RECEPTORS SPINAL CORD

Fig. 6. Schematic representation of CENTRAL the ‘gate control theory’ of Melzack CONTROL and Wall (1965). L = afferent fibers of a large diameter; S = afferent fibers of a SYSTEM OF CONTROL small diameter; SG = interferon of the gelatinous substance which L determines the presynaptic – + + inhibition of the afferent fibres which SYSTEM converge on the same neuron T. ENTRANCE S G T OF ACTION The activity of the interneuron (SG) – is aroused by impulses led by fibres + – of a large diameter and inhibited by S impulses led by fibres of a small diameter. OF THE ENTRANCE

DOLENTIUM HOMINUM N. 47-2001 1995). The interactions between Fig. 7. Systems of the organism which interfere with pain. these systems and the pain A physiopathological interpretation of the phenomenon of hematoidrosis. symptom are often reciprocal. Figure 7 seeks to provide a Sympathetic system schematic view of these rela- (activation) tionships.

Immunity System Pain and the Neurendocrine System Anti-body poiesis Meconic System (monokines, lymphokines) (endorphins) The relationships between the endocrine system and the other information systems of the or- Neuroendocrine system ganism Ð in the first instance the (cytokines, hypothalamus, nervous system and the immuni- hypophysis, ACTH, glucocorticoids) ty system Ð are at the present time the object of great scientific interest (Levi Montalcini, 1995; 1996). In particular, the importance of the glucocorticoids as hormones which every- where mediate nervous, meta- 26 bolic, and immunological functions is today recognised. Hematoidrosis (hemorragic Physiopathological PAIN syndrome from Aspects of Glucocorticoids hyperfibrinolysis)

The Secretion of Glucocorticoids

The suprarenal cortex is sub-divided into different zones: 1) the glomerular zone, which Inflammatory System Free radicals secretes aldotesterone; (hystamine, bradykinin, serotonin, PGE, 2) the fasciculated zone, K+, catecholamine, P substance) which secretes glucocorticoids; 3) the reticular zone, which secretes androgens. cyclical AMP (cAMP) (Gill, pituitary origin and substances This distinction, however, is 1979). However, side by wide from the underlying medulla by not absolute because the fascic- with the ACTH and angiotensin diffusion or by vascular path- ulated zone and the reticular II, other factors exercise an ac- ways (encephalins, corti- zone make up the same func- tivity of control on adrenal se- cotropin realising factor (CRH), tional unit. In fact, even if there cretion. In fact, if the control of opioids, and the ACTH) (Angeli exists as a rule a ‘physiological the fasciculated zone is essen- et al., 1994). specialisation’ by which the fas- tially the task of the ACTH, ciculated zone produces cortisol (probably with complementary The Secretion of ACTH and the reticular zone produces factors, amongst which the dehydroepiandrosterone, both same angiotensin II), glomeru- The pituitary secretion of the are able to produce the same lar secration is governed, to- ACTH is governed by more steroids (Angeli et al., 1994). gether with angiotensin II, also than one factor. In particular, the The endocrine secretion of by the concentration of sodium most important two molecules the fasciculated zone is sub- and potassium, by the atrial na- are the CRH and vasopressin stantially controlled by an- triuretic peptide (ANP), by (AVP, argininvasopressin). giotensin II. dopamine, by the ACTH itself, The CRH, in addition to the Both the action of the and by other substances. The already mentioned action in re- adrenocorticotropin hormone fasciculated zone, side by side lation to hyophysis, has other (ACTH) and of angiotensin II with the principal stimulus of actions: at a hypothalamic level on adrenal secretion takes place the ACTH, also feels the comit inhibits the activity of other through specific receptor sites plementary action of other fac- neurons secreting other realising belonging to the Gs group (re- tors, amongst which an- factors, it stimulates sympathet- ceptors associated with stimula- giotensin II. Our knowledge is ic activity at a central level, and tory G-proteins) (Mountjoy et less clear about the control of modulates endocrine, behav- al., 1992). The action of stimu- the secretion of dehy- ioural and neurovegatative func- lation exercised by the ACTH in droepiandroterone-sulphate by tions. In this sense, the CRH has the adrenal secretion of gluco- the reticular zone. It has been an important role in the reac- corticoids has as its fundamen- advanced that the modulators of tions of adaptation to stress tal intercellular messenger the this secretion are peptides of a (Richard, 1993). The secretion of CRH takes place for the most mechanism referred to above action, the ACTH exercises its part at a hypothalamic level and which recognises the CRH and own action also at an extra- is in its turn under the control of AVP as fundamental mediators, adrenal level. It has, in fact, a various molecules (acetylcolin, and the negative feed-back due melanocytostimulant activity serotonin, catecholmine, GA- to the glucocorticoids, emphasis and performs a role, whose BA, opioid neuropeptides, and should be placed on the role character is still not yet clear, in neuropeptide Y.). However, a played by two factors Ð stress the control of arterial pressure. peripheric synthesis of CRH is and the cytochines. In addition, the ACTH and also recognised. It is known that stress in itself some of its fragments have im- The role of ‘vasopressin’ is not a pathological phenome- portant effects on the central (AVP) as the worker of hypthal- non, but a reaction of physiolog- nervous system (CNS), aiding amic control,at the present time ical and paraphysiological adap- the perceptive and mnemic seems to be no less important tation which prepares the way processes and psycho-physical than that of the ACTH. Similar- for a reaction of defence. It is performance (Angeli et al., ly to the ACTH, the secretion of equally known that a subjective 1994). AVP by the paraventricular neu- individual variability exists in rons has more than one modula- the sense that the same stressor Glucocorticoids: tor (the adrenergic system, can bring about variable re- Peripheric Effects neurpeptide Y, GABA, the opi- sponses in different individuals. oid system). The glucocorti- However, the role of stress in The receptors for the gluco- coids inhibit the secretion of the release of the ACTH is very corticoids are in practice every- AVP and that of CRH (Uth, important and takes place both where and for this reason the ac- 1988). through an increased hypo- tion of these substances takes thamalic release of the CRH and place at more than one level. A 27 The Pituitary-Hypothalamic AVP, and through an increased detailed description of the pe- Axis pituitary response to these two ripheric effects of glucocorti- substances (Gaillard et al., coids is outside the scope of this The daily activity of the pitu- 1987; Donald, 1994). Further- paper. To summarise, let us re- itary-hypothalamic axis has im- more, according to the kind of member that they have complex portant characteristics. It is in- stress which is at work, the hy- effects on the lipidic, glycidic, termittent or pulsating because pothamalic microenvironment and proteic metabolism and on the episodes of secretion are changes. For example, emotion- the hydroelectrollytic balance. broken up by periods of func- al forms of stress increase the They have an activity at the car- tional rest. A circadian rhythm opioid tone (Gaillard, 1987), diovascular level (increase in follows as is borne out by the whereas the stress induced by the arterial pressure, vasocon- fact that over 70% of the pro- hypoglycemia induces a fall in striction, and strengthening of duction of the ACTH and corti- the opioid inhibitory tone and a the sympathetic), at the gas- sol takes place in the eight sympathetic stimulation. troenteric level (increase in the hours after midnight. It has a At the present time it is recog- secretion of chloridic acid, re- real endogenous syncronisation nised that some cytochines in- duction in the production of mu- in that the cells, in vitro as well, crease the secretion of the cus), at the respiratory level (in- and thus deprived of the usual ACTH (II-1, II-2, II-6, tumor crease in the interaction be- specific conditions, maintain a necrosis factor or TNF alpha, tween catecholomines and the certain rhythmic activity. Last- interferongamma). This idea bronchial beta-2 receptors, the ly, they experience an exoge- opens up prospects of very great synthesis of surfractant), and at neous synchronisation because interest in the study of the com- the hematological level (ery- such regulation is also modu- plex relationship between the throcytosis, leucocytosis, neu- lated by external factors which neurendocrine system, immuni- trophilia, acidopenia). For a act as synchronisers, such as ty, and pain. In fact, the release more detailed description of light-darkness changeover, the of cytochines can be consequent these effects we refer the reader rhythm of meals, and the work- upon tissue damage, the stimu- to other works on the subject ing timetable of a person. In lation of the immunity system (Angeli et al., 1994). Instead, terms of purpose, the highest se- brought about by factors of in- we will dwell here, albeit in a cretion which takes place in the fection, and traumas (Imura and summarising way, on certain early morning can be interpret- Fukata, 1994). In this sense, the fundamental notions concerning ed as an attempt to programme cytochines-hypothalamus-hypo- the relationships which connect the organism to face up to the hysis-glandulae the glucocorticoids to the feel- day in a state of full efficiency. suprarenalis-circuit is a physio- ing of pain, that is to say their The possibility of modulation logical factor in the limitation of effects on the central nervous on the basis of external stimuli the damage underway involving systm, their anti-inflammatory suggests, on the other hand, a phlogistic stimuli. This endoge- action, and their relationship to capacity to integrate with, and nous response is obviously con- the immunity system. to adapt to, the environment nected to the psychic-physical (Angeli et al., 1992, 1994). state of the subject as a result of Glucocorticoids and the which, for example in poor psy- Central Nervous System Pain, Stress, Cytochines cho-physical conditions, the and ACTH above mentioned mechanism It is believed that the gluco- may provide inadequate re- corticoids have an action on With regard to the release of sponses. cerebral development in the pre- the ACTH, side by side with the Side by side with its adrenal natal and postnatal stage, until

DOLENTIUM HOMINUM N. 47-2001 puberty (Doupe et al., 1982), at high levels of dosage. The ac- tomin and prostoglandin. The stabilising a series of neuronal tion of the glucocortocoids is same stimulus, through ascen- circuits which are prevently at modulatory in relation to the dant impulses in the hypothala- the limbic level, and that the lymphocytes B (dosage-depen- mic tracts, activates many en- principal targets of these hor- dent activation or inhibition of cephalic nuclei, above all the mones are the amygdala and the the anti-body reaction), whereas cholerngic ones, which have hippocampus. It is also believed it is inhibiatory in relation to the specific receptors for the NGF. that the steroids perform a role lymphocytes T, macrophages This activation extends to the of modulation in adrenergic and and monocytes, and natural nuclei of the base, to the hypo- serotoninergic neurotransmis- killer cells (NK). In addition, the thalamic nuclei, to the hypoph- sion (Mason, 1986). On the ba- glucocorticoids have an in- ysis, to the endocrine glands, sis of the role of the limbic sys- hibitory effect on the synthesis and to the sympathetic system. tem and the serotonin system in of cytokines and increase the It is above all else the role emotional and behavioural reac- genic expression of enzymes played by the sympathetic sys- tions, one understands how the and regulatory proteins. tem which constitutes one of the cortisol increases the emotional To summarise: the pain stim- most original and innovative el- state and promotes reactive im- ulus, and in particular the ements of this theory. Indeed, by pulses. This action belongs to events correlated to that stimu- stimulating the immunity sys- the purpose of preparing the lus (tissue damage, traumas, tem at its key points (the thy- way for suitable reactions to factors of infection) bring mus, the lymph glands, the stress (Angelucci et al., 1991; about a release of cytokines. spleen), this constitutes without Angeli et al., 1994). These substances, in their turn, doubt the structure of essential Other actions of cortisol at the increase the secretion of the connection for the working of 28 level of the central nervous sys- CRH and AVP at the hypothal- this integrated homeostatic system (CNS) include: psychic ef- amic level and thus the conse- tem. fects (euphoria, insomnia, but quent pituitary release of the An important work by Bese- also anxiety, depression, and ACTH and the adrenal release dowsky reports an increase in psychosis); hypoanosmia (in of steroids. The setting off of the ACTH and glucocorticoids chronic hypercorticalism); an the cytokine-hypothalamus-pi- after the endovenous injection increase in the hematic flow and tuitary-glanduale suprarenalis of interleuchin-1 (Besedowsky the stabilising of damaged neu- circuit brings about, in defini- et al., 1986). This observation ronal activity (after acute ad- tive terms, an endrogenous laid the ground for an under- ministration); and neurotoxicity analgesis-anti-phlogistic re- standing of the connections (because of a chronic excess of sponse on the part of the or- which exist between pain, the corticosteroids) (Angeli et al., ganism. neuroendocrine apparatus, and 1994). immunity. To summarise: a painful event provokes the acti- The Anti-phlogestic Action Pain and the Immunity vation of the neuroendocrine re- of Glucocortocoids System sponse (see above) through the immunity system. In turn, it can The clucocorticoids reduce Forty years of research by the be perceived how alterations in vasal permeability, leukocytari- group led by Rita Levi Montal- the immunity system are con- an migration, the synthesis and cini on the nerve growth factor nected to greater susceptibility the release of the phlogosis me- (NGF) (NGF, 1995; 1996) have in relation to pain stimuli. diators in the extracellular opened up new perspectives on space, and the formation of the the interactions between sensi- granulation tissue (Schleimer, tivity to pain, the endocrine sys- Pain and Free Radicals 1993). It should be emphasised tem and the immunity system. that that anti-inflammatory ac- In particular, it has been demon- A tissue wound, whether tion of the glucocorticoids strated that the nerve growth acute or chronic, generates a takes place in two different factor has the possibility of in- phlogistic process which in turn ways. Indeed, some effects re- teracting with many cells of the sets off a series of local and quire high concentrations of nervous, neuroendocrine, and general reactions of the organ- cortisol (pharmalogical load), immunity systems, thereby acti- ism. Such reactions, directed to- whereas the ‘physiological’ vating homeostatic systems wards limiting damageand ac- role of these substances must which strengthen the physiolog- celerating the processes of re- be assessed in the light of the ical defence systems of the or- generation, also produce a se- hypothalamus-hypophosis-glan ganism. ries of damaging effects, such dulae suprarenalis circuit (see For this reason, with the aim as pain. In the genesis of pain a above). of overcoming the rigid division large number of phenomena are into systems, Rita Levi Montal- involved (vasodilatation, exu- Pain, the Glucocorticoids cini has hypothesised the exis- date, the migration of leuko- and the Immunity System tence of a neuro-endocrine-im- cytes, and an increase in capil- munity system. lary permeability) which in turn In this sphere as well, the ac- According to such a system, are due to various activation re- tion of the glucocortocoids must the pain stimulus provokes the actions. These reactions include be seen both as a physiological activation of axonic anti-dromic the activation of the comple- component and as something reflexes with the release of sub- ment system, the coagulation which is secondary to a pharma- stance P, the activation of mas- system, the release of prostog- cological load, and thus a load tocytes, and the release of his- landin, of serotonin, histamin and other substances. In these into the skin. In these situations sympathetic afferences to the reactions of activation, an im- the symptom of pain is due to painful region brings about an portant role is today attributed the direct arousal of the me- immediate disappearance of the to the free radicals of oxygen. chanical nociperceptors. The re- symptom (Fields, 1988). These radicals are thought to be sult is a pricking pain (Galletti et With regard to the action of released following tissue dam- al., 1980). In these cases as well, pain on the sympatic nervous age (the activation of the com- however, side by side with the system, it has been demonstrat- plement, leukocyte chemiotas- direct mechanical stimulation, ed that the action of nocuous sis). The free radicals of oxygen the unleashing trauma can also stimuli at the level of the deep are thought, therefore, to be the activate the mediate-phlogosis somatic structures can bring principal agents of the sensation mechanism. about the arousal of sense re- of pain. The actions of these With regard to the opposed ceptors by activating afferent substances are thought to be: relationship of ‘pain as the ori- unloading and inducing a re- vasoconstriction and platelet gin of phlogosis’, this relation- flexive arousing of the efferent aggregation with local is- ship is implicit given, as has somatic and vegetative path- chemia; direct nervous stimula- been seen, that the wounding ways. The activation of the ef- tion due to edema; quinon and event is very often a painful ferent somatic fibres brings prostaglandin-mediated action; stimulus. In addition, the activi- about phenomena of muscular acidosis; and irritation because ty of the nociperceptors gener- contraction, and as a result the of the release of lithic enzymes ates in itself local tissue modifi- further arousal of the sense re- (Cuocolo, Novelli, Peduto, Ursi- cations with vasodilatation, ede- ceptors. The activation of the ni, 1986). ma, and the release of neuropep- sympathetic efferents induces a tides such as substance P. These direct release of noradrenalin, modifications continue beyond vasomotor phenomena, and a 29 the initial stimulus and extend variation in capillary permeabil- beyond the zone in which the ity. The effect is a modulation of same stimulus has been applied. the receptors (that is to say a In this way, the intensity and the variation of their threshold and quality of the pain are modified forms of response). In definitive and amplified (Fields, 1988). It terms, modifications are created should also be remembered that such as to perpetuate the al- pain, whether acute or chronic gogenous conditions (Maresca, in nature, always generates an 1987; Procacci et al., 1963). unfavourable psychological reaction (for the most part, anxiety in the case of acute pain, and de- Pain and the Meconic System pression in the case of chronic pain) which can contribute to The relationship between pain bringing about a favourable cli- and derivatives from opium has mate for the conservation of the very ancient origins and the use phlogistic state. of these substances in algoge- nous syndromes is still of fundamental importance. More re- Pain and Phlogosis Pain and the Sympathetic cently, however, much has been Nervous System learnt about endogenous opioid The relationship between pain peptides. These substances are and phlogosis have been in part In this case as well the rela- produced directly at the level of described in the previous sec- tionship is complex and recipro- the nervous system. So far, three tion. To summarise: the wound- cal. The role of the sympathetic groups of molecules are known ing event brings about the acti- nervous system in the genesis of about, namely encephalins, en- vation of a phlogistic process in pain is recognised and has been dorphins, and dinorphins. En- whose genesis various reactions emphasised many times in the cephalins have a similar mor- and systems take part (see literature on the subject. One phine action, antagonised by above). The pain, therefore, is need only think of causalgia, a naloxone. They are present in nothing else but one of the mul- complex noxological entity, be- the sympathetic nervous system, tiple effects of these reactions. longing to the group of reflex in the intestine, in the chromaf- In practice, therefore, the fol- sympathetic dystrophies or re- fin cells of the adrenal medulla, lowing schema comes about: a) flex algodystrophies. This syn- and in the central nervous sys- the wounding event; b) phlogo- drome is characterised by pyrot- tem. Here their highest concen- sis; c) pain. It should, however, ic pain, also unleashed by stim- tration is at the level of the be remembered that pain can al- uli of modest intensity, general- periductal grey substance, in the so be generated outside the ly localised in a limb. Trophic bulbous and bridge ventral ar- mechanism described above, alterations of the skin can co-ex- eas, and in laminas I, II, V and X that is to say when a wound is ist, such as glossy skin, vasomo- of the spinal column. The beta absent and the consquent phlo- tor disturbances, and bone dem- endorphin is, instead, highly gosis is absent. This is the case ineralisation (Galleti et al., concentrated in the hypothal- with cutaneous pain caused by 1980). The pain is sustained mus. The dinorphins are to be mechanical stimulation, pro- specifically by the sympathetic found in the same seats as the duced, for example, through the activity as is demonstrated by encephalins but they have less rapid introduction of a needle the fact that a blocking of the analgesic activity. At the present

DOLENTIUM HOMINUM N. 47-2001 time the endogenous opioids are ground like thick drops of nounced by St. Paul: ‘Yours is to recognised as having an impor- blood’. be the same mind which Jesus tant role. Indeed, it has been The etiology of hematoidrosis Christ shewed. His nature is, demonstrated that numerous (Fig. 7) in everyman can be from the first, divine, and yet he stimuli, amongst which are to be caused by intense physical pain, did not see in the rank of God- listed stress and stimulation of which is able, through a stress head, a prize to be coveted; he the nociperceptors activate activation, to provoke a hemor- dispossessed himself, and took these systems (Zoppi, 1991). rhage syndrome of hyperfibri- the nature of a slave, fashioned nolysis which brings about the in the likeness of men, and pre- phenomenon of the hemolysis senting himself to us in human Pain and the of the red globules with a suc- form; and then he lowered his Fibrinolytic System cessive release of hemoglobin own dignity, accepted an obedi- into the plasma and then into the ence which brought him to It is known (Neri Serneri, sweat. This event, rare in every- death, death on a cross’.2 In line Gordon) that in situations of el- man, took place in the with this, the Church teaches evated stress and intense physi- Christ-man. that the Son of God made him- cal pain, abnormal quantities of self man to save us by reconcil- plasminogenic activator are re- ing us with God: it was God leased from the tissues of our ‘who loved us and sent us his organism and that these circu- Son as a victim of expiation for late. In such situations of plas- our own sins’ (1 Jn 4:10). ‘The matic proteolytic activity, the Father sent his Son as the Sav- principal coagulative defect is iour of the world’ (1 Jn 4:14). 30 due to the presence of the prod- ‘He came to take away sins’ (1 ucts of proteolysis. These sub- Jn 3:5)’.3 stances, which come from the In the first part of this study, same fibronogen or from fibrin, the physiological interpretation circulate in the blood, and , act- of the physical pain, the moral ing as anti-thrombins, produce suffering, and the hematroidosis an abnormal polymerisation of of Jesus at Gethsemani was dis- the fibrinogen, and at the same cussed and addressed. In the time they alter the platelet second part of this paper a theo- function. In clinical situations logical interpretation of the involving intense physical agony of the Christ-Man is of- pain, both the local release of fered to the reader. thromboplastic substances and The clinical terminal state of of fibrinolythic substances is the dying Christ can be com- possible. PART II: pared to that of everyman. To A Theological Interpretation explain it, the scholar Pierluigi of Pain in Christ-Man Zucchi4 has used Ð in the first The Phenomenon part of this paper, something of Hematoidrosis ‘At the centre of the cate- which is more than right Ð em- chism we find essentially one pirical and theoretical data (Zuc- One of the rather rare aspects person: that of Jesus of chi-Honings, 1996).5 For this which must be taken into con- Nazareth, the only begotten son reason, in the thematic introduc- sideration in the pain of every- of the Father... who suffered and tion, the Person of Jesus is pre- man is the phenomenon of died for us and now, risen from sented as a person sent by the hematoidrosis. the dead, lives for ever with us... Father to achieve the salvation In the ‘Dictionary of the To catachise, therefore, is to re- of the whole of humanity.6 En- Technical Terms of Medicine’ veal in the person of Christ the tering in medias res, I would written by M. Garnier and V. entire plan of God... It is to like to refer to how this is pre- Delamare, the feminine noun search to understand the mean- sented by St. Gregory the Great, ‘hematoidrosis’, which comes ing of the actions and the words a Pope, in a yet more specific from the ancient Greek words of Christ, of the signs which he and pertinent way, in his Com- for blood and for sweat, and worked’.1 ment on the Book of Job: which in Italian is synonymous In line with what has been ar- ‘Christ, in fact, suffered his pas- for sweat of blood, is defined in gued and outlined in the first sion and bore the torment on the the following way: a distur- part of this paper, the death cross for our redemption, al- bance of the secretion of sweat agony of Jesus at Gethsemani though he had not committed characterised by a red colouring can represent the typical figure any violence with his own of the sweat. This colouring is of the terminally ill person. hands, not any sin, nor had he due to the presence of hematic However, his clinical terminal any deceit on his mouth. He pigments without red globules. state, although similar to the ut- alone amongst all raised his This phenomenon was pre- most to the terminal state of pure prayer to God, because sent during the agony of Jesus, everyman, has for the theologian even in the very trial of his pas- as described by St. Luke, who the meaning of a mysterious sion he prayed for his persecu- was both an evangelist and a purpose, that is to say, the salva- tors, saying: “Father, forgive physician: ‘And now he was in tion of sinful mankind. The them for they know not what agony, and prayed still more Church expresses this concept they do” (Lk 23:34)’.7 earnestly; his sweat fell to the in the hymn that was pro- With his portryal of the suffering Christ, this great Pontiff humanity ‘God was in Christ judged by God to be the instru- made clear that every bible- reconciling the world to him- ment most in conformity with based attempt by a theologian self’ (2 Cor 5:19).10 his compassion and fully in line should be placed, precisely be- In this way it is evident that with the requirements of his jus- cause we are face to face with a whoever seeks a theological in- tice. The Catechism of the great mystery, immediately terpretation of the hematoidrosis Catholic Church, in the light of within the riverbed of faith. He of Jesus at Gethesemani knows the written divine word, leads us is so convinced of this that he that he must enter into the mys- to understand the most convinc- continues his argument by ask- tery of Christ’s ‘vicarious or ing reasons for this: ‘For as by ing himself: ‘What can one say, substitutive’ suffering in our one man’s disobedience many what can one imagine that is place. One thereby becomes were made sinners, so by one more pure than a compassionate aware of the great complexity of man’s obedience many will be intercession on behalf of those the exegesis of a phenomenon made righteous (Rom 5:19). By who make us suffer? Thus it which from a scientific point of his obedience unto death, Jesus happened that the blood of our view can be encountered in clin- accomplished the substitution of Redeemer, shed with cruelty by ical pathologies as well. For this the suffering Servant, who his persecutors, was then taken reason, we should turn to the au- ‘makes himself an offering for on by them with faith, and the thor of the Letter to the He- sin’, when ‘he bore the sin of Christ was proclaimed by them brews. In order to grasp the many’ (all, B. Honings), and the Son of God’.8 meaning of the mystery of the who ‘shall make many to be ac- At this point the intention of atonement of our sins, through counted righteous’, for ‘he shall this study of the authors be- the instrument of the suffering bear their iniquities’ (cf. Is comes even clearer. Scientific and the agony of Christ at Geth- 53:10-12). Jesus atoned for our explanation on the one hand, semani, the author invites us to faults and made satisfaction for 31 and theological interpretation turn our gaze to: ‘Jesus, our sins to the Father’.13 on the other, are two instances crowned, now, with glory and Precisely in order to give which complement each other, honour because of the death he more weight to the convenience indeed they complete each other underwent; in God’s gracious of the ‘theological’ why behind because they reveal both the design he was to taste death, and the mysterious phenomenon of truth and the veracity of the taste it on behalf of all’.11 Con- the hematroidrosis of Christ, mystery of the Incarnation of tinuing in his argument, the two fundamental aspects are the Word of God and its salvific same inspired author brings out, stressed: 1) the full human purpose. The phenomenon of specifically in the light of this awareness of Jesus when faced hematroidosis provides, accord- observation, the extreme conve- with the horror of death; and 2) ing to the previously expounded nience of the passion as a cho- the fullness of ‘sacrificial’ love explanation, a surprising scien- sen way of the Father for the re- of the divine Dying One at tific proof of the corporeity of demption of the whole of Gethsemani. Here is a clarifica- the Christ-man. The description mankind. ‘God is the last end of tion of the point as made by the furnished by Luke allows of no all things, the first beginning of Magisterium of the Church: doubts on the matter: ‘And now all things, and it befitted his ‘The cup of the New Covenant, he was in agony, and prayed still majesty that, in summoning all which Jesus anticipated when more earnestly; his sweat fell to those sons of his to glory, he he offered himself at the Last the ground like thick drops of should crown with suffering the Supper (cf. Lk 22:19), is after- blood’.9 life of that Prince who was to wards accepted by him from his Now, and this is what this lead them into salvation. The Father’s hands in the garden at theological interpretation seeks son who sanctifies and the sons Gethsemani (cf. Lk 22:20), to make clear, it is a fact of who are sanctified have a com- making himself obedient unto faith that we are all redeemed mon origin, all of them; he is not death (Phil. 2:8; Heb 5:7-8). Je- through this blood, precisely ashamed, then, to own them as sus prays: ‘My Father, if it be because it was the blood of the his breathren. I will proclaim possible, let this cup pass from Son of the Father-God, the thy renown, he says, to my me...’ (Mt 26:39). Thus he ex- blood of the Second Person of brethren; with the Church presses the horror that death the Most Holy Trinity. around me I will praise thee; represented for hus human na- To avoid any misunderstand- and elsewhere he says, I will put ture. Like ours, his human na- ing on the question, reference my trust in him, and then, Here ture is destined for eternal life; may be made to the authentic stand I, and the children God but unlike ours, it is perfectly and authoritative teaching of the has given me’.12 exempt from sin (cf. Heb 4:15), Catechism of the Catholic the cause of death (cf Rom Church: ‘The name of the Sav- 5:21). Above all, his human na- iour God was invoked only once The Etiological Meaning ture has been assumed by the in the year by the high priest in of the Physical Pain divine person of the ‘Author of atonement for the sins of Israel, and the Moral Suffering Life’ (Acts 3:15) , the ‘Living after he had sprinkled the mercy of the Agony of Christ One’ (Rev 1:17; cf. Jn 1:4; seat in the Holy of Holies with 5:26). By accepting in his hu- the sacrificial blood’ (cf. Lev Thus we come to why the man will that the Father’s will 16:2, 15-16; Sir 50:20; Heb 9:5, physical pain, the moral suffer- be done, he accepts his death as 7). ‘When St. Paul speaks of Je- ing of Jesus, and his death on redemptive, for ‘he himself bore sus whom ‘God put forward as the cross, which culminated in our sins in his body on the tree’ an expiation by his blood’ (Rm the phenomenon of hemotoidro- (1 Pt 2:24).14 3:25), he means that in Christ’s sis that he experienced, were ad- What gave the mysterious

DOLENTIUM HOMINUM N. 47-2001 meaning, that is to say the value the language of the philosophers the Catholic Church teaches on of universal salvation, to the hu- who were his contemporaries, this point, ‘in the redeeming man phenomenon of the hemo- reaches the culminating point of love that always united him to troidosis experienced by Jesus his teaching and of the paradox the Father, he assumed us in the at Gethsemeni was his love until that he wanted to express: state of our waywardness of sin, the end. Yes: it was precisely ‘“God has chosen in the world... to the point that he could say in this love which confers the val- that which is nothing to reduce our name from the cross: ‘My ue of redemption and of atone- to nothing things that are” (cf. 1 God, my God, why have you ment, of expiation and of satis- Cor 1:28). In order to express forsaken me?’ (Mk 15:34; Ps faction, on the sacrifice of the gratuitous nature of the love 22:2).20 Having thus established Christ (cf. Jn 13:1). ‘He’, ob- revealed in the Cross of Christ, him in solidarity with us sinners, serves the Catechism of the the Apostle is not afraid to use God ‘did not spare his own Son Catholic Church on this point, the most radical language of the but gave him up for us all’ (Rom ‘knew and loved us all when he philosophers in their thinking 8:32), so that we might be ‘rec- offered his life’ (cf. Gal 2:20; about God. Reason cannot elim- onciled to God by the death of Eph. 5:2-25).(15) By now I inate the mystery of love which his Son’ (Rom 5:10). hope that the theological inter- the Cross represents, while the pretation is a luce clarius and Cross can give to reason the ul- that it gives a universal salvific timate answer which it seeks. It Conclusion value to the phenomenon of the is not the wisdom of words, but pain, the suffering and the blood the Word of Wisdom which From the present study on the and sweat of Jesus at Gethese- Saint Paul offers as the criterion physiopathological and theolog- mani and his death on the cross of both truth and wisdom’.19 ical interpretation of the physi- 32 which is seen as being based on cal pain, the moral suffering, the existence in Christ of the di- and the phenomenon of hema- vine Person of the Son. ‘No troidrosis, the following conclu- man, not even the holiest, was sions may be drawn: ever able to take on himself the a) man always needs a cultur- sins of all men and offer himself al formation which takes as its as a sacrifice for all’.16 starting point the salvific mean- The most proof-worthy con- ing of the passion suffered by firmation of our study is to be Christ-man at Gethsemani; found in the following words: b) man, in this hedonistic, ‘In reality only in the mystery of pragmatic and utilitarian world, the Word made flesh does the if a believer, must base and re- mystery of man find real light. fine his own ethical formation in Adam, in fact, the first man, was relation to the fundamental mo- the figure of that future (cf. Rom ments of life represented by 5:14), that is to say of Christ the physical pain and moral suffer- Lord. Christ, who is the new In a similar way, the authors ing to strengthen himself not on- Adam, specifically by revealing of this study have sought, with ly from an ethical point of view the mystery of the Father and his regard to the man of science and but also in physical terms, as has love also fully reveals man to of technology of today’s world, been brought out by the man and makes him observe his not only not to empty the mys- medical-theological interpreta- very high vocation... He is “the tery of the divine Dying One but tion of pain and suffering repre- image of the invisible God” (Col rather at the most to fill this sented by figure 1 (Zucchi-Hon- 1:15; cf. 2 Cor. 4:4). He is the mystery with his universal ings, 1996); perfect man who has restored to ‘salvific’ love. They have done c) man must get used to ac- the sons of Adam the likeness to this through a scientific explana- cepting suffering and interpret- God which had been deformed tion and a theological interpreta- ing death as the dies natalis immediately at the outset by tion of his physical pain, moral which is the path, through faith, sin’.17 Here is the mysterious suffering, hematroidosis, and to a new epiphanic manifesta- purpose of the Incarnation, but death on the wood of the cross. tion of God. what it is interesting to observe The authors have always re- is that the instrument by which membered that they are, like Prof. P. ZUCCHI, S.O., the Word of God achieved this everyone else, somewhat similar Director of the Institute for the Study and Treatment of Pain, purpose was our human nature. to the disciples of Emmaus. Florence. As the Magisterium of the However, when the discussion Catholic Church makes clear: bears upon Jesus it is necessary Rev. B. HONINGS O.C.D., ‘because in his incarnate divine to remember his words: ‘Too Professor of Moral Theology at the person “he has in some way slow of wit, too dull of heart, to Teresianum Lateran and Urbanian united himself to every man”; in believe all those sayings of the Pontifical University, Rome. him human nature was assumed, prophets! Was it not to be ex- without for this reason being an- pected that the Christ should un- nihilated; for this very reason it dergo these sufferings, and enter has been also raised within us to so into his glory?’ (Lk 24: Bibliography a sublime dignity’.18 15-27). and References In his encyclical letter Fides Certainly, it is not as though A. ANGELI, G. GATTI, and R. MASERA, et Ratio, Pope Wojtyla observes he himself had sinned (cf Jn ‘Chronobiology of the Hypothalamic-pi- that St. Paul, when speaking in 8:46). ‘But’, as the Catechism of tuitaryadrenai and Renin-angiotensin-al- dosterone System, in Y. Toitou, E. Haus M. MARESCA, ‘La sindrome acro- to the presence of hematic pigments with- (eds.), Biologie Rythms in Clinical and parestesica (Sindrome di Nothnagel-Put- out red globules. Laboratory Medicine (Springer-Verlag, namSchultze). Problemi eziopatogenetici Hemolysis: the release of hemoglobin Berlin, Heidelberg, 1992). e terapeutici, Algologia, 2, (1987), contained in the red globule following the A. ANGELI, R.G. MASERA, F. ORLANDI, 105-130. breaking of its wall. and M. TERZOLO, ‘Sindromi da eccesso di J.W. MASON, ‘A review of psychoen- Endorphins: endogenous substances glicocorticoidi’, in Atti dei congressi del- docrine research on the pituitary-adrenal with a meconic action (similar to that of la Società Italiana di Medicina Interna, 1 cortical system’, Psychosom. Med., 30, morphine) present in the organism and (1994). (1986), 576-607. which are released after algogenic stimu- L. ANGELUCCI, ‘Sistema ipotalamo- R. MELZACK and P.D. 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Cell. Endocronol., 81, vate the fibrinolysin and to the production R.A. DONALD, G.A. WITTERT, ‘Stress (1991), 43-52. by the sick tissues of a proteolytic fer- and Corticotropin Regulation’, Curr. P. PROCACCI, P.G. MARCHETTI, G. ment. It is at times primary but at times Opin. Endocrinol. Diab., 3 (1994), 24-28. BUAZZELLI, and P. ROCCHI, ‘Effetti del also secondary and reactive during the 33 A.J. Doupe and P.H. Patterson, ‘Gluco- blocco farmacologico del ganglio stellato course of a syndrome of widespread in- corticoids and the Developing Nervous sulla sensibilità dolorifica cutanea dell’in- travascular coagulation. System’, in D. Ganten and F. Pfaff (eds.), dividuo sano’, Arch. Fisiol., 62, (1963), GABA: Gammaaminobutyrric acid. Adrenal Actions on the Brain. Current 67-87. Gethsemani: the olive grove where Je- Topics in Neuroendocrinology (Springer- D. RICHARD, ‘Involvement of corti- sus underwent his agony. 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Activation of the hypothalamicpitu- ing the synthesis of anti-bodies. al libro di Giobbe, Lib. 13, 21: PL 75, itary-adrenal axis in inflammation’, Eur. Antibodies: specific substances which 1028. J. Endocrinol., 130 (1994) 32-37. form within the (sero) organism after con- 8 Ibidem. R. LEVI-MONTALCINI, ‘“Polypeptide tact with external agents (antigens). In 9 Lk 22:44. growth factors” with special emphasis on many cases they have a protective action. 10 CCC, n. 433. wound healing. Introduction’, Cell. Biol. Pain: ‘pain is a unpleasant experience 11 Heb 2:9. Int., 5 (1955), 355-359. of the senses and the emotions associated 12 Heb. 2:10-13. R. LEVI-MONTALCINI, R. DAL TOSO, F. with an actual or potential damage of the 13 CCC, n. 615. DELLA VALLE, S.D. SKAPER, and A. tissue and described with terms which re- 14 CCC, n. 612. LEON, ‘Update of the NGF saga’, J. Neu- fer to such damage’ (definition of the 15 CCC, n. 616. rol. Sci., 2 (1995), 119-127. Commitee for the Taxonomy of the Inter- 16 Ibidem. R. LEVI MONTALCINI, S.D. SKAPER, R. national Association for the Study of 17 GS, n. 22. DAL TOSO, L. PETRELLI, and A. LEON, Pain’ (IASP, 1979). 18 Cf. Ibidem and CCC, n. 618. ‘Nerve growth factor: from neurotrophin Hematroidrosis: disturbance of the se- 19 JOHN PAUL II, Encyclical Letter, to neurokine’, Trends Neurosci. cretion of sweat characterised by the red Fides et Ratio, n. 23. 11,(1996), 5, 14-520. colouring of sweat. This colouring is due 20 CCC, n. 603.

DOLENTIUM HOMINUM N. 47-2001 The Spiritual Needs of the Sick Child and his Pastoral Care XXV NATIONAL DAY OF HEALTH, MADRID SEPTEMBER 2000

‘Children love bakers more A child has the right to educa- one of these children in my than doctors because the first tion which, at least at an ele- name welcomes me’ (Mt 18:5). provide pleasure with their pas- mentary level, must be free and This is a welcoming which tries whereas the second pro- also compulsory refers to the Father (Mk 9:37). A voke pain by cutting and burn- In all circumstances, a child child constitutes the image of ing’ (Plato, Gorgias 464d-465a) must be amongst the first to re- the small human creature, who ceive protection and aid. is undefended or in a condition A child must be protected of need. ‘When you did this to 1. Children have the Right against every form of negli- one of these smallest brothers of to be Evangelised gence, cruelty or exploitation. mine, you did it to me’ (Mt A child must be educated in a 25:40). Jesus himself wants to ‘Evangelise children. They spirit of understanding, toler- be loved and welcomed in the too have the right to grow in ance, friendship amongst peo- form of a child...’1 faith. It is up to us to give. They ples, peace, and universal broth- In his preaching, Jesus con- have the right to receive: faith, erhood. stantly referred to children so 34 hope, and love’. that we would discover how These and many other slogans near the Kingdom is if we have were repeated during the World 2. The Child: an Important the characteristics of children Ð Missionary Day for Children Figure in the Bible simplicity, purity of heart, hu- which was held on 30 January mility, openness, and readiness 1977. The child is beginning his The child is the object of spe- to help. life and is sensitive to everything cial treatment in passages to be that surrounds him Ð his family, found in the Bible. The child is his school, his companions... His the ‘crown of the elderly’ (Prov. 3. The Religious Experience world is an imaginary world, 17:6) and ‘olive shoots around of the Child which is fantastic, ideal, beauti- the table’ (Psalms 128:3). Given ful, full of affection, but also a that his life is forming and is ‘Divine things slumber in the very fragile world. For this rea- fragile he needs further protec- child: the educator must awaken son, laws and adults must re- tion and support: ‘You will not them’ (Adrienen Necker de spect the rights of a life which maltreat the orphan’ (Ez 22:21). Saussure, pedagogue). can be easily manipulated. ‘When Israel was young, I loved The French singer and The United Nations Organisa- her’ (Os 11:1). ‘Her children song-writer Pierre Duval relates tion has recognised and set out will be carried in her arms, and the following experience of his ten fundamental principles for caressed on her lap’ (Is 66:12). own family: ‘In my home reli- the child, and they are as fol- The child Jesus, born in Beth- gion did not have any solemn lows: lehem, was presented at the tem- character at all: we limited our- The rights set out in this Dec- ple and was obedient in relation selves to saying prayers together laration must be bestowed upon to his parents (Lk 2:12-51), and every day. I well remember the all children, without any form of thus the figure of the child was physical position and stance my discrimination. exalted, and at Christmas the father adopted. He returned tired A child must benefit from a whole of mankind would come from working the fields with a special position so as to be able to remember and take pleasure heavy load of wood on his to grow in a healthy and normal from not only the birth of the shoulders. After supper he bent way at a physical, intellectual, Emanuel but also his childhood down on the floor, lent his el- moral, spiritual and social level. Ð this is because at every Christ- bows on a small chair and held A child has the right, from mas we are a little bit like chil- his head in his hands without birth, to a name and a nationali- dren. looking at us, without moving at ty. In the preaching of the Good all, and he did not give the least A child has the right to be fed, News, Jesus would subsequent- sign of impatience. to a dwelling, to recreation, and ly lay stress upon the fact that I thought: “my father who is to suitable medical care and children are in the condition to so strong, who runs the home, treatment. receive the Kingdom: ‘the king- who knows how to drive oxen, A child who is in a state of dom of heaven is theirs’ (Mt who does not bow before the physical, mental or social handi- 19:1), and that it was necessary mayor... My father in front of cap has the right to receive the to become children (Mt 18:3), to God becomes a child again. treatment, education and special be born again and to receive the How much he changes his ex- care that he needs and requires Kingdom like a child (Jn 3:5; pression when he begins to talk given his state and condition. Mk 10:15). to God. God must be very big if A child needs love and under- As one authority writes: ‘the my father bends down in front of standing in order to achieve the figure of the child is even seen Him. But He must also be good, harmonious development of his as a ‘sacrament’ of the welcom- if it is possible to talk to Him personality. ing of Jesus. He who welcomes without changing one’s clothes!” In contrary fashion I never about the principal element Ð to which the childhoods of al- saw my mother bend down. In educating their souls’. most all those present here at the evenings she was too tired to Children have the right to this national meeting belonged, do that. She sat amongst us, know God and it would be a de- something different from the holding the smallest of us in her plorable fact if parents and edu- contemporary context in which arms. She looked at us but she cators were to hide Him from the role of the family and did not say anything. She did them. schools is lacking strength as a not open her mouth even if the point of reference. smallest children annoyed her, a. The Influence of Parents Because all of this is present- even if a storm raged over the and Educators ed to children in an immature house or the cat did some dam- in the Sphere of Religiosity form, there is a great insistence age or other. in pedagogic terms on parents And thus it was that I thought a.1. The Trust of the Child and educators taking on the role to myself: “God must be very Towards his Educators of guiding children progressive- simple if it is possible to talk to A child learns from his par- ly until adulthood. This is a Him while holding a child in ents and educators how to face pathway of overall growth with one’s arms and while wearing up to life, to think and reflect, to regard to the physical, mental, an apron. And He must also be a wonder at things, to grasp the social and religious aspects of very important person if my richness of nature, and to be the child. At the same time the mother does not care about the sensitive. He learns to belong to presence of ‘models’ helps us to cat or the storm when she is a group, to a family which stim- reach our goals. If these models talking to Him”. The hands of ulates and encourages him, are near to hand and alive Ð that my father and the lips of my which brings him up with a is to say parents, educators and mother taught me much more knowledge of social, religious priests Ð then the embodiment 35 about God than the catechism’.2 and cultural values. In feeling of the model, although only pro- St John Chrysostome exhort- that he is loved and listened to, a visional, helps the child to grow ed parents to bring up children, child enters into the family pro- and to mature. to educate them, to make them ject with its own victories and There can be no doubt that a become the athletes of Christ. failures; he acquires experience, religious education helps a child Each and every one of us, he assimilates values and responds to grow. This is because such an said, should be like the painter to life beginning with the education places him face to who works on his painting with ‘words’ and above all the ‘ac- face with central problems, life care. We should do the same tions’ which he perceives in re- problems; it forces him to ad- thing with our children. lation, for example, to vital dress them, to assess them... At the same time he com- questions such as health, death, plained about things with the work, friendship, and social and b. How Should this be Done? following phrases: ‘Nobody religious commitment. thinks about their children, no- The family and schools are The answers here are certain- body speaks to them about vir- important places for a child in ly of a varied kind. I will con- ginity, nobody talks to them his early childhood; they are of fine myself here to the princi- about moderation, nobody determining influence in his for- ples which are valid for all peo- speaks to them about despising mation, in the construction of a ple. wealth and glory, nobody talks system of values, and in en- to them about the facts which abling him to grow up with sen- b.1. Words Illuminate Holy Scripture proclaims. So, if sitivity. Words reveal, explain, say children do not have teachers you are right, and say why. It is from an early age what will be- a.2. The Meaning of Things important for words to preach come of them? Everybody does A child begins to discover the the subject of God to children in everything possible to educate meaning of things at the stage of a joyous way, to say how much their children in the arts, in let- his life which goes between five God loves us, how much we can ters, and in eloquence, but no- and eleven years of age. Parents draw near to Him; it is impor- body is in the least concerned and educators play a sensitive tant for them to be words which and irreplaceable role at this speak about friendship with point. This is the moment of the God, words which generate a moral development, internalisa- wish for God, a wish to search tion, and personalisation of reli- for Him, to want Him, to love gious acts, of education in the Him, and also to preach Him. faith. This preaching does not be- Who has not heard, for exam- long to adults alone; children, ple, at the end of this stage a too, can engage in it. The Day of kind of call to become a mem- Missions and Childhood of this ber of a religious order? And in Jubilee Holy Year has had as its a balanced family and school subject: ‘children: missionaries context which is alive at the lev- of the third millennium’. el of values who has not seen It was to this, to missionary born as a spontaneous event a childhood, that John Paul allud- vocational call? ed when he said that ‘it is a real This photograph that I am network of human and spiritual showing here is more real in a solidarity between the children society which is called ‘sacred’ of the old and new continents’.

DOLENTIUM HOMINUM N. 47-2001 b.2. Examples and Actions child Jesus was born, young Scholars talk about this case Attract children who were only two with amazement because they ‘Contemporary man listens years old. They professed belief see in these writings of this more willingly to witnesses than in the child Jesus not with their child a most beautiful theologi- to teachers or if he listens to tongues but with their blood. cal system which at the same teachers he does so because they The Latin poet Prudentius said time reveals a life of intimate are witnesses’ (EN 41). of them: ‘play, innocent ones, union with God. A life of holi- Examples of life are more ef- under the altar, with the crown ness written up also through fective than words. Although and the palm leaves’. Their day suffering. The process of her this is valid for all people it is is celebrated on 28 December. beatification is currently under- especially true in the case of Ines the pure, the martyr who way and there are those who children. Children need models was thirteen years old. ‘How speak about her being a new to imitate; this is to be seen in many snares her persecutor Doctor of the Church. After St. sport, films, songs... They want used to seduce her!’ declared Teresa of Lisieux, a Doctor of to identify with figures from St. Ambrogius. Her day is cele- the Church at the age of twen- these worlds, they put them in brated on 21 January. Lucia, a ty-four, will we have another their hearts, in their lips, and put radiant name, a martyr during Doctor of the Church who photographs of them in a frame the persecution of Diocletian, reached that position at the age which then look over a part of who ‘struggled until death it- of seven? their bedrooms. Children see self for the law of Christ’. Her I have wanted to draw atten- these models from near to hand day is celebrated on 5 Febru- tion to these figures to bring out and identify with them, they ary. and to demonstrate the fact that even imitate their gestures, use Cecilia, on 22 November, holiness is also present in chil- 36 their words, and even dress like martyr of the faith. dren. them. Agatha ‘the good’, who met At the time of the beatifica- His Holiness Pope Paul VI martyrdom during the persecution of Francisco and Giacinta, underlined the importance of tion of Decius in 251. Her day is the Conference of Portuguese example when, in relation to celebrated on 5 February. Bishops published a pastoral prayer, he posed the following Justus and Pastor, respec- Nota (‘Note’) in which the re- question to mothers: ‘Mothers, tively seven and nine years old, cently beatified children were do you teach your children who met with martyrdom during held up as being examples to prayers the Christian way? Do the persecution of Diocletian on follow ‘because of the strength you make them used when they 6 August 304. of their charity and their other are sick to thinking about the Maria Goretti died a martyr evangelical virtues’. ‘The child suffering Christ, to calling on at the age of twelve on 6 July shepherds’, continued this Mary and the saints for help? 1902. She was canonised by His ‘Note’, ‘remind us that children, Your example is a lesson of life, Holiness Pope Pius XII on 24 too, have a role to play in the it is worth a year of worship... In June 1950. Church and in society... and that this way you bring peace into Francisco and Giacinta, the holiness is a vocation of every- your families... in this way you seers and visionaries of Fatima. body and a characteristic aspect build’.3 Francisco died at the age of of the people of God’ (L’Osser- Children need to learn the twelve; Giacinta at the age of vatore Romano, Spanish edition, things of God; let us tell chil- nine. They were both beatified 12 May 2000). dren about them with words; let by His Holiness John Paul II on The homily given by the us accompany them with exam- 13 May 2000. Pope during the beatification of ples. The list could be extended if Francisco and Giacinta drew at- ‘Divine things slumber in the we take into account our chil- tention to the spiritual side of depths of children and it is the dren’s hospitals, if we add the the little shepherds of Fatima duty of the educator to awaken families who live their Christian (cf. Ecclesia, 27 May 2000). It them’ (Adrienne Necker). lives in a coherent way, giving was precisely the Pope who Not all moments and circum- an example and bringing up during the celebration of the Ju- stances are the same. The edu- their children in the faith. I bilee of Children of 2 January cator must be discerning so as would like to give you two ex- 2000 exhorted young people to know how to speak during amples. with the following words: “In these moments and to accom- Alexia González Barrós, who beginning with you, children pany them Ð fostering, illumi- was fourteen years old and took and teenagers, this series of nating; transmitting energy, the real road of holiness begin- solemn Jubilee celebrations, the courage, serenity, greatness, ning with pain. She died in the Church places you at the centre goodness, and love Ð the attrib- university clinic of Pamplona on of the attention of believers. Re- utes of God which are mani- 5 December 1985. Her beatifi- ceive the gift of the Jubilee and fested in nature and in a funda- cation is now being subjected to go back home transformed by mental way in creatures. The study. the love of Jesus who has given truth that is God is said, stew- Antonietta Meo (Mennolina). you his friendship. Follow him arded, and handed on. She was born in Rome in 1930 with enthusiasm and help and died on 3 July 1937 when everybody to draw near to him b.3. The Witness of she had just reached the age of with total trust. Jesus is the Holy Children seven. She left us a diary con- Holy Door which allows you to The holy innocents. They taining one hundred and fifty enter into the Kingdom of God’ gave their own lives in Bethle- letters addressed to Jesus, to the (L’Osservatore Romano, 3-4 hem, in the place where the Holy Virgin, and to the Trinity. January 2000). 4. The Sick Child suffering. Many mothers were aged nine, afflicted by leukemia, attached to the cross, hoping for of José Manuel, aged six, and It is not easy to be face to face a ‘resurrection’, in success Maria, aged three? with a sick person. We do not achieved by medicine, even in a Ð Miguel was a child aged how to do this, we feel uncom- miracle. And then there was the seven who was ill with cancer; fortable, it is something which is professional activity, which was his was a desperate case. The difficult and arduous. All of us extensive and elaborate, and child was crying, he was ill, he was suffering and with the awareness of an adult repeated with a certain frequency between his sighs and cries: “Mummy, kill me!”. We spoke to his parents and tried to be close to them, to energise them, but we did not have further time for a longer conversation. Everything was interrupted. It was very difficult, there was so much anxiety! Ð Here is the observation made by a parent: ‘In my work I feel distant and removed and I do not trust my colleagues... I have always felt that there was a 37 lot of bad in people but after so many days in hospital I discovered this human value in the health care staff, in the volun- have gone through this experi- very serious, and in addition tary workers, in religious ser- ence, and priests in particular there were all the human and vice. I am happy even though feel uncomfortable Ð they carry ethical questions and issues my son is still sick. The hospital difficult ‘weapons’ of support in which arose every day. was a surprise’. order to feel safe when they find And in the midst of all this Ð And another parent: ‘We themselves face to face with a there was the pastoral team parents, drained of spirit and sick person. Health care staff which accompanied, encour- frightened by the incurable ill- and personnel have the technical aged and supported, and cele- ness of our daughter, were con- supports but often these consti- brated weak and sick life, but soled only by the words of the tute a barrier which give them which at the same time was life priest who accompanied us dur- only authority, prestige... These full of vitality and experience. ing the baptism and the death of are defensive weapons. All of us How many Holy Fridays, but our daughter’. have experienced these or simi- how many Easter Sundays! – ‘Many thanks, Elvira, you lar situations when we have How many memories! really helped me a great deal’. been face to face with a sick per- I remember the worry and These were the words of a son. stress of a young couple caused mother which were spoken to If this is true, it is also true by the illness of their own child the person who came to visit her that when the sick person is a who died at the age of three after the burial of her baby child the problem gets even months. And how much time daughter had taken place. worse. This is the mystery of spent in the chapel between Allow me to tell you about pain which has no age, has no hope and desperation! the witness of a young girl aged place, and not even gender. To Ð And the mother of Jordi, eight who suffered as a result of suffer at the beginning of one’s with what love and hope she an accident which also injured life Ð why should this be? Why looked after her child! her cousin, and whom we visit- do children suffer and die, that Ð How many families hoped ed in hospital quite often. After is to say the innocent? This is that we would visit them. ‘We being dismissed, she came one the question which Camus pos- were expecting you’, they often day to hospital to pay us a visit es, and it is also the question said to us. and brought various things in- which we ask ourselves. Ð And that father, Paco, disap- cluding a letter which read as I myself was a chaplain in a pointed and desperate because follows: ‘Dear St. John of God, children’s hospital in Barcelona. his child was afflicted by spina my grandmother thanks you It had four hundred beds, a large biphida, who did not believe in very much with this bouquet of consulting section, a first aid de- anything, who said that he had flowers for having looked after partment, and a maternity ward lost his faith... We pushed him to me and my cousin. Take care of with fifty beds which was joined move out of the darkness, from all the children of this hospital. to the hospital. his sadness, and with the pass- Help Yolanda and Gustavo, You can well imagine the ac- ing of the days we saw more Rafa, and all the others, who are tivity, the burden of pain and light and calm in that house, in looked after as you looked after hope, the ability of the profes- that couple with their child. me. I would like you to give a sionals, the hardship of the days, Ð And what should be said lesson to the cooks who cook the struggle for life, and many about Alicia, aged twelve, and very badly and the children of children who began their lives Juan aged eight, or of Gemma the hospital do not like their

DOLENTIUM HOMINUM N. 47-2001 cooking. I am leaving you my cover what should be the ap- advanced age, tiredness... Or crutches because I don’t need proaches, forms, and styles of even less allow yourselves to be them anymore because you presence of the component defeated by ‘illnesses of the cured me. I am leaving them to members of pastoral service. spirit’: apathy, sadness, lack of you so that other children who These are things, rather, which enthusiasm, contradictions, and need them can use them, but I should be studied and enriched the infinite difficulties that are ask you to make sure that no- through experience. I believe encountered... body has to use them this way that knowing how ‘to place one- Exercise yourselves, rather, in because I believe that there is no self’, that is to say knowing how the gifts of the Spirit: ‘love, joy, need for people to die and to to be somewhere, how to under- peace, patience, benevolence, suffer because if these horrible stand basic needs, how to have goodness, faithfulness, modera- things did not exist the whole the grounds for being sure that tion, self-control’ (Gal 5:22), world would live happily. I say you have a minimum of quality strength, hope; convinced that this to you with all my love, Is- for the ministry of that place, great works are the fruit of God abel Maria’.4 and for the organisation of that but things which need our Scenes like this are many in service, are the inescapable bag- co-operation. number in a children’s hospital, gage upon which all the compo- In this way will be born the and certainly a priest will not nent members of the pastoral new evangelisation: new in ar- have time to analyse as a psy- service should be able to rely. dour, new in methods, and new chologist does the experiences, All these criteria will help in in its expressions and manifesta- states, thoughts and reactions of the daily construction of pres- tions. a child in relation to ‘his illness’ ence, dialogue, help, and sacra- These are the bases and the or ‘his death’. We leave this mental and liturgical celebra- criteria around which we should 38 analysis to the specialists and tion. They will impart light to organise pastoral service in a we think in overall terms of the our words, and meaning to our children’s hospital which guar- daily life of the hospital with its actions. We experience the plea- antees an evangelising pres- large number of scenes and situ- sure of sharing hopes and des- ence. To this subject the next ations of parents and children peration, pain, anxiety, and joy section of this paper will now who suffer. In many cases pas- at the achievement of success, be devoted. toral care must be directed more of getting better. We will see towards the first Ð with their new lives being born, lives res- pain and their worry Ð than to- urrected amidst pain and death. wards their children, even those It is enough not to be submerged these last are very young. If the by routine, by improvisation, work of the hospital takes place and by not knowing what to do. in a real team, the pastoral ser- Today the Spirit is present, vice will be helped by other pro- working. Today it continues to fessionals, above all else psy- choose proclaimers of the news chologists, social workers, etc. of life, of resurrection, of love, It is enough to be in a team to of joy, of celebration. To this ‘gain advantage’ from the skill call of the Spirit we must give of the professionals so that this enthusiastic and intelligent an- can be of use to pastoral service. swers which are born from faith, I believe that pastoral service full of the Spirit. The risks and must play an important role in the trials will be many in num- the ‘child-parents’ tandem and ber but it is productive to call above all in the child-mother out with the strength of the Spir- tandem in order to understand it: “I am here”. experiences, needs, and prob- Evangelised to evangelise. lems; to understand life and be We are convinced that what we present within it. For this reason, proclaim is not our inheritance 5. The Service of pastoral care and service should but what is entrusted to us by Evangelisation in a be largely directed towards a re- the Lord: “Go and spread the Children’s Hospital lationship of health in which Gospel”. We are convinced as trust is born, and beginning with well that the design of God is a. To Evangelise Ð the Specific which one can deal with the very conditioned by the freedom of Mission of the Church many problems which come to those men who reject and do not the fore during moments of pain. welcome the message. The Church exists to evange- The best pastoral care will be, We must now follow the ex- lise, to proclaim, and to commu- therefore, a constant, discreet, ample of Christ, of the Apostles nicate the Good News, as a con- non-invasive presence, a pres- and of many evangelisers who tinuator of the words and ac- ence which is organised and did not withdraw in the face of tions of Jesus (Mt 28; EN co-ordinated in character and difficulties. Indeed, they armed 13,14). which lays stress on the salient themselves with courage, with Evangelisation is the reason points of the needs of people in a enthusiasm, and with hope. for the existence of the Church hospital. At the centre of things I exhort you for this reason and if this is her specific mission there will be the sick child and not to allow yourselves to be de- then all her members must be around him his parents and the feated by ‘illnesses of the body’ strongly aware of their own re- health care staff and personnel. which can check your evange- sponsibilities as regards the This is not the place to dis- lising enthusiasm Ð poor health, spreading of the Gospel. a.1. Awareness of this Mission tian meaning of suffering and a.2. An Evangelisation which To the Church as a communi- the second a Motu Proprio is new in Ardour, ty of believers, through the which established the Pontifical Methods and Expression apostolic mandate, is entrusted Council for Health Pastoral Pope John Paul II in his en- ‘caring for the sick’. This care Care, set in motion a new move- cyclical letter Veritatis Splendor for the sick is inseparable from ment for pastoral care for sick (6 August 1993) referred to this ‘evangelisation’. people. approach to the ‘new evangeli- The tradition itself of the This pastoral care and con- sation’ launched ten years ago Church, through her Magisteri- cern was referred to in the same in a speech to the bishops of the um, teaches us: way by the Pope in his two CELAM (9 May 1983). The Ð that service to the sick is an apostolic exhortations, Christifi- Encyclical has the following integral part of her mission (Do- deles Laici, sections 53 and 54, lines in section 106: ‘Evange- lentium Hominum, 1); and Vita Consecrata, sections lization is the most powerful Ð that the Church seeks en- 82 and 83. and stirring challenge which the counter with man in a particular In the same way the pastoral Church has been called to face way through the path of suffer- care and concern of the Church from her very beginning. In- ing: ‘man is the way for the towards sick people in to be deed, this challenge is posed not Church’ (Salvifici Doloris,3); found in the whole of the Mag- so much by the social and cul- Ð that caring for the sick is a isterium of the present Pope, tural milieux which she encoun- diaconia of local Churches and both in his numerous speeches ters in the course of history as the universal Church. This min- at meetings with sick people and by the mandate of the Risen istry does not confine itself to professionals of medicine,5 and Christ, who defines the very her faithful alone but, out of loy- in documents of great important reason for the Church’s exis- alty to the Gospel, is open Ð and and relevance Ð canonic legisla- tence “Go into the world and 39 indeed must be open Ð to all tion, the new Catechism, en- preach the Gospel to the whole those who suffer (Lc 10:25-37); cyclical letters, and apostolic creation” (Mk 16:15). At least Ð that care for the sick in- exhortations. In all of these we for many peoples, however, the volves approaching men in their find passages which directly or present time is instead marked spiritual-somatic unity (DH, 2); indirectly refer to the field of by a formidable challenge to Ð that it is thus mandatory up- health and health care and undertake a “new evangeliza- on the Christian community to which we have collected togeth- tion”, a proclamation on the help a sick person to free him- er and commented upon in the Gospel which is always new self from everything that hin- journal of our Pontifical Coun- and always the bearer of new ders suffering from being for cil, Dolentium Hominun. I here things, an evanglization which him and for other people ‘a present them as follows: must be “new in its ardour, force for redemption’ (SD, 19); Pastoral care in health in the methods and expression”’. Ð that care for the sick is an documents of the Church: Five years after his speech to ecclesial ‘diaconia’ which ex- Works written in the journal the CELAM in Salto in presses in a perfect way its of the Pontifical Council for Uruguay, the Holy Father ex- essence as a ‘universal sacra- Health Pastoral Care, Dolentium plained the meaning of those ment of salvation’ (LG, 1). Hominum: sentences and said that evange- This care and concern of the Taking care of sick people ac- lisation would be new in its ar- Church for sick people, whose cording to canonic legislation dour if Ð according to the extent witness is not only broad and (DH 11, pp. 5-8). to which it would be implement- wide but also great in terms of The Church and sick people ed Ð it increasingly strengthened quality, as is borne out by histo- in the new Catechism of the union with Christ, the first evan- ry; this care and concern, and I Catholic Church (DH 23, pp. geliser; it would be new in its repeat the point, has been em- 44-7). methods if every member of the phasised by the Magisterium Encyclical letters and apos- Church became a protagonist of over recent years. His Holiness tolic exhortations: the spreading of the message of Pius XII illuminated medical Ð Spiritum Vivificantem Christ; for this evangelisation to science with innumerable (DH 5, pp. 18-20). be new in its expression as well speeches of great relevance to Ð Christifideles Laici people would have to have their the present moment. Vatican (DH 12, pp. 8-10). ears wide open to what the Lord Council II, in addition to its Ð Redemptoris Missio could suggest at any moment. message to sick people, urged (DH 17, pp. 7-9). Every evangelising action both bishops and priests to have Ð Centesimus Annus must always begin with an ac- the greatest care and concern for (DH 17, pp. 10-12). tion from within. That is to say ‘the sick and the dying, visiting Ð Pastores Dabo Vobis the evangeliser must first evan- them and comforting them in the (DH 21, pp. 8-10). gelise himself or herself, under- Lord’ (PO, 6, 8; LG, 38). Canon Ð Evangelium Vitae go the experience of the en- law itself (can. 529 para. 1) re- (DH 29, pp. 4-14). counter with Jesus the saviour minds parish priests of their duty Ð Vita Consecrata (EN, 24) because evangelisation to help the sick and dying and (DH 32, pp. 7-10). is above all the communication reminds them that they should Ð Una Speranza Nuova per il of an experience. This is not a do so with generous charity. Libano (DH 36, pp. 10-11). professional activity connected Lastly, the two documents by Ð Ecclesia in America with ideological propaganda, the present Pope, John Paul II, (DH 41, pp. 6-8). nor a philanthropic service. It is, Salvific Doloris and Dolentium Ð Fides et Ratio above all else, a witness of life. Hominum, the first on the Chris- (DH 41, pp. 9-16). In order to transmit the doctrine

DOLENTIUM HOMINUM N. 47-2001 in a convincing way witnesses most insidious are certainly nites our lives and our futures, are required. those for which attempts are and which ignites our vacillat- We must avoid apostolic iner- made to find support in one or ing and tired steps. To ignite tia; we must go beyond past other teaching of the Council’ means to place one’s soul, one’s schemata and repetitive (EN, 80). life, one’s love, one’s service, rhythms. All of these cannot The Pope seeks to encourage and one’s solidarity in the ‘tech- meet people’s needs. It is not and stimulate people to over- nical body’, in the health care possible to evangelise with iner- come these difficulties: ‘the in- structures. Pastoral service must tia. ‘We must always escape the ternal and external difficulties be the soul of the hospital, the situation of a Church which has must not make us pessimistic or soul of the health care structure. lost her first love, which toler- inactive. What matters in this as It must be a fire which burns, ates idolatry, which has given in every other sector of the which imparts enthusiasm; a way to compromise; we must Christian life, is the trust that light which illuminates, a joy always avoid the torpor of a comes from faith, that is to say which alleviates pain, is compa- Church which is asleep or the certainty that we are not the ny in loneliness, and love which which lives in a lukewarm way protagonists of the mission Ð heals and saves. in mediocrity. This must be that role falls to Jesus Christ done so that we can be a poor and his Spirit. We are merely a.3. The Training of those Church, a Church which listens helpers’. Engaged in Pastoral Care to the Holy Spirit. The transfor- In 2001 we will celebrate the in Health mation of the human so as to ninth World Day of the Sick in Today, it will be difficult to make him divine Ð this requires Sydney, Australia. Its subject achieve a new evangelisation in a metanoia, a radical change. will be: ‘the new evangelisation line with the criteria which have 40 Such as that progressive and and the dignity of the man who just been pointed out if those then decisive change of the dis- suffers’. who engage in pastoral care in ciples of Emmaus: converted by In the message which the health do not have a basic pas- the word and by the alive pres- Pope has sent on the occasion of toral training and if this training ence of Christ, they proceeded this World Day there is empha- is not periodically up-dated. to change the direction they sis on the need to evangelise the Vatican Council II placed a were taking’.6 health and health care sector, in- great deal of emphasis on this Pope John Paul II faces up to volving as it does great human pastoral training and observed this difficulty. Section 36 of Re- experience. that all the other aspects of train- demptoris Missio, which refers In section three of his Mes- ing must be directed towards to difficulties within the Church, sage, the Pope tells us that hos- pastoral goals and objectives is of relevance here: ‘internal pitals are sanctuaries where (OT, 4). In the decree Apostolica difficulties within the people of people take part in the paschal Actuositatem, in sections 28 and God are not absent, indeed these mystery of Christ and that it is 29, it is argued that pastoral are the most painful. My prede- important that in these structures training must be multifaceted cessor Paul VI pointed out in the there should not be absent a and complete, suited to the vari- first instance ‘the lack of fer- clear and meaningful presence ous forms of the apostolate (sec- vour, even more serious because of believers who learn from tions 16-19, 31). it is born from within. It is ex- Christ to be Good Samaritans. ‘The clear objective will be to pressed in tiredness, in disap- Hospitals, health care centres achieve sufficient discernment pointment and above all in a and centres for elderly people of the pathways which the Spirit lack of joy and hope’ (EN, 80). are favoured milieux of the new is pointing out to the Church Past and present divisions evangelisation, says the Pope. It within the changes of this soci- amongst Christians are also is important at the beginning of ety which is in a state of radical great obstacles in the path of the the new millennium that a re- and accelerating transformation. missionary work and commit- newed impetus is given to evan- One is dealing here with educat- ment of the Church (AG, 6), gelisation in the health care ing through a serious theology deChristianisation in Christian world, the place indicated as of pastoral action which em- countries, the decline in the vo- that which should become a braces all fields: the moral, the cations to the apostolate, and the valuable laboratory of the civili- social, and the spiritual; with counter-witness of the faithful sation of love, as the Pope says training people through knowl- and of Christian communities in this Message. edge of a suitable of pastoral who do not follow the model of ‘If you are what you should methodology and an upright set Christ in their lives. But one of be you will ignite the whole of of criteria for action; of setting the most serious reasons for the the world’ (John Paul II to out the terms of the responsible scarce interest in the missionary young people in his homily at solidarity of the Church in her task is the indifferentist mentali- the end of the World Day of action as regards human society; ty, which is often rooted in an Youth, 20 August 2000). of educating people in basic unsound theological vision and These words are those of work, in personal initiative, in a marked by a religious relativism St.Catherine of Siena and the spirit of association, in team which believes that ‘one reli- Pope employs them to send his work, in openness to solidarity gion is worth the same as anoth- message to young people. They in ever broader forms’ (cf. Joint er’. We could add, as the same are words of great topical rele- assembly of bishops and priests, Supreme Pontiff himself ob- vance for pastoral care in health Spain, ‘ponenza’ VII). served, that there are also ‘alibis care centres where it is neces- The instruments to achieve which can impede people from sary to ignite an inner, spiritual this training are now many and engaging in evangelisation. The apostolic fire, a fire which ig- varied in number. People are trained beginning with experi- there are things which cannot be bishops and priests, Spain, ‘po- ence, with integration into pas- measured. nenza’ III, 01 and 02). toral activity where good organ- Pastoral action springs from a isation, co-ordination, and as- community of people and tends b. The Pastoral Project sessment exists. This is a very to create a community life of important teaching chair. Train- faith, charity, and participation. This must involve the following is achieved through attend- As a result: ing headings: the people whom ing the lessons of good mentors, 1. The result of pastoral ac- the project is directed towards, courses, and weeks of reflection tion cannot be measured in the pastoral team, and the pro- and thought. In order to achieve quantitative terms. It is not ac- gramme itself. education and training in pas- tion which leads to a production toral care in health with the aca- of things. b.1. The People whom the demic qualifications of a degree 2. The specific criteria of pas- Project is Directed towards: and a doctorate in the theology toral action require a process of Children’s Hospitals of pastoral care in health, at the elaboration which cannot be ex- Ð This is a project which takes present time there exists only pressed solely with legal con- into consideration the place, the one centre in the world Ð the cepts. hospital, with its many techni- Camillianum in Rome, directed 3. The organisational ap- cal, organisational, economic, by the Camillian fathers. How- proaches of public bodies, of social and ethical aspects. ever, in many countries schools trade unions, and of industry etc. Ð This is a children’s hospital, and centres for pastoral care in cannot be applied in a unilateral and therefore there must be a health are coming into exis- way to pastoral action, even knowledge of the realities of tence, and this subject is being though all the advances of the children, their experiences, their increasingly taught in seminar- human sciences in relation to needs, and the reactions which 41 ies and institutes which are en- group dynamics, work organisa- are required when there is a situ- gaged in teaching pastoral care. tion, planning, and so forth must ation of illness. I would like to emphasise the be certainly taken into consider- Ð To also see in a particular need for the health care worker ation. way the family context to under- to include in his life project a Pastoral action requires its stand the contact and the role certain space for on-going train- own channels which provide that the parents and above all ing. We should not forget that greater breadth, greater effec- else the mothers have. the reading of books, journals tiveness, and greater perma- Ð Knowledge of the health etc. makes up a part of this kind nence. These may be called pas- care staff and personnel Ð their of training, and that this acts to toral structures. ties, motivations, values and keep a person’s mind lively and The structures of the Church needs. his ideals active and operational. are functional and instrumental Ð The dynamics and daily life And one can pose the ques- when it comes to the carrying of the hospital and in particular tion: what is the result of all out of her mission. This is why a knowledge of the average stay of the children in the hospital. Today this stay is very short and conditions ‘solid and permanent’ projects. Plans must be engaged in with a new mentality in relation to so-called ‘urgent’ pastoral action as regards a short stay and when there are conditions of a long stay in the hospital.

b.2. The Pastoral Team It is true that in many cases there will only be one person linked to, and responsible for, the pastoral care provided in the centre. However, in this case as well this person must summon to help him ‘voluntary workers’ who have specific functions involving visits, the administra- this? The answer is that it is al- they are necessary and contin- tion of Holy Communion, and ways positive. A great deal of gent; this is why they are inter- so forth. progress has been achieved. A changeable. In many other cases there is a great deal, however, has still to The pastoral structures of the real team made up of a priest or be achieved, but so far the re- Church have a co-substantial priests, female members of reli- sults which have been obtained contingent and instrumental gious orders, and members of are a source of enrichment. character Ð they are never an the laity. All of these figures But we must be careful Ð we end in themselves, they come must have a good knowledge of must not fall into the trap of from life, they must loyally the hospital context and envi- stressing that which can be mea- serve life and be renewed with ronment, be ‘ready’ to carry out sured. Indeed, in pastoral care life (cf. the joint assembly of pastoral action in this sector, and

DOLENTIUM HOMINUM N. 47-2001 be suited to their tasks. The im- Once what programming is er its size, its dynamics, and its portant thing in pastoral action has been defined, the question concrete situations. This is are the people involved, that is poses itself: how should pro- something which is fundamen- to say its agents. Indeed, a per- gramming be engaged in? The tal. One is also dealing with a son cannot give what he does answer is the following: through pastoral team which wants to not possess. pastoral action which has goals operate as such, involving Pastoral care is worth what and aims. This is because we be- trained people with enthusiasm the pastor is worth; evangelisa- lieve that this is a largely educa- and the will to work; individuals tion is worth what the evangelis- tional process which responds in with a programme which envis- er is worth; and an apostolate is a better way to the end which is ages concrete activities and the worth what the apostle is worth. aimed at; because it obliges us allocation and co-ordination of These figures are not ‘func- to define choices in a better way functions. tionaries’ but rather witnesses and to be more serious as re- In this programming we who enlighten, stimulate, co-or- gards the tasks involved; be- should not forget two funda- dinate, supply, and transmit cause it progressively influences mental criteria Ð we must re- hope, experience, and life. the renewal of those engaged in spect the creed professed by the It is important to promote the word in a team, to create a team, to foster it, and to ensure that it achieves and obtains knowledge. Each and every team, each and every group, is always a dy- namic reality and has a process 42 of maturation similar to that possessed by a person who always passes through the same stages of life, that is to say, childhood, adolescence, maturity, and adulthood. At the beginning of the training of the pastoral team the following factors must be taken in- to consideration: Ð patience (life does not develop in an instant): Ð capacity for enthusiasm and hope; pastoral care; and because it patients, their family relatives, Ð a certain amount of techni- compels us to engage in greater and the workers who are pre- cal skills (because good will is levels of fostering and co-ordi- sent. Pastoral service must be not enough); nation. integrated into the work of care Ð material and mental time to This organisation based upon which is provided within the be devoted to the members of aims and goals requires an hospital. In no way should it be the team; analysis of the field of our work an island within the hospital. Ð a good choice of co-ordina- in terms the needs and possibili- A question then poses itself: tor to ensure that during the first ties which exist. Once the field what kind of pastoral activities stage of training of the group of work is analysed, it is neces- should be engaged in within a there are not any people who sary to propose general objec- children’s hospital? After my create difficulties. tives and specific and concrete comments on the pastoral team If the guiding spirit and the in- actions. and the actual place where the spiration of the pastoral team are The activities which support pastoral service is engaged in, I factors of change, of transforma- this programming must be stud- will dwell upon certain areas of tion, then the group can achieve ied well and have the ability to pastoral care. this transformation more easily. be carried into practice, con- It is easier to change a person nected with each other, in a way 1. The Staff of the Hospital who is part of a group than a per- which takes into account the cri- son who is isolated. A change terion of effectiveness. They A constant relationship with which is achieved within a team must also be convergent. It is al- the medical and nursing staff generally lasts longer. We also so necessary to take into consid- will strongly favour pastoral dy- know that decisions are more eration the principle of gradual- namics. The strong points of this easily accepted if they are made ness and the overall approach. relationship could be the follow- within a group. Lastly, in the programming ing: we must take into consideration Ð taking advantage of the vis- b.3. The Programme the present situation in which its to the wards and other ser- ‘Pastoral programming is the we find ourselves, what we vices; study, the drawing up, and the want, and what it is possible to Ð programming initiatives for deciding on a series of suitable do. the staff and personnel such as and appropriate pastoral actions For this reason, in this case courses, conferences, etc.; to ensure that the hospital the programme takes into ac- Ð integrating the pastoral ser- moves from a given situation to count the children’s hospital as a vice into the teaching dynamics one which is better’. reality: it is necessary to consid- of the hospital; Ð taking advantage of holiday ics and areas of thought and re- 2. Learning situations and social and family flection of the hospital Ð ethical events...; committees, welcoming and hu- From the child, from his or Ð co-operating with the manisation committees, teach- her family relatives, from the inter-professional team in mat- ing and instruction; health care staff, we learn to ters relating to the study of Ð the periodic assessment and enter into contact with others, ethics, humanisation; evaluation of pastoral activities to interact. We learn to rely up- Ð the questions and issues at various levels in line with a on people. They bring out how which arise in professional prac- specific and sensitive chrono- fragile we are and they teach us tice. gramme; that it is beginning with our Ð taking care of contacts with fragility, with our vulnerability, 2. With Children the local parish, the pastoral that we perform pastoral care area, and the diocese. This will and action. Only the ‘wounded’ The age, the situations and help to provide ideas and com- person, the vulnerable person, the length of stay in the hospital municate experience, in addition can heal and save. where the child is being treated to receiving both of them as must be taken into account. well. 3. Saying With all these elements taken in- to consideration, a pastoral pres- Before saying things we ence is defined which is directed Conclusion should listen and receive, cre- above all else towards: ate a context of nearness, of Ð constant and planned visits; After this long exposition, in friendship which accompanies – a ‘catechistic’ presence, es- which I have sought to identify a person, which takes care of pecially in services for a child and to shape a pastoral pro- people. 43 admitted to hospital for a long gramme for children’s hospitals, We should tell, invite, offer time, together with his school I would like to conclude by and exhort a person to take up which beginning with the hospi- summarising what has been said his bed and walk (Mk 2:1-12). tal follows the schooling of the in this paper by refering to the We should impart enthusiasm, child; four following notions: being, open up spaces, give life to Ð a sacramental dimension. learning, saying, and doing. ‘paralysis’, throw light on life Here various factors are at so that the encounter takes work: the number of children in 1. Being place, so that the other person the hospital who are of an age to discovers his or her own faith receive the sacraments, the reli- To ensure good music what is without having to be convinced. gious practice of the children, really important is the musician, Jesus in this is an example for the celebrations of the sacra- and not the musical instrument. us. Emmaus (Lk 24), Zaccha- ments that are possible, how Similarly, in pastoral care and rias (Lk 19), and Matthew (9: they should be practiced and work what is important is not 9-13). We must be certain that when; the programmes but the pastors, we will discover the presence of Ð the family. Everything that what they are, and the life and God in our neighbour, as hap- we do takes place through the the Spirit that they place in their pened with Mary and Elisabeth family: visits, religious actions, programmes. (Lk 1: 39-47). celebrations, etc. All these reali- In pastoral care and work, if We tell, we sow, but we ties should take into account the trust is not placed in the Spirit leave space to God; it is He mediating role of the family as then failure is the result. The who sows; let us allow time for regards the child and at the same Holy Spirit is strength and growth Ð after all every seed time the evangelising dimension light; the Holy Spirit is the pro- needs time to grow (Mt 13). that applies to the family. tagonist of evangelisation. It is not our methods which produce 4. Doing 3. The Team effectiveness; it is the Holy Spirit which performs this of- Programming: we need to The first dimension of the fice. Pastoral care and work are perceive needs, create, cele- programme must also take into a question of witness more than brate, participate, co-ordinate, account the nature of the team Ð methods. In pastoral work and and assess and evaluate. What its needs and its responsibilities. care it is not our efforts which should I do in a children’s hos- The elements of the programme matter Ð strength lies not in do- pital? Provide solutions? Be regarding the team could be the ing but in being, being able to paid back by God? Play at be- following: make the Risen Christ present, ing a doctor or a nurse? What Ð paying attention to the peo- in ensuring that people discover should we do, lastly, in the ple who make up the pastoral Christ and can say: he is the sphere of pastoral action and team: their training, experi- Lord! (Jn 21). care? ences, rhythms, integration, and What should we do for sick Like the Samaritan (LK 10: activity; children? We must be witness, 30-35), we should stop, draw Ð the strengthening of the dif- presence, silence, smiles, joy, near, and take care of. But re- ferent areas of the team: group hope, happiness, healing, and member: we are mediation, we dynamics, relations of mutual salvation. This is the dimension are Samaritans who draw near help, and the celebration of the which the pastoral team must be to the wounded man, take care faith; able to infuse in all the pastoral of him, place him on our mule, – ‘authorised and responsible’ care and action which takes and take him to the inn... the participation in certain dynam- place within the hospital. Lord does the rest.

DOLENTIUM HOMINUM N. 47-2001 Decalogue for the Overall H.H. JOHN PAUL II, ‘Textos con moti- A. PACIOLLA, ‘Psicologia della reli- vo de la beatificación de los niños Fran- giosità infantile’, in L’ancora nell’unità Care of the Sick Child cisco y Jacinta’, Ecclesia, 27 May 2000, di salute (Edizioni Centro Volontari della pp. 24-32. Sofferenza, n. 2, Rome, 1990). When I was a chaplain in the R. COLES, La vita spiritual dei bambi- CONFERENCIA EPISCOPAL DE PORTU- children’s hospital of St. John of ni (Rizzoli, Milan). GAL, ‘Nota pastoral sobre la beatificación M. ZATTONI and G. GILLIANI, Proteg- de los pastoritos de Fátima’, Osservato- God in Barcelona, a decalogue gere il bambino (Ancora, Milan, 2000). rio Romano, Spanish edition, 12 May was written which covered the A. STURIALE, Il libro di Alice (Rizzoli, 2000. scientific, human, deontological Milan, 1999). Revista Cuardernos de Bioetica, vol. M. R. DEL GENIO, Carissimo Dio XI, n. 14, 2000, January-March, Santia- and religious aspects of what Padre (Libreria Editrice Vaticana, 1999). go. was intended, a sort of commit- S. CAVALLETTI, Il potenziale religioso L.ACCATOLI, Cerco fatti di Vangelo ment on the part of the hospital tra i 6 e i 12 anni (Città Nuova Editrice, (Società Editrice Internazionale, Turin). to engage in and achieve overall Rome, 1996). P.M. REDONDA, ‘Aspectos éticos de la J.L. REDRADO, Presencia cristiana en atención pediátrica’, in Solución de dile- care for the sick child. This clinicas y hospitales (PPC, Madrid, mas éticos en la prática clinica (Cuarder- decalogue is as follows: 1969). nos de Bioetica, 1998/4). 1. Overall care for the child is J.L. REDRADO, ‘Programación y ani- AA.VV., ‘La famiglia e l’integrità del mación de la pastoral en el campo sani- disabile nell’infanzia e nell’adolescenza’, our first and our principal duty. tario’, Dolentium Hominum, n. 24, 1993. in Atti del Congresso organizzato del 2. We declare that we will J.L. REDRADO, ‘El trabajo pastoral en Pontificio Consiglio per la Famiglia et subject our opinions and our un hospital infantil’ (Servicio hospital in- Vita, Anno V, 1/2000. fantil S. Juan de Dios de Barcelona), in S. NENNOLINA, ‘Dottore della Chiesa a love to scientific truth. Actas del Congreso “Evangelización y sette anni?’, Vita Pastorale n. 3/2000. 3. The practice of teaching in hombre de hoy” (Edice, Madrid, 1986). P. VANZAN S.I., ‘Antonietta Meo, det- relation to the child will never J. LOZANO BARRAGÁN, Teologia e ta Nennolina: una musica di sei anni’, La be damaging for him or, nor will Medicina (Selare, Bogotá, 2000). Civilità Cattolica, 4 Dec. 1999. A. NARDêN, ‘La cura pastorale in un AA.VV., ‘Antonietta Meo’, Diziona- it offend his or her dignity. ospedale pediatrico’, Insieme per Servire, rio di Mistica (Vatican). 44 4. In the field of paediatrics, April-June 2000. Articles on the sick child published in the medical doctor and the nurs- A. PANGRAZZI, ‘El Capellán, la asis- Labor Hospitalaria. HH San Juan de tencia religiosa y la Capellania’, Dolen- Dios. C/Antoni Pujadas, 40 Ð 08830 Sant ing staff must act as delegates of tium Hominum, 33, 1996. Boi de Llobregat (Barcelona): the parents and for this reason ‘Seminario di studio sobre el tema F. FOX, ‘Preparación del niño para la love for the child must guide “La identidad del Capellán Católico en la hospitalización y la intervención quirúr- Pastoral de la Salud y Sanidad en los gica’, Labor Hospitalaria, 146/1972. and shape their work of help and Umbrales del 3er Milenio, 22-23 J. REDRADO, ‘El niño y la muerte’, La- care. Noviembre 1999’, Dolentium Hominum, bor Hospitalaria, 159/1976. 5. Any doubt that arises in re- 44, 2000. C. ESERVERN, ‘Los niños y los jóvenes C. CANGIË, Un papá di nome Dio minusválidos’, Labor Hospitalaria, lation to the treatment of the (Paoline e Assioma). 207/1978. child will be dealt with through E. SAVINI and C. COLOSIO, ‘Click su Parlamento European, ‘Derechos del consultation at the necessary Jesú?’ (Paoline e Laboratorio delle Idee). niño hospitalizado’, Labor Hospitalaria, VV.AA, La Iglesia en el mundo de la 207/1998. level. salud (Edice, Madrd, 1982). Comité Etic (Barcelona), ‘Criterios de 6. In relation to children, VV.AA., Congreso Evangelización y muerte cerebral en los niños’, Labor questions of race, religion, na- hombre de hoy (Edice, Madrd, 1986). Hospitalaria, 212/1989. tionality, social origins, or J.A. PAGOLA, Acción pastoral para Convención de la Naciones Unidas una nueva evangelización (Sal Terrae, sobre los derechos del niño’, Labor Hos- friendship are of no influence Santander, 1991). pitalaria, 220/1991. whatsoever. COMISION EPISCOPAL DE PASTORAL, La Cahué, ‘¿Hablar de la muerte con los 7. The incurable child, too, asistencia religiosa en el hospital (Edice, niños?’, Labor Hospitalaria, 225-226/ Madrid, 1987). 1992. has the right to live, to be cared L. BRANDONI, ‘I Fondamenti deonto- OTERO, ‘¿Cómo tratar con los niños el for, and to be loved. logici della professionalitá sanitarie’, in tema del sufrimiento?’, Labor Hospita- 8. We will give all the infor- Educazione e salute del bambino (Centro laria, 235/1995. mation that is necessary to those Editorial Cattolico Carrocio). MEDICAL RESEARCH INVOLVING CHIL- P. PELLIGRINO, Appunti di educazione DREN. BRITISH PAEDIATRIC ASSOCIATION, of our colleagues or the institu- religiosa (Elle DiCi, Turin, 1994). ‘Guías para la investigación con niños’, tions who will carry on with the L. SANDRIN, ‘Bambino malato’, in Labor Hospitalaria, 237/1995. treatment of the child. Dizionario di teologia pastorale sani- VARIOUS AUTHORS, ‘Equip pediátrico’, taria (Camillane, Turin, 1997). Labor Hospitalaria, 256/2000. 9. We will promote social E. SAPORI, ‘Il bambino e la morte’, M. MIGUEL, ‘Aspectos espirituales’, paediatrics, the prevention of ill- Anime e Corpi, September/October 1993. Labor Hospitalaria, 256/2000. ness in, and accidents to, chil- A. BARGAMO, ‘Pianeta bambino: verso una nuova cultura’, in L’ancora nel- dren through public campaigns l’unità di salute (Edizioni Centro Volon- and scientific meetings. tari della Sofferenza, n. 2, Rome, 1990). Notes 10. We declare ourselves 1 C. ROCCHETTA, Teologia della united to, and partners of, the tenerezza (EDB), pp. 145-146. World Health Organisation and 2 P. PELLIGRINO, Appunti di edu- UNICEF. cazione religiosa (Elle DiCi, Turin, 1994). 3 Ibid., p. 12. H.E. Msgr. JOSÉ L. REDRADO, 4 J.L. REDRADO, ‘El trabajo pastoral en O.H., un hospital infantil’, see Atti del Con- Secretary of the Pontifical Council gresso. for Health Pastoral Care, 5 J. JACIELKA, ‘La pastorale degli am- the Holy See. malati nell’azione e nell’insegnamenti di Giovanni Paolo II (1978-1992)’. In this doctoral thesis the author brings together 310 meetings of the Pope with sick peo- Bibliography ple and 230 meetings of the Pope with health care professionals, from 1978 to H.H. JOHN PAUL II, Letter to Children 1992, which took place in health care in the Year of the Family (Vatican, 1994). centres, parishes, and audiences granted H.H. JOHN PAUL II, Message for the to study-groups, conferences, etc. World Day of Peace 1996, ‘Let us Give 6 F.X. NGUYEN VAN THUAN, Testimoni Children a Future of Peace!’. della speranza (Città Nuova, Rome, 2000). Philosophy, the Construction of a Profession

1. Introduction ing after people, which is the Ð What am I doing? specific activity of nurses, is Ð What must I do and how The nursing profession is something which is very seri- must I do it? fundamental in the vast field of ous and involves much more Ð What does society expect health and health care. Not to responsibility than looking af- of me or what does it entrust recognise this would be a ter machines, computers or me with? calamity for the well being of numbers. It means taking care Upon what bases must it be society, populations, families, of a human being in his psy- based so that it proves: and individuals. chosomatic and socio-anthro- Ð advantageous; It is a certain fact that the pological unity. This is some- Ð fruitful; nursing profession is very well thing which is serious! Ð attractive; known about in the field of This profession does not be- Ð acceptable? health and health care, but it is long to the field of treatment, my opinion that the nursing which is the specific field of Now that the nursing profes- profession receives very little the medical doctor, but rather sion has reached a university recognition. complements and enriches the level, and when we now ask In a world which is already service of care and looking af- that jointly with us a university very advanced as regards many ter people. It is all a question of law is drafted and passed re- 45 sciences, experiences and knowing how to plan Ð a sci- garding the acquisition of all knowledge, the nursing profes- ence which today is an impor- the relevant academic qualifi- sion is easily placed in the con- tant part of the academic nurs- cations, it is logical that we be- text of ‘science, experience and ing curriculum. This profession gin to give signs of greater pro- knowledge’. It has undergone needs to obtain all the relevant fessional maturity, that we an increase in its responsibili- academic qualifications, and know and want to ask our- ties and it has identified them society needs competent, bal- selves aware questions, and and faced up to the conse- anced, and responsible male that we seek to obtain satisfac- quences. It has incorporated and female nurses who are able tory results. That we know how knowing how to be and how to to want and to obtain team- to distinguish what we should be spatially into its knowing work. do and that this is adapted to about how to do things. Today, what is requested by society. this profession has been placed We could form a kind of ax- on the level of a science and for 2. The Principles and Goals iom: our profession must adapt this reason involves and re- of the Nursing Profession itself to what society asks of us quires empirical contents and or may require of us. We speak epistemological elements. (I The nursing profession, in its here about society and not mean by epistemology the doc- long trajectory, has not been in- about the ideas of an interest trine of the foundations and clined to ask itself, or has only within society. methods of scientific knowl- just begun to ask itself, the fol- The nursing profession, ig- edge). lowing questions: norant or forgetful of its princi- With its move to the univer- Ð What is it (what am I)? pals and its ends, must con- sity level, the profession has Ð What do I want to say? struct or reconstruct its idiosyn- been enriched not only, and a Ð What am I seeking? cratic self, that is to say its great deal, in its own tasks and activities, but also with regard to other elements which come from medical doctors, pharmacists etc. Furthermore, it is enriching its own ‘curriculum’ through contents based upon principles relating to statistics, informatics, physics, management, psychology, sociology, law and other branches of knowledge such as philosophy, anthropology, human relationships and aid, its own history, the history of health and health care, etc. Some people, but they are increasingly few in number, argue that a higher level of knowledge is not necessary. They ignore the fact that look-

DOLENTIUM HOMINUM N. 47-2001 character, its individuality, its ploring, magical, psychologi- Philosophy, philosophical particular nature, its way of be- cal or natural in character. And principles; ing, of locating itself, and of he goes on to observe: implor- anthropology; doing and acting. This means ing speech is prayer; magical semiology; that the nursing profession speech is empirical care and culture; must construct its own sphere treatment, healing; psycholog- quality; of reference for contemporary ical speech is speaking pleas- ethics; times, for the geo-political or antly and evocatively.3 history... geo-social space in which we For all these reasons we can These are principles which are journeying, in which we observe that the nursing profes- do not allow space for contro- move, or in which we find our- sion is the profession which us- versy, and they require debate, selves. es praxis and logo in treatment discussion, the contrast and in- The doctrinal and opera- or care for sick people. Basing teraction of constructive, tional nursing ‘corpus’ comes itself on the philosophy of E. strong, realistic, and where this from the most meaningful and Kant, it revolves around three is possible, positive, opinions. ancestral aspect of the con- principles, which are as fol- They are our ‘logo’ and our sciousness of mankind.1 At the lows: ‘practice’. moment that the first feeling of Ð critique of pure reason; pain, affliction, and weakness Ð critique of practical reason; appeared on the earth within Ð critique of judgement.2 3. The Nursing Philosophy human beings, the nursing pro- In this paper I will not dwell fession also made its appear- upon practical reason, the prin- Every profession which sees itself as being a university pro- 46 fession must demonstrate that it possesses, and bases itself upon, philosophical foundations. Philosophy is not only the beginning of every higher reflection; it also becomes the principal element of human activity and feelings. To engage in philosophy means to search for basic principles so as to lo- cate foundations in something which is solid, in what is most solid and meaningful in action and abstraction, in professional and also human care. ‘It is vulgarly believed that science lacks philosophical problems and that it is nothing else but a machine with which to search for facts’. ‘Philoso- ance, always ready to place a cipal part of all professional ac- phy allows an embrace of all hand on the forehead of our tivity. The result would be a the aspects which can present neighbour, on the forehead of very complex outcome, albeit themselves in the examination the person who is nearest to us. fundamental in nature. Pure of science Ð both the logical This placing of hands on peo- reason and the reason of judge- and the gnoseological, and ple has always been accompa- ment, of aesthetics, is what will maybe even the ontological’. nied, indeed intrinsically joined be considered most fully in this (Gnoseology Ð the theory of by, words of consolation, by paper. It is what we know as knowledge. At times synony- words which treat and take care our philosophy. mous with epistemology. On- of. The nursing profession of the tology Ð the part of meta- The placing of hands on the nineteenth century and the first physics which deals with being forehead, the laying of hands part of the twentieth century in general and its transcenden- on pain, is exactly the title of was largely and almost totally tal properties). ‘It is necessary one of my published works on concerned with operational and to distinguish the metaphysical our profession2 and it is at the practical concepts. At that time problems of scientists, but one centre of the picture which ap- an executive hand of medical should not invent an abyss pears on a Greek vase from the indications or orders, at the which separates them. Perhaps fourth century BC. Lain Entral- very outset such was not the there is no scientific problem go analyses therapeutic speech, case. Today the university nurs- which does not raise philo- in its relationship to illness and ing profession obliges us to in- sophical problems, and no disease, basing himself upon quire into philosophy, other- philosophical problem which Homer, Hippocrates, Plato, and wise it would not be a universi- can be addressed with hope of Aristotle. ty career. This philosophical success if a scientific approach Beginning with Homer, he approach to the profession may is not adopted’.4 defines therapeutic speech in be summed up along a wide When we speak or address the following way: it is im- spectrum: questions of philosophy beginning with the nursing profes- our realities and are based upon services rendered, keep them in sion there are many people the human sciences. The branch health or retrieve them from who see the subject as some- of anthropology which should their bad general state, sustain- thing which does not concern most interest us is so-called cul- ing them and strengthening us, who believe that life is real- tural anthropology, although them with regard to their opti- ity, not philosophy. other authorities think that an- mistic and gratifying life-in- Life, they say, or do we say?, thropology should be ‘adopted fused state. is facts, not words. It is reality, in all its full multifacetedness’.5 Beginning with these con- not fantasies; it is results... Edward Burnett Taylor, the tents, which socially and acad- something that is tangible! father of modern anthropology, emically are recognised as For some, perhaps for many, defines this multifacetedness in something which our profes- philosophy is or seems to be a anthropological thinking with sion possesses, we can apply complicated subject, dealt with the following summary: ‘all the meaning, the appellative or well or dealt with badly, which that complex which includes the sign of an agent, that is to is imprecise, and at times knowledge, beliefs, art, morali- say, in these cases, of a profes- pedantic. However, philosophy ty, law, customs and any other sional who does something for is a question of approach and capacity or habit acquired by us. And this doing something, also of aptitude. Because if it is man as a member of society’.6 this professional positive sign, true that philosophy does not We agree with San Martin5 is good, pleasant and health-in- provide many practical instru- when he says that in the ‘sense ducing. ments, many technical discov- that the philosophy of man, Being agents, being people eries, many empirical certain- philosophical anthropology, is who do something, such nurs- ties, and special truths of sci- a theoretical, practical and epis- ing semiotics make us builders, ence, it is nonetheless also the temological discipline’. And I creators, the masters of works. 47 case that it searches for univer- would add, it is a cultural These are humanising works sal principles, vital and human hermeneutic (hermeneutics: the which produce health. Acts, logic, the concepts of common art of interpreting texts or con- signs, in practical terms, which sense, of general learning, of tents) discipline which seeks to for Aristotle took the form of history, of law, of ethics, of on- interpret universal discourse Ð actuality and power: tology... communication, questioning Ð actuality, a certain move- Thanks to the fathers of clas- and the understanding of the ment, a change towards neces- sical philosophy we know that human being, openness to oth- sary realities, a step towards through philosophy, meta- ers, the relationship of help. principles, philosophy, tech- physics, and wisdom, one The anthropology of suffer- niques, models, positive and comes to goodness. Goodness ing must encourage us to apply satisfying results; in Greek philosophy is identi- all the means, all the resources, Ð power, which is always fied with knowledge. Philoso- all our will, to a human being something and which becomes phy and goodness require theo- in a state of need. The sick hu- transformed into something ry and practice. For this reason, man being in today’s world is else. This something should be self-denial, lovability, the in conditions of precariousness positive, good, gratifying, and virtues: capacity, effectiveness, which we should assume and pleasant. aesthetics, ethics... fertility are sustain so that his life finds This vision of nursing semi- also called for. It is certain that meaning. otics, this professional concep- the nursing profession through In all this, the anthropology tion which actualises and pow- philosophy achieves fertility, of hope is of determining im- ers, also humanises. And this, abundance, riches, that is to portance.7 ‘The only thing in our work as health care say, as indicated at the begin- which in my judgement really agents, helps us to be more ning of this section, it comes to heals is unconditional love’.8 loveable, benevolent, good and goodness.2 understanding, but without us abandoning the professional 5. The Nursing Semiology side of things, that which is sci- 4. The Nursing Anthropology entific, technical and epistemo- Semiotics is an essential part logical. And in these proce- Through philosophy one of classical Greek philosophy. dures of providing assistance comes to anthropology and This paper will concern itself and care, of planning care, of psychology. We can well con- with pragmatic semiotics con- diagnosing and implementation sider Plato and Aristotle as the nected with the subjects who or practical activity, are to be fathers of this branch of learn- use it, that is to say with profes- found (or otherwise) the signs ing, at the least until near the sional nurses. We believe that of our professional operational end of the seventeenth century. the most important signs of the seriousness.9 The anthropologists of moder- profession belong to the se- The state and the form, the nity came after that time. mantic field of care. We will be meaningful aspect of our nurs- The anthropology that we known by the care that we pro- ing profession, must be based should consider beginning with vide, could be the determining upon, and indeed require of us, the nursing profession and to frame of reference. the following: which we should adapt our- Nurses as agents of humani- Ð aptitudes, centred around selves is the anthropology sation, of health. Nurses who general and specific training, which brings forms of knowl- look after people in the context theoretical and practical train- edge which are most suitable to of health, and, as a result of the ing, and on-going training as a

DOLENTIUM HOMINUM N. 47-2001 new and essential instrument of morality, law, customs and any right appreciation. We know work; other capacity or habit acquired that quality is demonstrable. If Ð attitudes, which require by man as a member of soci- these principles are not co-operation with the milieu in ety’.6 achieved quality is absent. which we work, with the thera- This frame of reference In each of the initiatives un- peutic team, initiative, interest, which has just been outlined dertaken by us we must always discipline, good human rela- must be a field of reflection and seek to achieve quality. Society tions, and a readiness to pro- practice for our professional cannot allow itself incomplete mote and provide a relationship work. And this obliges us to products or activities, or results of balanced help. And in addi- know and to follow in our work of a low quality, even though tion, work in a suitably bal- the concepts of inculturalisa- quality will always be subjec- anced team. tion, the culture that one gener- tive and not objective, subject ation transmits to another, that to the interplay and balance of peoples, regions etc, transmit to other elements, whether they 6. Nursing Culture new generations. It is certainly are well ascertained necessi- the case that some people are ties, rather unsuitable instru- A distinction should be modifying this ethnocentrism ments, up-to-date knowledge, made here between subjective with their cultural relativism, constant training, or otherwise. culture, education, instruction, but we have to deal with the At times we speak about the academic ‘curriculum’, and problem with care, with re- quality, its measurement, and it objective culture, the set of spect, at times with admiration seems that we are dealing with works and achievements of and always with prudence be- something that does not actual- people, of peoples, which are cause with regard to these great ly exist, that does not even be- 48 acquired social traditions, total themes universal models of long to the category of ideals as lifestyles, established and re- conduct do not exist. However, expounded by Plato. It would current ways of thinking, feel- we must also dedicate great at- be sad, I think, to have to say ing and acting Ð ontology. tention to alternative points of that health care professionals, In nursing we believe that view. male and female nurses, with these two concepts are in- Both the objective and the regard to the quality of their escapably bound up. Even subjective cultures must lead work, are what Heraclitus de- more we believe that each cul- us, professionally speaking, to scribed as: ‘men who have not ture depends on the other. Be- research, to innovation, to reached these logos which have cause of the fact of being an methodological creativity. We always existed, whether before academic profession, nursing can say that the person who hearing about them or after becomes of determining impor- searches with faith, with hope, hearing about them’.11 tance as regards the subjective always finds treasure. Health After dwelling upon the con- culture. This intensely enriches is always research, always a cept of quality, let us now turn the provision of services. There great treasure. People who ask our attention to what we mean is thereby a deeper knowledge for service, help, and support, in summarising terms by con- of the principles, the contents, are, by definition, the great trol. A control is an exploration and the value that accompany, treasure of mankind.2 When of what has been proposed and or which should accompany, we come to those who are in what has been achieved. Con- each form of help and care giv- need of care and treatment, trol is bound up with verifica- en to those who are in need. nurses must aspire to provide tion, confirmation, corrobora- Without a subjective profes- them with happiness, ‘a neces- tion, levels of probability and sional culture it is impossible to sary impossibility’.10 the correspondence between achieve the level which is re- two previously laid down lim- quired by work provided with- its. In this way there emerges a in an integrated team. We 7. Nursing Quality paradigmatic, analogical, ques- would obviously and shameful- tion. (Paradigm: the relation- ly sing out of tune. Therefore I To ask oneself questions, to ships which exist between two believe in, and support, the subject oneself to self-debate, elements. Analogy: the rela- need to intensify such culture to work, to develop, to arrive at tionship of likeness which ex- through known and necessary the attainment of a philosophy, ists between distinct things or on-going or permanent train- to energise a practice of the elements). ing. On-going and permanent control of quality in the health The truth is born from an ad- training means adding empha- care world, in the field of the equate examination of the fact sis, values, attraction, quality, nursing profession, means at in hand, of its quality, and the and meaning to the supply and the least to seek something convenient application of a cor- the provision of services, help, which is certainly utopian or rect form of control. For the an- and the proper and unrefusable highly difficult. cient Greeks, it may be ob- care of the profession. The nursing profession must served, truth and justice were The objective culture ‘in its offer quality, and evaluate and closely bound up with order broad ethnographic (ethnogra- perceive the level of its quality. and measure. Plato proclaimed phy: the science whose object This is because everything that himself a teacher and a defend- is the study and the description we do, if it does not receive a er of justice. His book ‘The Re- of races or peoples) meaning’ is specific weight, that is to say a public’, indeed, constitutes a that complex which includes value suitable to its reality, will constant argument in favour of form of knowledge, beliefs, art, lack value, will not have the justice.12 Quality and its control are ian ethics tell us why we per- to their respective professional bound up with aesthetics, form our duties and why we codes of ethics, around the fol- ethics and meta-ethics. They should perform them: lowing points: are used to establish order and Ð freedom; Ð prolonging life, saving hu- analysis in the lives and actions Ð immortality; man lives; of individuals, of professional Ð the existence of God. Ð humanising the circum- people. Aristotle not only This pre-supposes formal stances of sick people who founded or rebuilt ethics as a ethics which tell us how we have a high risk of losing their philosophical discipline but in should behave: autonomy, the lives; addition established most of the commitment of the same sub- Ð respecting the opinion of questions and issues that would jects; proceeding without in- the dying person, who must later command the attention of terested motives, distant from take his own decisions regard- moral philosophers: the rela- every form of selfishness. ing the end of his life and his tionship between norms and Such ethics require a balanced way of dying, and this either on what is good; the relationship between individual ethics and social ethics; the classification of the virtues; the examination of the relationship between the theoretical life and the practical life, and so forth.13 Later in this paper I will study the question of ethics. Aesthetics, justice, truth, 49 good and quality, and its control, must raise many questions for our professionals because they touch upon the deepest part of the human being, on the deepest part of the human being who is in need of care, assistance, and help. To formu- late and to ask oneself questions is of determining importance for individuals, for persons. Quality and control Ð knowledge centred around the his own or through his family what else are they and what do recta ratio. Reason, indeed, relatives or accredited or legal they seek to be if not doing was something which ob- representatives. things well, without commit- sessed Kant. All of this draws us near, and ting mistakes, with justice, with The Catechism of the leads us, to knowing the deep- truth, and with aesthetics? Catholic Church observes that est meaning of thanatos. And These and many others are the the morality of human acts de- with this of euthanasia, its questions that we should ask pends on: range, and even its responsibil- ourselves. In this field I believe Ð the object chosen; ities and transcendence. And that we should impose upon Ð the end which is sought for, we spontaneously ask, we ask ourselves a series of metaphys- the intention; ourselves: why do we educate ical reflections.14 Ð the circumstances of the in eros and not educate in action.15 thanatos? However, we should In this conjoining of objects, make certain distinctions re- 8. Nursing Ethics intentions and circumstances is garding the styles, forms or to be found, or may be found, meanings of this term: With respect to ethics we virtue, the balance which the Ð active euthanasia: the arti- should well bear in mind the ancient Greek philosophers ficial bringing forward of the philosophy of E. Kant and in (and in particular Aristotle) end of life; particular his thesis on categor- canonised. It is the intermedi- Ð passive euthanasia: caring ical imperatives, that is to say ate term between what is good for a dying person without us- necessary, universal and incon- and what is not good, between ing artificial means which testable realities regarding ethi- what is correct and what is not modify a death of quality; cal behaviour; and on hypothet- correct. But, certainly, ‘the Ð orthoeuthanasia: death at ical imperatives Ð technical and morally good act presumes at a given time; pragmatic realities which con- the same time the goodness of Ð cacoeuthanasia: active eu- cern practical life. Summing up the object, of the end, and of thanasia without taking into ac- these Kantian imperatives, this the circumstances’. count the wishes of the sick same philosopher proclaimed: This can be said to corre- person or his family relatives or ‘work in such a way as to al- spond to the retto operare of his legal representatives; ways deal with humanity, both the classical thinkers. Ð dystanasia: deformation of in your own person as in that of Professionals who look after the process of death, a dispro- another person, as an end, and sick people centre their own portionate use of resources to never use it as a means’. Kant- professional ethics, according obtain an extension of a life

DOLENTIUM HOMINUM N. 47-2001 which has very low human tant thing in history is the char- ing! Everything is inter-relat- quality.16 acter or the behaviour of indi- ed! The history of the Hispanic In this area concerned with viduals who have a noble lin- profession offers us a long se- ethics, the therapeutic team is eage’.18 ries of really enviable histori- of essential importance. In rela- The nursing profession has cal studies which are without tion to these questions it is al- not always borne in mind the doubt based upon sound scien- ways necessary to act in agree- need to know its own history tific evidence. ment, to have united ideas, cri- with empirical data and for this With these data we can make teria, thoughts, programmes reason there are in our libraries the suggestions of Gaarder our and techniques, objectives, re- more reported or handed-on own: ‘I am doing everything sources, and analyses of re- written materials than authentic possible to make you aware of sults. Professional secrecy has a great deal to do with ethics and vice versa. It is central to the Hippocratic oath. Roman law laid down that ‘the rules must be respected and secrets must be kept’. Christian culture talks about the sigillum. In more modern times we have the Charter of the Rights of the Sick Person and the Deontological 50 Code of the Nursing Profession. In Europe we work on the basis of interpretations of the following different approaches: Ð the French approach: the secret must always be kept; Ð the English approach: the secret must always be kept as long as it does not damage the common good, which is always documents based on evidence. your historical roots. Only in of greater importance. These are informative materials this way will you be a human Informed consensus is anoth- more than evidence-based doc- being. Only in this way will er ethical subject that the nurs- umentation, material more of a you be more than a monkey ing profession must today em- universal character than con- dressed up in clothes. Only in brace with the highest rigour. It crete, precise and empirical is- this way will you avoid floating involves respect for people and sues and questions. And the in the void’.25 the prevention of the legal universal is generalised, less To quote a contemporary problems which can arise if precise, as might be the case in Spanish author, ‘in times of or- such informed consensus has the work by M. Patricia Don- phans, when so many not been given.17 ahue.19 This can also happen in scoundrels have an interest in the case of other authors who our continuing to be orphans, follow this path.20 the past is the only thing that 9. The History of the In Spain, starting in the saves us and provides us with Nursing Profession 1980s, historical monographs serenity to oppose ourselves to have been published, such as such times. History is the mem- History is the richest patri- that by Francisco Ventoso or ory of what we were’.26 mony there is of peoples, of in- my own in 1984;21 by Carmen This is what happened in our dividuals, of institutions, and of Dominguez-Alcon in 198622 profession until recent times. professions. We could say that and by Juana Hernandex Cone- That is to say we were or we a profession without a history sa in 199523. In 1995 the sec- seemed to be orphans. We did is not a profession: ‘what histo- ond edition of my work was al- not have or we did not seem to ry studies is not a dead past but so published.24 One is dealing have parents, brothers or sis- a past which in a certain way here with works which are rich ters, or a place of reference. For still lives in the present’. ‘The and based on historical proof. I this reason we went to other duty to respect the facts which do not know if all countries sources, to identify ourselves the historian adheres to does can offer on the subject such with brothers or sisters who did not terminate with the obliga- equally rich documented stud- not belong to our people, to our tion to verify their accuracy. He ies. I think that in this field of blood, to our culture. The nurs- must strive to ensure that there the history of nursing, Spain ing schools, many of their lec- are not absent from his frame- has followed the best path, a turers, still drink at foreign work any known facts or facts path which can serve as a basis springs while they have at that could be so, and which are for other well documented his- home so many rich, abundant relevant in one way or another torical inquiries into the His- and cool springs. It is not a bad to the subject that concerns him pano-American nursing pro- thing to see what other people or to the interpretation which is fession. Things, means and his- do, but it is better to know and being proposed’. ‘The impor- tory do not come from noth- taste one’s own things, above all else if they are very good. control are necessary elements J. MARIAS, Persona (Alianza Editoríal, S.A. Madrid, 1996). These are some of the causes in ensuring the carrying out of 11 R. VERNEAUX, Textos de los behind my dwelling on figures our work with aesthetics and grandes filósofos. Edad antigua (Herder, of professional nursing of a ethics. With philosophical prin- Barcelona, 1982). 12 PLATON, La República, 3 volumes, high level and teaching such as ciples. Greek and Spanish edition, (Edicíon del (to avoid going back to the me- 6. Our professional patrimo- Instituto de Estudios Politicos, Madrid, dieval period) the figure and the ny is made up of our set of ex- 1969). teaching of St. John of God periences and what has been 13 J. FARRATER MORA, Diccionario de 24 filosofía, 4 volumes (Alianza, Madrid, (1539-1550) or Andrés Fer- learnt during the course of his- 1986). nandez (1625)27 or José Bueno tory. 14 R. DESCARTES, Discurso de método. Meditaciones metafisicas (Espasa-Calpe, Gonzalez. The work of this last, 7. Nursing schools, with Madrid, 1984). which has been recently pub- their directive bodies and 15 M. KANT, Fundamento de la lished, saw the light twenty-six teaching staff, must know and metafisica de las costumbres (Aguilar, years before the first work of teach history on the basis of Madrid, 1984). 16 E. KUBLER-ROSS, Sobre la muerte y Florence Nightingale, in rela- general evidence and by going los moribondos (Grijalvo, Barcelona, tion to whom Bueno Gonzalez deeply into our realities. Only 1980). did not pale in terms of the con- in this way will we be informed J. GAFO, Etica y legislación en enfer- mería (Universitas, Madrid, 1980). tributions he made to the pro- professionals and stop seeing 17 J.J. ARECHEDERRA et al., Bioética, fession, nor was he of lesser ourselves as orphans. We psiquiatría y derechos humanos (Interna- importance. Indeed, quite the should make our own history a tional Marketing and Communications, 28 Madrd, 1988). contrary. The whole of this sit- field of methodological and R. SPAEMANN, Etica: Cuestiones fun- uation of our profession; the empirical research. damentales (Eunsa, Pamplona, 1988). whole of this historical docu- 8. With this paper ‘I have 18 E. H. CARR, ¿Qué es la historia? (Ariel, Barcelona, 1983). mentation, has been an example simply tried to open windows; 19 M. PATRICIA DONAHUE, Historia de 51 of constant neglect, ignorance in our happy country windows la enfermería (Doyma, Madrid-Barcelo- which could have been over- were not opened on the first na-Mexico, 1988). 20 T.M. MOLINA, Historia de la enfer- come. We must always be pro- day of its history Ð be con- mería (Interamericana, Buenos Aires, fessionals in the search for vinced!’29 1973). meaning! Taking into account what I 21 F. VENTOSA ESQUINALDO, Historia de la enfermería española (Ciencia, have presented and outlined in Madrid, 1984). this paper, one can build and C. ESEVERRI CHAVARRI, Historia de la 10. Conclusion strengthen a profession: our enfermería española e hispano-ameri- cana (Salvat Editores, Barcelona, 1984). nursing profession! 22 C. DOMINGUEZ-ALCON, Los cuidados To conclude means to finally y la profesión enfermera en España Rev. CECILIO ESEVERRI (Pirámide, Madrid, 1986). end the analysis of the subject 23 CHAVERRI J. HERNANDEZ CONESA, Historia de of concern. I recognise that this la enfermeria (Interamericana McGraw- has been a rather theoretical ex- Hill, Madrid, 1995). position but I have sought to 24 C. ESEVERRI CHAVARRI, Historía de la endermería española e hispanoameri- present it with empirical facts cana, second edition, heavily revised and supports. I will try, there- (Universitas, Madrid, 1995). fore, to draw certain practical 25 J. GAARDER, El mundo de sofia, fifteenth edition (Siruela, Madrid, 1995). conclusions: 26 Bibliographical References A. PEREZ-REVERTE, ABC Cultural, 1. To be aware of the fact 12 January 1996, 219, p. 19 (Madrid). 27 that our profession must base 1 C. ESEVERRI CHAVERRI, Un hospital A. FERNANDEZ, Instrucción de Enfer- itself on and demonstrate that it un mundo (Editorial 29, Barcelona, 1989). meros. Año 1625, with facsimiles (Conse- 2 SEVERRI HAVERRI jo General de Enfermería, Madrid, 1993). C. E C , Enfermería 28 possesses principles and philo- hoy. Filosofía y antroplogía di una profe- J. BUENO GONZALEZ, El arte de la sophical bases, in addition to sión (Diuaz de Santos, S.A. Madrid, enfermería (Hermanos de San Juan de empirical contents. 1992). Dios, Madrid, 1833), facsimile editio: 3 P. LAIN ETRALGO, La curación por la Consejo Autónomo de Enfermeria de 2. The anthropology which Aragón, Zaragoza, 1997. palabra en la antigüedad clásica 29 we should see as ours is its cul- (Madrid, 1987). M. DELIBES, Cinco horas con Mario 4 (Destino, Barcelona, 1981). tural branch, centred around M. BUNGE, La ciencia, su método y su filosofia (Siglo Veinte, Buenos Aires, knowledge, beliefs, morality, 1988). art, law and customs. Philo- 5 J. SAN MARTIN, El sentido de la sophical principles. filosofia del hombre. El lugar de la antropología filosófica en la filosofía y en 3. Nursing semiotics centre la ciencia (Anthropos, Barcelona, 1988). around care, services, and at- 6 M. HARRIS, Introducción al la tention being given to sick peo- antropologia general (Alianza Universi- ple and people in need. They dad, Madrid, 1984). 7 P. LAIN ENTRALGO, Antropología de must be positive signs of our la esperanza (Guadarrama-Labor, S.A. professional work: philosophy Barcelona, 1978). and practice. P. LAIN ENTRALGO, Ser y conducta del hombre (Espasa Calpe, S.A. Madrid, 4. Our profession must look 1996). deep into the contents that it 8 E. KÜBLER-ROSS, La rueda de la vida provides to subjective and ob- (B. Grupo Zeta, Barcelona, Madrid. Mex- ico D.F., 1997). jective culture, in order to in- 9 M. E. DOENGES and M. F. MOOR- crease research, innovation, HOUSE, Guía de bolsillo de Diagnosticos y creativity, and the methodology actuaciones de enfermeria (Doyma-En- fermería, Barcelona, 1992). of assistance and care. 10 J. MARIAS, Antropología metafisica 5. Quality and its methods of (Alianza Universidad, Madrid, 1987).

DOLENTIUM HOMINUM N. 47-2001 Neurological Aspects of Death

Man has a genetically limited not it alone Ð affirms the contin- a) Cardio-respiratory arrest life-span. The average life-span uance, beyond doubt, of the is now calculated as being man’s spiritual principle”. Faith A cardio-respiratory arrest of eighty years for a woman and nourishes in the Christian the over ten minutes in duration is seventy-six for a man. The max- hope of “again finding his per- sufficient to cause the irre- imum duration of longevity has sonal integrity transfigured and versible loss of all the encephal- not increased, even though the definitively possessed in Christ” ic functions, and thus, in ordi- people who reach this age are (1 Cor 15:22)’.1 nary circumstances, proof to the increasing in numbers. It is ob- In other ages medical science effect that this arrest has taken vious that with the passing of saw in the ending of breathing place leads to the affirmation time a person ages, that is to say or of the heart beat the moment that the person is dead. Howev- that there is a decline in his in- of death. The theology and the er, with techniques of resuscita- tellectual and physical capaci- pastoral action of the Catholic tion one can in some cases re- ties, even when that person is in Church held to these condi- verse the situation (in general in a good state of health. On the tions, for example in the admin- the case of arrests which are other hand, there are illnesses, istration of the sacraments. Lat- identified at the moment at such as Parkinson’s disease and er, with the progressive devel- which they take place Ð sick 52 Alzheimer’s disease, which are opment of technology, the diag- people who are being carefully without doubt bound up with nosis of death changed and the- followed, neonatal asphyxia be- age. It is has been calculated ology absorbed this, aware of ing amongst the most frequent that if people were to reach the the fact that it is up to medical examples). age of a hundred and ten, they science to determine the mo- Resuscitation and cardio-lung would all be afflicted by ment at which death takes rehabilitation constitute the set Alzheimer’s disease. Further- place, as Pius XII pointed out.2 of techniques which are em- more, man is exposed to illness- This decision, obviously ployed to re-establish breathing es and accidents Ð living in- enough, is based not upon sub- and/or circulation when these volves a great risk Ð which can jective criteria but upon a rigid have stopped because of a po- provoke great limitations, and verification of the criteria tentially reversible cause. The naturally enough, death at any which have been established for most frequent cause of cardiac age. this purpose. In October 1985 arrest in adults is ventricular fib- Death, as a biological process, the Pontifical Academy of Sci- rillation (a kind of arrhythmia) is common to man and animals. ences published a document on within the context of an is- In man, however, it has a bio- this subject in which it was af- chemic heart disease (angina or graphical aspect, a specifically firmed that ‘cerebral death is myocardial heart attack). Every human perspective. Differently the real criterion of death’.3 A year in the United States of from animals, man knows that subsequent document of this America (where reliable statis- he is to die and as a result, being Pontifical Academy made clear tics are available on this subject) face to face with his own death, that ‘the total and irreversible about five hundred thousand he must adopt an approach and loss of all the encephalic func- people experience an episode of develop a form of conduct. Ani- tions is the real medical criteri- cardiac arrest. Only one hundred mals do not know that they will on of death which is habitually thousand of these cases are re- die; they cannot reflect about accepted’.4 versible but less than 3% (fif- death. If they do foresee it, this teen thousand people) respond is not the outcome of an individ- to the techniques of resuscita- ual fact but the result of an in- Medical Aspects: tion and then return to a produc- stinctive act of the whole species Irreversibility and tive life. The goal of resuscita- (the bull in the arena who hides Decomposition tion is first to substitute and then behind the fence; the elephant to re-establish spontaneous cir- cemeteries etc.). The more a be- Death has two determining culation in order to supply a ing is human, the more he is characteristics: one is irre- suitable flow of blood to the aware of the fact that life has an versibility Ð that it is not possi- heart and the brain. To this end a end. ble to return from death to life Ð set of techniques and different As happens in the case of and the other is the decomposi- methods are employed (the great questions, it is difficult to tion of the body which begins opening of the mouth, artificial define death. ‘“It comes when once the person has died. In ventilation, cardiac massage, the spiritual principle which some tissues of the body this electric defibrillation, the ad- governs the unity of the individ- takes place within a few minutes ministration of vasoactive ual is no longer able to exercise and then reaches over the space and/or anti-arrhythmic pharma- its functions on and in the or- of a few months total disintegra- cies, etc.) in order to try to avoid ganism and the elements of the tion, finally leaving only the the cerebral damage produced latter, left to themselves, disso- bones. by the absence of a suitable sup- ciate. Certainly, this destruction In order to affirm the pres- ply of oxygenated blood. does not affect the entire human ence of death two conditions In normal circumstances, being. The Christian faith Ð and must be met: when a cardio-respiratory arrest takes place in a patient in a ter- encephalic trunk which allows only in intensive care units, and minal phase because of an ill- him to engage in autonomous in some exceptional cases in the ness which is an advanced state breathing (the vegetative state operating room, because one of and thus necessarily leading to and other similar clinical condi- the conditions for death will al- death, there is no point in at- tions), and cortical, sub-cortical ready have come into existence tempting a cardiac resuscitation. and encephalic trunk damage Ð irreversible respiratory arrest In many cases, even though car- with consequences at the level which will have led the person ried out and having available all of consciousness as well as de- to be connected to a respirator. the technical means to hand, pendence on a respirator (coma To prove that the person meets such an action would not man- states at all levels). At times the neurological criteria of age to make the heart beat again death inevitably takes place af- death, all the medicines which in an autonomous way. In other ter a certain period of time even can have a depressant effect on cases, even if one managed to if the person is connected to a the person’s nervous system effect the operation and to con- respirator and the heart beat is have to be removed. In cases of nect the patient to a respirator, maintained and the circulation poisoning the necessary time cerebral circulatory arrest and a of the various organs is sus- has to pass so that all the toxic complete halting of the en- tained through the use of multi- substance disappears. In this cephalic functions would have ple pharmacies with peripheric process, first of all the absence taken place, and for this reason a effects. This is because all the of the cortical functions (the respirator would have been con- encephalic functions have irre- ability to perceive) and of the nected to a dead body. To avoid versibly ceased. sub-cortical functions (the abili- these two last situations which ty to react at a non-specific level wound the dignity of people, it and to pain) is ascertained. Then is the usual practice in many b) The Individual is Dead the person is ventilated with 53 hospitals to indicate that if a per- even though his Heart keeps oxygen at 100% for twenty min- son in a terminal condition dies Beating (the neurological utes. After this the respirator is then these kinds of techniques criteria of death) turned off and oxygen is intro- and methods are not practiced. duced at the level of six litres/m In other circumstances, such The heart is able to beat in an through an endrotracheol as traumas, heart attacks in autonomous way even though it catheter, and after ten minutes a healthy people, poisoning be- is completely detached from the check is carried out into whether cause of drugs and pharmacies, rest of the body. This ability al- there is a respiratory function. very small children and in par- lows a person, even in a situa- After this test has been carried ticular accidents through being tion involving the complete about, the respirator is reconnect- put under water, everything pos- sence of encephalic functioning, ed. sible must be done to carry out to be connected to a respirator Then an inquiry is made into cardio-lung resuscitation. and also enables the circulation the integration reflexes of the Once the heart beat has been of the other organs of the indi- cerebral trunk to see if they are recovered and breathing has vidual to be maintained. In this absent: the pupils of the eyes do been re-established (whether way, the organs can be kept in a not respond to light or to actions spontaneously or mechanically), state of good health and their re- which provoke pain, there are the situation of neurological moval for the purposes of trans- no changes in the heart beat as a consequences in which the per- plantation can be carried out. In result of pain, ocular move- son finds himself can be very this kind of situation, the indi- ments are not obtained through varied Ð complete recovery, in- vidual is dead even though his placing iced water in the ears, tellectual and motorial limita- heart carries on beating. there is no cough reaction with tions at various levels, serious The ascertaining of the irre- the introduction of an instru- cortical damage albeit with a versible loss of all the cerebral ment in the trachea, there is no functional effectiveness of the functions has to be carried out change in the heart beat after the injection of atropine, and hy- pothermia is also looked for. If these circumstances, which indicate the total absence of cortical and sub-cortical responses, and of integrated reflexes of the encephalic talus, exist, a diagnosis of death can be made. The respirator is removed and in a short time, usually after a few minutes and rarely more than a half hour, the heart beat also stops. The clinical data which allow the ascertaining of death in the circumstances which have just been cited, can be corroborated by various exploratory techniques, such as the use of the electroencephalograph to ascer- tain the absence of cerebral activity, and the use of the arterio-

DOLENTIUM HOMINUM N. 47-2001 graph and the ecodoppler which tion and alimentation. However, can say that death is a process reveals the absence of blood the criterion of irreversibility re- from a clinical point of view. flow to the brain. This latter mains valid and for neurologists For example, the period which phenomenon is another phys- one is merely dealing here with is considered terminal in a sick iopathological fact specific to what are unrepresentative patient, or the hours which re- this situation. episodes. What is hoped for and main to a patient with an un- what takes place according to changeable condition of en- the experience acquired day af- docrinal hypertension with Legal Requirements ter day in intensive care units af- cranio-caudal herniation, or the in Cases Involving the ter the neurological criteria of death throes of a person, we Transplantation of Organs death have been verified, and rightly describe with the phrase: with all the therapeutic opportu- ‘he is dying’. However, it would If it is envisaged that the per- nities which exist to maintain be erroneous to say that a person son in relation to whom the neu- the functioning of the heart, is is not dead until all his cells rological criteria of death have that life ceases after a short have died. As Martinez Lage ob- been demonstrated to exist is to while. Hence the need to reduce serves: ‘death or the end of life be an organ donor, the law re- the legal time limit regarding do not need adjectives’.5 Either quires that death should be veri- when it is possible to engage in a person is dead or he is not. The fied according to neurological the removal of organs for the phrases ‘clinical death ‘ or criteria produced by the use of purposes of transplantation. ‘cerebral death’ are not advis- an electroencephalograph car- Another matter for controver- able. They can give rise to con- ried out by a specialist in neurol- sy is that there is a wish to put fusion about levels or types of ogy and then carried out again on the same level the very pro- death, which is reality is of one 54 after six hours. Furthermore, at longed situation which ends up nature and unequivocal. It the moment of the use of the with a cardiac arrest and a pro- would be better to refer simply electroencephalograph the brain longed vegetative state. Even to ‘death’. The neurological di- must be inactive. This is a pre- accepting that in social terms the agnosis of death must be (and in cautionary legal measure which two solutions could involve an fact is) total as well as indepen- in absolute terms is not neces- approach with certain analogies, dent of any factor or circum- sary from a medical point of in scientific terms one is dealing stance relating to the dead per- view and which in practice can with situations which are not the son, the plans or beliefs of his have the result that the organs same given that in the vegeta- family relatives, and the possi- cannot be used after the six-hour tive state the patient breathes in ble donation of his organs for wait. For this reason, there are an autonomous way. One could the purposes of transplantation. attempts to reduce this period of also want to put it on the same time or to replace the require- level as situations of deep coma Dr. PURIFICACION ment of the EEG with the crite- which are considered to be irre- DE CASTRO, rion of an absence of flow of versible where it is opportune to Specialist in Neurology, blood as measured with an support the breathing which the ecodoppler. In Spain there was a patient continues to engage in, Rev. MIGUEL ANGEL MONGE, parliamentary bill in 1999 albeit in a very precarious way, Medical Chaplain, which provided for the removal with assisted ventilation, be- the University Clinic of Navarra, of the need for the second EEG cause the patient would have a Spain. after six hours and the replace- cardio-respiratory arrest if this ment of this requirement with aid was removed. In these cases the forms of proof already re- the respirator can be removed if ferred to. it is thought to be a dispropor- tionate measure Ð the patient would die after a short period of The Controversy about time, but his organs could not be the Criteria Employed for removed because a cardiac ar- Notes

the Ascertaining of Death rest would have already taken 1 THE PONTIFICAL COUNCIL FOR PAS- place. TORAL ASSISTANCE TO HEALTH CARE The neurological criteria of A final reason for debate is WORKERS, Charter for Health Care death enjoy great consensus in provoked by the fact that the Workers (Vatican City, 1995), n. 128. 2 Allocution, 1957. the scientific community be- various tissues have a varying 3 ‘Il prolongamento artificiale della vi- cause they were set out by the sensitivity to hypoxemia, with ta e la determinazione esatta del momento ‘Criteria of the Ad Hoc Harvard the result that the cells die in a della morte’, in L’Osservatore Romano, 30 October 1985, p. 5. Committee’ of 1968. There is staged way and the functioning 4 Cf. R.J. WHITE and I. CARRASCO DE still controversy about the maxi- of certain organs continues even PAULA; Angstwurm, The Determination mum length of time for the when others have been irre- of Brain Death and its Relationship to Human Death (Vatican City, 1992), pp. maintenance of the heart beat versibly damaged. Death means 207ss. because there have been some the irreversibility of the overall 5 Diagnóstico de muerte. Criterios cases, especially of young peo- biological functioning of the neurológicos, Doc. Oficial de la Soc. Es- pañola de Neurologia, approvato dal V ple and adolescents, where a person as a unity, and a process Congresso Nazionale, 12.IX.1982; cf. E. continuation of the heart beat for of the disintegration of the tis- MARTINEZ VILA and M. MARTINEZ-LAE, several months has been ob- sues begins. These conditions ‘Diagnóstico de la muerte. Criterios neu- served, something which with- arise once cerebral circulatory rológicos’, in J. HERREROS, R. ARCAS, R. AZANZA and P. ERRASTI, Trasplante car- out doubt was helped by the arrest has taken place, and only diaco (Cinetifico-Médica, Barcelona, practice of continuing ventila- when this has taken place, One 1986), pp. 65-67. Fears and Hopes in the Face of Death

The philosopher Plato used which involve mortality, soci- The Roots of Fear: to impart the following lesson ety clothes itself in fear and Cultural Conditioning to his disciples: ‘practice dy- these are clothes which many ing’. And the psychiatrist E. people wear all the seasons of The burden of fear in the face Kubler Ross has repeatedly ob- the year. of death has first of all cultural served: ‘the person who has not This is not so much a fear roots. People are the victims of really looked death in the face which makes people human, a model of looking at death is a person who is not really thoughtful and inspired with which makes them lack re- free to live’. solidarity, but a fear which sources with which to manage Death is an appointment paralyses, suffocates freedom, this event in an open and ma- which awaits everyone Ð both and takes space away from ture way. those people who expect, and hope. It is a fear which means Daily demonstrations of this have made provisions for it, that some phrases (such as, for disturbance are on the one hand and those who have rejected it. example, ‘I am about to die’) the tendency to employ Ð in the Day after day we build up cannot be pronounced without face of diagnoses which offer our lives; day after day we ex- encountering a reproach, that no hope Ð underhand methods, perience death. These two di- some subjects cannot be dealt benevolent deception, or the 55 mensions of existence assert with without the people who do so-called ‘conspiracy of si- themselves constantly. so appearing pessimists or peo- lence’ in the mistaken belief of Although on the one hand ple who give up, and that some being able to protect one’s Western society has achieved ‘goodbyes’ cannot be made loved ones from the truth, or on enormous progress in the without unmasking a truth the other hand, the practice of sphere of medicine and in pro- which it has been decided to drawing upon a certain kind of ducing the illusion of health deny. language so as to soften or re- and well-being, on the other The dominance of fear in- duce impact with pain. hand a regression can be ob- volves as a consequence the Thus, for example, people served in the ability of modern abandoning of openness and speak about ‘neoplasm’, or an man to manage the event of creativity Ð the daughters of re- ‘oncological problem’ or a ‘bad death. In fundamental terms, al love Ð and the provision of a malady’, because to say ‘can- fear has now achieved a posi- welcome to anxiety and futility cer’ seems to be too cruel and tion of dominance. Ð the daughters of paternalism disrespectful. Or people use In the face of situations or selfishness. phrases such as: ‘ he has gone’, ‘he has left us’, ‘he is no longer with us’, ‘he has gone away’, ‘he has fallen asleep for ever’, because to say that ‘he has died’ seems to be too cold in tone and too final. At times, even in front of people who insistently uphold their right to know the truth of their own condition, their family relatives, conditioned by fear, play to the last card the game of paternalism, which is nothing else but a false way of interpreting charity. In this way dying people are deprived of the right to fulfil their own lives, to take leave of their own loved ones by giving expression to the thoughts and feelings that are within them and expressing their last wishes. In this way the opportunity to be loved deeply in the most authentic way possible is taken away. We are deprived of the never to be repeated experience of preparing ourselves for the break by sharing smiles and

DOLENTIUM HOMINUM N. 47-2001 tears, memories and hopes, reading of articles and books Ð disfigurement or physical feelings and messages, without which generate new forms of decay; handing such things over to the sensitivity, by the suggesting of Ð the loss of self-control grave or to later regret. ways of dying which are differ- (mental self-control or inconti- The model of communica- ent from those suggested by the nence); tion which is learnt is handed mass media, and above all else Ð the loss of dignity; down, and for this reason par- by an experience at a family or Ð loneliness; ents transmit to their children professional level which is Ð the feeling of uselessness the inheritance of their unre- lived out in an innovative, hu- (the loss of meaning or of the solved fears. In this way, chil- man and humanising way. will to fight); dren are protected from pain Ð Ð the fear of being forgotten rather than visiting their dying about (of not leaving any traces grandfather in hospital they The Various Faces of Fear of one’s passing); must remember what he was Ð the fear of total elimination like when he was healthy; The conditioning effects and in death. rather than preparing them- consequences of the cultural Of all these expressions of selves for the funeral of a loved model in its various expressions death, the fear of dying alone is one they are invited by their (the removal, denial, institu- that which is most frequently aunt and uncle to the seaside for tionalisation and medicalisation encountered. a few days. of death) become translated in- Fear is the child of our hu- It is not realised that in pro- to a personal experience when manity and springs from the ex- tecting them from pain one is death knocks at the door of perience of vulnerability, pow- protecting them from life by one’s own door. erlessness and mortality. There 56 perpetuating in them the inca- The threat to one’s own safe- are no magic formulas which pacity to face up to, and to ad- ty and project-making unleash- can eliminate it. Some people dress, the inevitable events of es a range of fears whose char- calm fear with prayer and faith; existence with realism and acter conforms to the identity, others with breathing exercises serenity. experience, values and roles of and meditation; and yet others Death can neither be taken the protagonists involved. Fear with an approach of sharing and away nor avoided. The chal- does not have only a name Ð it acceptance. lenge lies in facing up to it Ð also has different faces and It is often the case that giving both those who die and those shades. voice to one’s own fears means who remain Ð by activating the In paying special attention to that they change and become a inner resources which are pre- the terminally ill, different fears matter of placing oneself in the sent within each person. can be identified, each one of hands of, and trust in, that Somebody who said: ‘do not be afraid, I will be with you for ever’. In general, fear becomes cut down to size in proportion to the extent to which it is coun- terbalanced by the dynamism of hope.

The Different Faces of Hope

Man is instinctively led and impelled towards hope, and this is something which is most ac- tivated when one’s health or life is in danger. Hope, like fear, is a Joseph’s coat of many colours. When faced with a grave infirmity or the drawing near of In proportion to the extent to which can be the central worry death, man perceives the hori- which people are educated to of the person. Of the most com- zon of his own experiences break the slavery of fear so as mon fears the following may be along the following three path- to begin a season of hope cited: ways: through a healthy facing up to Ð physical pain; reality, cultural models which Ð the unknown; a. Medical Hopes are more constructive in char- Ð judgement (by God, by oth- acter are created by which to er people, by oneself); In the majority of cases this is manage dying and death. – separation from one’s loved the favoured and special terrain The spread and diffusion of ones; where the destiny of one’s own these models depends upon the Ð dependence on other peo- future comes to be played out. embrace of a change of mental- ple (one’s family, the health The range of hopes linked to ity which is facilitated by care personnel and staff); science and physical recovery courses on the subject, by the Ð feeling that one is a burden; include the following: Ð trust in medical doctors and an apprenticeship which re- c. Spiritual Hopes their knowledge and profes- quires an ability to live in a pos- sional skill; itive way with one’s own hu- The third horizon of hope ex- Ð the arrival of new drugs, manity and powerlessness, a tends beyond the biological and medicines and forms of treat- knowing how to leave to the beyond the human to embrace ment; other person the protagonism of the transcendent, that is to say Ð journeys of hope to special- his or her dying, and making that which gives meaning to ist centres; oneself a discreet and near pres- life, to suffering, and to dying, Ð alternative medicines. ence during the course of the fi- that which goes beyond death. This understandable but at nal journey. The spiritual horizon intimes exaggerated and unrealis- This is how Calrise, a teacher cludes first of all acceptance tic concern with the healing of who died a few years ago in the and reconciliation with one’s the body emphasises the pre- United States of America, own past, with its wounds, er- ponderant role that the biologi- sought to prepare her husband rors, sins, and missed opportu- cal dimension has at the ex- for the separation: nities. pense of an overall vision of The process of reconciliation health. For many people hope Can I Leave? can be facilitated by the sacra- has only one name Ð that of Can I go away? ment of confession, by sharing physical healing. Don’t you think that the one’s experience of guilt or re- moment has come? gret with someone, and by the b. Human Hopes I am ready to say goodbye to silent dialogue of the dying per- days full of pain, son with God Ð He who reads These are a favourable ter- and nights full of loneliness. in the secrecy of each and every rain for the building up of heart. 57 spaces of health; health under- I have lived my life and I did Living out reconciliation stood in a broad sense and thus my best. means ensuring that remorse or not limited merely to the bio- Now, let me take this step inner torment brought about by logical sphere but inclusive, as and allow me to free my spirit. errors which have been com- well, of biographical health Ð mitted or plans that have never something which embraces the At the beginning I did not want been realised do not come to whole of the emotional, social, to go away; prevail. It means, rather, en- cognitive and spiritual sphere I struggled with all my abling the compassion of God of the person. strength. to direct one’s path, living in Human hopes when faced But now there is something peace with one’s own limita- with death include: which attracts me tions, and acquiring inner Ð the need to communicate towards a light that gives me serenity. one’s own thoughts and feel- peace and warmth. Secondly, the spiritual hori- ings to one’s loved ones; zon embraces the present and Ð the desire to live and to I want to leave! Really, I want includes the ability to honour make small plans; to! human dignity, even in the Ð the wish to share the It is difficult for me to stay. midst of physical trial and archive of one’s own memories, tribulation, which prostrates it- whether they are fully open or I will try to live to the best for self and is wounded in the face hidden away; one day more of the limits of human nature Ð to give voice to those of to give you time to take care of which make one experience the one’s dreams and projects me, ‘dark night’ of the soul with a which have never been realised; to share your love and your feeling of dismay and disorien- – the need to alleviate one’s fears. tation. pain or loneliness; I know that you are sad and In the face of the knowledge Ð the wish to be able to die at worried, that life is gradually coming to home; I can read it in your tears. an end, one can ignite a new Ð the need to take care of spirituality which has a positive those questions which are most I promise you that I will not be evaluation of the small things urgent before dying; distant from you: of life, those things which are Ð forgiveness or the receiving with my spirit I will be near to so often taken for granted, and of forgiveness; you. draw upon the resources of – saying goodbye to one’s Wherever you are... prayer, of thought and reflec- own loved ones. Thank you for having loved me, tion, of faith in God, of the The presence of good listen- you know how much I love you comfort of the sacraments, so ers who give space to the dying too! as to transform the wait into person, who adopt an approach This is why it is difficult to say hope, and death into resurrec- of welcoming and humility, up- FAREWELL tion. holding and honouring the and separate myself from you. To live the present in a spiri- choices which have been taken, tual way means to find spaces help the move onto the other Embrace me once again of light in the darkness of dy- side of the bar. and tell me that TODAY you ing, to pronounce and receive It is clear that human ability will let me leave, healing words and actions in re- in this sphere is not something because you love me. lation to one’s loved ones or which can be improvised Ð it is (Clarisse H., 1993). those who are taking care of us.

DOLENTIUM HOMINUM N. 47-2001 The spiritual horizon is pro- death as a part of one’s life, in longer be in here”, answered jected, lastly, into the future: it creating positive experiences the second: “We can’t remain goes beyond the mortality and and models as to how one can inside here for ever, we will be the finiteness of the flesh. It is die, and in educating family rel- born”. based upon the belief that the atives and health care workers “I don’t want to leave here at destiny of man is a full en- to be instruments of comfort all”, objected the first, “I want counter with God, it is to be- and nearness at the side of those to stay here for ever and ever!” lieve in continuing existence in who are dying. “Think about it”, his twin a mysterious life beyond this Christian hope is not an alter- brother answered him, “there one which awaits us, and where native; it has a complementary are no other possibilities, and it will be possible to meet again role in relation to the other then perhaps there is another one’s loved ones and enjoy the hopes. It is at the same time his- life out there, once we’ve got fullness of life. torical and transcendent. It is out of here”. Accompanying dying people going on living the mystery “But that’s not possible”, ar- requires respect for the various which began with birth, some- gued the second, “without the creeds and religious, which are thing which is so well interpret- umbilical cord you can’t live! professed. Even where the per- ed in the following parable: Moreover, many others have son says that he or she does not left the maternal womb before believe in a life beyond this one us but nobody has come back to it is important not to persist in The Two Twins1 tell us whether there is another trying to convince him or her life after birth. Believe me, otherwise but to help that per- While two twins were grow- once we are out of here every- son to revisit his or her past and ing in their mother’s womb thing comes to an end!” 58 to uphold the values, achieve- they had a conversation with Thus between one contention ments and meanings which each other. They were full of and another they spent their fi- have marked out his or her per- joy and said: “Well, don’t you nal days in the womb until the sonal history. think that the experience of life moment of birth arrived. When is incredible? Isn’t it great to be they came out into the light here together”. they opened their eyes and gave The Mystery Day after day they went on out a great cry. to be Discovered discovering their world. One What they saw far surpassed day they became aware of the what they had ever thought they For all people, death is a des- umbilical cord which connected would see. tination and a mystery Ð an in- them to their mother, and by evitable destiny and an in- which they were fed and nour- Rev. A. PANGRAZZI, escapable mystery. ished. They were surprised and Professor at the ‘Camillianum’ The fact that death places an said: “Just look how much our International Institute of the end to human project-making mother loves us: she is sharing Theology of Pastoral Care in Health, produces in many people dis- her life with us”. Rome. turbance and disquiet. The ob- In this way the weeks and jective is to ensure that fear months passed by and they sud- does not come to prevail over denly realised how much they love, over creativity, and over had grown. Note hope. “What does all this mean?”, The cultural and personal asked the first twin. “It means 1 Labensangste-Lebenstraume, en challenge lies in receiving that in a little while we will no Kranteunrief (1999), 1, p. 3. Testimony

The Servant of God, Manuel Lozano Garrido: Paralytic, Blind Man, Journalist and Writer

The Hospital of the Holy Spirit of Rome as an Example of the Apostolate of Compassion

The Department of Pastoral Care at the Cardinal Tien Hospital in Taiwan

Archdiocese of Philadelphia: Protocol for Evaluating the Catholic Health Care Collaborative Relationship

The Paulinian Approach to Nursing Education: A Response to the Church’s Call or Compassionate Caring

DOLENTIUM HOMINUM N. 47-2001 The Servant of God, Manuel Lozano Garrido: Paralytic, Blind Man, Journalist and Writer

On 5 November 1994, in the guided, through the wise advice 1. Biographical Aspects diocese of Jaén, the opening of that he supplied, hundreds of the process for the canonisation young people and adults, who Manuel Lozano Garrido, Ser- of the Servant of God, Manuel turned to him as a friend, a con- vant of God, was born in the in- Lozano Garrido, was celebrated. fidant, and an adviser. dustrial and mining town of The solemn ceremony was Manuel was a member of the Linares (Jaén, Spain) on 9 Au- presided over by the Bishop of laity who lived out his life in gust 1920. He was a member of Santo Reino, H.E. Msgr. Santia- love with the Church, for which the Youth Section of Catholic go Garcia Aracil. he had a real passion and tried to Action from its foundation in On 20 February 1998, at the serve in his apparent useless- that town in 1931, first as an ac- Congregation for the Causes of ness; he was a paradigm and an tivist and then as a person with Saints, the decree on the validity example of ‘today for today’, posts of responsibility. At the of all the diocesan practical pro- and had a spiritual profile which age of twenty-three, while he cedures in the matter was was simple and at the same time was doing his military service, signed. The ‘Positio’ on the heroic. he was attacked by rheumatism heroic virtues of this sick man The universal call to holiness which completely paralysed him 60 was printed and submitted to the and the role of a layman within and turned him into an invalid. examination of the Consultors. the Church, emphasised by Vati- In the last years of his life this can Council II Ð which this Ser- illness also made him blind. He vant of God followed with pas- died in Linares on 3 November Who was Manuel sion from his wheelchair Ð met 1971. Lozano Garrido? with a deep echo in Lolo. Dur- His years of adolescence and ing his years of adolescence and youth coincided with those of Manuel Lozano Garrido was as a young man in Catholic Ac- the Spanish Civil War a member of the laity who was tion he was already writing in (1936-1939) when he was put in shaped in his views by being a his notes about his keenly-felt prison for a few months because member of the Youth Section of wish to follow Christ; and as a of his faith. Before going to Catholic Action; he was an in- young member of the laity he prison, like a twentieth-century valid, a blind man, a journalist risked his own life during war version of the novice ‘Tarci- and a writer. He was a simple time and religious persecution sius’, he secretly distributed man who experienced Christian because he openly professed his Holy Communion on behalf of joy, born from his deep faith, in faith and his devotion to the Eu- Don Rafael Alvarez Lara, who a condition of pain which lasted charist Ð this even led him to was a parish priest of Linares for more than twenty-five years suffer imprisonment and to wish and later Bishop of Guadiz and when he was completely immo- for martyrdom. Mayorca. bile on a wheelchair. The simplicity of life of this After the Spanish Civil War His life of constant prayer has boy, who in the fullness of youth he was a member of the Youth been handed down to us be- became completely paralysed, Section of Catholic Action when cause it is captured in his nine made him live out in a natural he forged his apostolic spirit and books, examples of very high and ‘joyous’ way the extraordi- deepened his human and spiritu- religious literature, and in hun- nary circumstances in which he al education, which he subse- dreds of press articles in which experienced his very long life in quently expressed to the full he expounded the social doc- the condition of an incurably during his twenty-five years of trine of the Church or spoke sick person. being an invalid. about the small successes of his What has just been observed During these years (1939- daily life which were obtained is merely a compendium of his 1941) he pursued the career of a beginning with his Christian life. I would go beyond the con- teacher and studied to become commitment. fines of this paper if I comment- an expert in mining. ‘Lolo’, as he was affection- ed on every one of the charac- Once his condition as an in- ately called, was also known for teristic traits of this spiritual valid had been made official, his his deep devotion to the Eu- profile that I have just outlined. life took on a totally different di- charist and a tender Marian But the richness of the Christian rection Ð starting with his total compassion. life of this young man of immobility he became a journal- His life was a constant apos- Catholic Action, an invalid and ist and a writer, an adviser to tolate amongst the incurably ill yet a writer and an adviser of hundreds of young people and to whom he joined himself in a the young, has an aspect on to all those who drew near to pious union, called ‘Sinai’, and which it is necessary to dwell in him. to whom he offered his prayer this paper, which will be pub- His life, which was only ap- and his own pain through the lished in the journal Dolentium parently useless, became won- Catholic press. At the same Hominum, namely the apostolic derfully productive and fruitful time, his home and his own life dimension which the Servant of Ð when he could no longer write became a lighthouse which God, Manuel Lozano Garrido, with his right hand he wrote shone light on, and apostolically gave to his illness. with his left hand; and when he lost his sight he recorded what with Franciscan simplicity. In God, who turned his wheelchair he wanted to say on a tape 1969 the commune of Linares into a redemptive trial, undoubt- recorder. made him a chosen son of the edly had much to say to contem- He published hundreds of ar- town. porary man, educated as he is in ticle in the press on social, sci- a society which gives itself up to entific, literary and above all easy pleasure and which has else religious subjects and 2. The Servant of God made today’s average man lose themes. (an Invalid and a Blind the meaning of pain. His strength came from an in- Man) Gives his Life It is helpful to quote here the tense life of prayer, from a deep an Apostolic Dimension work Reflexiones clinicas y loyalty to the Eucharist, and antropológicas acerca de un pa- from a tender Marian devotion, One of the readers of the ciente ejemplar Manuel Lozano as we can see from his profound works of Lolo perceives in the Garrido, written by Dr. Fermin spiritual ‘diaries’ which make chapter ‘con la señal de la cruz’ Palma.2 up parts of the nine books that the thought of this Servant of Dr. Palma transcribed the fol- he published. God on pain: the joyous accep- lowing passage by the Servant When, as an already sick tance of the cross, the redemp- of God: ‘are you always in pain, man, he was allowed to cele- tive value of pain joined to the always? Well, yes, always, al- brate Holy Mass in his own home, he asked for his type- writer to be put under the altar so that in this way ‘the Cross will become nailed to the key- board and put its roots into it’. 61 He called on the Virgin, to whom he dedicated beautiful pages in his writings: ‘Holy Mary of things without splendour; Queen of the Twin Hours; the Chosen One for mute missions; Teacher with an abacus of silences; Lady of Honour of the useless; Mother of the eternal Cross...’ The titles of his works are the following: 1. El sillón de ruedas (1961) (preface by José Pérez Lozano and Antonio Castro). 2. Dios habla todos las dias (1962) (preface by Antronio Navarette). 3. Mesa redonda con Dios (1963) (preface by Francisco Javier Martin Abril). 4. Las golondrinas nunca saben la hora (1967) (preface by José Maria Pemán). 5. Cartas con la señal de la cruz (1967) (preface by P. Félix Garcìa). 6. Reportajes desde la cumbre passion of Christ, and the purify- ways, always’.3 And offered us (1969) (preface by P. J.M. ing strength which springs from this comment: ‘always, always, Llanos). this acceptance. Lolo wrote always, the swallow flies and 7. Bien venido amor (1969) about this in the following way: the river makes its noise, ac- (preface to the second edition by ‘three approaches when faced cording to the poems by Lolo Rafael Higueras). with pain: that of the person who which Guillermo Sena sum- 8. El árbol desnudo (1970) has not yet gone beyond the marises perfectly in “Scrutidor (preface by various authors of burning of his own wound: del alma”’.4 the Catholic press). “God has abandoned me...”; that Always and perpetually pain, 9. Las estrellas se ven de of the person who accepts it as all the authors, journalists and noche (posthumous) (preface by without, however, entering into his friends have observed. From Francisco Javier Martin Abril). the spirit of its meaningful activ- Robert de Taizé who would ac- His literary work and output, ity: “God has asked me...”; and claim him as a ‘sacrament of which was fundamentally of a the person who understands the pain’ to his biographers Juan religious nature and character, is communitarian value of suffer- Sánchez and Juan Rubio Fer- full of poetry, beauty, and ten- ing and offers himself fully to nández and many others who derness. the ideal of redemption: “Lord, I have been fascinated, without He won a large number of lit- offer you...”’1 being aware of the fact, that erary prizes which he received The profile of this Servant of both love and pain “derive from

DOLENTIUM HOMINUM N. 47-2001 the same wound”, which be- number of letters addressed to 4. The Exulting Joy of the comes transformed into a source sick people.8 Servant of God in his Pain of thought, spiritual vigour, and The review Sinai9 had this life. aim and purpose. It wanted to ‘What is joy’, this Servant of He feels the pain that does not unite the pain of all the sick peo- God asked in an article pub- ‘fall asleep’ before him. For this ple who belonged to this apos- lished in Vida Nueva.14 And he reason, in one of his pages he tolic work to offer up their suf- provided the following answer: wrote, when talking about the fering through the Catholic ‘joy is a vital manifestation of Lord: ‘How hard is anxiety, and press. For this reason, in all the man and thus of essential im- I don’t have to tell you this be- issues of this review, there are portance in his growth and de- cause you know about agony!’5 writings by our Servant of God velopment’. He later quoted Without any doubt the most on the value of pain, as there are Bernanos: ‘there is a joy in God characteristic thing about this also in the twenty-three articles and a poorer joy’. In the ac- Servant of God was the very published in Enfermos Mi- counts of his death there were long time of his painful illness. sioneros.10 present ideas which had been He was an invalid and during The subject of pain is ever spread through his writings – ‘I the last years of his life he was present in his diary-books: Dios am yours and I renew my ap- also blind. During this infirmity hablas todos los dias, Las pointment with you in Joy’. he was accompanied by a set of golondrinas nunca saben la ho- ‘Joy’ with a capital letter; the permanent consequences which ra, and Las estrellas se ven de Joy that is Christ and the Joy meant that he was always at noche. that is the encounter with the death’s door. Father. This Servant of God was a All the witnesses at the in- 62 suffering worker or a sick per- 3. The Experience of Pain quiry have spoken about the joy, son who worked. During his life Beginning with the Faith the smile, the good humour, and hard work and acute illness in- the good spirits of this Servant tertwined in a single lattice. But However, more than what this of God. He wrote: ‘above embit- during his life his profound de- Servant of God wrote about tered or sugary men, beyond the votion to the Eucharist made pain, it was his experience of silences or the lips open to song, him live out his life in a way pain that really mattered Ð that is we must believe that jubilation that was joined to the sacrifice to say how this Servant of God moves man as a product of a of Christ. His daily work and lived out his ‘identity’ as a sick tendency and an ascension: joy his daily pain Ð like bread and person. is the fruit of a conquest...’ And wine Ð were joined to the Eu- The witnesses at the inquiry he added: ‘Christianity is above charistic sacrifice of Jesus speak about the home in which all else an operation of joy’.15 Christ in the daily taking of the he lived, in which he received This Servant of God constant- Eucharist. care and treatment, and where ly expressed and transmitted Vatican Council II spoke he often had to stop working be- this joy. about the sick and included cause his illness had become In a metaphor which de- them within the universal call to very acute.11 scribed his life: ‘with a life holiness: ‘we know that they are This Servant of God saw pain which lights up little more than also joined in a special way to as a path of redemption. He saw a very short candle, I believe in Christ, who suffers for the sal- his illness as a gift of God: ‘fi- your spring... Now, tomorrow vation of the world...’6 The im- nally, I fall on my knees and and always, I believe in God, mense force of human pain can- give free expression to my grati- who has given spring to us and not be useless. The redemptive tude... I do not want to com- has made all springs possible’.16 action has its supreme expres- plain. Bring me, in exchange, This is what this Servant of God sion in the Cross of Christ. ‘For your smile and allow joy to wrote when he felt that his life this reason in the Christian life place garlands and roses on my was drawing to an end. This the encounter between pain and heart because it is here that there passage was written in his love should be achieved, linked is the fragrance of the heart posthumous book, the proofs of together in the Cross of Christ. which supports the architecture which were handed over to him All this pain should be accepted of suffering’. He then began to a few minutes before his death with love so that it is redemp- draw up a list of benefits: the when he was already in the eter- tive and leads to the fullness of proximity to God who searches nal spring of the encounter with life’.7 for him, faith, providence, spiri- God. Perhaps for this reason the tual care, affection, personal vo- most abundant literary output to cation... because ‘if one road come out of the pen of this Ser- closes He offers the resource of 5. ‘Supernatural Naturalness’ vant of God was that of trying other lateral paths which then to engage in a Christian reflec- take its place’.12 All people can reach holiness tion on pain. This is what he This Servant of God entitled given that God himself imposes tried to do in his first book, El one of the chapters of his book it on everyone. As J. Urteaga sillón de ruedas. But another El sillón de ruedas in the fol- said: ‘God will not ask of every- book of his, Cartas con la señal lowing way: ‘El dolor se ar- one a holiness with extraordi- de la Cruz, is engaged in the rodilla’.13 What he writes about nary forms of prophecies and same undertaking. In this work here is his life Ð he lived accep- miracles, but the holiness of do- he describes a Via Crucis, and tance of pain in such a way that ing extraordinarily well the ordi- comments on the four stations he would one day publish his nary and usual things of every of the cross and adds the same ‘Credo of Suffering’. day’.17 But this doing of ordinary things extraordinarily well The first of his diary-books You are here, seated next to my does not remove the fact that ends with a number of pages of wheelchair, and with affection I ‘circumstances and the context conversation with the Lord put my arm around your shoul- treat you with harshness’.18 about faith and hope. ‘I must ders...’22 This aspect of ‘naturalness’ dream of seeing you, I will die When this Servant of God which this Servant of God because I do not see you and wrote these words twelve years demonstrated when doing the you will go on being protected still had to pass before this blind ordinary, he saw as the constant by seven veils, always hidden man came to see the spring of his days: ‘I live my useless- and unreachable... I say more to which had been wished for so ness with a characteristic of nor- you than I do not say... that often of the final encounter with mality, in the same way as a per- every tear is worth an act of the Lord; twelve years when a son is born with red hair or with laughter; pain is worth a conso- path of immobility as a paralytic a vocation to be a machine oper- lation; night is worth a mid-day. passed ‘in a hurry’, together ator’.19 Thus it is faith which asks for with the Friend who had arrived This Servant of God, aware as alms. Like hope as well... Thus and was there, sitting next to the he was of the fact that his illness the hunger for faith tears at me, wheelchair. At the end of these was a gift of God, took it upon burning and purified faith’.21 In twelve years he finally came to the encounter with the Lord which had been so often wished for.

Rev. RAFAEL HIGUERAS ALAMO ‘Canonico Magistrale’ of Jaén, Spain. 63

Notes

1 M.L. GARRIDO, Las estrella se ven denoche (Bilbao, 1973), p. 102. 2 F. PALMA, Reflexiones clinicas y antropólogicas acerca de un paciente ejemplar Manuel Lozano Garrido (Zamora, 1998), p. 18. 3 M.L. GARRIDO, Dios habla todos los dias (Bilbao, 1967), p. 146. 4 M.L. GARRIDO, Surtidor del alma (La Carolina, 1997), p. 36. 5 M.L. GARRIDO, Las golondrinas nunca saben lahora (Bilbao, 1967), p. 152. 6 Vatican Council II, LG, n. 41. 7 B. J. DUQUE, ‘Universal vocación a santitad’, in Comentarios a la Constitu- ción L.C. (Madrid, BAC, 1996), p. 775. 8 M.L. GARRIDO, Cartas con la señal de la Cruz (Bilbao, 1967), pp. 149-196 and 29-103. 9 Summ., Pars altera, V, pp. 249-258. 10 Cf. C.P., Proc. Supl., Vol. V., pp. 28-30 and 88-135. 11 Cf. Summ., Proc. Ord., XI witness, Maria dolores Muñoz, p. 70, n. 217; cf. himself as such and accepted it. this passage, as in so man oth- Proc. Ord. VII witness, José Ganzàlez, p. ‘He transmitted an impression ers, we can appreciate his faith 51, b. 163; Proc. Supl., VII witness, Anto- of naturalness which made what as a contemplative who looks nio Maldonado Trigueros, p. 152, n. 477. 12 M.L. GARRIDO, El sillón de ruedas, appeared in him to be a very for, and wants the God that he pp. 7, 19, 72, 88. harsh trial to be natural. This has felt. 13 M.L. Garrido, El sillón de ruedas, p. was a trial that he bore with Twelve years before his death 267. kindness, with the grace of on 3 November 1959, the same 14 Vida Nueva, 1 December 1957. 15 M.L. GARRIDO, El sillón de ruedas, God... The admirable thing day that he died, he wrote anoth- pp. 203 and 205. about Lolo is that his life, the er of the many passages on the 16 M.L. GARRIDO, Las estrellas se ven same day after day, made him worsening of his illness: ‘after de noche (Bilbao, 1973), p. 309. 17 J. URTEGA, El valor divino de lo hu- live the ordinary of every day in two months of silence, now, mano (Edic. Rialp, Madrid, 1959), p. 49. an extraordinary way. And he Lord, my diary is in front of 18 J. URTEAGA, op. cit., p. 72. lived in an ordinary way the ex- you. You opened readily, with 19 M.L. GARRIDO, Dios habla todos los dias (Bilbao, 1967), p. 20. traordinariness of his pain, of jubilation, just as an early 20 Summ., Proc. supl., V witness, Car- his invalid state, without giving flower in the pots on my bal- men Troyano, p. 136, n. 429 and p. 138, importance to them’.20 cony do, Today the day is like a n. 436; cf. XI witness, Esperanza Fortes, To conclude this paper, per- station shelter when the train ar- p. 174, n. 538. 21 M.L. GARRIDO, Dios habla todos los haps it would be opportune to rives a friend gets off who we dias (Bilbao, 1967), pp. 238-240. quote some of his other texts. have not seen for a long time. 22 M.L. GARRIDO, op. cit., p. 167.

DOLENTIUM HOMINUM N. 47-2001 The Hospital of the Holy Spirit of Rome as an Example of the Apostolate of Compassion1

1. Brief References to the tions, brotherhoods, cities, and all else in order to deal with the Order, and the Hospital, corporations. The social care needs of the sick and the poor. of the Holy Spirit and charitable activity which However, the taking care of were expressed above all in the abandoned children was also a In the history of the develop- foundation of hospiteller Or- prominent and integral part of ment of the various forms of ac- ders were, during the medieval its activities. This function of tivity and initiatives of a chari- period, a fundamental task and the hospital is not directly de- table character, inspired in a de- responsibility of the Church. scribed in the documentary evi- cisive way for almost eighteen The ecclesiastical charitable dence that is available to us. Af- centuries until the Enlighten- undertakings, side by side with ter the refoundation of the Hos- ment by the Christian teaching the foundation of Orders, pital and its extension carried on compassion, the foundation schools, and universities, were out by Sistus IV during the fif- of the Hospiteller Order of the one of the fundamental charac- teenth century, two institutions Holy Spirit towards the end of teristic trends of the culture of existed within the hospital, fully the twelfth century was an that time. The development of connected to each other but with 64 event of fundamental impor- hospital activity drew inspira- different functions Ð the hospital tance and significance. This Or- tion from ascetic philosophy proper for the sick and the hos- der was founded in Provence and the medieval mentality, ac- pice for the foundlings. The hos- by Guidone di Montpellier and cording to which the peuperes, pital of the Holy Spirit, as a cen- was called the ‘Ordo Fratrum and thus all people in need, en- tre of health care, was not only Canonicorum Regularium Sanc- joyed general acceptance and concerned with the care and ti Spiritus’. Even though it was even glorification on the part of treatment of sick people Ð it was one of the many charitable and the Church and society. also a great medical centre and knight-hospiteller Orders which The large size and the exten- centre for medical studies, and arose in the eleventh and twelfth sion of the Roman Hospital of was indeed equipped with the centuries, nonetheless, with its the Holy Spirit was expressed famous Lancisian Library and a rapid development, the breadth not only in the monumental medical academy. Within its of the organisation of its works character and dimensions of its walls there also existed a broth- and initiatives, and the variety buildings but also in the fact that erhood of charity and a bank of its forms and expressions, it it was always the mother house which bore the same name as dominated in a decisive fashion of the religious of the Holy Spir- the hospital. During certain peri- the other Orders dedicated to it and the headquarters of their ods the administration and man- similar ends and missions. The Superior General. For almost the agement of lesser hospitals in activity of the Order of the Holy whole of its existence, that is to Rome depended on that provid- Spirit represented an epoch all say until the unification of Italy ed by the Hospital of the Holy of its own, not only in the histo- in 1870, it was constantly under Spirit. The hospital for children ry of compassion and charitable the care and protection of the afflicted with mental illness, works but also in the whole of Pope, and for this reason it was among other maladies, formed a Christian civilisation and me- called a ‘pontifical arch-hospi- part of its wider complex. dieval culture. tal’. There was nothing like the Even though the activities of The undisputed symbol of Hospital of the Holy Spirit of the part of the hospital which the power and leading role of Rome, neither during the me- was responsible for care and this Order in the field of chari- dieval period nor during modern treatment has not so far been table works in medieval Europe times, when, after the restoration studied in the least, that topic was the Hospital of the Holy work carried out at the end of the will not be the subject of this pa- Spirit, which was founded by fifteenth century, and the later per. This study will, instead, Pope Innocent III between 1198 investments made during the dwell upon the hospice for and 1201 in Rome, on the site sixteenth century it enjoyed its abandoned children (the ‘bre- of the previous Schools of the period of greatest splendour. De- fotrofio’ or ‘foundlings hospi- Saxons, and entrusted to the re- spite radical changes which were tal’) which existed within the ligious of the Holy Spirit. From connected with its forms of ad- confines of the Hospital of the the beginning of its existence, ministration and management, it Holy Spirit. this hospital was the most fa- has maintained its level and mous and largest charitable standing right up until the pre- centre in Europe, and was also sent day and is one of the most 2. The Abandonment a model and example for the important and largest institutes of Children hospitals which rapidly devel- of health care in contemporary oped during that period which Rome. In the investigations into the were administered by the reli- During the first three cen- history of the provision of social gious of both the Holy Spirit turies of its existence (the care a fundamental role is attrib- and of other Orders, or founded twelfth to the fourteenth cen- uted, in the course of history, to by secular and ecclesial institu- turies) the hospital acted above the problem and issue of unwanted children, usually new- maintain themselves in an eco- based themselves upon the mod- born and called ‘foundlings’ or nomic sense. As for the girl or- el and example of this particular ‘abandoned children’, who were phans, in addition to being hospital. This system may be present above all else in the maintained them they were also adjudged to be complete be- great European cities. This was a provided with a marriage dowry cause it guaranteed care for special category of people in in order to keep them away from these foundlings for the whole need who were particularly prostitution.4 of their lives. weak. Not receiving any imme- During the medieval period My work of research for the diate help, they had no chance of care for abandoned children was most part concerns the eigh- survival. For this reason, saving not something specifically dealt teenth century which from a abandoned children and looking with within the system of organ- European point of view may be after them was one of the most isations and institutions of the defined as the century of ‘the important missions of Christian Church. Usually unwanted chil- Enlightenment’. The choice philanthropy and charity. dren were left in churches, in was dictated only in part by The abandonment of children monasteries, or were sold, or merely practical considerations, was practised on a large scale in were entrusted to outside people above all because of the fact the times prior to Christianity. or families. Until the end of the that the documentary evidence Newly born children were aban- twelfth century taking care of which survives to us is much doned in secret. Given that their foundlings was a matter of richer for the eighteenth centu- destiny was surrounded in mys- chance or accident, and was ry than for previous centuries. tery, and easily the matter of largely a matter for private indi- As terminus ante quem the end legend and superstition, to the viduals.5 A radical change took of the eighteenth century was foundling was applied the root- place at the beginning of the chosen, the time of the birth of ed popular belief that at the thirteenth century when in the the Roman Republic and the 65 height of misfortune there was great and small cities of Europe occupation of the Papal States always the possibility of chang- there began to arise and rapidly by Napoleon. Furthermore, the ing one’s destiny. Romulus and spread hospitals, hospices, and turn of the century was a clear Remus, the founders of a civili- foundling hospitals exclusively break in terms of the develop- sation, and Moses, for example, for foundlings, one of whose ment of hospital care and social were foundlings who have in- principal missions was to pro- provision throughout Europe. spired our imaginations.2 vide care to these abandoned From that moment onwards In the Roman culture of the children.6 Most of the institu- there began the rapid process of second and third centuries the tions of this kind were hospitals the state assuming responsibili- newly born child was placed on run by the largest and most im- ty for hospitals or their being the ground and if the father, or portant charitable religious or- given over to an independent the master of the slave-mother, der of the medieval period Ð the board made up of municipal took it up it was fed and brought Order of the Holy Spirit. representatives. From that spe- up. Otherwise, it was placed The number of abandoned cific moment, furthermore, the outside the door or actually newly born children was to in- previous hospitals, which were abandoned.3 The decrees of crease even more with the ad- usually hospices, began in gen- Constantine of 331 and of Ono- vent of the modern age. This eral to be transformed into cen- rius and Theodosius of 412 en- was especially the case in tres of health care. trusted foundlings to those peo- France, Spain and Italy. In the The documentary evidence ple who found them and gave eighteenth century the phenom- on the hospital amounts to more them the option of deeming enon of the abandoning of chil- than three thousand volumes them free or slaves. But many dren exploded and displayed a and large files which are kept in were found and educated by the striking increase in numbers. In- the State Archives of Rome.9 Church, which generally was deed, the eighteenth century is engaged in providing these spoken of as ‘the century of the young people with a trade, as foundlings’.7 The foundlings 3. The Welcoming was done with orphans, so that hospital was one of the typical of Foundlings they would then be able to foundations of this century and into the Hospital every large city built its own institution for this purpose. In- The initial idea of Innocent deed, this process was so wide- III was that the hospital-hospice spread that in Europe 356 such of the Holy Spirit should be for institutions existed in the middle illegitimate children and such of the nineteenth century with was the case. However, in prac- more than 460,000 children be- tice a large part of the aban- ing cared for within their walls.8 doned children were legitimate Amongst the institutions cre- children. Poverty and the illness ated to look after foundlings the and physical defects of the new- hospital of the Holy Spirit in ly born children were the seri- Rome enjoyed a particularly ous reasons which led mothers prominent profile. With the to abandon their children.10 Dur- passing of time all the centres ing the seventeenth century managed by the Order of the about a thousand children every Holy Spirit as well as other in- year ended up in the Hospital of stitutions responsible for this the Holy Spirit. During the category of people in need eighteenth century this annual

DOLENTIUM HOMINUM N. 47-2001 figure was much lower in size their health, their lifestyle, their educators, tutors, teachers, cate- (500-700). The abandoned chil- morality, the religious character chists and even nurses and di- dren came in particular from the of their lives, and their econom- rectors who monitored and con- towns and villages within a ic condition. Because of better trolled their activity. With the range of a hundred kilometres conditions as regards climate reforms carried out in 1666 by from Rome.11 and mores, wet-nurses from out- Commendatore F.M. Fabei, The buildings and the struc- side Rome were preferred. these nuns, who for some cen- tures of the hospital were de- After a period of stay with turies had governed the Conser- signed so as to guarantee the these wet-nurses the abandoned vatory, no longer did so. Their people who abandoned their children had without any reser- transfer to another place and children absolute discretion. vation be handed back to the their subjection to a rigid life of The children were usually hospice Ð the girls before the seclusion in order to prevent brought to the hospital during age of eleven and the boys be- other admissions into their con- the night or at dusk or dawn, a fore the age of twelve. After go- gregation condemned them to reality which made anonymity ing back to the hospital the girls natural extinction.17 From the easier. The children were left in (called ‘spinsters’) were placed end of the 1760s the direction a wooden box which was large in the Conservatory and the of the Conservatory was totally and round, rather like a barrel, boys went to the ‘Scuola dei in the hands of female members and which was known by the Putti’. The boys did not stay for of the laity, who were them- name of ‘the wheel’. It was built a long time in this school Ð very selves often former pupils of into the external walls of the soon they were entrusted to the the Conservatory.18 hospital. The person who care of artisans so that they The life of the girls in the brought the child placed it with- could learn a trade or skill. Conservatory was rigorously 66 in this box through an opening, About 30-50 boys were in this regulated by the higher authori- turned it round, and then rung a school. The situation was differ- ties of the hospital and the bell so as to alert the person on ent for the girls who were only Church. The girl foundlings, duty by day or night within the rarely entrusted to outside peo- from the moment that they en- hospital.12 To ensure that the ple, and for this reason there tered the walls of the hospital women who abandoned their were always about 400-700 girls and for all the time that they re- children were safe in what they in the Conservatory.15 Further- mained within the institution, were doing and could enjoy a more, both the girls and the boys were obliged to observe its reg- certain privacy, thereby avoid- were sometimes given to people ulations and to carry out tasks of ing dishonour, the papal authori- in adoption. various kinds established by ties took them under their pro- their superiors or by the hospital tection and for example prohib- authorities. In particular, in the ited the representatives of the 4. The Conservatory hospital an attempt was made to public services from applying instill good habits and to devel- any sanctions to such women.13 When wanting to outline the op the morality of the boarders. Afterwards the ‘wheel’ was daily life of the spinsters and Taking account of the great opened with a key and the child describe the internal structure moral dangers to which the girls was taken out, the person on du- and the management of the hos- would have been exposed from ty used a lancet to incise a dou- pice, one cannot avoid talking too great a freedom or a light- ble cross on the child’s right about the role from this point of ness in contacts and conversa- foot. This was the sign of the view that was played by the tions with outside people, and hospital and of the Order of the nuns of the Congregation of the indeed with the internal male re- Holy Spirit as well. When the Holy Spirit. During the first ligious or secular staff and per- cut of this mark was still fresh it five centuries of the existence sonnel, it was decided that the was filled with a black dye of the hospital these nuns were members of the Conservatory which made it more evident and closely bound up with the would be subject to a very se- which gave it the character of a working of the Conservatory vere system of seclusion.19 Strict tattoo or even of a brand.14 and with the life of the pupils. seclusion for these girls was The children which had been These nuns, resident in the hos- maintained from the beginning left to the hospital were breast- pital founded in 1198 by Pope of the creation of the Conserva- fed by wet nurses who went Innocent III and subject to the tory and did not in the least di- there specifically for the pur- rule of St. Augustine, from the minish after the spinsters had pose, the so-called ‘house outset had to help sick people been separated from the nuns or wet-nurses’. After a short stay in and foundlings.16 All the nuns in after the recruitment of nuns for the hospital the children were the convent were the highest the congregation had been ter- entrusted to women who lived authority for all the pupils en- minated. outside the hospital to be fed trusted to their care. Their task The principle of the life of and brought up, these were the consisted in the main in teach- seclusion of these girls was put so-called ‘outside wet-nurses’. ing the pupils various kinds of into practice not only through These nurses were given a trades and skills, in looking prohibiting people from outside monthly allowance of money over them as they did so, and in the confines of the Conservato- and clothes to look after these ensuring that things went well ry from coming within its children. Those women who de- in this sphere. Until the end of precincts but also through a rig- cided to adopt the role of full the 1760s these nuns had total orous prohibitory edict on the wet-nurses in their homes were and absolute power over these formation of any kind of contact subjected to rigorous conditions pupils. For their pupils these with the outside world by the by the hospital with regard to nuns were thus administrators, same girl boarders. During the eighteenth century instructions attention because it was linked for the foundlings. From the on more than one occasion were to the full to the institutions of very moment of the abandon- given to the girls not to ap- the Order of the Holy Spirit ment of the child at the ‘wheel’, proach the main gate of the where the spiritual and religious the hospital became responsible Conservatory under any pretext way of life was laid down by the for his or her upbringing and ed- without having previously ob- monks and nuns.22 ucation and in particular for his tained the permission of the In 25 December 1623 friar or her religious and spiritual mother superior or the commis- Domenico Borguracci, the sec- training.25 The interest of the au- sioner of the hospital.20 retary and archivist of the Order thorities of the hospital in the re- From the analyses which have of the Holy Spirit, when draw- ligious life of its pupils also con- been carried out, it can be de- ing up the rules and regulations, tinued after the period when they duced that the spinsters of the suggested to the religious of the were entrusted to the wet-nurses, Conservatory lived in total Order of the Holy Spirit the way when they were given to people seclusion, and indeed were iso- in which the hospital should be ad artem or a tempo nubile, and lated from the external world. governed, and expressed the fol- in the case of marriage. In prac- Those who did not marry and lowing opinion: ‘so that the sick tice, this interest was due to the decided not to go out to work people and foundlings who dai- fact that the hospital wanted all were deprived of all contact ly come to be looked after in the wet-nurses, all the artists, ar- with the rest of society and thus this apostolic archhospital of the tisans, potential husbands, and spent the whole of their lives in Holy Spirit, can be in the right the families which adopted these the Conservatory in a state of ways governed and helped both girls, to be marked out by sound complete separation. The only in the service of the soul and of morality, good conduct mores, and a zealous profession of the 26 Catholic faith. The abandoned 67 children were received into the Catholic community through baptism, which they received immediately after being accepted into the hospital.27 With rare exceptions almost all the foundlings, after a short stay in the foundlings hospital, were entrusted to ‘outside’ wet-nurses with whom they spent about ten years of their lives. In their homes these foundlings were in- structed in the basics of the faith. After about ten years with the wet nurses the foundlings returned to the hospital. From that moment until their final exit from the hospital (adoption, guardianship a tempo nubile, guardianship ad artem, mar- opportunities the boarders had the body...’23 The hospital was riage), their education was ex- to go out officially from the made up of two separate institu- clusively in the hands of their walls of the Conservatory took tions but had a unified and sin- immediate superiors who were place three times a year at the gle administration. These insti- for the most part ecclesiastics time of the solemn processions tutions were: the hospital for the and religious. to the basilica of St. Peter’s. sick on the one hand and the As was the case with all These took place on Pentecost, hospice for the abandoned chil- Catholics, in the case of the St. Mark’s day, and the Sunday dren on the other. According to boarders of the Hospital of the before the solemn feast of St. the above mentioned rule of Holy Spirit as well one of the Anthony.21 As was the case dur- 1623, the sick person, as soon as most important events in the ing the medieval period, in the he or she had arrived in the hos- process of formation was the period after the Council of pital and immediately after be- first communion. This is borne Trent, as well, the hospitals, like ing subjected to the preliminary out by the order of Commenda- the other institutions under the medical examinations, had to tore Virgilio Spada of 1660, ac- direct administration and man- immediately engage in confes- cording to which all the spin- agement of the Church, were sion with one of the four confes- sters who were reaching their places where not only the illness sors on duty and on the next day twelfth birthday at Lent had to but also the religious life of he or she had also to receive prepare for their first commu- those who were admitted was holy communion.24 nion, which took place on Easter looked after and taken responsi- In the case of the sick, the au- day.28 Frequent and regular tak- bility for. This was the norm in thorities of the hospital confined ing part in the sacraments of general which was followed in themselves to requiring of them confession and the Eucharist the hospitals managed and ad- the obligation to receive Holy was the most important reli- ministered by religious orders, Communion only for the period gious activity of the boarders of but the Hospital of the Holy of their stay for treatment and re- the Conservatory. This was rig- Spirit of Rome requires special covery. The case was different orously directed through the

DOLENTIUM HOMINUM N. 47-2001 regulations and depended above prayers as had been recited in sick and very elderly women. all else on the age of the spin- the morning. It seems that the Work was seen above all else in sters. According to the orders of spinsters did not have any free terms of its educational, social 1660, the resident spinsters and time reserved to themselves and utility value. In involving the nuns of the convent had to during the day Ð everything was the female boarders in tasks of regard confession as the highest planned with extraordinary de- various kinds an attempt was good and as a practice which tail and scruple. The above being made to train them in hard guaranteed the salvation of the mentioned regulations also re- work, honesty and discipline, to soul.29 ferred briefly to the religious teach them various kinds of Taking part in the holy sacra- duties of the youngest spinsters trades and skills as well as ments, and in particular the but it is directly clear from house work which would be sacraments of penitence and these regulations that the useful to them when they were communion, was only one of youngest girls did their evening married and had to run a home. the forms of the education and devotions in their dormitories.30 Their work also had a real eco- the religious life of the ‘spin- The periodic organisation of nomic and material value. sters of the Conservatory’. The ‘spiritual retreats’ formed an One of the most detailed lists register of the obligatory reli- important part of the care of of the activity carried out by the gious and spiritual activities of souls. For example, the ‘spiritu- girls and women living in the the hospital was unusually rich al exercises’ in the hospital of hospice is to be found in docu- and complete. Living together the Holy Spirit took place be- with the nuns of the Holy Spirit, tween 16 and 29 May during the the spinsters almost behaved year 1760.31 Given the very im- like nuns, and based their portant role of spiritual life in 68 lifestyles on the monastic spirit. the hospital, in order to make Their daily tasks, such as work the religious practice more and their religious activities, fol- solemn in character the creation lowed the same lines. For this of a liturgical choir was request- reason, the religious life of the ed which was to accompany spinsters, the enforced seclu- most of the religious cere- sion, and their clothes, all made monies which took place in the their existence similar in charac- Conservatory and the hospital. ter to that of the monastic life. This choir also sang during the This state of affairs, in this area, saying of prayers and the of- did not change even when the fices. The principal task of the spinsters were separated from choir was to recite and sing var- the nuns. ious prayers (for example At the beginning of the eigh- psalms) during the shared func- teenth century, Pope Clement tions and the offices.32 XI imposed regulations regard- From these related facts it ing the timetable for the daily emerges that the hospital of the ments from the year 1660. From tasks and activities of the spin- Holy Spirit was not only given these it can be deduced that the sters and sought to lay down the the role of looking after health Ð female boarders cooked, washed category of religious practices it also had a pastoral and educa- clothes and dried, ironed, mend- envisaged for them. In general, tional responsibility. The life of ed shirts, amices, surplices, the character and time of the those living in the hospital had gloves, purificators, and the carrying out of these practices to be imbued with a spirit of liturgical vestments of the depended on the age of the zealous religiousity and devo- church of the hospital, as well as spinsters involved. The elderly tion, with every action and mo- the underclothes of the patients. and middle-aged spinsters, with ment of the day being regulated. In addition, they made sheets, the exception of the sick and The education of the pupils of tablecloths, napkins, and other those unable to work, woke in the Conservatory had to take things that were necessary for the morning at the sounding of place through the development employees of the hospital, the ‘Hail Mary’ bell and then of spiritual and religious life as shirts, sashes, and ribbons for all went to church to attend mass, well as through daily work. In the foundlings, both those who make their devotions, and en- 1679 Cardinal Acciajoli, refer- lived in the hospice and those gage in the ‘divine office of the ring to the decrees of Pope Ur- who lives with wet-nurses. They choir’. After these undertak- ban VIII and Alexander VI, or- also cut and sewed clothes, ings, they went to the dining dered all those who lived inside blouses, sleeves and socks for hall for their breakfast and af- the Conservatory, according to themselves and for the nuns terwards engaged in their usual their age and capacities, to dedi- who lived in the convent.34 In manual work. During this work cate their whole time to various addition to the above mentioned they sung together the praises kinds of work to the benefit of productive work, at the begin- of the Blessed Virgin Mary. The the hospital and thereby to en- ning of the 1760s the spinsters pause between their morning gage in works of Christian com- helped in, served in, and cleaned and their afternoon work was passion, prayer, and spiritual ex- the hospital. Six of them worked taken up by lunch. After their ercises.33 for a week in the kitchen to pre- afternoon work the elderly and The obligation to work every pare the meals of all their com- middle-aged spinsters had sup- day applied to all the female panions in the Conservatory, per and afterwards went to the boarders in the hospital with the and the week afterwards dedi- chapel to recite the same exception of those who were cated themselves to cleaning the clothes of all the members of the daily uniform of the boarders merous and permanent presence Conservatory. Every seven days was a dark blue dress which was within the complex was envis- the area of work changed. Four similar to a religious set of aged from the beginning and or six women also helped the clothes. This was how they had was in addition an indispensable nuns in their work of adminis- to be dressed inside the precincts condition for the effective and tration and management.35 of the institution as well as dur- sound working of the whole in- The professional activity of ing the processions which were stitution. the female boarders was one of held three times a year and The direction and the surveil- the principal tasks of their edu- which took place in the streets of lance of the school for children cation. Each of them had to car- the city.38 without families was in the ry out certain functions, and had hands of an elderly priest who to make themselves useful ac- had the qualification of a teacher cording to their abilities, age 5. The Boys School or a schoolmaster. In addition to and physical condition. looking after general order and The reality of seclusion of the Boys who were at least seven discipline, he had the duty to daily lives of the female board- years old lived in the school for teach the boys twice a day, in ers was also expressed in the boys. The youngest boys, on the the morning and after lunch. He fact that they wore the clothes other hand, who previously had taught them to read and write, prescribed by the rules and reg- returned from the custody of grammar, the catechesis, com- ulations, and these clothes were their adoptive families, stayed passion and Christian piety, as similar to those worn by the with the wet nurses of the hospi- well as instilling in them good nuns. The principal characteris- tal until reaching that age. Ac- habits and the bases of a sound tic of the clothes of the female cording to the rules of 1759, the education. He was also obliged boarders was their uniformity, abandoned children could be to organise the daily work of 69 simplicity, and modesty. Ac- maintained and brought up in service and order for the good of cording to the regulations and their own school at the expense the hospital, the school and the the ordinances, which were of- of the hospital until they were church, in which the boys above ten renewed, uniformity of dress twelve years age and were then all else performed the function was obligatory for all the female given in adoption or ad artem. of altar boys. He also had to be boarders, irrespective of age or Only those few for whom peo- responsible for the health of the physical condition, both within ple could not be found to entrust boys and to send them to be the precincts and during the rare them to outside the hospital had treated if they fell ill.39 trips outside the hospital and the right to stay further within Differently from the girls who during the visits and the proces- the hospital until suitable learnt the practical arts which sions.36 guardians were found for them prepared them for adult life The order to wear the uniform or families who wanted to adopt within the Conservatory, the applied to clothes, shoes, and them were identified. boys received their professional bonnets, as well as to hairstyles. The Hospital of the Holy training outside the precincts of In special and justified cases the Spirit provided initial help and the hospital. This did not mean management of the hospital al- refuge to all the foundlings irre- that all the male pupils of the lowed some female boarders to spective of whether they were foundling school, without any wear clothes etc. which did not boys or girls. However, the girls exception, completed their edu- belong to the uniform. This and adult women received a cation of knowing how to read largely applied to the boarders more specific form of care and and write, their course of cate- engaged in heavy work and dif- approach. In the sources we chesis, or in a more distant fu- ficult jobs where the uniform have available there are no ref- ture the practical learning of a was not appropriate.37 The uni- erences to adult male boarders, trade or skill. Some of them Ð form and modest clothes were former foundlings that is to say the more intelligent Ð as was the suited to the monastic style of who lived in the precincts of the case with the students of other life of the female boarders and hospital institution. Hence, in- charity centre in Rome, were en- the religious-sacred character of deed, the name: the phrase trusted to higher education or to the place where they lived. In ‘Scuola dei putti’ in Italian the priesthood. In such a situa- living for a number of centuries clearly indicates that only small tion they left the walls of the with the nuns in a shared con- boys were present. The stay in hospital of the Holy Spirit and vent they took on from the nuns the hospital, which usually last- were then sent to suitable insti- with whom they lived not only ed a few months or years, was tutions for further education.40 the habits and customs of the life only a brief episode in their The rule of 1587 of Commenda- of seclusion but also its confor- lives. From the moment of their tore G.B. Ruini is proof that the mity, simplicity, and the severity adoption or their guardianship superiors of the hospital occu- of its way of dressing. Wearing a by which they could learn a pied themselves with enabling uniform set of clothes according trade or skill, their ties and con- the more talented boys to ac- to the founders had an educa- nections with the hospital were quire a broader education so that tional purpose Ð it was some- broken for ever. Indeed, the hos- in the future they could obtain thing intended to teach modesty pital, given the nature of its higher positions within society.41 and moderation to the boarders: buildings and organisation, was virtues which would be useful in not intended to provide services their future adult lives as well as over a long period, places to 6. The Subsequent Destiny acting to impede the acquisition live, jobs, education, or income of the Foundlings of vanity and bad habits. to adult men. The situation was The essential feature of the different for women whose nu- During the whole of their stay

DOLENTIUM HOMINUM N. 47-2001 in the homes of the wet nurses, were made legal by a contract The number of girls entrusted the abandoned children contin- between the hospital and the a tempo nubile each year was ued to be under the constant su- guardians or adoptive parents. markedly lower during the first pervision of the hospital of the In the case of girls given a tem- decade of the eighteenth centu- Holy Spirit. The wet-nurses as a po nubile and the boys given ad ry. During that period it rarely rule had no rights in relation to artem once again all the duties happened that ten girls a year them, indeed the tie between the of the new guardians or adopted were given out in service. A children and the families to parents towards the children clear tendency can be observed which they were entrusted had a were listed in detail. They were for the subsequent decades. The temporary character and arose obliged to maintain the children highest number of spinsters on the whole from economic in their own homes, to clothe given out by the hospital a tem- needs. With the passing of time them, to give them meals at the po nubile took place in 1739 these relationships increasingly family table, to treat them well, and amounted to ninety-nine acquired a familial and emo- to teach them and to make them girls.47 tional character. Between the live the rudiments of the The adoption of the hospital children and their guardians a Catholic faith, and to habituate girl pupils took place much relationship of love, cordiality, them to good mores, honesty, more rarely. In the twenty-five and affection developed.42 As a and moral principles, and also years from 1711 to 1736 the result, many wet-nurses ex- when they fell ill to make sure disproportion between the pressed the wish to go on looking after the children that had been entrusted to them. According to the proposals 70 made by potential guardians, three forms of looking after the foundlings were possible. The first was adoption, which in a strong and lasting way linked the children to their future step-parents. After adoption the foundlings acquired the rights which were possessed by the children who were born to their families and brought up in them. Another form of ward- ship allowed for the female foundlings was that of their being entrusted a tempo nubile to serve in a family where they stayed until they got married and became independent. The people who offered this kind of guardianship undertook to guarantee these girls lodgings, that they had treatment and number of girls sent out to ser- food, education and mainte- care. They could not mistreat vice (664) and the number of nance until they were married. them, evict them, or give rise to girls who were adopted (73) Formally, however, the girls re- situations where the children was enormous. From 1737 to mained under the tutelage of fled from the home which 1790 the cases of the adoption the hospital and had the possi- looked after them. In cases of girls was only a sporadic bility of going back to it when- where a boy abandoned the phenomenon Ð for this period ever they wanted. The entrust- home of his own free will the the evidence reveals only twen- ing of the boys ad artem, above guardians had to find him and ty cases of adoption whereas all else to artisans, was similar take him back home, inform- the number of girls handed to the system whereby the girls ing, however, the hospital com- over a tempo nubile was about were given a tempo nubile.43 mission of the fact. In handing 1200. During the course of the The most convenient and wel- the girls over a tempo nubile whole century the girls who come age, in the view of the au- the contract required that the were adopted amounted to 7% thorities of the hospital, to be- guardians undertook to give of all the spinsters entrusted to gin to learn a profession, was these girls, by then teenagers, a the care of families who lived ‘about thirteen years old’.44 dowry at the time of their mar- outside the hospital. Over a It was a long-standing custom riage if one took place. In the hundred years, all in all 2,050 that the women or their families signed agreement the hospital girls were given out a tempo who had looked after an aban- reserved to itself the right to de- nubile, whereas 164 were doned child for eleven or twelve cide on what happened to the adopted. years and wanted to receive adult girls who went on living If one analyses what hap- them under one of the forms of in these homes Ð before decid- pened to the boys most of them guardianship had to first give ing whether to marry or to be- were given to artisans so that back the child to the hospital.45 come nuns they had to receive they could learn a trade or skill Both adoption and guardian- the consent or the approval of rather than given out to adop- ship ad artem or a tempo nubile the hospital commission.46 tion. The greatest disproportion in this sphere is to be ob- 7. Conclusion mission to an extent which is served for the period of the vis- not to be found elsewhere. Dur- it to the hospital for the years From its origins onwards, the ing the seventeenth and eigh- 1737-1740. The number of Hospital of the Holy Spirit of teenth centuries it saved the males adopted during this peri- Rome was the most important lives of about a hundred thou- od (44) was four times lower charitable institution in the sand unwanted children. It is than those handed over ad Christian world. As a pontifical true that many of these in the artem (183).48 Generally, how- hospital it was for centuries a months or years thereafter died ever, the difference between central point of interest for the but it should also be remem- the two options for the lives for Apostolic See and enjoyed pro- bered that in those times death the boys was not as great as tection and constant help which decimated the infant population, was the case with the case for allowed it to continue to work and this was not only the case the two options for the girls. during the period of the Refor- within hospitals. One can argue During the course of the mation, something that was that the system of protection of eighteenth century the number tragic in the European context the foundlings introduced and of girls who were adopted or for the hospitals run by the Or- practiced in the Hospital of the handed over a tempo nubile and der. Renewed and expanded in Holy Spirit of Rome was for of boys who were given out ad the fifteenth and sixteenth cen- those times an excellent solu- artem was 2,291 and 6,178 re- turies, thanks to the interest of tion, and above all else for the spectively.49 Overall, therefore, the Popes, the Roman hospital foundlings themselves. Thanks in this period of a hundred during the seventeenth and eigh- to this system, the children, de- years 8,469 abandoned children teenth centuries reached the prived of their natural parents, found adoptive parents, care, high-point of its existence. For could be brought up in a way and work outside the hospital. centuries all the other centres of which was almost normal in the 71 It should be noted that in no the Order, as well as other insti- substitute families. At the same year during the course of the tutions which were responsible time, for the inhabitants of whole of the eighteenth century for the same category of people Rome and its hinterland as well, did the number of girls handed in need, drew upon it because of the various forms of protection over to service and adopted ex- the models and approaches offered to the foundlings were ceed the number of boys given which it developed. This was a from a material point of view a over ad artem and in adoption. complete system, which for very remunerative occupation. The hope of the authorities of those times was very modern, The problem of unwanted the hospital was to arrange which guaranteed help, protec- children, which has always been things so that the highest possi- tion and education for aban- evident since ancient times, is ble number of their girl board- doned children for the whole of also of relevance in our own ers became integrated into soci- their lives. Even though the days. A reflection is called for, ety in a positive way through foundlings usually spent only a namely that in order to solve marriage. But if the authorities certain part of their existence in this problem certain models and left a great deal of indepen- the hospice, they nonetheless reforms of experience developed dence and freedom to the boys mained for the whole of their by the Hospital of the Holy in deciding about their own fu- lives under its protection and su- Spirit down the centuries could tures, they dedicated especial pervision. The hospital opened be useful, naturally after certain care and prudence to the future its kind of umbrella of care for changes and after adapting them life of the adolescent girls. The and defence of its former resi- to contemporary needs and so- cares and concerns of the man- dents even after they had be- cial realities. In this way, aban- agement of the hospital regard- come independent and had doned children would not risk ing their future were expressed founded their own families. ending up in rubbish dumps but in the application of very severe About two thousand foundlings, would find themselves in a requirements and conditions to both small and grown up, resi- modern ‘incubator’ cradle. those men who wanted to mar- dent in the hospice, adopted, liv- ry such girls. Indeed, all the ing in the families of their Prof. MARIAN SURDACKI, men who wanted to marry the wet-nurse, in service with other Professor of the History girl boarders had to be subject- people, apprentices of a trade or of Social Care, ed first to rigorous kinds of living with their own families, the Catholic University of Lubelski, tests and examinations.50 after getting married enjoyed at (Poland) During the eighteenth centu- the same time, during the differ- ry, each year 30 to 190 spinsters ent stages of their lives, the help married, and during the whole and protection provided by the of the century more than 7,000 hospital in its various forms. In girls of the Conservatory en- general, the foundlings, who tered marriage. They married at came from the hospital of the a very early age, when they Holy Spirit of Rome and made were about fourteen or fifteen. up a social group with a certain Notes Usually, they married boys profile which was both special 1 More detailed information on the from the country or artisans and closed, were a life element Hospital of the Holy Spirit and on its ac- who lived in small towns and in the villages and in the lives of tivities in relation to caring for abandoned villages. At the time of the mar- the peasant women of the hin- children can be found in M. SURDACKI, riage the hospital paid a dowry terland of the capital of the Pa- Dzieci porzucone w Szpitalu Swietego Ducha w Rzymie w XVIII wieku (Lublin, of a hundred scudos for each of pal States. Without doubt the 1998) (‘The Foundlings of the Hospital of its girl boarders.51 Roman hospital carried out its the Holy Spirit of Rome in the Eighteenth

DOLENTIUM HOMINUM N. 47-2001 Century’) and in other works by the same XXV-XXVI, pp. 177-242. See also M. author: ‘Dzieci porzucone w Rzymie i SURDACKI, ‘Dzieci porzucone w Rzymie’, okolicach w XVIII’, Roczniki Nauk pp. 98-104. Spolecznych’, 22, 1994, n. 2, pp. 84-108; 27 Vedi M. SURDACKI, ‘Dzieci porzu- idem, ‘“Figli legittimi” w Rzymie i Paqst- cone w Rzymie’, pp. 98-99. wie Kocielnym w XVIII wieku’, Roczniki 28 n. 1305, ‘Ordini per dentro il Monas- Nauk Spolecznych, 23, 1995, n. 2, pp. tero 1660’, in NSVP, p. 4. See alsp n. 87-100; idem, Malzenstwa wychowanek 1414B, ‘Stato dell’officii...’, pp. 41-42; n. Szpitala Swietego Ducha w Rzymie w 1305, ‘Regolamento delle Zitelle del XVII-XVIII wieku’, Kwartalnik Historii Conservatorio del Monsig. Pallavicini Kultury Materialnej, 44, 1996, n. 2, pp. Commendatore 1748. Regole che devono 137-156; idem, ‘Marriages of wards of osservarsi nel Conservatorio del Sagro Rome’s Holy Spirit Hospital in the 17th Apostolico Archiospedale di S. Spirito in and 18th Centuries’, Acta Poloniae His- Sassia di Roma’. torica, 79, 1999, pp. 99-122; idem, ‘Zycie 29 n. 1305, ‘Ordini per dentro il Monas- religijne podopiecznych Szpitala swijtego tero 1660’. Ducha w Rzymie w XVII i XVIII wieku’, 30 n. 1305, manuscript entitled Roczniki Nauk Spolecznych, 24, 1996, n. ‘Clemens XI. P.O.M.’. 2, pp. 315-333; idem, ‘La vita religiosa 31 n. 61, ‘Giornale. Memorie delle nel “Conservatorio” dell’ospedale di San- Cose più Notabili accadute circa gli Af- to Spirito in Roma nei secoli XVII-XVI- fari del Ven. Archiospedale di S. Spirito II’, Ricerche di storia sociale religiosa di da 28 luglio 1758, sino a 28 dicembre Roma, 27, 1998, 54, pp. 149-165; idem, 1758’, p. 15. ‘“Bambini esposti” w Rzymie i w Paqst- 32 n. 1305, manuscript entitled wie Kocilenym w XVII i XVIII wieku’, ‘Clemens XI. P.O.M.’. in Christianitas et Cultura Europae. Ksij- sioni, e salariati del Ven. Archiospedale 33 n. 1305, ‘Decreti di Visita...1679’, p. ga Jubileuszowa Profesora Jerzego Kloc- di S. Spirito, tanto di Roma quanto di 73. zowskiego, vol. I (Lublin, 1998), pp. Campagna’, p. 9; n. 1305, ‘Regolamenti 34 n. 1305, ‘Questo è il modo del vi- 148-157; idem, ‘Kondycja zdrowotna che si praticano nell’Archiospedale di vere, e governare, che fanno le Monache, podopiecznych Szpitala Swietego Ducha Santo Spirito in Sassia di Roma per il e le Zitelle sue di S. Spirito in Sassia di w Rzymie w XVII i XVIII wieku’, buon Servizio di tutti gli esposti 1754’; n. Roma indigentissime Serve e Suddite etc. 72 Roczniki Nauk Humanistycznych, 46, 1305, ‘Visita de Proietti ed utili 1740’. 1660’, pp. 21-22. 1998, n. 2, pp. 117-148; idem, ‘Losy See also n. 1296, ‘Intorno a quello spetta 35 n. 1305, ‘Editto a tutti i Ministri del wychowankrw Szpitala wijtego Ducha w Monsignore Commendatore’; n. 1305, Conservatorio Nuovo 1662’, inNSVP, p. Rzymie w XVIII wieku’, Roczniki Nauk ‘Regolamento per Baliatico. Regolamenti 45; n. 1305, ‘Officio della Priora del Con- Spolecznych, 25, 1997, n. 2, pp. 137-164; del Baliatico di S. Spirito’. servatorio 1661’. idem, ‘Dzieci porzucone w rodzinach za- 13 C. SCHIAVONI, ‘Gli infanti “esposti” 36 n. 1305, ‘Ordini della Sagra Visita di stjpczych w Rzymie i okolicach w XVII i (o “proietti”) alla “ruota” dell’ar- non entrare nel Coservatorio, di non XVIII wieku’, Roczniki Humanistyczne, chiospedale di Santo Spirito in Saxia di lavare, e sopra il vestire, inferme, medico, 47, 1999, n. 2, pp. 125-148. Roma dal 1700 al 1824’, in La De- portinare, ascoltatrici, confessore ed altro 2 G. DA MOLIN, Nati e abbandonati. mografia Storica delle Città Italiane 1808’, p. 217; n. 1305, ‘Ordini per il Con- Aspetti demografici e sociali dell’infanzia (S.I.DE.S., Bologna, 1982), p. 1028. servatorio di S. Spirito. Giovanni Battista abbandonata in Italia nell’età moderna 14 Ibidem., p. 1028. Spinola Commendatore 1688’, in NSVP, (Bari, 1993), p. 5. 15 M. SURDACKI, Dzieci porzucone w p. 78. 3 G. PAGLIANO, ‘Il motivo dell’infante Szpitalu, pp. 232-241, 335-350. 37 n. 1305, manuscript entitled abbandonato in letteratura: Consider- 16 n. 30, ‘Notizie diverse di Casa in ‘Clemens XI. P.O.M.’. azioni su alcuni testi italiani’, in Enfance tempo di Monsignor Racagni’, p. 5. 38 n. 1305, ‘Stato della Casa... di Mon- abandonnée et société en Europe XVI-XX 17 C. SCHIAVONI, ‘Gli infanti’, p. 1040. signor Spada, 1661’, pp. 6-7. siècle (Rome, 1991), p. 879. 18 n. 1305, ‘Decreti di Visita dell’Emi- 39 n. 1305, ‘Regolamenti che si pratti- 4 V. MONACHINO, ‘L’antichità e l’alto nentissimo Cardinal Acciajoli 15 giugno cano... 1754’. medioevo’, in La carità cristiana in Ro- 1679’, in ‘Notificazione sopra varie prov- 40 C. SCHIAVONI, ‘Gli infanti’, pp. ma, edited by V. Monachino (Bologna, idenze riguardanti il regolamento e buon’ 1039-1040. 1968), p. 78. See also J. BOSWELL, L’ab- ordine del Conservatorio di S. Spirito. In 41 n. 12bis, ‘Ordini di Monsig. Gio. Bt- bandono dei bambini in Europa occiden- Roma MDCCCVI’ (hereafter cit. NSVP), ta. Ruini Commendatore dell’Apostolico tale (Milan, 1991), p. 265. p. 73. Hospitale di Santo Spirito di Roma pub- 5 J. BOSWELL, op. cit., pp. 25, 150, 256; 19 Ibidem. blicati sotto il di 1587’. G. DE ROSA, ‘L’emarginazione sociale in 20 n. 1305, ‘Edictum pro Conservatorio 42 n. 1305, ‘Stato della Casa... di Mon- Calabria nell XVIII secolo: Il problema Puellarum S. Spiritus 1716’; n. 1305, signor Spada, 1661’, p. 6; n. 1305, ‘Visita degli esposti’, Ricerche di storia sociale e ‘Antonio Maria Pallavicini Arcivescovo de Proietti ed utili 1740’ (“...per il grande religiosa, 13, 1978, pp. 5-19 di Lepanto e Commendatore del Sacro affetto che li portano verso dette per aver- 6 L. CALZOLA, ‘Caratteristiche de- Apostolico Archiospedale di S. Spirito in le allevate” (‘because of the great affec- mografiche di abbandono degli esposti Sassia 1739’. tion they feel for them because they have dell’Ospedale di S. Maria della Miseri- 21 n. 1305, ‘Stato della Casa... di Mon- brought them up’); n. 1414B, ‘Stato del- cordia di Perugia nei secoli XVI e XVII’, signor Spada, 1661’, p. 6. l’officij...’, p. 13 (“per carità e buon affet- in Trovatelli e balie in Italia. Secc. 22 On religious life in the Conservatory to, che portano verso questi poveri proiet- XVI-XIX, edited by G. Da Molin (Bari, see M. SURDACKI, ‘La vita religiosa’, pp. ti se li pigliano per figli adottivi” (‘be- 1994), p. 13; J. Boswell, op. cit., p. 256. 149-165. cause of the charity and good affection 7 V. HUNECKE, I trovatelli di Milano. 23 Biblioteca Apostolica Vaticana, Bar- they feel for these poor foundlings they Bambini esposti e famiglie espositrici dal berino Latino 10683 (ff. 2-29v), cap. 2. take them as their adopted children’). XVIII al XIX secolo (Bologna, 1989), p. ‘Relatione del modo, che si tiene da Reli- 43 n. 1305, ‘Stato della Casa... di Mon- 15; idem, Die Findelkinder von Mailand. giosi di Santo Spirito in Sassia di Roma signor Spada, 1661’, pp. 8-9. Kinderaussetzung und aussehende Eltem nel governo dell’archiospedale apostolico 44 n. 1305, ‘Visita de Proietti ed utili vom 17. bis zum 19 Jahrhunderts di Santo Spirito, e dell’ordine, che si os- 1740’. (Stuttgart, 1987); V. PAGLIA, Storia dei serva nella cura degl’infirmi, et esposti, 45 n. 1305, ‘Regolamenti che si prati- poveri in occidente (Milan, 1994), p. 327. scritta da fra Domenico Borgarucci reli- cano... 1754’. 8 V. PAGLIA, op. cit., p. 327, J. Sandrin, gioso, et secretario del medesimo Or- 46 n. 1305, ‘Concessione a tempo nu- Enfants trouvès. Enfants oublihs. dine’. bile delle Proiette fatta dall’Archi- XVIII-XIX siècle (Paris, 1968). 24 Ibidem., cap. 3. ospedale e Pia casa di Santo Spirito in 9 Almost all the documents quoted and 25 The details and comments on the Sassia. Questo è il modulo che si com- cited hereafter are to be found in the procedure by which children were aban- pilava al momento della concessione’. ‘Archivio di Stato di Roma’ (‘Archivio doned at the ‘ruota’ of the hospital of the 47 M. SURDACKI, Dzieci porzucone w dell’Ospedale di Santo Spirito di Roma’). Holy Spirit and how these childern were Szpitalu, pp. 358-360. The numbers in the references refer to the taken care of are to be found in the article: 48 Ibidem, pp. 360-362. folders in which the documents quoted or M. SURDACKI, ‘Dzieci porzucone w 49 These data are taken from tables 8 cited are kept. Rzymie’, Roczniki Humanistyczne, 22, and 9 in M. SURDACKI, Dzieci porzucone 10 See M. SURDACKI, ‘Figli legittimi’, 1994, z. 2, pp. 84-108. w Szpitalu, pp. 360, 364. pp. 87-100. 26 For the wet-nurses who raised the 50 n. 1305, ‘Decreti di Visita...1679’, p. 11 M. SURDACKI, Dzieci porzucone w ‘abandoned children’ see C. SCHIAVONI, 79. Szpitalu, pp. 106-118; idem, ‘Dzieci ‘Le balie del brefotrofio dell’ospedale di 51 M. SURDACKI, Dzieci porzucone w porzucone w Rzymie’, pp. 84-108. Santo Spirito in Saxia di Roma ‘500 e Szpitalu, pp. 373-396, idem, ‘Marriages’, 12 n. 1414B, ‘Stato dell’officij, provi- ‘800’, Archivi e Cultura, Nuova Serie, pp. 99-122. The Department of Pastoral Care at the Cardinal Tien Hospital in Taiwan

1. The Beginning 2. Mission and part of new-employees’ train- of the Establishment Objectives ing program. c. Provide spiritual seminars As a tradition, when the To communicate Christian and seminars for those inter- Catholic Church is considering love/good news to all the pa- ested in knowing more about building a hospital, she usually tients, their family members Catholicism. looks at where there is a lack and to all the hospital staff d. Instructions in Catechism of good medical service in the through the Pastoral Care Min- by offering the Rite for the poorer section of town. The istry in the forms of: caring, Christian Initiation of Adults Church in caring for the peo- being present, listening, and and preparation for First Holy ple is concerned not only providing guidance. Communion, classes are of- about the cure of the body, but fered to employees and their even more about the needs of family. the mind (heart) and soul (spir- 3. Role and Functions e. Classes in self-under- 73 it). Therefore, from the outset, standing and better communi- a Chaplain was assigned to ad- The pastoral care givers: cation among family members minister the sacraments to the 1. Endeavor to build up mu- are also offered for the hospi- sick. The rest of the priests, tual trust with the patients, and tal staff. sisters and lay Catholics on the their families, and to develop a f. Participation in “Grief staff served the patients in var- friendly atmosphere in order Counseling” series by those ious capacities but with a pas- to assess their spiritual as well staff in need. toral care perspective. as other emotional or temporal In the early part of 1990, needs. C. Liturgy Ð To promote with the expansion of the Car- 2. Provide religious and evangelization. dinal Tien Hospital, Sister spiritual services to Catholics, a. Conducting weekly morn- Mary Ann Lou SDSH, Direc- and spiritual assistance to non- ing or noon prayer/group, tor of the Hospital, responded Catholics whose practices dif- meetings, in the various de- to the needs of the time. She fer from our own. partments of the hospital. initiated a pastoral care unit as 3. Act as a bridge of com- b. Adoration of the Blessed an independent department. In munication and good will be- Sacrament (Holy Hour) in the this way the pastoral care min- tween: Chapel every Friday. istry was officially begun by a A. Patients and their family c. Advent and Lenten Days full time staff trained for such members. of Recollection for the services. The Pastoral Care B. Patients and other staff Catholic and interested mem- Department began with the members. bers of the staff. priest Chaplain and one pas- C. Among the staff mem- d. Feast day celebrations toral care giver, now we are bers themselves. Christmas: 1) Procession, staffed by one Chaplain 24 Holy Mass, shared meals. hours on call, one supervisor, (agape) 6 full time, 2 part time pastoral 4. Responsibility of the 2) Carolling and choir con- care givers and one clerk. Pastoral Care Givers test to encourage learning of Christmas songs. 1. Services provided 3) Christmas decoration for/to the hospital staff: contest for all nursing stations, to promote understanding of A. Psycho-spiritual assis- and love for Christmas. tance: Offering support to the Easter and Pentecost: Spe- staff in their work, through at- cial liturgy for the staff, e.g. tentive listening, counseling Pass-over Agape, egg paint- and acceptance of complaints. ing, contest and exhibition. Chinese New Year: Cere- B. Education: Participation monial expression of worship in planning and executing: to God, honor to ancestors, a. Staff orientation to the goodwill to each other, as a hospital’s mission of charity bridge between Christian and and service. local customs. b. An introduction to the e. Planning and executing of Pastoral Care Department as a the liturgical ceremony for the

DOLENTIUM HOMINUM N. 47-2001 blessing of every new area or offers a small scale Pastoral toral Care Givers of other service of the hospital at its Care Fund for patients’ current Catholic and Protestant Health formal opening. use, such as clothing, food, Care Institutions: exchanging nutrition, even short term sub- ideas, giving mutual support, D. Activities: sidies for the family, so that encouraging the upgrading of a. Assisting the employees’ the patients can have a rela- quality of services. “Christian life community” tively peaceful hospital stay weekly gathering in order to during the crisis. give them a better sense of be- 5. Others longing and spiritual growth. F. To provide books, arti- b. Managing the annual as- cles, pamphlets of a spiritual 1. Attending to the needs of sembly of Catholic health care nature for patients and family “Community Health” pro- professionals (hospital admin- members to read. grams, e.g. the Evergreen Se- istrators, physicians, nurses, nior Citizen Group, in their etc.) G. To assist priests and reli- spiritual well being. c. Providing a religious at- gious in the processes of hos- 2. Regularly contributing mosphere in the hospital pital admission and discharge. spiritual articles and reports of through art and music so that enriching experiences to the patients and staff may feel the H. To plan liturgical cele- hospital’s monthly newsletter. warmth of a Christian envi- bration of World Health Day ronment. for patients and their families. 6. Plans for the Future 2. Services given to patients: I. To participate in case con- 74 Include the following areas ferences in hospital wards. 1. To reinforce the spiritual of concerns: growth and renewal of the J. To plan basic training pro- hospital staff. A. To visit new patients: To gram for the volunteers in pa- 2. To strengthen and work listen and to comfort by em- tient visitation. towards an ever more harmo- pathic listening and making nized team work among the referrals to related resource K. Foreign laborers who medical and para-medical persons. Special attention is come to Cardinal Tien Hospi- staff, so that the Christian spir- given to patients with cancer, tal for the required pre-em- it be further manifested. major surgery, suicide, assault ployment physical examina- 3. To up grade the profes- etc. major emotional issues. tion are also our concern. Reli- sional quality of our Pastoral gious articles, spiritual books, Care givers: to prepare teach- B. To offer spiritual services directory of Churches near ers and provide a training of Mass, Holy Communion, their work places etc. are pre- center for this country’s fu- Baptism, Reconciliation and pared for their use. ture Hospital Pastoral Care Anointing. L. Net working with Pas- Givers.

C. To offer to those patients with long term hospital stay support and comfort, includ- ing their family members in their needs. When occasions arise, attempts are also made to explore the meaning of life and of suffering, sharing with them the good news of the Gospel.

D. For the family members of dying patients or patients suffering from fatal accidents, the pastoral care givers’ presence is very important to comfort them and to assist the family to carry out a Christian burial service. Bereavement care is also provided whenever needed.

E. Whenever the patients present a financial need, referrals are made to the Social Service Department for appropriate allocation of funding. The Pastoral Care Department Archdiocese of Philadelphia: Protocol for Evaluating Catholic Health Care Collaborative Relationships

Due to the complex nature Collaborative Relationship. c) witnessing to a responsi- of health care, some Catholic Catholic health care ble stewardship of limited health care providers have de- providers shall not enter into health care resources; termined that in order to pre- any major alliance or affilia- d) providing poor and vul- serve their ministry, there is a tion agreement with non- nerable persons with a more pressing need for joint ven- Catholic health care providers equitable access to basic tures, partnerships or other without the nihil obstat of the health care. types of collaborative relation- Archbishop of Philadelphia. 2. All activities arising from ships relevant to the joint fi- For subsequent “collaborative the Collaborative Relation- nancing and the joint delivery relationship” flowing from the of health care a (hereinafter re- major alliance or affiliation ferred to as “Collaborative Re- agreement, a petition for a ni- 75 lationships”). It is understood hil obstat needs to be made that in such Collaborative Re- only when the Secretary for lationships, Catholic health Catholic Human Services is care providers operating in the reasonably concerned that the Archdiocese of Philadelphia “collaborative relationship” will give priority to entering might negatively affect the into relationships with other mission or religious or ethical Catholic health care institu- identity of such Catholic tions and agencies in order health care providers. The that the Catholic presence in Archbishop will specify a the provision of health care process for the review of such might remain strong and influ- ventures in consultation with ential, witnessing collectively all relevant parties. Because to their shared ministry. of the necessity for the Arch- If it is determined that no diocese to be apprised at the exclusively Catholic relation- onset, such Collaborative Re- ship will conform to the “Eth- ship is possible and a Collab- lationships are to be presented ical and Religious Directives orative Relationship with a in writing to the Archdiocese for Catholic Health Care Ser- non-Catholic provider is proof Philadelphia before any vices”; posed, the Catholic health substantial negotiations are 3. Catholic providers will care provider must evaluate undertaken with the prospec- only enter into Collaborative the proposed Collaborative tive partners. The Collabora- Relationships that do not vio- Relationship in light of each tive Relationship will be eval- late the principles of coopera- of the following: uated in light of Church teach- tion with evil regarding pro- 1. the necessity of strength- ing and canonical legislation, cedures judged to be immoral ening the Catholic health care the proper law of the Spon- by the Catholic Church, for apostolate within the Arch- sors, the necessity of the rela- example as stated in the Ethi- diocese; tionship and the likely effect cal and Religious Directives 2. the future viability of the that the activity will have on for Catholic Health Care Ser- particular Catholic health care other apostolates within the vices as they currently exist or provider as well as the future Archdiocese. are amended in the future. possible harm to the particular The Archbishop or his dele- 4. A Catholic provider can- Catholic health care provider gate will use the following not own or manage an institu- if it did not enter into the Col- criteria among others in eval- tion that by policy or practice laborative Relationship; uating these relationships. engages in intrinsically im- 3. the need for pro-active ad- 1. Collaborative Relation- moral activities. vocacy on behalf of Catholic ships shall enhance the local 5. A nihil obstat will not be ethical and moral principles; Catholic health care aposto- granted to Collaborative Re- 4. the necessity of avoiding late by: lationships in which the result formal cooperation in evil; a) helping to implement the will be that the Catholic 5. the necessity to avoid Church’s moral and social health care provider becomes public scandal; and, teaching; a publicly traded, investor 6. the necessity to educate b) furthering the health care owned, for-profit entity so as the community regarding the ministry to the community; to lose its not-for-profit status.

DOLENTIUM HOMINUM N. 47-2001 Procedure for evaluating fined in the relevant particular provider, the Secretary will ei- Catholic health care law. ther monitor the proposal, ask collaborative realtionships 4. The Committee will confor additional information or sist of the Secretary for refer the proposal to the Com- PURPOSE: Catholic Human Services of mittee. Prior to the submission the Archdiocese of Philadel- of any proposal to the Commit- 1. To preserve the Catholic phia (who will serve as chair), tee, the Secretary will work identity and ensure the continu- no more than three (3) priests, with the Catholic health care ation of the mission of health one member of a religious con- provider to assure that the draft care apostolates operating gregation and one Catholic lay which is to be reviewed reflects within the Archdiocese of person, all of whom will have all changes which have been Philadelphia; some expertise in Catholic recommended by the appropri- 2. To promote cooperation of health care issues. ate consultants. all parties involved in the 5. The members of the Com- 2. In collaboration with the Catholic health care apostolate mittee shall be appointed to Catholic health care provider in the Archdiocese of Philadel- serve for a term of three (3) proposing the Collaborative phia; and, years, which may be renewed Relationship the Committee 3. To further the healing min- once. will determine the time line istry that embodies the Gospel 6. The Archbishop shall ap- necessary for submission to the message of Jesus Christ as re- point all the members of the Archbishop for his considera- flected in the values and teach- committee. tion. While it is understood that ings of the Catholic Church and 7. The committee will have the Committee will always be in the Ethical and Religious Di- the opportunity for consultation sensitive to the time constraints 76 rectives for Catholic Health with individuals or appropriate, of the Catholic health care Care Services. recognized groups with the req- provider, it is likewise noted uisite expertise in civil law, that the Committee itself will SCOPE: canon law, moral theology and require adequate time to read health care. and evaluate the documents In compliance with particu- submitted to it. lar law of the Archdiocese of PROCEDURE: 3. The Committee will deter- Philadelphia, promulgated mine the extent of the review February 25, 1999 and effec- The procedure for the evalu- based on the significance and tive as of March 25, 1999, all ation of Collaborative Rela- nature of the matter. Catholic health care providers tionships which affect the mis- 4. Upon completion of its re- operating in the Archdiocese sion or religious and ethical view, the committee will sub- are obligated to follow these identity of Catholic health care mit its report and a recommen- procedures. providers is as follows: dation to the Archbishop for his 1. Because of the necessity consideration. POLICY: for the Archdiocese to be ap- 5. All Committee discus- prised at the onset, the health sions, meetings, correspon- 1. The Archbishop of care provider will notify in dence and recommendations to Philadelphia shall establish the writing the Secretary for the Archbishop are to be main- Catholic Health Care Review Catholic Human Services of tained in the strictest confi- Committee (“Committee”). the potential for a such a Col- dence. 2. This Committee will re- laborative Relationship before 6. The Procedure will be review all proposed Collabora- any substantial negotiations are viewed after three years. The tive Relationships with non- undertaken with the prospec- Secretary for Catholic Human Catholic providers which tive partner. In consultation Services will initiate this re- would result in a major alliance with the Catholic health care view. or affiliation and thereby require the nihil obstat of the Archbishop of Philadelphia. For subsequent collaborative relationships flowing from the major alliance or affiliation agreement, or other collaborative relationships of a less sub- stantive nature, review by the Committee will only occur upon recommendation from the Secretary for Catholic Human Services. 3. The Committee will provide a recommendation to the Archbishop of Philadelphia regarding the appropriateness of such Collaborative Relation- ships based on the criteria de- The Paulinian Approach to Nursing Education: A Response to the Church’s Call for Compassionate Caring

Introduction Church to the challenge laid Paulinian nurse’s calling is by the burgeoning Protestant rooted and sourced in Christ, In the light of the present Mission School of Nursing of and flows from Him. It is ac- societal condition where the the Central Philippine Uni- tive, life giving, and dynam- nursing profession is being versity. It was the call of the ic... flowing from Jesus, giv- threatened by the dehuman- time to prepare lay Catholic en to the Church, shared by ization of health care, the for- nurses to carry on the caring the Congregation of the Sis- mation, strengthening, and ministry of the Church. ters of St. Paul of Chartres, deepening of the carative From its inception, the ori- commissioned to the College character of nursing is of entation of the school was of St. Paul, and made actual prime importance. Formation wholistic; its focus, Christic. in the Bachelor of Science in is essentially the task of edu- It aimed at preparing nurses Nursing Program. It is profes- cation, and education, to be who would care not only for sional because it is an orga- authentic and wholistic, has the physical and medical nized, integrated, and system- to address itself to the whole needs of the patients, but also atic discipline, with its own 77 person. This paper, undertak- for the spiritual and moral as- set of objectives, goals, rules, en by those who are involved pect of the patients illnesses standards, practices, and ac- in the formation of Paulinian as well Ð nurses who would tivities, the performances of nurses, has helped the writer bring Christ to the sick. To at- which entitles the person to to scientifically validate the tain this goal a program of receive a commensurate re- efficacy of the process of the study that would promote the muneration. Its process is Paulinian training, and to as- enhancement and develop- clearly understood and appre- sess and see what area in the ment of the gospel caring val- ciated by all concerned and approach to Paulinian Nurs- ues, as much as academic ex- has been passed on from gen- ing Education impacts on the cellence and professional eration to generation, not on- life and professional practice competence, has always been ly in the classroom, but also of the students and graduates. utilized by the school as its through the witness and ex- It has also enabled us to cor- tool. All through its exis- ample of its graduates. The rect weaknesses, clarify am- tence, the needs of the times, term paulinian is the bench- biguities, strengthen positive the advent of innovative edu- mark of the training. This aspects, revise/enrich the cur- cational strategies, and tech- identifies the nurse as a mem- riculum, and adopt proper nological progress, have al- ber of a particular group or measures to further enhance ways been considerations for family, formed according to a the carative quality and stan- constant adaptation, but the specific approach, upholding dard of excellence of our program’s basic approach and a particular tradition and be- nursing education. core values for the last 50 lieving in the same ideal in years have remained con- life. The term nurse defines stant. The conceptual model and particularizes the disci- The St. Paul College of Iloilo of the program is known to pline of the educational pro- both faculty and students as gram. The students are The formation of Care the stream of the professional trained to become nurses Ð Givers, particularly Catholic paulinian nurse vocation. not midwives, not doctors, nurses, has always been in the not therapists, not pharma- forefront of the apostolic cists, not physical therapists, work of the Sisters of St Paul The Paulinian nursing not any other health profes- of Chartres. In the Philip- education framework sionals, but nurses. And final- pines, this evangelizing activ- ly, theirs is not only a profes- ity formally began in 1946, The educational framework sion, an occupation that shall when the St Paul School of of the Paulinian Approach to be their source of income but, Nursing in Iloilo was estab- Nursing is Christocentric. most of all, a vocation, A RE- lished. Primarily, the purpose This has been so from the be- SPONSE TO A CALL, the for opening the school was to ginning of its foundation. The call to follow Christ-Prophet, meet the need for trained graphical presentation of the King and Priest, the Health Catholic professional nurses model is titled the stream of Care Giver par excellence. who could minister to the pa- the professional paulinian This is clear to all Paulinians tients of St Paul Hospital, the nurse vocation [SPPNV]. It is and is deeply ingrained in only Catholic hospital in the called a stream because, like their hearts, especially the region. In a way, the move the gentle flowing body of older graduates, who have was also a response of the water we call a stream, the had the fortune to be taught

DOLENTIUM HOMINUM N. 47-2001 by the nuns themselves. (Servant Ð Leader), and Atti- of all cultures and of science, What is this Stream, this tude (Lover). and to enrich with the Gospel approach, this theoretical truth and values their secular framework of the Paulinian Teacher-Learner [Knowl- learning Ð in the words of the Nursing Education? edge] Ð The cognitive com- Holy Father, “to unify culture

STREAM OF THE PAULINIAN NURSE VOCATION

JESUS CHRIST

CHURCH

ST. PAUL COLLEGE

ST. PAUL COLLEGE DI ILOILO

BSN PROGRAMME

PROPHET KING PRIEST Teacher – Learner Servant – Leader Lover (Knowledge) (Skills) (Attitude)

Serious pursuit of knowledge The building and service to Repect born out of the love for God, 78 that is good and true community and paulinian family Person, Creation and Country

GENERAL EDUCATION COURSE CLINICAL DUTY PRAYERS/LITURGY

NURSING CONCEPTS RLE COMMUNITY THEOLOGY CLASSES SERVICE LEVEL I B.E.C. GRACIOUS LIVING

LEVEL II PARISH INVOLVEMENT SACRAMENTS LEVEL III

LEVEL IV CHRIST LIKE PROFESSIONAL PAULINIAN NURSE

The Paulinian nurse ponent is aimed at the devel- and faith, gospel with life”. rooted in Christ opment of the mind or the in- This integration of scientific tellect of the Paulinian nurse. knowledge and faith is even The Paulinian Nurse is Engendered through general more explicit in the treatment Rooted in Christ Ð Christ education and professional of the professional nursing Prophet (teacher), Christ nursing subjects, this is nur- subjects. Here, the wholistic King, (servant-leader), Christ tured in an institutional cul- approach is demonstrated Priest (lover). Inspired by and ture that values serious pur- with the symbol of the Eu- following the footsteps of Je- suit for knowledge that is charist, with each nursing sus, the Paulinian nurses are good, beautiful, and true. The year-level subject require- to become, in their turn, general education subjects, ment representing a segment teacher-learners, servant-lead- consisting of courses in so- of the Host. ers, and loving caregivers; cial, natural and practical sci- caregivers who are knowl- ences, philosophy, language, Servant-Leader [Skills] Ð edgeable, competent, com- arts and humanities, broaden The second component of the passionate. These qualities, the horizon of the students. program refers to the skills or values to be acquired, are in- The professional subjects psycho-motor development grained and developed in the equip them with the knowl- portion of the Stream. This educand’s mind, hand, and edge of nursing concepts, aspect is focused on the appli- heart via the three fold as- principles, theories and prac- cation of the knowledge pects or components of the tice. The students are exposed gained in theory, on acquiring teaching-learning process: the to various philosophies, intel- the competency expected for cognitive, the psycho-motor, lectual persuasions, and secu- the level and the living out of and the affective or attitudinal lar subjects and orientations, the Christian notion of leader- components. In the context of but the Christian message and ship as service. Of utmost im- the Paulinian Nursing Pro- perspective are brought out to portance in this portion is en- gram of study, these are seen them. In other words, they are abling the student to apply the in terms of Knowledge taught to uncover the Gospel work ethics they are taught in (Teacher Ð Learner), Skills values that are at the ground the classroom, and to witness in their day-to-day activities come to us at this point in in the Christian tenets of their Christian commitment to time are “children of the me- knowing, serving and loving serve like Christ. This is car- dia” whose values, more of- God in the sick; of seeing ried out in the Related Learn- ten than not, are shaped by Christ in the client and of being Experience activities in this “very powerful teacher”. ing Christ to them. In a nut- the clinical area and the com- It is unnecessary to detail how shell, Paulinian Nursing Edu- munity setting, and in their in- the values of the “world” are cation hopes and strives to volvement in the parish activ- directly in opposition to the form Catholic professional, ities through the Campus Gospel value of loving ser- competent nurses who, with Ministry Program. To incul- vice and of caring. To help, the Blessed Mother as their cate the value, they are im- therefore, bring about the de- model, and inspired by St. mersed in an institutional cul- sired attitudinal change in the Paul their patron, think with ture which promotes “the student, the school promotes a the mind of Christ, serve with building of and services to the vibrant Christian Formation the hand of Christ, and love community and the Christian Program. This consists of an with the heart of Christ. Ad- family”. The current global integrated course in Religious mittedly, this is a very ambi- shift of the health care ser- Education and Gracious Liv- tious goal; but, always re- vices from the institution to ing, the regular celebration of minded by the proverbial the community in a very real the Liturgy and the Sacra- Gospel “seed” and the vari- sense dovetails with the ments, provision for spiritual ous kinds of “soil”, and trust- Paulinian approach to com- retreats and times for prayer, ing in God, the Paulinians munity service. In fact, in the guidance and counseling, and forge on with their motto, 1980’s the College of Nursing in patiently allowing the stu- “Caritas Christi Urget Nos”. was chosen by the Depart- dents to express themselves “You will know the tree by 79 ment of Nursing Education to and “to become” in an exis- its fruit”. The effectiveness of be the pilot school for the new tential experience of life. All an educational approach is curriculum which required in- these in an environment of re- generally measured by the tensive student community spect that is born out of love performance of its graduates. immersion. Today, once for God, persons, creation, On the academic plane, an as- again, the Paulinian Colleges and country, and in truly lov- suring confirmation of the ef- of Nursing are spear-heading ing them. ficacy of the Paulinian Ap- the new Health Resource De- proach is the track record of velopment Program Commu- THE PRESENT its graduates performance in nity Organizing Participatory the National Nurses Licen- Action Research [HRDPÐ Clearly, the Paulinian Ap- sure Examination. Since COPAR] approach to Primary proach to Nursing Education 1948, the school has always Health Care. is undertaken within the con- been among the Ten Out- text of the Sisters of St. Paul standing Schools/Colleges of LOVER [Attitude/Affec- of Chartres’s mission. The Nursing in the country recog- tive] Ð The third component fact that ours is a Christian nized by the Philippine Gov- directly pertains to the heart. Country and that 95% of our ernment Professional Regula- It most directly touches the students are Catholics, is the tion Commission Board of core of Paulinian Education. one great factor that enables Nursing and the Commission Without minimizing the im- us and facilitates the anchor- on Higher Education. It is al- portance of knowledge and ing of our program of study so among the few colleges of skill components, the students are made aware of the primacy of this dimension in their education. Christian value formation and transformation is impressed on them as that which makes their training different, that which sets them apart from other nurses. When the Stream is explained to them for the first time, the students are thrilled to learn that they are to become Lovers Ð compassionate, humane, gentle, warm, tender lovers like Christ.

Of the three components of learning this dimension in the Paulinian educative process, this is the one most in need of being stressed today. This is because the students who

DOLENTIUM HOMINUM N. 47-2001 nursing deputized by the uates. While the intent of the same Commission to imple- law is good, its application is ment its Expanded Tertiary prejudicial, both to the Education Accreditation Pro- prospective student and the gram. Colleges of Nursing. Nursing Within the last 50 years, St. education must, therefore, Paul College has graduated provide opportunities to de- thousands of professional velop Christian assertiveness nurses who are now scattered among students, so that they in many countries. Quite a may be able to stand for a just number have made their mark cause with serenity and in their places of work, recog- courage. nized not only for their com- A third and most exciting petence but also for their challenge is the globalization Christian professionalism. of the third millennium. Nurs- Some have been recipients of ing must make the quantum prestigious awards, such as leap or perish as a profession. the Legion of Honor of Considering the pace at which France and the Posthumous sions which do not bring in societal changes are taking Award of Recognition for cash, coupled with the high place today, nursing cannot Dedication to Duty. Mostly, cost of nursing education. afford to stand still and live in they work as missionaries, This is evident in the Philip- the glory of its past. It must educators, administrators, pines. As previously pointed adjust, adapt, and change, be 80 practitioners, clinicians, com- out, the youth of today are in step with progress in sci- munity health workers, vol- very much influenced by the ence and technology. As some unteers, nurse entrepreneurs culture of the mass media modern psychologists put it, it or simply parenting their chil- which extolls materialism should be like a dolphin, able dren, quietly spreading the and consumerism as a way of to gracefully ride the crest of Good News of Christ through life. Success is equated with the waves of change. Howev- their caring ministry. having more, with what is big er, in this quest for progress The small nursing school being beautiful. Also, due to and amidst the whirling rapid- offering the Graduate Nurse the closure of the foreign em- ity of societal and cultural Certificate Program is now a ployment market on the one change, nursing must never college offering not only the hand, and the economic diffi- forget its essence of caring Nursing Baccalaureate de- culty prevailing in the coun- and loving service. Maintain- gree and a Graduate School try on the other, there has ing this balance is the chal- Nursing Program, but other been a marked decrease of lenge that all nursing educa- courses as well. Also, there enrollment in the course. This tors share today. are now four Paulinian Col- has serious repercussions. leges of Nursing in the Many schools have had to re- Sr. ROSAMOND MARIE Philippines. trench; others have had to ABADESCO, SPC Yet another affirmation of close. Nursing employment BSN Program Coordinator St. Paul College of Iloilo, this approach is the support opportunities are affected, Philippines from grateful parents that the faculty have had to be de- school receives, parents who loaded or their employment believe in the quality of edu- terminated. cation that the school offers, Another challenge that has and therefore continually en- to be met, in our country, at trust the formation of their least, is the political passivity Bibliography children to the college. But of our nurses. Because, his- perhaps the most satisfying torically, Filipino nurses were 1 “This is Our Story” SOCI, Caritas [Iloilo City 1996]. assurances are the testimonies trained and made to believe 2 LAURENTE, CECILIA M. [ed.], En- of the graduates themselves, that they were handmaidens richment of the Nursing Courses, A whose lives are marked by the of the physicians, many Fil- Guideline [Manila 1992]. 3 ROCHE, FR. JOSEPH, SJ, “Integration mark of Christ, their coat-of- ipino nurses have remained in the National Catechetical Directory”, arms, “Caritas Christi Urget the passive silent majority. Docete 8 [Manila 1993]. Nos! Once a Paulinian, al- Uninformed or unconcerned 4 POPE JOHN PAUL II, “Born From The Heart of The Church”, Catholic Interna- ways a Paulinian!”. with many social and/or po- tional [USA 1990]. litical issues, legislation prej- 5 ANGELINI, FLORENZO CARDINAL, THE FUTURE udicial to their welfare is “To serve the Sick is to Serve Life”, Do- lentium Hominum [Vatican 1992]. passed and becomes law 6 Luke 6:44. As it faces the coming of without their knowing about 7 AQUINO, “Gaudencio and Razon the third millennium today, it. An example of this is the Perpetua”, Educational Psychology [Manila 1993]. what are the challenges, the provision in the Philippine 8 MAYNARD, HERMAN BRYANT, Jr., obstacles the college is fac- Nursing Law which regulates Fourth Wave: Business in the 21 Centu- ing? First of all, there is the the eligibility of entrance to ry [San Francisco, USA 1993]. 9 TAYCO, PILAR, “Discovering the loss of appreciation of the the Nursing School to the up- Dolphin in You”, SPC Congress Pro- youth for the service profes- per 40% of high school grad- ceeding [Manila 1993].