DOLENTIUM HOMINUM No. 76 – Year XXVI – No. 1, 2011

JOURNAL OF THE PONTIFICAL COUNCIL FOR HEALTH CARE WORKERS (FOR HEALTH PASTORAL CARE)

Proceedings of the XXV International Conference

Organised by the Pontifical Council for Health Care Workers

Caritas in Veritate Toward an Equitable and Human Health Care

November 18-19, 2010 New Synod Hall Vatican City BISHOP ZYGMUNT ZIMOWSKI, Editor-in-Chief CORRESPONDENTS BISHOP JOSÉ L. REDRADO, O.H., Executive Editor REV.MATEO BAUTISTA, Bolivia MONSIGNOR JAMES CASSIDY, U.S.A. REV.RUDE DELGADO, Spain REV.RAMON FERRERO, Mozambique REV.BENOIT GOUDOTE, Ivory Coast PROFESSOR SALVINO LEONE, Italy REV.JORGE PALENCIA, Mexico EDITORIAL BOARD REV.GEORGE PEREIRA, India MRS.AN VERLINDE, Belgium REV.CIRO BENEDETTINI PROFESSOR ROBERT WALLEY, Canada DR.LILIANA BOLIS SR.AURELIA CUADRON 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 MRS.STEFANIA CASABIANCA DR.FRANCO PLACIDI DR.ANTONELLA FARINA REV.LUCIANO SANDRIN DR.MATTHEW FFORDE MONSIGNOR ITALO TADDEI DR.GUILLERMO QWISTGAARD

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Cover: Glass window Rev. Costantino Ruggeri

Poste Italiane s.p.a. Spedizione in Abbonamento Postale - D.L. 353/2003 (conv. In L. 27/02/2004 nº 46) art. 1, comma 2, DCB Roma DOLENTIUM HOMINUM N. 76-2011 3 Contents

6 Message of the Holy Father Benedict XVI 36 Towards Anthropocentric Health Care: to the Participants in the XXV International a Health Service with a Human Face Conference of the Pontifical Council for Prof. Enrico Garaci Health Care Workers 38 Pontifical Diplomacy and 8 Inaugural Prayer the Promotion of Health for All Sr. Marianna Caprio H.E. Msgr. Silvano M. Tomasi

43 Ethics and Access CARITAS IN VERITATE to Health-Care Technologies TOWARD AN EQUITABLE Dr. Reinaldo A. Garcia AND HUMAN HEALTH CARE 48 The Contribution of Catholic THURSDAY 18 NOVEMBER Health-Care Institutions to Improving the Conditions of Health of Peoples 10 Speech of Greetings and Opening Address Rev. Renato Salvatore, MI by H.E. Mons. Zygmunt Zimowski 58 The Vatican-CMMB Initiative: 12 Address of His Eminence Touching Lives, Bringing Health and Hope Card. Tarcisio Bertone Dr John F. Galbraith

61 The Cooperation of Various Government PROLUSION Ministries in Health Care Hon. Marek Jurek 15 Caritas in veritate: Good News of Integral Health Care H.Em. Card. Peter Kodwo Turkson FRIDAY 19 NOVEMBER

21 Euntes docete et curate infirmos (Mt 10, 7-8) 64 The Good Samaritan is the Greatest Justice The Urgency and Biblical Pertinence H.E. Msgr. Willem Eijk of the Mission for the Sick H.Em. Card. Gianfranco Ravasi 69 The World of the Future: Demographic Prospects and Health Needs 26 The Salus Animarum Prof. Massimo Petrini in Pastoral Care for the Sick H.Em. Card. Angelo Amato, SDB 77 Biomedical Technologies at the Service of Life 28 Access to Primary Health Care: Prof. Antonio G. Spagnolo Thirty-Two Years after Alma Ata what Advances have been Achieved 83 Health, the Safeguarding in the Continent of Africa? of the Creation and Justice Dr. Luis Gomes Sambo Dr. John M. Haas

33 The Mass Media 86 DREAM – Treating AIDS in Africa: and the Health of Citizens a Possible Challenge Dr. Mario Benotti Dr. Paola Germano 4 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

91 Traditional Medicine 112 The Blessed Don Carlo Gnocchi: Dr. Emilio La Rosa Rodríguez a Heroic Figure of Charity of our Time Rev. Bonifacio Honings, OCD

ROUND TABLE: 116 An Example of Heroic Charity of our Time: EQUITABLE AND HUMAN HEALTH CARE Sr. Marta Wiecka, a Daughter of Charity of St. Vincent de Paul 94 1. Equitable and Human Health Care at Home Sr. Anna Brzek Prof. Mario Falconi 118 Welcoming: a New Paradigm 95 2. Equitable and Human Health Care of Humanisation in Hospices: The Taiwanese Experience Fra Pascual Piles Ferrando, OH Dr. W. Henry Chiang 122 The Contribution of Volunteers 97 3. Equitable and Human Health Care to the Humanization of Health: in Prison the Portuguese Reality Prof. Christoph von Ritter Dr. Manuel de Lemos

99 4. Equitable and Human Health 124 Health-Care Centers in Factories and Care for the Poor Prof. Stanislaw Szczepan Góźdź Sr.M.Benedicta,MC

127 A Challenge that has Just Begun 102 Health-Care Workers Faced Fra Mario Bonora with Certain Questions of a Deontological, Ethical and Legislative Character 131 Concluding Paper by Prof. Jean-Marie Le Méné Prof. Filippo Boscia

106 The Question of the Use of Psychiatric 135 Concluding Observations by Pharmaceuticals in Paediatrics H.E. Msgr. Zygmunt Zimowski Dr. Barry L. Duncan

The illustrations in this edition are taken from the book: Dove il cielo ha toccato la terra by P. Girolamo Salvatico Elledici - Editrice Velar, 2010

6 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

Message of the Holy Father Benedict XVI to the Participants in the XXV International Conference of the Pontifical Council for Health Care Workers

To my Venerable Brother veritate. Toward an Equitable and Human Health Archbishop Zygmunt Zimowski, Care’ – is of special interest for the Christian com- President of the Pontifical Council for Health munity, where care for man is central because of Care Workers, his transcendent dignity and inalienable rights. Health is a precious good for the person and soci- With joy I wish to send my cordial greetings to ety which should be promoted, conserved and de- those taking part in the Twenty-fifth International fended, with an allocation of the necessary funds, Conference which well belongs to the year that resources and energies so that more people can en- celebrates the Twenty-fifth Anniversary of the joy it. Unfortunately, the problem still remains to- creation of the dicastery, and offers a further rea- day of many populations of the world that do not son for thanking God for this valuable instrument have access to the necessary resources to satisfy of the apostolate of mercy. A grateful thought fundamental needs, particularly with regard to goes to all those who strive, in the various sectors health. It is necessary to work with greater com- of pastoral care in health, to live that diakonia of mitment at all levels so that the right to health is charity which is central to the mission of the made effective, fostering access to primary health Church. In this sense, I am happy to remember care. In our epoch we are witnessing, on the one Cardinal Fiorenzo Angelini and Cardinal Javier hand, health care that runs the risk of being trans- Lozano Barragán who led this Pontifical Council formed into pharmacological, medical and surgical for Health Care Workers for twenty-five years, consumerism, almost becoming a cult of the body, and I address a special greeting to the current and, on the other, the difficulty that millions of president of the dicastery, Archbishop Zygmunt people have in gaining access to minimal condi- Zimowski, as well as to the Secretary, to the Un- tions of subsistence and to medical products that der-Secretary, to the Officials, to those who work are indispensable to their treatment. with it, to the speakers at this Conference, and to Also in the field of health – an integral part of all those present. the existence of each individual and of the com- The subject chosen for this year – ‘Caritas in mon good – it is important to install true distribu- tive justice that assures to everyone adequate care on the basis of objective needs. As a consequence, the world of health cannot avoid the moral rules that must govern it for it not to become inhuman. As I emphasised in the encyclical Caritas in veri- tate, the Catholic Church has always stressed the importance of distributive justice and social justice in the various sectors of human relationships (n. 35). Justice is promoted when one welcomes the life of the other and one takes responsibility for him, responding to his expectations, because in him one perceives the very face of the Son of God, who became man for us. The divine image im- pressed in our brother is the foundation of the most high dignity of every person and generates in everyone the need for respect, care and service. The link between justice and charity, from a Chris- tian point of view, is very close: ‘Charity goes be- DOLENTIUM HOMINUM N. 76-2011 7 yond justice, because to love is to give, to offer ficial techniques of procreation involving the de- what is “mine” to the other; but it never lacks jus- struction of embryos, or legalised euthanasia. tice, which prompts us to give the other what is Love for justice, the defence of life from its con- “his”, what is due to him by reason of his being or ception until its natural end, respect for the dignity his acting…If we love others with charity, then of every human being, should be supported and first of all we are just towards them. Not only is borne witness to, even when this is to go against justice not extraneous to charity, not only is it not the mainstream: fundamental ethical values are the an alternative or parallel path to charity: justice is shared heritage of universal morality and the basis inseparable from charity, and intrinsic to it. Justice of democratic co-existence. is a primary way of charity (ibid., n. 6). In this A joint effort by everyone is needed, but what is sense, with a summarising and incisive phrase, St. also, and above all, needed is a profound conver- Augustine taught that ‘justice consists in helping sion of the inner look. Only if one looks at the the poor’(De Trinitate,XIV,9:PL 42, 1045). world with the look of the Creator, which is a look To bend down like the Good Samaritan to the of love, will humanity learn to be on earth in peace wounded man, abandoned at the side of the road, is and justice, directing with fairness the earth and its to perform that ‘greater justice’ that Jesus asked of resources to the good of every man and every his disciples and actuated in his life, because to act woman. For this reason ‘I would advocate the in conformity with the Law is love. The Christian adoption of a model of development based on the community, following in the footsteps of the Lord, centrality of the human person, on the promotion has obeyed the mandate to go out into the world ‘to and sharing of the common good, on responsibili- teach and heal the sick’ and over the centuries it ty, on a realization of our need for a changed life- ‘has felt strongly that service to the sick and suf- style, and on prudence, the virtue which tells us fering is an integral part of her mission’ (John Paul what needs to be done today in view of what might II, Motu Proprio Dolentium Hominum,n.1)to happen tomorrow’(Benedict XVI, Message for the bear witness to integral salvation, which is health World Day of Peace, 2010, n. 9). of the soul and health of the body. I express my nearness to my suffering brothers The People of God, on a pilgrimage along the and sisters and an appeal to live illness, as well, as tortuous pathways of history, joins its efforts to an occasion of grace to grow spiritually and to those of so many men and women of good will to share in the sufferings of Christ for the good of the give a truly human face to health-care systems. world, and I express to all of you involved in the Health-care justice must be among the priorities of vast field of health my encouragement for your the agendas of governments and international in- valuable service. In asking for the maternal protec- stitutions. Unfortunately, side by side with positive tion of the Virgin Mary, Salus infirmorum,ina and encouraging results there are opinions and heartfelt way I bestow upon you my Apostolic lines of thought that wound such justice: I am re- Blessing, which I also extend to your families. ferring to questions such as those connected with so-called ‘reproductive health’, with resort to arti- From the Vatican, 15 November 2010 8 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

Inaugural Prayer

O God our Father, whose tenderness is be- Holy Spirit of God, only from you, which you stowed upon every creature, to You, true love of give to us without measure, do we receive abun- life, we entrust the expectations regarding these dance of life. Illuminate our minds and our hearts days of listening and sharing; may it be a time of so that we know how to perceive the signs of your grace, a space of fraternity, an experience of sin- passing in the distracted world that surrounds us. cere communion for the advent of your Kingdom Effuse your blessing on this assembly and confirm of justice and of peace! Bless all of us, merciful in us the intention to serve you in our weakest Father, and make us worthy of serving you in brothers and sisters through the humble and dis- man, willed by you in your image and infinitely creet offering of our presence; bless, O Spirit of loved. charity, our work and our families, our consciences Lord Jesus, Saviour and Redeemer of humani- and the entire human community. ty, still today you pass amongst us doing good to May we be accompanied by the maternal inter- everyone and proclaiming the inestimable pre- cession of Mary, she, the Comforter of sorrows be- ciousness of every human life. We recognise that cause she is the Custodian of hope, Prophecy of we have been healed anew by your wounds, new times because Witness to your Gospel. strengthened by your Spirit, sent to our brothers Through total dedication to the Word made flesh, and sisters by the urgency of your compassion. may there rise soon the dawn of that day when, Take us by the hand, Lord Jesus, and teach us to every tear being dried, we know how to make bend down with you before every creature who is shine forth in us and amongst us the beauty of your sick in body and in spirit; make us know how to face and our dignity as your children! Amen. give new hope to so many of our brothers and sis- Sr. MARIANNA CAPRIO ters who are deprived of love, of health, of trust Mother Abbess of the Monastery of Monte Carmelo, and of the wish to live praising your glory. Viterbo, Italy Caritas in veritate Toward an Equitable and Human Health Care 10 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

thursday 18 Speech of Greetings and Opening Address november by H.E. Msgr. Zygmunt Zimowski

I would like to thank Mother Mexico, nences Cardinal Tarcisio Bertone, Marianna Caprio, the prioress of Namibia, the Secretary of State; Cardinal the Carmelite convent of Vetralla Nigeria, Raffaele Martino and Cardinal Pe- for this intense moment of prayer, the Netherlands, ter Kodwo Appiah Turkson, re- and I greet all of you, coming from Panama, spectively President Emeritus and sixty different countries, at the Peru, President of the Pontifical Council opening of this twenty-fifth inter- Poland, for Justice and Peace; the two national conference organised by Portugal, heads of Vatican ministries who the Pontifical Council for Health Russia, the day after tomorrow will re- Care Workers which is on the sub- the Holy See, ceive a Cardinal’s hat and to whom ject ‘toward an equitable and hu- Slovakia, once again I express with great joy man health care in the light of the Slovenia, my congratulations: His Excellen- encyclical Caritas in Veritate’. In- Spain, cy Monsignor Angelo Amato deed, you make up six hundred South Africa, S.d.B, Prefect of the Congregation participants from: Switzerland, of Causes for Saints, and His Ex- Angola, Thailand, cellency Monsignor Gianfranco Argentina, Togo, Ravasi, President of the Pontifical Austria, the Ukraine, Council for Culture. Australia, Uganda, I also extend my greetings and Bangladesh, the UK, welcome to the ambassador to the Belgium, the USA, Holy See of the United States of Benin, Venezuela America, His Excellency Miguel Belarus, and Zambia. Diaz; the ambassador to the Holy Bolivia, See of Benin, His Excellency Brazil, Loko Comlanvi; the ambassador Burkina Faso, to the Holy See of the Republic of Burundi, China, His Excellency Larry Yu- Cameroon, Yuan Yang; the ambassador to the Canada, Holy See of Panama, His Excel- the Czech Republic, lency Delia Cardenas; and the am- the Republic of China (Taiwan) bassador to the Holy See of Togo, Columbia, His Excellency Felix Sagbo. the Republic of the Congo, We also have the pleasure to the Democratic Republic have here the representatives of His of the Congo, Eminence Cardinal Giovanni Lajo- South Korea, lo, President of the Governorate, the Ivory Coast, the Archiater, Dr. Patrizio Polisca, Croatia, the Director of Health Care and Ecuador, Hygiene of the Vatican City, and Eire, Prof. Giovanni Minisola, Chief France, And thus, at least in the most Consultant in Rheumatology at the Georgia, widespread languages: good Hospital of St. Camillus, Rome, as Germany, morning and welcome to you all; well as many other figures. Ghana, Bonjour et bienvenue à tous les We have thus all come together Greece, participants; buenos dias y bien- in this New Hall of the Synod India, venidos a todos; bom dia e benvin- which on Saturday will be the set- Indonesia, dos a todos; herzlich willkommen; ting for the much looked forward Italy, Sredecznie witam wszystkich to consistory, to study and find Kenya, uczestnikow z Polski; jambo na pathways of for the implementa- Lesotho, Karibu kwetu. tion in the health-care field of the Liberia, On this happy and well attended third and most recent encyclical of Luxembourg, occasion I have the honour and the His Holiness Pope Benedict XVI, Malta, pleasure to welcome Their Emi- Caritas in Veritate. DOLENTIUM HOMINUM N. 76-2011 11

It will certainly not be an easy Health is recognised as being figures that will draw near to these task to identify and address some one of the fundamental human microphones starting this morn- of the principal evils which, as is rights by the international commu- ing, I will end my opening address emphasised in this papal docu- nity and it is a natural right: we are by stressing that this conference ment, today threaten the health, the thus called to treat every person as has been conceived of and organ- salus, of the human person, and our peer and to respect his or her ised to contribute, in harmony thus to outline the basic approach- dignity, giving him or her the with, and in the light of, Caritas in es by which to promote fairness same opportunities to grow and Veritate, to the mission of truth and and humanisation in medicine and live in the healthiest way possible. justice that the Church is called to more in general in the field of suf- All of this, as regards what is up- carry out by promoting, and where fering. held on ‘paper’, encounters diffi- this is necessary by defending, a To help us, as we can already culty in being implemented: in the society that is really in harmony observe, there will be experts from least industrialised countries of with man, his dignity and his voca- all the continents of the world: ec- the world health-care institutions tion. clesiastics, men and women reli- are still dramatically absent and It only remains to me to entrust gious, and men and women mem- basic medical products are inac- our deliberations to the protection bers of the lay faithful. cessible; in the West we run the of the Most Holy Mary, Salus Infir- We will thus focus in on the mis- risk of losing from sight the prin- morum, and to wish to everyone: sion of the Church in favour of the ciples of care for the human per- good work; bon travail; buenos sick, the promotion of ‘human- son because of an overly ‘techni- travajos; bom trabalho; gute Ar- ised’ and thus anthropocentric cal’approach which ends up by ig- beit; owocnej Pracy; kazi njema! health care, and the role of health- noring the person of the sick indi- care workers, civil society, institu- vidual in his or her entirety and his H.E. Msgr. ZYGMUNT ZIMOWSKI tions and private agencies in the or her dignity. President of the Pontifical Council promotion of justice, fairness and Given the short time available to for Health Care Workers, solidarity in the health-care field. papers and respecting the many the Holy See 12 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

Address of His Eminence Card. Tarcisio Bertone

Your Eminences, the duty of the State, the need for Church’s very heart; “it cannot but Dear Brothers in the Episcopate, solidarity and subsidiarity, and the affect her at the core of her faith in Distinguished Authorities, problem of intellectual property the redemptive Incarnation of the Ladies and Gentlemen, rights. Son of God, and engage her in her mission of proclaiming the Gospel I greet with affection all partici- of life in all the world and to every pants at this 25th International Con- 1. The Prophetic Mission creature” (EV, 3). ference organized by the Pontifical of the Church Council for Health Care Workers, on the topic Toward an Equitable Pope Benedict XVI observes that 2. The Duty of the State and Human Health Care in the “love in truth - Caritas in veritate - Light of the Encyclical Caritas in is a great challenge for the Church The Universal Declaration of Veritate. I thank His Excellency, in a world that is becoming pro- Human rights of 1948 (Art. 25) list- Archbishop Zygmunt Zimowski, gressively and pervasively global- ed health among those elements to President of this Pontifical Council, ized” (Caritas in veritate, 9). which everybody should be able to for the invitation extended to me to Globalization makes people and have access. This paved the way to address this august assembly. My nations inevitably interdependent, its definitive proclamation as a fun- sincere gratitude goes to all who with the risk however, that this is damental right in the Alma-Ata De- have worked closely with the Pres- not often “matched by ethical inter- claration of 1978 by the World ident in the organization of this action of consciences and minds Health Organisation. The Declara- Conference, in particular the Secre- that would give rise to truly human tion states that: “Health… is a fun- tary and Undersecretary of this development” (ibid.). Therefore, in damental human right and that the Pontifical Council, and all mem- the face of development that is not attainment of the highest possible bers of the Staff. I welcome all the integral, that is, when it does not level of health is a most important participants who have come from promote the good of every man and world-wide social goal whose real- near and far, and wish you fruitful of the whole man, in front of a soci- ization requires the action of many deliberations in these two days of ety that is not attuned to man, his other social and economic sectors study. dignity and his vocation, the in addition to the health sector.” At I wish also to extend my heartfelt Church has a mission of truth to ac- the basis of the doctrine of rights is congratulations to the newly nomi- complish. the need to direct social organisa- nated cardinals who will be speak- The Church, which is God’s fam- tion in order to ensure that every- ing at this conference, His Emi- ily in the world cannot sit back and body can meet their own essential nence Gianfranco Card. Ravasi and not address, for example, the per- needs. His Eminence Angelo Card. Ama- sistent inequalities in the access to Health is a social phenomenon to. Dear brothers, I welcome you to health care services. For indeed that concerns not only the protec- the College of Cardinals. “the joys and the hopes, the griefs tion of individuals and their rights, The topic for this Conference To- and the anxieties of the men of this but also the promotion of the com- ward an Equitable and Human age, especially those who are poor mon good. It is a fundamental good Health Care in the Light of the En- or in any way afflicted, these are to which all should have access. cyclical Letter Caritas in Veritate, the joys and hopes, the griefs and The right to health of every human puts forward the crucial issues of anxieties of the followers of Christ” individual is a constituent element justice and human dignity in health (GS, 1). Though the Church “does of a civil society and its legislation.1 care and invites us to address them not have technical solutions to of- In other words it sets important from the perspective of charity in fer,” and does not claim to interfere obligations on the State. And there- truth, which is the principle around in the politics of States, she howev- fore the “concern for the health of which the social doctrine of the er has a mission of truth to accom- its citizens requires that society Church turns. plish, so as to promote a society help in the attainment of living- With respect to the topic, I wish that is attuned to man and to his conditions that allow them to grow to highlight four issues raised in the dignity and rights (Cf. Caritas in and reach maturity.” 2 Encyclical, which among others, veritate, 9). The right to health care demands need to be taken into consideration The deprivation of a right is a vi- that the state ensures equal access if we are to ensure an equitable and olation of human dignity and any of its citizens, to health care ser- human healthcare, namely: the threat to human dignity and life, vices. This is in consonance with prophetic mission of the Church, must necessarily be felt in the the equality of its citizens as human DOLENTIUM HOMINUM N. 76-2011 13 beings, irrespective of their social appropriate legislative, administra- The response to situations of or physical status and capability. tive, budgetary, judicial and pro- minimal resources is twofold: in Indeed as the Venerable, Pope John motional measures. This will in- the first place there is need on part Paul II affirmed “nothing better clude, among others, adopting a na- of the political leaders, doctors, than the right to health leads to the tional health policy with a detailed hospital administrators, and re- defence of the priority right to life plan for realizing the right to searchers, not to waste their re- and its quality, in the context of re- health. Besides, it has to ensure sources which are already meagre spect for the human person, created equal access to all the underlying but rather in respect of human dig- in the image and likeness of God.”3 determinants of health (safe food, nity, they should use them to ad- Unfortunately, for various reasons water, housing and sanitation, and vance the common good. This re- this right is not always guaranteed so on). Moreover, it is also the duty quires practical and daily choices, for all citizens in the different parts of the State to ensure that other which may not be easy but at the of the world. providers of health care services same time not impossible. (the private sector) conform with Secondly, there is need for soli- human rights standards, and that darity between rich and poor na- privatization does not constitute a tions in order to ensure universal threat to the availability, accessibil- access to medical care.5 In Caritas ity, and quality of health facilities, in veritate, Benedict XVI makes a goods, and services.4 strong appeal for the “Co-operation of the Human Family.” He notes that “the development of peoples 3. Solidarity and Subsidiarity depends, above all, on a recogni- tion that the human race is a single In general all developed coun- family working together in true tries provide all their residents with communion, not simply a group of access to a broad set of public subjects who happen to live side by health and individual medical inter- side” (Caritas in veritate, 53). ventions. In these countries, access In order to avoid paternalistic so- to care is assured despite income cial assistance, which is demeaning and wealth inequalities through to those in need, he urges that the universal coverage health systems. solidarity of the rich nations to the In the contemporary globalised Though all of these health care sys- poor countries be closely linked world, where it seems that every- tems assure universal access to all with the principle of subsidiarity. thing is reduced to a discussion of citizens, the services provided vary If economic aid is to be true to its social questions and issues in mere- from country to country and from purpose, it must not pursue sec- ly economic and financial terms, a region to region. Moreover, in ondary objectives, for example be- serious problem is raised when ref- some countries, there are persistent ing attached to specific anti-life erence is made to health and the re- inequalities, particularly with re- healthcare policies, like the imposi- lated question of economics and fi- gard to certain disadvantaged tion of abortion in exchange for aid nancing. It so happens that this groups, especially poor adults and (Caritas in veritate, 28). Develop- right is not possible if the State children, refugees and immigrants, ment aid ought to “be distributed does not guarantee access to health who for one reason or another may with the involvement not only of care to all of its citizens. not be covered by the existing in- the governments of receiving coun- Caritas in veritate affirms that surance schemes. All these need to tries, but also local economic “if we love others with charity, then have their rights respected and pro- agents and the bearers of culture first of all we must be just to them. moted. within civil society, including local Not only is justice not extraneous The situation in most developing Churches. Aid programmes must to charity, not only is it not an alter- countries, especially those charac- increasingly acquire the character- native or parallel path to charity: terised by political instability and istics of participation and comple- justice is inseparable from charity, meagre resources leaves much to tion from the grass roots” (Caritas and intrinsic to it. Justice is the pri- desire. Very often the respect and in veritate,58). mary way of charity…. On the oth- protection of the rights of the citi- At the level of each single nation, er hand charity demands justice: zens, among which access to health we have to remember that “there is recognition and respect for the le- care especially with regard to the no ordering of the State so just that gitimate rights of individuals and common people, is far from being a it can eliminate the need for a ser- peoples” (Caritas in veritate,6). reality. vice of love” (Deus caritas est, Justice requires providing uni- To ensure access of the citizens 28b). This means that even in the versal access to health care. Today to essential health services, one most just society, one can never do it is commonly agreed that minimal must see to it that the available re- without caritas. We need therefore levels of basic health needs must be sources/services are administered “a State which, in accordance with provided as a fundamental human not only with humanity, but also the principle of subsidiarity, gener- right. Thus in order to fully realise with charity, having as a goal the ously acknowledges and supports the right to health of its citizens the protection and enhancement of the initiatives arising from the different State has the obligation of adopting human dignity. social forces and combines spon- 14 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE taneity with closeness to those in cial argument should be taken into public sectors, as well as individu- need. The Church is one of those consideration, but only as a means als, who should be guided by the living forces” in the health care and not as an end. These economic commitment to advance the com- field (Ibid.).6 Moreover, “the State imbalances and the resulting health mon good in respect of the human which would provide everything, problems can be counteracted by dignity. absorbing everything into itself, the growing awareness of the dig- It is my sincere hope that during would ultimately become a mere nity of every human person and of these two days of reflection the dis- bureaucracy incapable of guaran- radical human interdependence; tinguished speakers will help the teeing the very thing which the suf- which ensue in a greater sense of participants to delve more into fering person – every person – the need for solidarity. these and many other issues raised needs” (Ibid.). Patent license holders should by Caritas in veritate, with regard “never let financial gain prevail to the promotion of an equitable over the consideration of human and human health care. 4. The Problem of Intellectual values, but be sensitive to the needs Property Rights of those who do not enjoy social se- His Eminence Cardinal curity, carrying out effective pro- TARCISIO BERTONE Lastly, in order to ensure equal or grammes to help the poorest and Secretary of State, universal access to health care one most marginalized. … we must the Holy See has to make the required medicines work to reduce and, if possible, not only available but also afford- eliminate the differences between able. The main obstacles to this ob- the various continents, urging the jective have proved to be the pro- more advanced countries to make hibitive costs and the limits caused available to the less developed their by the patent license holders. experience, technology and some Notes Thus Caritas in veritate de- of their economic wealth.”7 This nounces “the excessive zeal for will make them capable of provid- 1 CCC, n. 2273. 2 CCC, n. 2288. protecting knowledge through an ing for their own citizens, health 3 JOHN PAUL II, “Address to participants in unduly rigid assertion of the right services that are not only accessible the Plenary Assembly of the Pontifical Council to intellectual property, especially but also qualitative. for Pastoral Assistance to Health Care Work- ers,” in Insegnamenti XIII/1 (1990), n.5, p.406. in the field of health care” (n. 22). 4 Cf. UNCHR and WHO, The Right to There is a war of interests between Health, Fact Sheet N.31, pp. 25-27 (ISSN the owners of pharmaceutical com- Conclusion 1014-5567). 5 Cf. Address of John Paul II, at Oua- panies and the developing coun- gadougou 29 January 1990, n. 4, in Giorgio tries where the economic capacity Every human person has a right Filibeck, Les droits de l’Homme dans l’en- is very minimal. Moreover, the new to health and demands absolute re- seignement de l’Eglise: de Jean XXIII à Jean- Paul II, Libreria Editrice Vaticana Cité du Vat- medicines are protected by patent spect of his physical and spiritual ican 1992, p. 219. The Holy Father launched a licenses leaving the monopoly to life. By recognising health as a fun- solemn appeal to humanity and on behalf of the holders of the same. And this damental right, the legal system humanity, in particular for the millions of African people who among others are threat- usually results in high costs for the recognises and also takes seriously, ened by the fact of never having good health acquisition of the necessary drugs. the shared and equitable subjectivi- and living in a dignified way, not to deny them Profit as the exclusive goal ty of all human beings. Resources their universal right to human dignity and secu- rity of life. See also John Paul II’s “Address to “without the common good as its should be conformed to God’s plan the Constitutional and Diplomatic Corps at ultimate end, risks destroying so that no one will feel excluded Yaunde in Cameroun,” 12 August 1985, no. 9, wealth and creating poverty” (Car- from the care owed to his person in Giorgio Filibeck, Les droits de l’Homme dans l’enseignement.., p. 218. itas in veritate, 21). Development, and his health, with respect for the 6 See also PIUS XI, Quadragesimo Anno,n. if it is to be authentically human, equal dignity of all. This is a task to 79; JOHN XXIII, Mater et Magister,n.53. 7 JOHN PAUL II, Address to the 14th Interna- must make room for the principle be undertaken by all responsible tional Conference organized by the Pontifical of gratuitousness, as an expression parties, on the international, nation- Council for Health Care Workers,19Novem- of fraternity. Definitely, the finan- al and local level, both private and ber 1999, n.5. DOLENTIUM HOMINUM N. 76-2011 15

PROLUSION

PETER KODWO TURKSON Caritas in Veritate: Good News of Integral Health Care

I bring you all greetings and Caritas in veritate, insights of theology, philosophy, prayerful wishes for a successful a Papal Teaching1 economics, ecology and politics conference from the Pontifical have been harnessed coherently to Council for Justice and Peace! Announced in 2007 to mark the formulate a social teaching that It is also my honour and plea- 40th anniversary of the encyclical places the human person – his inte- sure to be with you at the begin- Populorum Progressio of Pope gral development and so his real ning of this most promising Twen- Paul VI (1967) and the 20th an- health – at the centre of all world ty-fifth International Conference niversary of the encyclical Sollici- systems of thought and activity. organized by the Pontifical Coun- tudo Rei Socialis of Pope John The salvation of every human be- cil for Health Care Workers, on the Paul II (1987), Caritas in Veritate ing was at the centre of the mission topic “Toward an Equitable and was originally intended to cele- and ministry of Jesus Christ: as the Human Health Care in the Light of brate the memory of these two en- revelation of the love of the Father the Encyclical Caritas in Veritate. cyclicals, especially for their treat- (Jn 3:16) and the truth of man’s Whether one looks back, with ment of the question of true hu- creation in God’s image and of his gratitude, at the 25 years of exis- man development. Since the social transcendent vocation to holiness tence of the Pontificial Council for issues which beset development in and to happiness with God. This is Health; or at you, the delegates and the days of Pope Paul VI and Pope the setting of the two concepts participants from 60 countries John Paul II have now become ut- love and truth3 which drive the en- around the world with all your rich terly global, Caritas in Veritate cyclical. Love and truth not only experience; or ahead to the chal- originally intended to take up hu- lie at the heart of the mission and lenges of offering health services man development in the new situ- ministry of Jesus; they also corre- that are attuned to the dignity of ation of a rapidly globalizing spond to the essential character man and his sublime vocation – it world. and activity of human life on earth. is a providential grace to take up The bewildering onslaught of The human person is a “gift and Caritas in Veritate and meditate the economic crisis of 2008-2009 love of God” with a vocation, a di- together on its significance for all motivated the Pope to address the vine calling, to “become gift and the various ministries under the meaning and ethics of economics love” too. And this dynamic of auspices of this Pontifical Council. in the context of human develop- charity received and given is what May our Conference be a fitting ment in careful detail. This some- gives rise to Church’s Social thanksgiving for the countless what delayed the promulgation Teaching, which is Caritas in Ver- blessings of the past 25 years as but, on 29th June 2009 (feast of itate in re sociale.4 well as an urgent invocation for Sts. Peter and Paul), the Holy Fa- The res socialis or human soci- God’s help to further the good ther signed his social encyclical ety, the context and reference of health and indeed the whole good addressed “to all people of good the Church’s Social Teaching, has of each person – man, woman and will” and promulgated it on 7th Ju- changed over the years: from the child, – each social group and the ly (month of St. Benedict), just be- misery of workers during the in- whole of humanity (Cf. Caritas in fore the meeting of the G-8 in dustrial revolution and the emer- Veritate, 18). L’Aquila, Italy. gence of Marxism (Pope Leo XI- Caritas in Veritate is a social en- II), the great depression of 1929 cyclical, like many others before (Pope Pius XI), decolonization and it, beginning with Pope Leo XIII’s the emergence of the third world Rerun Novarum (1891). 2 In it the (Pope John XXIII and Pope Paul 16 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

VI), political changes in Eastern total development, in all the activ- family has not accepted me, not Europe before and after the fall of ities of the human person (man). my mother or sisters or husband. the Berlin wall (Pope John Paul To teach that man’s activity, I’ve lost jobs because I’m HIV- II), and now Pope Benedict XVI with which he builds the earthly positive.” She also lost an infant addressing globalization, under- city, is an anticipation of the uni- daughter to AIDS, but her 10- development, financial, economic, versal city of God when his activi- years-old son – conceived before moral and anthropological crises.5 ty, inspired by love and justice, Rosanna got infected – is HIV- In these remarkably changing situ- seeks the well-being of the human negative. Jomo is a bright, healthy ations, the Papal social encyclicals person, whole and entire. boy who loves drawing and soc- have continuously brought the Andthisiscentralgood news of cer. His mom tries to keep healthy, Church’s basic social principles up the encyclical Caritas in Veritate, too, and says: “I want to see my to date and re-applied them. So the context for every vocation of son grow up”. From time to time, Catholic AIDS programmes invite Rosanna to tell groups the story of her diffi- cult life, explaining her HIV status and encouraging young people to live well and to avoid the mistakes which lead to infection. Rosanna is grateful for help, but she seeks more. “Myself, I am young. I want to have a future even if I didn’t fin- ish secondary school. I want my son to be someone.” Unable to do physically demanding work, she stands little chance of finding someone to hire her. But recently she had an enterprising idea: The landlords in her slum refused to provide water, telling the poor ten- ants to find it for themselves. So, with the help of a Catholic organi- zation, she bought a storage tank and a pump and set up a water business. Things are going well, and she is paying back nearly 2% a “the Church’s social doctrine illu- the human person, including the month. minates with an unchanging light vocation to the ministry of health- Knowing Rosanna, the Jesuit di- the new problems that are con- care delivery as both medical and rector of the programme was be- stantly emerging”;6 andthisispre- pastoral care workers. ginning to wonder what Caritas in cisely what the encyclical letter, Veritate might mean for her and Caritas in Veritate, seeks to do in Jomo when, providentially, she our day. Caritas in veritate dropped in on him. So he gave her So Pope Benedict is in full har- as Good News a four-page summary and, after an mony with more than a century of hour’s careful reading, she came Catholic social teaching about the Let me illustrate the good news up with pretty clear ideas of how human person. Caritas in Veritate that Caritas in Veritate is even to the Encyclical speaks to Jomo and addresses the complex conditions the “afflicted and infected” with herself. under which people develop inte- the real story of Rosanna. My per- Rosanna and Benedict XVI love grally, in all the human dimensions sonal secretary as Justice and life and see society much the same and forms including illness and Peace in San Calistro, Fr. Michael way. “I know the Encyclical is healing, under the challenging ide- Czerny SJ, used to be the director about the whole world,” she said, ological conditions of our contem- of a Jesuit HIV-AIDS programme “but when I read the Pope’s words, porary globalized world. Situating in Nairobi; and he shared this story he is talking exactly about Kenya, himself fully within the social with me, which I believe serves as even my slum. He says that the teachings of the Popes before him, a parable of our theme, the promo- market must not become “the Benedict XVI refers especially to tion of authentic and integral place where the strong subdue the Gaudium et Spes (1965) of Vatican health in the light of Caritas in weak,’ but it is.” Billions of us live II and to Populorum Progressio Veritate: as neighbours to one another in our (1967) of Pope Paul VI and Sollic- The Story: Rosanna is an aban- global village – or is it a global itudo Rei Socialis (1987) of Pope doned mother in her late twenties, slum? – yet with too little fraternal John Paul II: HIV-positive and struggling to get relationship. “Kenyan authorities To underline the centrality of the by in a Nairobi slum. “Six years see the poor as a problem. If you human person, his well-being and down the line,” she says, “my do not have a job, they try to send DOLENTIUM HOMINUM N. 76-2011 17 you back up-country. Our politi- Rosanna’s word. To acknowledge ety moves towards the denial or cians feel supported by foreign aid the abundant gifts we receive is to suppression of life, it ends up no and just take advantage of the be filled with gratitude. It is also longer finding the necessary moti- poor.” Accordingly, aid is misdi- the fundamental truth of our situa- vation and energy to strive for rected and badly distributed; it cre- tion. So we are creatures before man’s true good (CiV 28). ates dependence, generates cor- we become investors, bosses or Unfortunately, selfish and short- ruption, abuses the poor and solves employees; each our own person sighted ideologies claim to reduce nothing. “Without ethics, we are in but radically related to one anoth- harm but in fact attack life itself a total mess.” er; responsible, but not totally in and violate the most fundamental The Pope “is thinking in the charge. Instead of doing whatever components of human dignity, not right channel,” Rosanna said, but we like, as global culture cajoles do mention long-term health and many of us have become discour- us to, without reference to human- happiness. aged and, frankly, lazy. Addicted ity and God, things will get better Some non-governmental organi- to sound-bites and ideological slo- only if we each graciously, gratu- zations work actively to spread gans, the local and global picture itously give our best: mind, heart, abortion, at times promoting the seems too complicated to under- goods, time, and energy even in practice of sterilization in poor stand. Ever more resigned to a the service of the sick, the aged, countries, in some cases not event fragmented world, we just let oth- the handicapped etc. informing the women concerned. ers (‘the market’) decide. And in- And so, Caritas in Veritate is in- Moreover, there is reason to sus- stead of ploughing through the En- deed very good news for society, pect that development aid is some- cyclical and thinking about what it in that the Holy Father calls upon times linked to specific health-care means, we easily say it is too long Christians and people of good will policies which de facto involve the and too heavy. to recall the best of what t means to imposition of strong birth control By contrast, Benedict XVI be human, to be grateful to God for measures. The British Ministry of seems tireless in wanting to find the myriad of ways in which He International Aid announced, just the way forward. Without preach- bestows his graces on us each day, before the Pope’s visit to England ing, yet showing us how, the Pope and to use our gifts and talents, our and Wales, that Britain was going invites us to think clearly about resources: great and small, as gift to “hardwire” the demand for re- (our) society and (our) economy. to others and to make the world a productive health education in her He shows us how to put order into better place. aid-packages. Further grounds for our thinking, keeping things in So, just as Caritas in Veritate concern are laws permitting eu- their proper places. Social science shed light on Rosanna’s plight and thanasia as well as pressure from seeks the facts and the trends. So- prospects, I trust that her story lobby groups, nationally ad inter- cial policy implements govern- opens up for some of its ways of nationally, in favour of its juridical mental decisions about what to do; addressing the issues surrounding recognition... (CiV 28). but only we (believing and think- the integral health-care of the hu- The truth about the human per- ing people) can weigh up the pros man person, sometimes directly son demands that people of faith and the cons, only we can opt for and often obliquely included in hu- and good will recognize things for the basic values and work for what man development and well-being. what they truly are – hatred is ha- is best under God for the whole Like Rosanna, we want to apply tred, murder is murder, injustice is human family. the Encyclical to our situation and injustice – and political or ideolog- For example, when Benedict our challenges. ical motives cannot serve as ex- XVI shows that respect for life and Globalization is at once bringing cuse not to recognize and to ad- responsible sexuality are essential people closer together, but ironi- dress these human problems. The for development, Rosanna con- cally making us strangers (as long painful process of healing and curs. Honesty and true charity Rosanna also observed). In spite of reconciliation within families, be- aren’t born of selective or senti- inventions and advance in technol- tween friends, and among nations mental wishing; they hang on a ogy millions (1/6 of the world pop- and peoples can only begin when complete picture of man which ulation) go to bed hungry every the truth has been established. can only come from God. “In pro- night.7 And in spite of all of the New seeds of conflict are always moting development, the Christian structures of international finance, sown when this truth is obscured faith does not rely privilege or po- development and diplomacy, wars, or when vengeance dominates our sitions of power,” the Pope af- famines and disease rage on. thoughts and actions, as individu- firms, “but only on Christ,” to als and as a community. Only which Rosanna adds: “So I urge when the fundamental right to life the Church to show us what being Life is the Foundation is respected can the requirements a Christian is all about. Isn’t it lov- of justice begin to be fulfilled. ing your neighbour; and loving When the Holy Father writes him/her sincerely: in truth?” about his vision of human devel- The heart of the Encyclical is opment, he reflects upon the fun- Healthcare is both gift, gratitude, graciousness, gratu- damental need to respect the right Physical and Spiritual itousness. “Gift” and “gratuitous- to life. ness” come up about three dozen Openness to life is at the centre Caritas in Veritate is emphatic times, and “graciousness” is of true development. When a soci- on the point that human develop- 18 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE ment is not reduceable to mere ma- alism, combined with relativist ture, including that of our day, is terial and technological develop- and nihilistic thought”. The Pope offered the means of liberation to ment. For the Holy Father, “the de- referred to the latter as “sickness of serve the well-being of humanity. velopment of individuals and peo- the spirit” and “spiritual toxic Caritas in veritate articulates ples is (likewise) located on a refuse” which the so-called first this means of liberation;andit height, if we consider the spiritual world was exporting and thereby may be seen as an offer of a social dimension that must be present if contaminating the peoples of other teaching, rooted in and derived such development is to be authen- continents with it. from the ministry of Jesus, who tic. Similarly, healthcare and the Just last May, at the plenary as- sets all things free, to continue to wellbeing of the human person sembly of the Pontifical Academy fee man’s culture, his state of mind may not be limited to the “body”, of Social Sciences, eminent schol- and soul from burdens, and to help the merely physical component of ars and professionals described the them emerge from shadows of the the person. It must reckon also technical causes of the current so-called “new and modern ideas” with both the psyche and the spiri- economic, technological and so- which diminish man’s vision of tual component of the person; and cial crises, but also signalled very the truth and reduce his sense of it is in this that the Holy Father important “remote causes”. They healing to the organs of his body. goes beyond the MDG’s and identified these remote causes as One manifestation of the sick- NEPAD’s indication of disease spiritual and moral.8 Though not ness of the spirit is an emerging control and access to healthcare, quantifiable, the spiritual factor is misunderstanding of the human good governance, economic sta- present in every human activity, person, a mistaken sense of man. bility and growth, poverty eradica- distorting it.9 Thus the Pontifical The Holy Father analyzes the pre- tion and food security as Africa’s Academy appeared to affirm with vailing conception of man that in path to development and wellbe- Pope John Paul II that “sin and these fifty years human sciences ing to draw attention to the “hu- structures of sin are not categories and human engineering have pro- man heart, the seat of all that which one applies often to the situ- duced. In the name of science, destabilizes the continent”. It is ation of the contemporary world. these otherwise beneficial fields thus the suggestion of caritas in However, one cannot easily under- have succumbed to a pervasive veritate that healthcare delivery al- stand in depth the reality which ideology, according to which man so include morality and a care of stares us in the face without identi- is only the product of culture; and the spirit/soul: the sickness of the fying the root of the evil which af- that he evolves/fashions himself soul. flict us”.10 independently of human nature Accordingly, addressing the ple- and any universal laws inherent in nary assembly of the Italian Bish- his being. Man mistakenly consid- Healing the Sickness ops (May 27), Pope Benedict XVI ers himself to be his own author, of the Spirit also referred to the seriousness of the author and master of his/her the current economic crisis and af- life and of his society (CiV 34). Finally, we may describe the firmed the presence of an equally Man feels self-sufficient; and not good news of the encyclical as the serious spiritual and cultural cri- only neglects or displaces God, but healing of the spirit of man and the sis11 which should not be glossed does away with God completely. liberation of human culture. over. And for the Pope, this spiri- As a consequence of this sick- Shortly after the promulgation tual and cultural crisis in human. ness, man thinks he/she owes of the encyclical Caritas in Veri- The current crisis may be mani- nothing to anyone except to him- tate, the Holy Father presided over fested in the area of economics, self; and he believes that he only the African Synod in October market, trade and business, in has rights (Civ. 43) and no natural 2009. During the opening Eu- technology, ecology and politics; norms and responsibilities. The in- charist in his homily, the Holy Fa- but it is ultimately anthropological dividual is thus the master of his ther exhorted Africa and the in character. own existence and autonomous in- Church in Africa to cherish its cul- This, then, for the Holy Father, terpreter of its meaning. tural and spiritual heritage, “which is ultimately where the present cri- Indeed, there is in all of these a humanity needs even more than sisistobelocated:inman,inthe perverse dynamic at work in the raw material”. “From this point of “sickness of his spirit”, in his cul- continuous modern demand for view”, the Holy Father continued, ture and spirituality, infected by more rights, the removal of every “Africa constitutes an immense the “new and modern ideas” limit, and the progressive widen- spiritual ‘lung’for a humanity that which he calls “spiritual toxic ing of the scope of man’s action, appears to be in crisis of faith and refuse” and “pathologies”.The up to contemplating the idea of hope”. The Pope appealed to culture of our day, then, as the self-reproduction. In fact, this dy- Africa passionately to make sure Pope affirms, “has burdens from namic, while it closes up man in a that this spiritual “lung” was not which it must be freed and shad- egoistic self-production, also pre- infected by “two dangerous ows from which it must emerge” vents him from assuming any du- pathologies”: religious fundamen- (CiV,59); and the Good News is ties, without which all rights are talism combined with political and that, in the incarnation of Jesus, the sucked into a self-referential spiral economic interest; and a disease love of the Father and the tran- which eradicates every meaning.12 already widespread in the Western scendent Word of God (Logos),in It is just as Pope Benedict XVI ob- world, namely, “practical materi- human culture, every human cul- serves, “appeals are made to al- DOLENTIUM HOMINUM N. 76-2011 19 leged rights, arbitrary and non-es- Ecological Health and and other properly environmental sential in nature, accompanied by the Integral Human Health issues will impose themselves as the demand that they be recog- important and indeed basic condi- nized and promoted by public In recent years a whole new di- tions for human health, especially structures, while, on the other mension of health and sickness has of the poor and marginated. hand, elementary and basic rights opened up to human awareness remain unacknowledged and are and now demands urgent attention. violated in much of the world” We call it environment or ecology, Psycho-spiritual Health (CiV. 43). and it has to do with the soundness A link has often been noted be- and sustainability of our habitat, As if to help us put all the previ- tween claims to a “right to ex- the earth. Largely neglected until ous considerations into their great- cess”, and even to transgression now, the emerging problems – or est context, towards the end of the and vice, within affluent societies, even crises – of the environment Encyclical the Holy Father ad- and the lack of food, drinkable wa- “The significant new elements in dresses what we might call the cul- ter, basic instruction and elemen- the picture of the development of minating threats to human health, tary health care in areas of the un- peoples today in many case de- namely the collective mental ill- derdeveloped world and on the mand new solutions. These need to ness born of false ideologies and outskirts of large metropolitan be found together, respecting the false development which threaten centres (CiV. 43). laws proper to each element and in our human well-being. Let us lis- Thus disconnected from the the light of an integral vision of ten to a longer citation and notice common good and the universal man, reflecting the different as- how Pope Benedict brings togeth- dimension of objective moral law pects of the human person, con- er the many strands of human de- (natural law engraved on the heart templated through a lens purified velopment into this consideration of man), man now seeks in major- by charity” (CiV 32). In the rush to of the health and well-being of ity opinion, however unstable it face the new urgencies, some “the whole man and of every man” may be, the basis for the determi- thinking and planning go too far, (Paul VI). nation of the morality of law. This elevating nature above man and One aspect of the contemporary has led to a moral and an anthropo- seeing man as a threat to nature. In technological mindset is the ten- logical deregulation, giving the his ever balanced way, Pope Bene- dency to consider the problems impression that norms are created dict addresses ecology within the and emotions of the interior life solely by consensus. Moral law, larger picture of both Creation and from a purely psychological point the highest instance of regulation of all laws, has been secularized and replaced by civil law, which is ascribed a moral value, by reason of the fact that it has been decided upon by democratically-elected governments claiming consensus. This has generated a lot of totali- tarian points of view, position and ideologies; and the human being is himself the first victim. Denied as a reality in himself/herself, the hu- man person is increasingly being considered self-creating and the product of culture. Another false ideology also lead to the false utopia of a return to humanity’s original natural state. This detaches progress from its moral evaluation and human re- sponsibility (CiV 14), and it re- its Creator who is Our Father. Our of view, even to the point of neuro- veals a desire to deconstruct con- intelligent attention “is demanded, logical reductionism. In this way ceptions about the human person in any case, by the earth’s state of man’s interiority is emptied of its and its institutions (man, woman, ecological health; above all it is re- meaning and gradually our aware- family, marriage, children and quired by the cultural and moral ness of the human soul’s ontologi- their education etc.). The truth crisis of man, the symptoms of cal depths, as probed by the saints, about man would then be freed of which have been evident for some is lost. The question of develop- all models and moulds. Man time all over the world. (CiV 32). ment is closely bound up with our would not be differentiated in any- In your discussions during this understanding of the human soul, way. All would be equal, and all conference, ecological issues of insofar as we often reduce the self would be the same. This intro- pollution, lack of drinking water, to the psyche and confuse the duces us into the ante-chamber of agricultural livelihoods spoiled by soul’s health with emotional well- the general theory! reckless exploitation of resources being. These over-simplifications 20 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE stem from a profound failure to Conclusion into the Encyclical, too. The mes- understand the spiritual life, and sage is in the title, THINK! LOVE! they obscure the fact that the de- The good news for integral We must do both if Rosanna and velopment of individuals and peo- health care grounded in Caritas in Jomo and we are to have authentic ples depends partly on the resolu- Veritate is best summed up by human development and health. tion of problems of a spiritual na- these words of our Holy Father: ture. Development must include In every truth there is something H. Em. Cardinal PETER KODWO not just material growth but also more than we would have expect- TURKSON spiritual growth [and health], ed, in the love that we receive President, Pontifical Council for Justice and Peace, since the human person is a “unity there is always an element that sur- the Holy See of body and soul”, born of God’s prises us. We should never cease to creative love and destined for eter- marvel at these things. In all nal life. The human being devel- knowledge and in every act of love ops when he grows in the spirit, the human soul experiences some- when his soul comes to know itself thing ‘over and above’, which and the truths that God has im- seems very much like a gift that planted deep within, when he en- we receive, or a height to which Notes ters into dialogue with himself and we are raised. 1 The reception of the encyclical, having his Creator. When he is far away The development of individuals something for everybody to identify with, has from God, man is unsettled and ill and peoples is likewise located on been great. Within 30 days of its publication, Vatican Radio counted about 4,300 articles on at ease. Social and psychological a height, if we consider the spiritu- the encyclical in English, French, Italian, alienation and the many neuroses al dimension that must be present Spanish and Portuguese on the web. The Melt- that afflict affluent societies are at- if such development is to be au- water Group, extending its survey to other languages, counted 6,000 articles on the en- cyclical (cf. Gianpaolo Salvini SJ., “Enciclica ‘Caritas in Veritate’, in La Civiltà Cattolica #3822, 19 Sept 2009, 458. 2 Counting the letter of the Sacred Congre- gation of the Council to Mons. Liénart, Bish- op of Lille, on 5 June 1929; Gaudium et Spes and Dignitatis Humanae of Vatican Council II; the second half of Deus caritas est”; and the Instruction: Dignitas Personae, on certain bioethical questions from the Congregation for the Doctrine of the Faith (8 Dec. 2008), one may reckon 22 official documents on the social teaching of the Church (cfr. Le Dis- cours social de l’Église Catholique: De Léon XIII à Benoit XVI, Bayard Montrouge 2009). 3 The introduction to the encyclical is de- voted to the meanings of these two concepts: love and truth, their relatedness, their rooting in the life of the Triune God, their revelation to man through Christ, and their distortions at the hands of men and in human history. Jesus who reveals and shares them with is also the one to liberate and free them from human dis- tortions. 4 Caritas in Veritate, no. 5 tributable in part to spiritual fac- thentic. It requires new eyes and a 5 Cf. ibid. no. 75. tors. A prosperous society, highly new heart, capable of rising above 6 Cf. ibid. no. 12; Solicitudo rei socialis, no.3. developed in material terms but a materialistic vision of human 7 United Nations 2009 World Hunger Re- weighing heavily on the soul, is events, capable of glimpsing in de- port. not of itself conducive to authentic velopment the ‘beyond’ that tech- 8 They have to do with greed and ideologi- cal/theoretical presumptions. development. The new forms of nology cannot give. By following 9 Thus discourses about the human being slavery to drugs and the lack of this path, it is possible to pursue and about his vocation lose sight of his inner hope into which so man people fall the integral human development being and character: spirit (soul) and body, corporal and spiritual, which is the specific can be explained not only in socio- that takes its direction from the dri- nature of man (cfr. Sollicitudo Rei Socialis, logical and psychological terms, ving force of charity and truth no. 29) and economics and business life are al- but also in essentially spiritual (CiV 77). so distorted by presumption about the infalli- bility of false economic theories, while, out of terms. The sense of emptiness [or Let me conclude in the way I be- greed, human labour is replaced at the center malaise] in which the soul feels gan. For Rosanna, forgiving her of the creation of wealth by financial activity, abandoned, despite the availability relatives, living for Jomo and his carried out not as a Thought”, Plenary Assem- bly of the Pontifical Academy of Social Sci- of countless therapies for body and future, teaching youth to be re- ences, Vatican City, 1 May 2010. psyche, leads to suffering. There sponsible in the face of AIDS, 10 Sollicitudo Rei Socialis, no. 36. cannot be holistic development leading a little support group for 11 “...una crisi culturale e spirituale, altret- tanto seria di quella economica”. He went on and universal common good un- HIV-positive women, selling wa- to say: “Sarebbe illusorio – questo vorrei sot- less people’s spiritual and moral ter to her neighbours – all helped tolinearlo – pensare di constatare l’una, igno- welfare is taken into account, con- prepare her to read and appreciate rando l’altra” (Benedetto XVI, “Discorso al- l’assemblea della Conferenza Episcopale Ital- sidered in their totality as body and Caritas in Veritate very much. I iana”, 27 maggio 2010). soul (CiV 76). am sure she has helped us to enter 12 Cf. FONTANA, S., Per una Politica dei DOLENTIUM HOMINUM N. 76-2011 21

GIANFRANCO RAVASI Euntes docete et curate infirmos (Mt 10:7-8). The Urgency and Biblical Pertinence of the Mission for the Sick

The lips and the hands of Jesus was forced to live on the outskirts went to her, took her by the hand, are two capital presences in the of inhabited centres, usually in and helped her up. The fever left Gospels. On the one hand, there ghetto-caves or, like Job, amongst her’ (Mk 1:31); in Mt 8:15 one are his words which trouble and refuse, and was forced to indicate reads: ‘he touched her hand’, al- comfort, which preach the his or her presence as soon as a most taking her pulse as one does ‘gospel’, the good news of salva- healthy and normal citizen ap- when one measures the accelerat- tion, which lead to conversion, to peared on the horizon. Indeed, one ed heart beats of a person who had being followed, and to a commit- can read in the Biblical book of a fever). ment to build up the Kingdom of Leviticus: ‘A person who has a On other occasions the gesture God. On the other hand, however, dreaded skin disease must wear is even more concrete and direct, there are his acts of healing, his torn clothes, leave his hair un- as when Christ ‘put his fingers in bending down over sick flesh, his combed, cover the lower part of the man’s ears, spat, and touched ‘touching’ of the devastated or in- his face, and call out “Unclean, un- the man’s tongue’ (Mk 7:33), ert bodies of a very large number clean!”…and must live outside the thereby referring back to an archa- of marginalised people. Indeed, in camp’ (Lev 13:45-46). He was, as ic therapeutic praxis which held the New Testament the Greek a consequence, an individual who word ‘áptein’, ‘to touch’ (in the was socially dead, repulsed with ‘median’ form), occurs thirty-nine horror by the faithful who feared times, whereas the word ‘hand’, that they would be infected not on- ‘chéir’, occurs as much as 177 ly physiologically but also, and times. above all else, morally and at a sacral level. Jesus, instead, meets this man The Hands of Jesus on his journey, draws near to him, and reaches the point of touching Let us choose at random some him. Not only does he not con- examples of this. The case of the demn him but, as Mark observes, lepers is emblematic: ‘A man suf- he is profoundly moved (splanch- fering from a dreaded skin disease nisthéis), he heals him and he came to Jesus, knelt down, and sends him to the priests, almost as begged him for help. “If you want a point of irony, in order to receive to”, he said, “you can make me an official attestation of his healing clean”. Jesus was filled with pity and readmission to civil society. In and stretched out his hand and abolishing all the taboos of the eth- touched him. “I do want to”, he an- ical-judicial case studies of that swered, “Be clean!” At once the epoch, this miraculous act has the disease left the man, and he was characteristics of an original and clean’ (Lk 1:40-41). In Israel this even provocative form of behav- affliction was considered to be – iour of Christ who privileges care that some of syndromes of saliva because of the famous ‘thesis of for the suffering over sacral ritual- had an effective power. This is an retribution’ (crime-punishment, ism. On other occasions, instead, it act that is repeated in the case of thus illness-sin) – an unspeakable is pure and simple daily routine the man born blind when Jesus shame. A leper, therefore, was not that is entrusted to the hands of Je- ‘spat on the ground and made only a sick person but also and sus. We may think of the case of some mud with the spittle; he above all an excommunicated per- the mother-in-law of Peter who rubbed the mud on the man’s eyes’ son. It was thought that he or she was suffering from a fever. The (Jn 9:6). On other occasions he had been punished by God be- two hands of the Saviour and the simply ‘touched their eyes’ (Mt cause of a very grave sin, he or she sick women are intertwined: ‘He 9:29; 20:34), freeing them from an 22 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE affliction, that of ophthalmic syn- The soul of his action is religious ‘No, it is not Beelzebub, but God’s dromes, which was almost endem- and not propagandistic or apolo- Spirit, who gives me the power to ic in the ancient Near East and was getic in character. drive out demons, which proves caused by various factors connect- Christ refuses to move forward that the Kingdom of God has al- ed with hygiene and the environ- on the messianic-political enthusi- ready come upon you’ (Mt 12:28). ment. asm of his contemporaries; he is In ‘continuity’ with his constant Christ refused to wear the concerned above all else to preach style of preaching and action in clothesofamagicianorofaguru the advent of the Kingdom of God. favour of the poor, the margin- of an apocalyptic approach. His Indeed, the miracles almost preach alised and the excluded by the ‘of- ficialdom’ of his time, Christ allo- cated to them alone his miracu- lous, effective and saving words. For this reason, we should say that the Kingdom of God, Christ’s res- urrection and his miracles form a part of a single coherent system which defines the historical Jesus in his constant personality but also in his originality. A chapter apart in this sense – which, however, I can- not address within this very sim- plified and specific analysis – is that of the gospel accounts where he comes to deal with a possessed man through the liberation of his obsessions. This is an explicit confrontation with the dark root of evil which has in itself a dimension that is al- so moral and transcendent and which, therefore, cannot be re- miraculous gestures, indeed, have an action of the Kingdom, they are duced to illness alone. It is certain- nothing to do with resort to spells, an effective and ‘symbolic’ repre- ly the case that in some cases we paranormal techniques, dramatic sentation of it, and they are an ‘ex- encounter ‘satanic’ coverings of scenes or oracular excitement, as a periential’ confirmation of it. In what are pure and simple grave follower of his to celebrate his one sentence, seen by scholars as psycho-physical syndromes: we teacher would have dreamed of being handed down by an ancient may think of the ‘possessed’ boy doing (and possibly invented) and pre-gospel Aramaic tradition, Je- who was healed at the foot of the as still today we see take place in sus exclaims: ‘How terrible it will mountain of the Transfiguration certain exaggerated religious be for you, Chorazin! How terrible and who manifested the typical movements and in popular curiosi- for you too, Bethsaida! If the mira- symptoms of epilepsy (‘Whenever ty as regards the ‘mysterious’. His cles which had been performed in the spirit attacks him, it throws acts were, in contrary fashion, ele- you were performed in Tyre and him to the ground, and he foams at mentary. As has already been ob- Sidon, the people there would long the mouth, grits his teeth and be- served, he touched people’s eyes ago have put on sackcloth and comes stiff all over…he fell on the and ears, he laid on his hands, he sprinkled ashes on themselves, to ground and rolled around, foaming prayed, and he engaged in dia- show that they had turned from at the mouth’ (Mk 9:18-20). On logue with the sick person. On one their sins’ (Mt 11:21). The mira- other occasions, however, the occasion he does not even manage cles, in the intentions of Jesus, are mystery of Satan which over- to heal a sick person immediately: intimately intertwined with his whelms the person even when that this was the case of the blind man words and become a ‘visible’ ap- person is at prayer in a synagogue of Bethsaida who was healed in peal to conversion and faith, in is explicitly involved (Mk 1:21- two stages (during the first stage conformity with his general be- 26): the hand of Christ does not this man managed to see ‘people, haviour, and not huge advertising hesitate to place itself, becoming a but they look like trees walking and promotional signs of a politi- source of liberation and salvation, around’ but during the second cal and magical messianism, as on this moral evil as well, as it stage he ‘saw everything clearly’, Satan wanted in the famous ac- does on the whole of the dark hori- Mk 8:22-25). What interests Jesus, count of the temptation when he zon of sin. more than his personal triumph suggested to Christ certain dramat- In this light the miracles of Je- and the success of his action, is ic and spectacular approaches (Mt sus, which occupy an ample space faith, individual conversion and 4:1-11; Lk 4:1-13). The intimate on his public ministry (about 45% liberation from evil, to the point link between miracles and faith in of the account of Mark of the offi- that he may even heal far from a the Kingdom of God is formalised cial activity of Christ – excluding crowd in order to avoid publicity. by Jesus himself when he declares: his passion and his resurrection - DOLENTIUM HOMINUM N. 76-2011 23 is made up of descriptions of mira- On the one hand, therefore, ‘those who believe in me will do cles), are a fundamental element of there is the kérygma, the ‘preach- what I do – yes, they will do even the portrait we have of him, and to ing’ (kerýssete, ‘preach’) which greater things, because I am going such a point that it is not only Jesus has – like the preaching itself of to the Father’ (Jn 14:12). The min- who ‘touches’ the sick in order to Christ (Mt 4:17) – its programme istry of revelation and of salvation, heal them but it is they who seek in the proclamation of the King- of which the miracles are signs, him out to be healed: ‘all those dom, that is to say the project of will continue on from Christ in the who were ill kept pushing their salvation of God. On the other disciples, that is to say in the way to him in order to touch hand, there are the signs of the Church, his glorious body at work him…people would…beg him to Kingdom in action, expressed in in history. let them at least touch the edge of the four imperatives that define the If we wanted to create an exem- his cloak; and all who touched him same number of categories of peo- plary model of this action of liber- were made well’ (Mk 3:10; 6:56; ple to be freed from evil, following ation and of love performed by a one may also remember the the model of the behaviour of disciple, we could refer to the episode of the woman with an is- Christ in his public action: the sick parable figure of the Good Samar- sue of blood in Mk 5:27-31). It is (asthenountes)tobehealed(thera- itan who not only is moved ‘vis- because of this realism – as an Ital- péuete); the dead (nekroús)tobe cerally’ (splanchnísthe), taking ian writer, Luigi Santucci, ob- risen (eghéirete); lepers (leproús) part in the suffering of the unfortu- served in ‘life of Jesus’entitled Vo- to be purified both physically and nate man, but who also cares for lete andarvene anche voi? (1969) socially, as has been mentioned him with concern and with active – that we ‘narrate the miracles of above (katharízete); and lastly the charity: ‘He went over to him, Christ as though they were things victory over the daimónia. Well, poured oil and wine on his wounds that befallen us, because each one this programme is implemented and bandaged them; then he put of us, if one thinks only of history, immediately afterwards through the man on his own animal and has been to Cafarnaum, on the lake the first apostolic mission since Je- took him to an inn, where he took of Galilee, has experienced paraly- sus ‘sent them out two by two. He care of him (Lk 10:33-34). This is sis, fever, madness, storms, and gave them power over impure what is performed by the apostles death. A thousand times it has been spirits’ (Mk 6:7). in their public ministry. Here what said to us: ‘Be healed!’ and our be- is of significance of the testimony ing has been reborn, ‘Be of the two columns of Christianity cleansed!’ and our wounds have at its origins – Peter and Paul – disappeared, ‘Come out!’ and he within the account of the Acts. stone of the tomb has rolled away To the paralytic Aeneas of Lyd- in our darkness’. da – as had already happened in the case of the lame man of the Beautiful Gate in Jerusalem, The Hands of the Disciples healed by Peter and John (Acts 3:1-10) – Peter proclaims: “Ae- There is, however, at this point a neas, Jesus makes you well . Get decisive element that should be up…!” (Acts 9:32-35). The work added, that of the imitatio Christi of the disciples is based, therefore, of his disciples. And this takes on the salvation offered by Christ. place on the basis of a precise mis- In a similar way, at Jaffa, it is Peter sion that goes back to the historical who once again repeats the same Jesus himself. Indeed, as is well Their missionary activity is ex- acts of Jesus towards the daughter known, during his public ministry plicitly modulated both upon of Jairus (Mk 5:41: ‘He took her he assigned to his group of disci- preaching, and thus upon words: by the hand and said to her , “Tal- ples a precise mandate which has they ‘preached that people should itha, koum,” which means, “Little its lapidary formulation inside the turn away from their sins’, and up- girl, I tell you to get up”’). Indeed, second of the five discourses to be on their healing works because to Tabitha who is lying in a funeral found in the structure of the their hands ‘drove out many bed he says: ‘“Tabitha, get up!”. Gospel of Matthew, the so-termed demons, and rubbed oil on many She opened her eyes, and when ‘missionary discourse’. In this sick people and healed them’ (Mk she saw Peter, she sat up. Peter sense the same intertwining be- 6:13). This is what was empha- reached over and helped her get tween words and acts, between sised in the post-paschal mission up’ (Acts 9:40-41). lips and hands, that had outlined of the disciples since the risen A scene which from certain the portrait of the Teacher and Christ declared of his disciples: points of view is analogous even Lord, is formulated in a clear way: ‘they will drive out demons in my though pertains much more to ‘Go and preach, ‘The Kingdom of name…they will place their hands ‘daily life’ has as its protagonist heaven is near! Heal the sick, bring on sick people, who will get well’ the apostle Paul. At his shoulders the dead back to life, heal those (Mk 16:17-18). In practice we is the dramatic event of the ship- who suffer from dreaded skin dis- have in these synoptic passages the wreck which had thrown him onto eases, and drive out demons’ prefiguring of the promise in John the coasts of the island of Malta. (10:7-8). of the discourses of the last supper: There the local Roman governor 24 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

(prótos), known as Publius, helps healed. The prayer of a good per- byters. Reference is then made to him and hosts the apostle in a kind son has a powerful effect’ (Jm the recipients – these are the sick way, and Paul reciprocates his ges- 5:13-16). (the Greek word ‘asthenein’ ture in an unexpected way: ‘Pub- As is well known, it is specifi- means ‘being infirm, weak’) and lius’ father was in bed, sick with cally on the basis of this passage not the dying. Indeed, it is ob- fever and dysentery. Paul went in- that Christian tradition has cele- served that they themselves must to his room, prayed, placed his brated the sacrament of the anoint- be able to call the church elders, hands on him, and healed him. ing of the sick which unfortunately that is to say they must be con- When this happened all the other in the past often degenerated into scious and be characterised by sick people on the island came and ‘last anointing’ as though it was freedom and participation, as is re- were healed’ (Acts 28:8-9). only a sacred act reserved to the quired – at least implicitly – by dying. The Council of Trent every sacrament so that it is not solemnly established that it is a transformed into an act that is al- ‘sacrament instituted by Christ our most magical. Lord and promulgated by the This has been the approach of blessed apostle James’. As has al- recent pastoral care in relation to ready been observed in this paper, suffering which bestows the in the Gospel of Mark we read that anointing of the sick on those who the disciples who were sent out by are conscious, without excluding, Jesus on their first mission ‘rubbed certainly, those people who, in a oil on many sick people and healed critical situation or when dying, them’ (6:13). Now, in the ancient have, through their lives or at least Near East oil was considered to be through their general approach, a tonic for the tissues of the organ- demonstrated an openness to the ism and this to such an extent that grace of faith. Unfortunately, as it was rubbed onto athletes as well. has already been pointed out, for However, holy oil was also the some Christians anointing of the material used for the consecration sick is still only a ‘last anointing’ of kings and priests because it had of the terminally ill, if, indeed, not Prayer and Illness the function of irradiating in the for those who have just died: once, chosen one the power and energy indeed this sacrament was admin- It is significant that the Apostle themselves of God. The phrase istered sub conditione,thatisto also implements the appeal of that the prophet Isaiah used for say conditional upon a person’s re- Christ to lay on hands and to heal. himself and for his prophetic voca- al capacity to go on living which But there is always care to avoid tion, but which Christ applied to could not be verified externally. conceiving these acts as pure and his messianic consecration, is fa- Let us now pass, after the ministry simple acts of healing. Indeed, ei- mous: ‘The Sovereign Lord has and the subject of this sacrament, ther there is an explicit invocation filled me with his Spirit. He has to what used to be called the ‘ma- of the name of Christ or the gesture chosen me…’ (Is 61:1; Lk 4:18- terial’ of the sacrament. is intertwined with prayer. It is in 19).1 Two elements should be consid- relation to this dual element that So let us now return to the text ered in this rite. On the one hand we can introduce a further consid- of the Letter of James where we the anointing with holy oil in line eration that unites lips and hands encounter various elements that al- with that symbolism to which ref- in a special way, that of prayer and low us to be able to intuit the reali- erence has been made above; on healing. Let us read first of all the ty of the sacrament: suffering, the other hand, there is prayer text of reference we have chosen prayer, the sick person, his or her which includes an authentic for- and which is taken from the Letter appeal, the elders of the church, mula for the anointing, and to such of James, a passage that deserves that is to say the heads of the com- an extent that reference is made to to be reflected upon both by sick munity, anointment with oil, the the ‘name of the Lord’ in line with people and by pastoral workers in invocation of the name of the a liturgical dimension that is well the field of suffering. ‘Are any of Lord, healing and the forgiveness known and connected with this you in trouble? You should pray. of sins. We will now try to define phrase. Lastly, one comes to the Are any of you happy? You should the physiognomy of this sacra- effects of this sacrament which are sing praises. Are any of you ill? ment, that is to say of that gift of of two kinds. There is physical sal- You should send for the church el- divine grace offered in the Church vation, the health offered by the ders, who will pray for them and to those who believe in the Lord God of life to the sick person who rub olive oil on them in the name Jesus which is often administered can thus rise from his or her bed or of the Lord. This prayer made in in our hospitals and not rarely is from where he or she was lying. the faith will heal the sick; the celebrated in a communal way, as But there is also spiritual salvation Lord will restore them to health, is specifically appropriate to a true which is liberation from sin where and the sins they have committed sacrament and as is suggested by the sick person is still involved in will be forgiven. So then confess the Letter of James itself. There interior evil or recognises that he your sins to one another and pray are first of all the ministers of the or she needs the mercy of God be- for one another, so that you will be sacrament – these are the pres- cause of his or her frailty as a weak DOLENTIUM HOMINUM N. 76-2011 25 and unfaithful creature. In this ever, one can see in this mention of who entrusts himself to the Lord in union between illness and sin one the forgiveness of sins a more gen- faith and prayer and takes part in can perceive the Biblical tradition eral statement about the function the life and the worship of the ec- which has already been cited in of salvation of every sacrament, clesial community, a setting of sal- this paper known as ‘retribution’, that function, that is to say, of free- vation. We can, therefore, refer which tried to identify a sin at the ing man from evil and making him this sacrament to its ecclesial con- root of every illness (see for exam- belong to the life itself of God. I text, to its solemn celebration and ple Psalm 38). mentioned above that a response is to its function as an efficacious Jesus very much reduced this required from man to the gift of sign of salvation and of hope for idea. One need only read the be- God: this response is expressed in those who live in the shadow of ginning of the account of the blind the faith of the sick person who pain. man in the Gospel of John: ‘As Je- welcomes the grace offered by sus was walking along, he saw a Christ. In the passage quoted His Eminence Cardinal man who had been born blind. His above of James reference is made GIANFRANCO RAVASI disciples asked him, “Teacher, in an explicit way to faith: ‘This President of the Pontifical Council for Culture, whose sin caused him to be born prayer made in the faith will heal the Holy See blind? Was it his own or his par- the sick’. In this way the two di- ents’ sin?” Jesus answered, “His mensions of this sacrament inter- blindness has nothing to do with sect: on the one hand we have the Note his sins or his parents’ sins. He is efficacious action of God who 1 Translator’s note: some translations of blind so that God’s power may be saves, and on the other hand, we Holy Scripture choose to employ a reference seen at work in him’ (9:1-3). How- have the free choice of the man to oil in translating these passages. 26 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

ANGELO AMATO The Salus Animarum in Pastoral Care for the Sick

1. A person who suffers does not ible but nonetheless real infirmities, by agents of pastoral care to the use leave us indifferent – he or she calls such as ignorance about being of the sacrament of the sick. Indeed, upon us. A sick person, in his or her Christian, neglecting one’s own the Church, having received from weakness and powerlessness, is the way of behaving in life, and the ob- the Lord the command to heal the bearer of a call for help, for assis- scuring of one’s own existence of sick, is commited to putting this tance, for nearness, and for sharing. faith. The invocation of physical commandment into practice His or her painful situation stresses healing can be united to care for through care for the sick and prayers the frailty and the weakness of our spiritual health. of intercession: ‘Above all the humanity and its impelling need for 2. Hence the urgent need for a Church possesses a sacrament physical healing and spirtual re- service that those who work in the specifically intended for the benefit demption. field of pastoral care in health, of the sick. This sacrament was in- His or her ‘voice’ makes sound whether they be parish priests, hos- stituted by Christ and is attested by out in us a truth that is often con- pital chaplains, make religious, sis- Saint James “Is any among you cealed, that is to say the reality of ters, extraordinary ministers of sick? Let him call in the presbyters our finitude, our being limited and communion or volunteers of various of the Church and let them pray the conseqeunces of that original sin kinds, can, and must, provide. One over him and anoint him with oil in that brings with it suffering, illness is dealing here with spiritual accom- the name of the Lord” (Jas 5:14- and death. panying which can, with prudence, 15)’.1 In his or her frailty as well, how- supplement catechesis, the adminis- This sacrament, as is known, can ever, a sick person always remains a tration of the sacraments, and, be repeated many times, indeed person created in the most resem- where this is appropriate, the first each time that a worsening of the ill- bling image of God and redeemed preaching of the Gospel of Jesus ness takes place. Perhaps it is advis- by the precious blood of His son, Je- Christ. In our multireligious and able to remember that this sacra- sus Christ. multiracial society, one can but pro- ment can be administered only by In the Gospel, Jesus paid particu- pose the good news of salvation in priests, whether they are bishops or lar attention to the poor, to the mar- Jesus Christ, without any kind of presbyters.2 ginalised and to the sick. In addition constriction and with the most rigor- The effects of this sacrament are to being a physician of souls, he al- ous attention being paid to respect particularly important. First of all, it so presented himself as a physician for the consciences of other people. bestows a special grace which of bodies, healing the deaf and For Christians who are often unites the sick person more inti- dumb, those suffering from leprosy dazed by a society that is distracted mately to the passion of Christ, for and paralystics, and raising people and shallow, who forget about car- his or her good and for the good of from the dead. For him, man was ing for their own souls, agents of the whole Church. It also gives him wounded both by sin and by infirmi- pastoral care can but give value to or her comfort, peace, courage and ty. To both these limits of man the sacraments, above all the sacra- also the forgiveness of sins if the Christ provided a remedy, forgiving ments of reconciliation and of the sick person has not been able to go sins and restoring physical health. Eucharist. By the first one frees the to confession. This sacrament at For him, healing was like a holy soul of sick people from those wor- times allows, if God so wishes this, door through which to place in the ries and fears that always, con- also the recovery of physical health. heart of a sick person the abundance sciously or unconsciously, accom- Lastly, anointing prepares the sick of divine grace. A sick person was pany a sinful situation, restoring person for the move to the House of thus restored to physical and spiritu- serenity and joy in living. By the the Father.3 al health. Physical healing constitut- Eucharist one places in the heart of a 4. Divine grace gives to illness ed the visible image of invisible sick person that divine grace that and suffering a particular value of spiritual healing. This relationship impregnates his or her person, his or purification and of redeption. The between the healing of illness and her feelings, and his or her thoughts, Compendium of the Catechism of the healing of the soul is an impor- with charity and holiness, giving the Catholic Church teaches that: tant indicator for the pastoral path- him or her the courage and the ‘The compassion of Jesus toward ways of Christian health-care work- strength that are needed to rest his or the sick and his many healings of ers. head on the breast of the Crucified the infirm were a clear sign that with Medical treatment can be accom- Christ, so as to share with him the him had come the Kingdom of God panied, in the freedom of, and sa- sufferings and the humiliations that and therefore victory over sin, over cred respect for, the consciences of illness often brings with it. suffering and over death. By his other people, by healing other invis- 3. Especial attention must be paid own passion and death he gave new DOLENTIUM HOMINUM N. 76-2011 27 meaning to our suffering which, of the creation, ending up by be- ment. Her apostolate was to unite when united with his own, can be- coming, we ourselves, deaf and this valley of tears and heavenly come a means of purification and of dumb. Lolo saw and understood the Jerusalem in a harmonious way. A salvation for us and for others’ (n. thousand beneficial presences of di- meeting with Chiara – one witness 314). vine Providnce in his personal life even came to say – gave a ‘sensa- The infirmity itself, with its bur- and in the history of humanity. For tion of meeting God’. den of physical weakness, can also this reason, his existence was not 5. In his encyclical letter Spe salvi become an opportunity for religious marked by sadness but, instead, by the Holy Father Pope Benedict XVI maturation and at times a vocation joy; not by regrets but by apostolic observes that ‘The true measure of to Christian perfection and to holi- enterprise; not by loneliness but by humanity is esseentially determined ness itself. This is a common experi- communication and friendship with in relationship to suffering and to ence not only of consecrated people everyone, great and small, healthy the sufferer. This holds true both for and ministers of God but also of and sick, poor and rich. His was an the individual and for society’ (n. men and women members of the lay existence of authentic gospal holi- 38). In this sense the Church contin- faithful who, afflicted by illness, ness. ues to offer a contribution of incal- have become heroic witnesses to culable value to promote a world faith, hope and charity. that is more able to welcome and I will cite only two examples of care for sick people as persons. I such members of the lay faithful, will end with a reference to the Ven- who were solemnly beatified in this erable Pope John Paul II who, at the year of grace 2010. They were sick height of his personal physical suf- people who turned their beds of suf- fering, which was not concealed fering into altars to offer up to the from, but instead shown to, the Lord their physical tribulations and world with humility and fortitude, into teaching chairs to educate the in his Message for the Thirrteen healthy to give thanks to God for World Day of the Sick invited peo- their physical health. I am referring ple to appreciate pastoral care in to Blessed Manuel Lozano Garrido, health more: ‘In our time, marked known as ‘Lolo’, a journalist and by a culture imbued with secular- writer, who was beatified in ism, some have at times been tempt- Linares, Spain, on 12 June of this ed not to recognize the full value of year, and the young member of the this pastoral context. They think focolare movement, Chiara Badano, A second example is provided by that human destiny is played out in who was beatified here in Rome on the eighteen-year old member of the other fields. Instead, it is precisely 25 September 2010. hearth movement Chiara Badano. in times of sickness that the need to After being raised to the cross of Love for Abandoned Jesus infused find adequate responses to the ulti- suffering at the side of Jesus, divine in her that spiritual energy, that mate questions about human life is grace strengthened their souls and grace capable of bearing every mis- the most pressing: questions on the transformed their Calvary into the fortune. Struck by osteosarcoma at meaning of pain, suffering and Tabor of the transfiguration. Afflict- the age of sixteen, she accepted the death itself, considered not only as ed by grave illnesses which made cross with pain but with serene for- an enigma that is hard to face, but a them invalids, both of them, nour- titude: ‘I no longer have my legs mystery in which Christ incorpo- ished by divine grace through the and I very much liked riding my bi- rates our lives in himself, opening sacraments of reconciliation and of cycle but the Lord has given me them to a new and definitive birth the Eucharist, were teachers of wings’.4 She suffered, but her soul for the life that will never end. In serenity, of Christian fortitude, and sang. She rejected morphine be- Christ lies the hope of true, full they converted their illnesses into a cause, she said, ‘It takes away my health; the salvation that he brings is mission of evangelisation and con- lucidity and I can offer to Jesus only the true response to the ultimate version. my pain’. At the end of December questions about man’. Lolo, with the eyes of his body 1989, when her illness was divour- eclipsed, refined his eyes of faith so ing her, she received a Message of His Eminence Cardinal that he could perceive the Holy life from Chiara Lubich: ‘Those ANGELO AMATO, SDB, Spirit in himself and in his neigh- who remain in me, and I in them, Prefect of the Congregation bour. For this reason, he was wont will bear much fruit’ (Jn 15:5). On for the Causes of Saints, to say that you see the stars at night. 26 July 1990 Lubich gave her a new the Holy See Despite his stiffened limbs, he name, ‘Light’. A very well chosen moved wih agility with his heart and name because Chiara became an ex- his mind, travelling in the skies of plosion of divine light which sur- Notes truth and beauty. His physicial mal- prised everyone, both young and adies made him more sensitive to old. She often said: ‘Jesus should be 1 The Catechism of the Catholic Church. Compendium (Paulines, Paulines Publications spiritual harmonies, differently loved, and that’s that’. Those people for Africa, Nairobi, Kenya), n. 315. from ourselves who, stunned by a who visited her thought they were 2 The Catechism of the Catholic Church. sea of futile daily images and deaf- bringing her affection and comfort Compendium n. 317. 3 The Catechism of the Catholic Church. ened by the din of their sounds, no but in reality it was they who were Compendium n. 319. longer manage to perceive the song receiving comfort and encourage- 4 Informatio Relatoris,p.2. 28 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

LUIS GOMES SAMBO Access to Primary Health Care: Thirty-Two Years after Alma Ata what Advances have been Achieved in the Continent of Africa?

It is a great honour and privilege embraces knowledge of, and re- which revealed the inability of for me to be here at the Vatican, sponses to, new public health health services to meet the expec- addressing this august gathering threats and their determinants. Its tations of the majority of the pop- of eminent personalities. I would practice involves a wide range of ulation due to increasing costs and like to express my deepest appre- actors and initiatives within health inequities in access to health care. ciation and gratitude to His Holi- systems. Second, the Thirtieth World ness, Pope Benedict XVI, for the The subject on which I was re- Health Assembly of 1977 which latest encyclical, Caritas in Veri- quested to give a speech at this agreed that the main social target tate, in which he provides us with gathering, ‘Access to Primary by the year 2000 would be the at- his profound reflections on social Health Care: Thirty-Two Years af- tainment by all peoples of the and economic issues connected ter Alma Ata what Advances have world of a level of health that with inequalities and underdevel- been Achieved in the Continent of would permit them to lead socially opment in the world today. By ad- Africa?’, is timely and pertinent and economically productive vancing concepts such as integral especially when placed within the lives. Third, the 1978 Internation- human development and develop- context of the Millennium Devel- al Conference on Primary Health ment as a vocation, and by pro- opment Goals and their attainment Care (PHC), held at Alma Ata in moting respect for human dignity by 2015. This international con- the then USSR, which reaffirmed and the equality of all men,His ference is therefore an opportune the goal of ‘Health for All’ and Holiness reminds the world com- moment for reflection and stock- adopted primary health care as the munity and its leaders of their du- taking. strategy for attaining this goal by ty and responsibility to address the In my paper, I will first briefly the year 2000. plight of billions of people living review the concept of primary On the one hand, because of its in poverty today. health care and what has been primary focus on health promo- One of the key features of pub- achieved since the Alma Ata Con- tion and disease prevention, pri- lic health is its underlying philoso- ference of 1978. Based on the lat- mary health care was put forward phy of social justice. Significant est statistics available, I will then and accepted as a cost-effective factors within society such as dis- give an overview of primary strategy for achieving health for tinctions of social class, racism, health care implementation and all. On the other hand, the princi- ethnicity, culture and differences the factors hampering progress to- ples underpinning primary health in norms and values, hamper the wards achieving universal access care, such as social justice, equity, fair distribution of societal bene- to health care. In the final section human rights, universal access to fits and burdens. These differ- of my paper I will focus on the services, community involvement, ences often create tensions and role of the Church. and priority for the most vulnera- conflicts between people and in- ble, were upheld. These principles stitutions that have competing attracted interest and gained wide views and interests. Health, as a The Concept of Primary currency within the international state of complete physical, mental Health Care community and with people of and social well-being, is affected good will. by such tensions. Permit me to recall the histori- The need for universal coverage Primary health care, as a social cal developments that led to the of health services is as paramount movement, is both public and po- emergence of the concept of pri- today as it was in Alma Ata thirty- litical in nature, but it is grounded mary health care.Inmyview, two years ago. The current social, on the broad basis of the biologi- three main events laid the founda- economic, political and environ- cal, physical, social and behav- tions for primary health care. First, mental climate, the impact of ioural sciences. The primary in 1973, a WHO global study on globalization, and the advances in health care approach has provided ‘Methods of Promoting the Devel- health science and technology, all new public health thinking that opment of Basic Health Services’, call for health sector reforms to DOLENTIUM HOMINUM N. 76-2011 29 achieve its continuous adaptation tection of people from counterfeit volves teamwork by health profes- to complexity and change. These drugs in such a situation is indeed sionals from various disciplines reforms should be guided by evi- a herculean task. Such unsafe and at various levels, it provides dence-based health policies that care, as it is called, leads to high an excellent approach to improve also take into account fundamen- rates of avoidable hospital infec- multidisciplinary and intersectori- tal values such as equity, human tions, and many other complica- al responses to health and health- rights and social justice. tions. related needs. Today, a number of health sys- Primary health care is therefore tems and public health challenges Fifth, it is common epidemio- a useful strategy for addressing persist in sub-Saharan Africa. logical knowledge that the burden current health system issues relat- These challenges compromise the of illness is better addressed ed to leadership and governance; health status of people and their through health promotion and ill- human resources for health; health ability to lead socially and eco- ness prevention and control. How- financing; access to health tech- nomically productive lives. ever, funding priorities usually put nologies; quality of health care; The current weaknesses in more resources on hospitals and the social determinants of health; health care systems can be other curative services. Such dis- research promotion; and the man- grouped into five categories: tortions in the allocation of re- agement of information and sources within the health system knowledge. First, there is an apparently leads to what has become known paradoxical situation whereby as misdirected care. people who are better off in soci- Access to Primary ety and relatively less likely to The implementation of the pri- Health Care need health care services consume mary health care approach to more of health services than those strengthen health systems has the Since the Alma-Ata Conference who have the least means and are potential to expand the gains from on primary health care, some in greatest need of such services. health investments to cover more progress has been made by coun- This reflects an inequitable access people in the world. The essential tries in the African region. The to health care. features of primary health care in- eradication of smallpox is a major clude: achievement shared with all coun- Second, the vast majority of People-centeredness – meaning tries of the world. More recent ex- people in the region lack social a focus on the needs of individu- amples include the control of protection, and a large proportion als, families and communities at measles, the progress in po- of payments for health services the local level. liomyelitis eradication, the elimi- are inevitably made out-of-pocket. The full involvement of individ- nation of guinea-worm disease Most of these people subsist on uals, families and communities in and leprosy, and the control of riv- meagre resources and live under decision-making about their own er blindness in most areas of the precarious conditions, almost on health and health care. continent. the brink of poverty. Millions of Comprehensiveness – in addi- There have also been reductions them, confronted with major ill- tion to offering curative services, in child mortality and maternal nesses and catastrophic health ex- PHC offers opportunities for mortality, even though these indi- penditures, easily and quickly health promotion, preventive care cators are the worst in the world slide into poverty. These reflect and rehabilitation. and a source of great concern (Fig- impoverishing systems of health Integration – because PHC in- ure 1). care that need to be addressed.

Third, having gained wide ac- Figure 1 – Trends in life expectancy at birth, in selected regions, ceptance, the holistic approach to 1950-2010 health care for individuals and families is taught in medical and public health schools everywhere. However, in practice, in health- care settings almost everywhere excessive specialization and a nar- row focus on vertical illness con- trol programmes creates situations of fragmented health care where illnesses are managed irrespective of the social and mental dimen- sions.

Fourth, health systems in the African region are under-re- sourced. Thus, ensuring optimal safety, hygiene standards, and pro- 30 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

The trend of increasing life ex- three of these goals (MDGs 4, 5 child with a set of priority inter- pectancy in the African region in and 6) concern the health of chil- ventions. These interventions in- the 1970s and 1980s was reversed dren and women and major dis- clude: appropriate breastfeeding in the 1990s with the advent of the eases such as AIDS, tuberculosis and infant and young child feeding HIV/AIDS pandemic which dev- and malaria. As I will show in sub- practices; the prevention of vac- astated several countries in Africa. sequent slides, progress towards cine-preventable diseases through Because of a lack of progress in the MDG targets has been vari- effective immunization; and the human development and in health able. prevention and management of in particular, and mindful of exist- The under-five mortality rate common childhood illnesses such ing knowledge and wealth in the dropped from 182 per thousand as pneumonia, diarrhoea, malaria, world, global leaders, in the year live births in 1990 to 142 in 2008. malnutrition and HIV (Figure 2). 2000, agreed on the Millennium However, it is decreasing at an av- Declaration and the Millennium erage rate of 1.4% per year, much For example, if we consider im- Development Goals (MDGs) to slower than the 8% per year need- munization coverage among one- address income poverty, hunger, ed to achieve MDG4 by 2015. year-old children for the third ignorance, squalor and disease. The key to progress towards at- dose of Diptheria/Pertusis/Tetanus This brought renewed hope for taining this goal by 2015 is to (DPT3), we note that this coverage millions of people. As you know, reach every newborn baby and increased in the African region from 57% in 1990 to 72% in 2008. The maternal mortality ratio al- Figure 2 – Percentage of DPT3 immunization coverage so decreased from 910 per 100,000 among 1-year-olds, 2008 e 1990 live births in 1990 to 620 in 2008. The rate of decline in maternal mortality ratio is such that reach- ing the MDG5 target by 2015 is unlikely in most of the countries in the African Region (Figure 3).

We have the knowledge and the technologies to deliver proven and cost-effective interventions to avert the vast majority of maternal deaths if every woman has access to quality reproductive-health ser- vices. These include skilled atten- dance during pregnancy, childbirth and the postnatal period, emer- gency obstetric care and family planning. In addition, there is a need to promote the social and

Figure 3 –Percentage of births attended Figure 4 – Number of adult and child deaths due to by skilled health personnel, 2000-2008 AIDS (in millions) in sub-Saharan Africa DOLENTIUM HOMINUM N. 76-2011 31 economic status of women and much progress in tuberculosis con- reviewed past experiences in PHC strengthen the capacity and in- trol, the fight against malaria is and adopted the ‘Ouagadougou volvement of families and com- progressing significantly in some Declaration redefining the African munities. countries providing good coverage strategy for scaling up essential in- Coverage of skilled birth atten- of essential anti-malaria interven- terventions to achieve the health dance in the African region re- tions such as artimisinin-based MDGs’. mains low at 47%, with a wide combination therapy, vector con- The Ouagadougou Declaration variation in the rates among coun- trol including the use of insecti- focused on nine major priority ar- tries. Only a small fraction of preg- cide-treated nets (ITN) and indoor eas, namely Leadership and Gov- nant women requiring emergency residual spraying (IRS), and inter- ernance for Health; Health Ser- obstetric care or adequate antena- mittent preventive treatment of vices Delivery; Human Resources tal care actually receive it. malaria in pregnancy. for Health; Health Financing; The global community has re- Health Information Systems; solved to halt and reverse the inci- Health Technologies; Community dence of HIV/AIDS, malaria and Ownership and Participation; Part- TB by 2015 as part of efforts to nerships for Health Development; achieve MDG6. Yet whereas the and Research for Health. African region is home to just over The social determinants of 10% of the world population, it ac- health are being addressed through counts for a staggering two-thirds a framework of interventions de- (67%) of people living with veloped by the WHO Commission HIV/AIDS worldwide; two-thirds on Social Determinants of Health. (68%) of all new adult HIV infec- The interventions aim at action on tions; over 90% of new HIV infec- the circumstances of everyday life tions in children; and over 70% of and the structural drivers of in- AIDS-related deaths (Figure 4). equity. On the improvement of dai- ly living conditions the commis- Although the fight to contain sion calls on countries and their HIV/AIDS is far from over, there partners to improve the well-being are indications that the epidemic is of girls and women and the cir- declining in magnitude. There has cumstances in which their children been a decline in the number of are born, and to create the condi- deaths due to AIDS in the last cou- tions for a flourishing older life. In ple of years. The number of new order to tackle the inequitable dis- HIV infections per year is on the tribution of power, money and re- decline on average, but in general sources, the commission recom- the incidence rate is still very high mends countries and their partners and requires the strengthening of to place responsibility for action preventive measures among the Strengthening Health Systems on ‘health and health equity’ at the population. and Tackling the Social highest level of governments, and Primary prevention methods are Determinants of Health ensure its coherent consideration not yet widely applied among the across all policies. population. Access to prevention It is now clear to governments At its inception sixty-year years services is also limited, although and partners that progress in ago, the World Health Organiza- coverage of services for the pre- achieving the MDGs will be slow tion (WHO) made human rights vention of mother-to-child trans- as long as access to essential inter- central to health and social justice, mission has improved in the last ventions remains limited. There is putting them at the core of its val- few years. Although Africa has also increasing awareness that ues. The Constitution of the World made significant progress in in- cost-effective and equitable deliv- Health Organization states that: creasing access to antiretroviral ery of these interventions requires ‘the enjoyment of the highest at- treatment, over half of the people the strengthening of health sys- tainable standard of health is one who need anti-retroviral treatment tems, using the primary health care of the fundamental rights of every still lack access. approach. It is no wonder, there- human being without distinction The African region also ac- fore, that the need to renew prima- of race, religion, political belief, counts for more than a third (31%) ry health care is gaining increasing economic or social condition’. of all TB cases; the situation is ag- recognition three long decades af- These values were reiterated 32 gravated by the lethal combination ter it was first formulated. years ago at Alma Ata and also un- of HIV with TB and poses new As part of this global drive to re- derpin the current WHO11thGen- challenges to the control of both new primary health care, the WHO eral Programme of Work covering diseases. Regional Office for Africa orga- the period 2006–2015. Malaria in Africa constitutes nized an ‘International Conference Before ending my paper I want 85% of all malaria cases and 89% on Primary Health Care and to refer to the important role that of all malaria-related deaths Health Systems in Africa’ in Burk- the Catholic Church has played in worldwide. While there is not ina Faso in 2008. The conference medicine and public health 32 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE throughout its long history. In ear- and health workers who provide tus of people. Nevertheless, ly medieval times, Church institu- health care through charity, with African communities, govern- tions such as monastery hospitals particular emphasis on people in ments and partners still have a were established to provide charity greatest need and usually living in long way to go before achieving and care to ease the suffering of poor-resource settings. the highest possible level of health. the sick and the dying. In the Age Caritas in Veritate focuses on It is my strong hope that the of the Enlightenment ideals such the current global issues of under- Twenty-Fifth International Con- as human autonomy, reasoning, development, inequity, hunger and ference entitled ‘Toward an Equi- equality and progress also started the environment. These issues are table and Human Health Care in influencing the governance of hu- central to health and health sys- the Light of the Encyclical Caritas mankind and gradually permeated tems and are major social determi- in Veritate’ will shed more light new developments in health and nants of health, influencing the un- on, and bring renewed impetus to, health systems. derstanding and implementation of the application of its values for the Actually, through its vocation, the primary health care approach. better health and dignity of every the Church has remained a major Therefore, thirty-two years after human being. stakeholder in health-care provi- Alma-Ata, I should say that the sion. This is demonstrated by the African region has made some Dr LUIS GOMES SAMBO, work of mission hospitals, faith- progress in reforming health sys- Director Regional for Africa, based organizations, and social tems and improving the health sta- World Health Organization. DOLENTIUM HOMINUM N. 76-2011 33

MARIO BENOTTI The Mass Media and the Health of Citizens

I would like to thank the Presi- subject by definition and condition. standards at the apex becomes sec- dent and the Superiors of the Pontif- It is not conceivable that access to ondary, on the condition, however, ical Council for Health Care Work- health should be regulated by in- that in life-saving situations there is ers for the attention that they have come and that there should be dis- no discrimination in relation to care wanted in this conference – which crimination within societies or out- because of the wealth of individu- is rich in important points for re- side them. Within societies, be- als. I would like never to have hear flection for the governing classes tween the rich and the poor; outside my colleagues tell me the story of a and for politics – to pay to the role them between developed nations middle-class Afro-American who of information and communication. with ease of access to treatment and was obliged to kidnap, by gunpoint, We live in a globalised world and it nations with retarded development a medical doctor of a hospital be- is evident that globalisation is a where it is a difficult undertaking to cause his credit card was not phenomenon that should be gov- have basic care and medical prod- enough to pay for the urgent opera- erned, in the same way as it is in- ucts which in the rest of the world tion that was needed to save the life creasingly evident that the econom- are available in clinics or across the of his five-year-old son. He was ar- ic factor in the thought of Benedict counter. rested but his son had the operation. XVI and the whole of the social Equally inconceivable is the ap- Do we have to come to this? This is doctrine of the Church should be proach to health-care policy of the something that should not take analysed, thought about anew, and most developed countries with hos- place. made available to everyone. Very pital structures rewarded by addi- In the same way it should not often, indeed increasingly often, the tional funds on the basis of what happen that grave but curable and issues of health care are linked to they save in an indiscriminate way controllable diseases such as malar- the economy in a mechanism that at the level of expenditure. But how ia, TB or AIDS, which are weak- does not always take into account often do the media become pressing ened or under control in the devel- an important factor, indeed the most with governments as regards these oped world, continue to cause mas- important factor of globalisation: needs? Almost never. Perhaps we sacres in the third world because of that of the globalisation of rights. journalists should begin to say in a alackof nursing, hospital and phar- But in what sphere does informa- clear way – because this is some- maceutical assistance. Although it tion move, in what sphere does the thing the press can do and should do is fashionable to speak about AIDS cultural instruments that govern this – that it would be advisable to re- – even though this is much less the mechanism move, to which the ward hospital institutions on the ba- case than in the past – and the sub- Pope also refers in Caritas in veri- sis of how many lives they save. On ject is spoken about in major eco- tate when he says that ‘connected the basis of the results of the re- nomic newspapers such as The Fi- with technological development is search that is engaged in. On the ba- nancial Times, we forget to talk the increased pervasiveness of the sis of services of care. Not on the about important subjects and dis- mass media’? We are speaking here basis of savings tout court.Thusit eases about which almost nobody about subjects that closely concern happens that treatment is prescribed speaks any more in the developed health care and health: at times the that is less expensive but devastat- world but which exist even though mass media replace medical doc- ing, for example, for the liver, to the we do not want to see them. Some tors for citizens; the new media and applause of the politic al world and observations on malaria to which social networks mean that at times public opinion. unfortunately or fortunately only word of mouth acquires credibility, The point where action should be the Holy See and the United Na- that people by now construct on taken is not at summit levels but at tions refer: there are 247 million their own – and this is especially the level of basic standards. And cases of malaria in the world, of true of young people – their infor- this is something that we do not which 212 million are in Africa, 21 mation palimpsests through internet manage to communicate. We need million are in Asia, 8.1 million in and TV webs. But what do the me- to raise basic standards to an ade- the Middle East, and 2.7 million in dia say, or rather what should they quate level as regards respect for the Americas. There are 881,000 say, in the field that we are the individual, taking care of his or deaths because of this disease every analysing here today? her needs, and the requirements, of year: 801,000 are in Africa, 38,000 It is the duty of all organised so- a psychological character as well, in the Middle East, 36,000 in Asia, cieties to take responsibility for of welcoming and care. Once these but also 3,000 in the developed their weak internal sections; and a basic standards reach a satisfactory Americas. And 85% of these deaths sick person is a particularly frail level of excellence, the question of involve African children under the 34 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE age of 5. But in the media little is be addressed on two fronts: the do- izen increasingly places health care said about this or nothing at all, just mestic policies of developed coun- third amongst the six most impor- as we do not in the least say that a tries and the aid policies for coun- tant questions for the country – one half of the world’s population, that tries whose development is de- could think of tax rebates on large is to say 3.3 billion people, continue layed. incomes when portions of these are to be at risk to malaria according to On the first front I do not see any given to projects that aim at pro- the World Health Organisation. And alternative to the use of the lever of moting the common good. Private there is more. general taxation within a clear and forces and volunteers are welcome. In Europe we take it for granted rational framework of health-care They help to improve the service that every birth is accompanied by policy that impedes duplications and to complete it. But a serious qualified medical or paramedical and waste. And with a reasonable state cannot think of seeing its du- staff. Such is not the case every- and progressive contribution of citi- ties replaced by external interven- where in the world. In Ethiopia or zens to expenditure. But this policy tions, of the Church or some other Laos, this is an exception. Ninety must be clear and the controls must party. We journalists must have the women out of every hundred, be clear as well. This is because courage to say and to write that a se- roughly speaking, give birth on waste and abuses are not problems rious state subsidises the action of their own or with the help of neigh- of personal civil responsibility – private forces and supplements the bours or of family relatives. they are deliberate actions against action of volunteers. It is not they This is an area where national and multilateral institutions should act. If somebody who has the possi- bility to waste money and decides to treat himself by buying a monastery in Tibet, that is his prob- lem. If he thinks this is an intelli- gent move, let him go ahead and do it. The real point is to assure rea- sonably easy access of everyone to the treatment that is needed and in adequate structures. This is the challenge. And it is no accident that this idea forms the basis of the Mil- lennium Development Goals of the United Nations. But although health should not become a market, health-care poli- cy lives in the market. And I would not be serious if I addressed the question only from the point of view of theorizations, without in the least bearing upon the point that saying ‘Yes’ is entirely to be sub- scribed to and is beautiful, but who provides the money and how is re- the common good and as such who are entrusted with building up search to be financed? I believe that should be prosecuted. And with ex- a health-care policy; the state this, too, is a duty of journalists, treme harshness they should be should not cede to them what is its who are men of culture and who brought to the attention of the mass duty to offer. If a state does not as- must narrate, but who must also media. sure basic services, why should cit- study and make proposals to those The policy of financial rewards izens pay taxes? And I do not say who have to decide. And I also take for virtuous situations must, in ad- this because at times it may appear the liberty of trying, starting from dition, be modulated not according easy to engage in populism. I say the fact that I am speaking at an in- to narrow parameters of accounting this because people tell me this in ternational conference organised by worthy of Mr. Scrooge. It must be writing; people say it to be when I the Holy See which through the lo- based upon a transparent mix of pa- travel around the world. cal Churches, missions, religious rameters whose priority is care for, The problem for the third world Congregations, the Good Samaritan the welcoming and the treatment of is more difficult. In the third world Foundation and the apostolic nun- the patient, efficiency in saving central structures do not exist that ciatures makes its contribution lives, and excellence in research. are able to have an overall policy. every day, making available 117 And, as takes place in the United We should, therefore, refer again to thousand Catholic health-care in- States of America –where,forthat the logic of aid. The new political stitutions in the world which, how- matter, a major debate is underway approach of the European Union is ever, cannot replace the responsi- about the reform of the health-care convincing. No longer aid for pro- bilities of states. system of President Obama and jects but subventions for budgets, In my view the problem should where, furthermore, the average cit- with the African Union taking re- DOLENTIUM HOMINUM N. 76-2011 35 sponsibility for performing the role A commitment of this kind can only can agree that it is the duty of jour- of being a guarantor and for those be made by multilateral institu- nalists to be responsible for correct controls that are needed to prevent tions: the United Nations with the and explored information and a development aid being used to fi- help of the World Bank. And one suitable work of sensitisation. And nance the development of a few po- could think of a kind of Tobin tax in my role as the director of the tele- tentates and the purchase of for the health-care emergency, to be vision channels of the largest Euro- weapons. To summarise: it is no calculated as a minimal percentage pean public service and one of the longer a matter of financing a spe- contribution on the basis of special largest in the world, I before you cific hospital or specific research. rights of imposition on the part of make that commitment. The accounts are supported so that the International Monetary Fund. However, sensitisation does not the state pays the salaries of nurses Naturally enough on the condition mean a prior partisan alignment or invests in the purchase of equip- that this money is used for a pur- with one thesis against another. ment. Side by side with this there is pose that is agreed upon, and not for Apart from the fact that this does an impressive amount of aid from the villa of a director or the large car not form a part of the ethics of the non-governmental institutions, reli- of the head of a project. profession, it is also dangerous and gious associations and private ini- For all of this, the role of the me- counter-productive. It is a good tiatives. A great deal of money dia and communication is of funda- thing to have journalists as friends which, however, has produced al- mental importance, both in terms of who support you, whatever the most nothing that has taken root. contributing to the shaping of pub- case, in your battles. But, and here Perhaps because in the end it is not lic opinion and in sensitising and in- we should be careful, in the per- known whether something really forming people. But let us be clear verse logic of the journalist who is a happens because newspapers and about what we mean by the media friend of yours, there is the equally TV do not speak about this things, and what the responsibilities of a perverse logic of the journalist who with the exception of means of journalist are, as well as what our is your enemy. And when the wind communication that are connected responsibilities are. The media are changes it is not a good thing to see with missions or the environment. generalist and speak to everyone. yourself attacked a priori because And since journalists at times need The scientific and sectorial press is general thinking has changed and to have fresh news, it is increasing- an information and communica- what is right or wrong, good or bad, ly necessary for the Church to make tions structure within those who does not count – what counts is on- an important effort to be present work in this field, who at times love ly the dichotomy friend/enemy. within the world of big communica- to use it to quarrel with each other. And I can well imagine that those tion, that communication which The role of this specialised infor- present here today understand what reaches the homes of millions of mation is important and crucial but I am referring to at an international citizens and hundreds of thousands sensitisation does not pass by way and national level. of decision-makers with an authen- of this instrument. A journalist is a witness. He or tic supra-structural emergency in- The generalist media, in special- she is the eyes of public opinion. tervention designed to create agree- ist pages as well, are obliged to en- And he or she must maintain, ac- ment not about a caprice or com- gage in simplification and the use of cording to what is possible in hu- plaint of the Church but to create language that can be generally un- man capacities, an impartial posi- agreement about Man. This is a lit- derstood. They are not perfect, tion in telling the news and a bal- tle like when everyone invokes there are errors and omissions; at anced and responsible position in ‘growth’, forgetting about Man and times there is not a sufficient his or her comments. The system then producing the dramatic crisis amount of cross checking, and of- then works. Otherwise we are deal- into which the developed world has ten sensationalism is looked for. ing with the delirium of an aligned fallen. This was observed this But in general terms one thing is press, a press that is on one side, a morning by Prof. Gotti Tedeschi certain: a journalist tells about what press of disinformation. who is a living example of what a is told to him or her. The more To end this paper of mine, the committed layman should do with- scrupulous he or she is in checking sources should play their part with out appearing to be complaining: things, the better he or she is as a transparency, seriousness and deter- writing every day or almost every journalist. But if at times one can mination. Journalists will play their day in the Osservatore Romano, see splashed across newspapers part if it is possible to draw near to certainly, but also for Il Foglio, dramatic news about the discovery them, to speak to them, to offer Sole 24 Ore, going on television, of a molecule that is a panacea for news or a point of view in a clear speaking with the clarity of an all maladies, before criticising the way. That clarity that marks out the economist who talks not about a journalist one should go and see message of the Church and also the fantasy but something that is con- what a researcher or a research in- capacity to listen to a journalist that crete, perhaps one of the most con- stitute, which are interested in fame you wanted to invite here to engage crete of things, and of common or obtaining new funds, said to him in a discussion with you. sense, the social doctrine of the or her. One should also assess what Church. the source said if we want to under- Dr. MARIO BENOTTI And to continue with my paper, stand what is disseminated. And if Director General of RAI International, we need a centralisation of health- tongues were connected to brains, Rome, Italy care policies at a supra-national lev- things would be better. el and certainty at the level of funds. Once this has been clarified, we 36 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

ENRICO GARACI Towards Anthropocentric Health Care: a Health Service with a Human Face

What is the contemporary state of claim that it has the instrument by only the corporeal part of human medicine: is it a medicine of illness which to explain all physical, so- beings – they also afflict them in the or a medicine of the person in his or cial, cultural and psycho-sociologi- totality of their somatic-spiritual her totality? Has progress con- cal phenomena. This is equivalent unities. served the fundamental task of to the claim of dogmatic positivism In addition a sick person has a medicine (which was applied from which transforms the philosophy of family and friends. These people, as the Council of Nicaea of 325 on- science from being rational to being well, can have need of treatment, wards when it was established that irrational. This vision precludes a consultation and support. episcopal curias had to provide wel- real understanding of human In the final analysis, a medical come and accommodation to pil- thought, of suffering and of death, doctor should make his or her own grims) which is at times to treat, of- of the beauty of the visual arts, of the questions and the worries of the ten to provide relief and always to music, of literature, of philosophy, sick person and his or her family. comfort? How many critical points, of religion and spirituality, and of Thus it is that this incomplete unfortunately, are present today! the emotions (Andrew Miles). model of medicine based upon ill- There is something that has not We must, therefore, make a dis- nesses must be transformed into a worked in medicine! The great tinction between scientism which medicine of the person in his or her medical-scientific advances, al- does not admit that it has limits and totality, a medicine centred around though, on the one hand, they have science which, inasmuch as it the person (Andrew Miles). solved problems of very great im- recognises its own limits, becomes The Holy Father Benedict XVI in portance connected with patholo- a real instrument of advance. his encyclical Caritas in veritate gies that would otherwise be fatal, When we apply these concepts to declares that authentic development they have also introduced critical medicine we see that the scientistic must be centred around the person elements by placing in medical doc- position is a position that separates and must promote the advance of tors an approach of clinical and hu- care and improvement from care to every man, of every group of men man disengagement. The same hap- patients, thereby constituting a rad- and of the whole of mankind. pens with new scientific equipment. ically incomplete model of clinical A health-care service with a hu- The patient is cut up, photographed practice that does not being benefits man face must promote this new and examined to the most intimate to the patient or to the medical doc- culture, which does not necessarily details and then left alone in the tor. In this vision the patient be- address patients alone – it also ad- poverty of loneliness that is typical comes a clinical case, a diagnostic dresses healthy people in order to of those who lack a vision of human code, an anonymous individual to prevent pathologies. Our national existence and become lost in an whom medical products are admin- health service is the second in the ocean of expectations – the gravest istered and to whom the results of world as regards life expectancy of which is that health is always biomedical knowledge are applied. (81 years in women and 78 years in within reach of a medical product A more correct scientific position men) but health expectancy, that is and wellbeing is something to do is one based upon a holistic model to say an absence of disability, is with medical doctors. of care based upon the person and very low. How should we act to correct this upon his or her interpersonal rela- Research over recent years has situation? The fundamental cause tionships. demonstrated that correct lifestyles behind the critical character of the A sick person requires clinical (diet, physical activity) can combat process of humanisation is the loss readiness to help, a presence, atten- obesity (an epidemic on a vast of a holistic vision of the person as tion, understanding, benevolence, scale) in an effective way, reduce a consequence of a scientific reduc- patience, dialogue and dignity. Sci- the risk of many (cardiovascular, tionism which it is difficult to rec- entific experience is necessary but neurodegenerative) pathologies, in- oncile with the emergent complexi- on its own it is not enough. In addi- crease life expectancy with health ty of medicine. Scientism is a philo- tion, care for the sick must never and without disability and thus save sophical position that exalts the lose from sight the profound corpo- on resources that could be directed methods of the natural sciences be- real, affective, intellectual, spiritu- towards other pathologies that can- yond other methods of human in- al, social and environmental unity not be prevented. This medicine is vestigation and embraces material- of human beings. Illness and suffer- medicine that is centred around the istic-mechanistic thought with the ing are not experiences that afflict person. This is also a demonstration DOLENTIUM HOMINUM N. 76-2011 37 that science and research, when cor- the qualitative assessment of the engage in ongoing training. The rectly applied, can be a formidable humanisation of institutions and risk of technical and managerial in- instrument in the promotion of workers, both in the definition of competence is high. One needs, health. In order to promote the cul- pathways and settings and in the as- therefore, more method and a more ture of person-centred medicine it is sessment of quality, through stan- widespread professionalism. necessary to create training courses dardised instruments (based upon The definition that Pope John and university master’s degrees that reports and ratings). Paul II gave at a famous conference take into consideration: narrative The ‘hospital system’ changes entitled ‘The Humanisation of medicine, spiritual and religious as- radically if the patient returns to its Medicine’ which was held in Rome sistance, psycho-social assistance, centre, and it becomes easy to un- in 1987 is much more detailed and personalised medicine, social and derstand the revolutionary impor- stimulating: a) ‘Within the context rehabilitation assistance, the impor- tance of humanisation both for the of individual relationships, where tance for medicine of the humani- purposes of the structural organisa- humanisation means openness to ties, art, music, literature, complex- tion of a hospital and as regards the everything that can help to under- ity and reductionism in medical professional conduct of the work- stand man, his interiority, his world care, and the sharing of decisions. ers. Humanisation is not something and his culture. To humanise such As a consequence of a low-level extra to be done, something that is relationships involves both giving of attention and imperfect concep- added. Instead, it is something nat- and receiving, creating, that is to tualisation (a shared framework is ural to the organisation itself of a say, that communion which is total absent), we have witnessed a total hospital. Relationships, powers and participation’. b. ‘At a social level absence in health care of indicators communication are directed to- the need for humanisation is trans- that are able to assess (that is to say wards the patient. lated into the direct commitment of all health-care workers – each in his or own field and according to his or her competence – to improving conditions that are suitable for health, to improving inadequate structures, to fostering a just distrib- ution of health-care resources, and to ensuring that health-care policy in the world has as its goal only the good of the human person’. In this way the intelligence and the rationality of the people of God are called to actuate humanisation as a way of relating to sick people. The best way of humanising medicine lies, to sum up, in treating patients as persons, respecting their dignity and making them partici- pants in the decisions that affect their lives and their health. to measure the presence and inten- Patients who at the centre of a hu- I have outlined a general picture sity of a phenomenon and judge its manised hospital must receive an- of the prospects for the humanisa- dimensions and quality) the level of swers that are not only scientific tion of medicine in the West. In the humanity (humanisation). The de- and technical in character but also South of the world as well, and per- velopment of indicators of struc- human. haps to an even greater extent, there tures (what is available), of process- Here are some of the characteris- is a need for strongly humanised re- es (what is done) and of outcomes tics of a humanised hospital: it must lationships with patients, but there (what is obtained), in order to test have its doors open, be open, and be also exist strong inequalities as re- their quality and adequacy and in- ready to engage in specific and con- gards access to care and treatment. crease the possibility of comparing structive changes. The so-called poverty-related medical doctors, centres and care A transparent hospital calls rela- diseases (AIDS, malaria, tuberculo- settings, is indispensable. tives, nurses, medical doctors, the sis) provoke millions of deaths It is of fundamental importance local church and assessors to sur- every year and require, as the Presi- that we define the human impact round the patient so that a constant dent of the Pontifical Council for factor, an instrument for assessing flow of humanity is created without Health Care Workers, Zygmunt Zi- the quality of the humanisation of too many filters and precautions. mowski, has pointed out, coura- health-care workers which could A humanised hospital has a map geous action and urgent interven- constitute the discriminating ele- of power that is very precise and tion. ment in the choice of personnel and transparent and it is characterised Prof. ENRICO GARACI workers. by a constant assessment of the President of the Higher Institute Patients and their family relatives work group. of Health Care, must be privileged interlocutors in In a humanised hospital one must Italy 38 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

SILVANO M. TOMASI Pontifical Diplomacy and the Promotion of Health for All

Globalization and Cooperation the benefit of all in our multi-polar dispensable and a fruitful virtue.” In system. his closing remarks to the U.N. 1. Only 53 States in a world of 2. During his visit to United Na- General Assembly, the Holy Father some 2 billion people attended the tions Headquarters in 2008, His identified the United Nations as “a foundation stone ceremony of the Holiness Pope Benedict XVI of- privileged setting in which the Palais des Nations in Geneva in fered an equally compelling view of Church is committed to contribut- 1929. But they shared with the 192 the challenges to be faced by the in- ing her experience ‘of humanity’, Member States of today’s United ternational community.2 He remind- developed over the centuries Nations, now representing over 6.5 ed those assembled on that occasion among peoples of every race and billion global citizens, a clear un- that the peoples represented there culture, and placing it at the dispos- derstanding of our interdependence. “look to this institution to carry for- al of all members of the internation- We are living in a time of multiple ward the founding inspiration to es- al community.” crises, including those related to tablish a ‘centre for harmonizing economics, finance, food, mainte- the actions of nations in the attain- nance of peace, and health. None of ment of these common ends of The Trend to Universalizing these challenges can be confronted peace and development.’”3 He re- the Right to Health successfully by any one nation act- called the call by his predecessor, ing alone. These threats require col- Pope John Paul II, for the Organiza- 3. Papal diplomacy responds to lective strategies. Thus U.N. multi- tion to serve as a “a moral centre the Church’s efforts to embody her lateralism addresses disarmament, where all the nations of the world message and witness her good climate change, economic and so- feel at home and develop a shared works in today’s historical context cial development, global public awareness of being, as it were, a and it adds an original and neces- health and food security. It works at ‘family of nations’.”4 He urged sary contribution, the subsidiarity building consensus as the indis- “…all international leaders to act approach, which gives the right pensable basis of effective multilat- jointly and to show a readiness to place to States, NGOs, corporations eral action. Across national borders work in good faith, respecting the and the civil society in general in and institutional boundaries, the law, and promoting solidarity with the construction of a global system. search for the global common good the weakest regions of the planet.” The area of health is part of the con- is pursued through consolidation of He insisted that, “[in] the context of cern for the global common good. partnerships, negotiations, and op- international relations, it is neces- Several U.N. agencies in Geneva erational engagement in the field. sary to recognize the higher role aremandatedtoworkonhealthis- Realistically, the international sys- played by rules and structures that sues and papal diplomacy is en- tem often is paralyzed while pursu- are intrinsically ordered to promote gaged with them as well as with ing its noble ideals. Strains in multi- the common good, and therefore to Catholic NGOs that engage in ad- lateralism are seen in the lack of safeguard human freedom” and vocacy for all people with health success in the Doha Round of world called for “renewed emphasis in the problems. trade negotiations and in the cli- principle of the responsibility to The health-related policies of the mate change talks. The effort to protect”. He rejected efforts “to World Health Organization share mutual benefits and responsi- reinterpret the foundations of the (WHO), the World Trade Organiza- bilities between developed and de- [Universal] Declaration [of Hu- tion (WTO), and the International veloping countries vis-à-vis the man Rights] and thus to compro- Labor Organization (ILO), repre- looming challenges, such as water, mise its inner unity so as to facili- sent an increasing attempt to uni- diseases, migration, demographics, tate a move away from the protec- versalize health protection through post-conflict states, often appears to tion of human dignity towards the the strengthening of health care in- be a difficult task. But the call for an satisfaction of simple interests, of- frastructures, the affirmation of effective global architecture and a ten particular interests.” He warned right-to-health standards, the pre- healthy ‘new multilateralism’ is re- against attempts to facilely link vention of pandemics, etc. The peated again and again.1 Multilater- “new situations” to “new rights”, strengthening of intellectual prop- al institutions need to be inclusive, and counseled that “since important erty rights and the subsequent prob- fast, flexible and accountable, serv- situations and profound realities are lem of access to medicines have led ing as an interconnecting tissue for involved, discernment is both an in- States, international organizations, DOLENTIUM HOMINUM N. 76-2011 39 non-governmental organizations religious and lay, committed to the (agencies, research groups, interna- and academia to express their con- apostolate of the sick,6” and by the tional officials, etc.) is not easy, cerns in an increasing number of fo- daily witness of tenderness and care since it requires competent prepara- rums within the international com- offered, by a variety of apostolates. tion, up-to-date information, suffi- munity. Intellectual property issues At the level of pontifical diplo- cient understanding of scientific re- are currently high on the agenda of macy, the Holy See has been repre- search, of its consequences for the international organizations, such as sented, as an Observer State, at the common good, as well as of the ap- the World Health Organization World Health Assemblies since plication of its findings. But the (WHO) and the Food and Agricul- 1952, and was invited, even earlier, task indicated by the Second Vati- ture Organization (FAO), and they to the Second World Health Assem- can Council and the Holy Father is are discussed by such bodies as the bly held in Rome in 1949. The par- clear: the charity of the Church – Conference of the Parties to the ticipants in the latter event were re- her love for people – does not allow Convention on Biological Diversity ceived in audience by Pope Pius her to retreat from presence in, and of 1992 and the United Nations XII, who declared, “[Health] is that service to, modern society, espe- Council on Human Rights. States which encompasses the positive cially to its more vulnerable seg- and other political actors in the in- spiritual and social well-being of ments like the sick. ternational community are advanc- humanity and, on this ground, is ing negotiations within areas other one of the conditions required for than those related to intellectual universal peace and common secu- property, including areas related to rity.”7 fundamental rights or biodiversity. In the field of health, especially These issues and objectives are with regard to some areas of human much closer to the interests of de- behavior, ethical differences be- veloping countries and call into tween the Holy See and the interna- question regulations and obliga- tional community have become tions already established in interna- strident, and, in high-handed fash- tional conventions, while success- ion, the media focuses on these dif- fully creating new approaches and ferences. The roots of these differ- standards to facilitate the process of ences include the underlying an- access to medicine. Today’s thropology of extreme individual- progress is rooted in history and it ism, as well as the lack of respect carries on a long tradition. and understanding for natural law. In particular, the ethical shortcom- ings of such an approach are evi- The Church’s Care for dent in a definition of freedom the Sick: an Integral Approach without any reference to the com- mon good, the mistaken criteria for 4. Solicitude for the sick and suf- understanding the family or the fering is certainly not a recent de- right to life, and the attempts to for- velopment in the Church’s ministry. mulate policies on research and on From their experience and witness access to medicines from the sole of Jesus’ constant concern for, and perspective of profit. 5. In this vast area of human con- response to, those suffering from Within a cultural context of this cern, there exists significant poten- physical, mental, and spiritual chal- type, the representation of the Holy tial for cooperation between the lenges, Saint Peter, our first Pope, See finds itself, in some ways, in Holy See and the international com- accompanied by Saint John, re- convergence, as in the case of ef- munity on many issues that affect sponded to the beggar’s plea for forts to achieve universal access to the health of people, from poverty- alms, “I have neither silver nor health care and medicines, and, in related and chronic, non-communi- gold, but what I have I give you!” other ways, countercultural, as in cable diseases, to pandemics such Immediately thereafter, according the case of its defense of life and as HIV/AIDS, malaria, tuberculo- to the Acts of the Apostles, “the family ethics. In particular, our sis, and various forms of influenza. beggar’s feet and ankles became diplomatic activity pursues infor- Through its representatives in strong; he jumped up, [and] then mal dialogue and makes public in- the multilateral system and their ac- began to walk around.”5 The terventions to orient the develop- tivities in field of health concerns, Church’s tradition of caring for the ment of a public health culture to the Holy See assumes a particular sick has been maintained faithfully meet the needs of all persons, poor role by insisting that the dignity of and lovingly throughout the ages. and rich, through its advocacy for the human person and respect for Today, the same pastoral response universal care on the basis of a jus- life from conception to natural is carefully promoted by this Pon- tice-oriented Christian anthropolo- death must be promoted and main- tifical Council, which was estab- gy: the person at the center of con- tained at the centre of such activi- lished by the Servant of God, Pope cern, but also in relation to others. ties and that all persons should gain John Paul II, twenty-five years ago, This type of dialogue with concrete equal access to decent care, medica- to “serve as the coordinating organ- aspects of post-modern culture and tions, and life-saving and life-en- ism for all the Catholic institutions, with the “producers” of this culture hancing technology. 40 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

Specific Issues Defects; this motion was postponed Board Meetings in May 2008 and for consideration by the WHO Ex- January 2009, about the use of 6. Now let us review some of ecutive Board meeting to be held in “non-heart-beating” organ donors: these specific issues as well as the January 2010. At that time, the “Particular care should be encour- response of the Holy See in the light WHO Secretariat listed “selective aged and taken in order to assure of Caritas in Veritate. termination of pregnancy” as one that, in all cases, the cessation of vi- means, inter alia, of preventing tal functions is truly irreversible and a) “Morally responsible openness birth defects. The Holy See delega- that it is certified by valid criteria.” to life represents a rich social tion to this meeting reacted deci- and economic resource” – sively10 by stressing that “… human b)“The question of development Caritas in Veritate, (n. 44) life begins at the moment of con- is closely bound up with our ception and that life must be de- understanding of the human Affirmation of the sacredness fended and protected. Abortion and soul”- Caritas in Veritate, (n. 76) and dignity of human life, from the policies which favor abortion first moment of conception until should not be accepted. The Holy In this landmark encyclical, the natural death, constitutes the essen- See can never condone abortion or Holy Father cautions against “over- tial foundation of the Holy See’s en- policies which favour abortion… simplifications” that “stem from a gagement in diplomacy at the Unit- The Holy See further affirms that profound failure to understand the ed Nations and other inter-govern- the right of conscience of health spiritual life”, and warns that these mental and global forums. Pope service providers is assured by, in- mistaken notions “obscure the fact Benedict XVI explained this in un- ter alia, Article 18 of the Universal that the development of individuals compromising fashion when he Declaration of Human Rights11.” and peoples depends partly on the wrote “Openness to life is at the The Delegation called attention, resolution of problems of a spiritual centre of true development. When a moreover, to Article X of the United nature.” He further maintains that society moves towards the denial or Nations Convention on the Rights “Development must include not just suppression of life, it ends up no of Persons with Disabilities, which material growth but also spiritual longer finding the necessary moti- declares that “States Parties reaf- growth, since the human person is a vation and energy to strive for firm that every human being has the ‘unity of body and soul’.”14 This man’s true good. If personal and so- inherent right to life and shall take point is particularly relevant with cial sensitivity towards the accep- all necessary measures to ensure its regard to the World Health Organi- tance of a new life is lost, then oth- effective enjoyment by persons zation’s definition of “health”. In er forms of acceptance that are with disabilities on an equal basis January 1998 a special working valuable for society also wither with others.12” In its report to the group of the WHO Executive Board away.”8 The Holy Father details ad- 2010 World Health Assembly, the on the Review of the Organization’s ditional disturbing trends in this re- WHO Secretariat maintained the Constitution, and the Executive gard: “To the tragic and widespread reference to “selective termination Board itself, recommended to the scourge of abortion we may well of pregnancy” as a means of pre- 51st World Health Assembly that the have to add in the future — indeed venting birth defects, but the resolu- preamble of the WHO Constitution it is already surreptitiously present tion passed by the Assembly made be amended to include the follow- — the systematic eugenic program- no such reference. ing definition of “health” as “a dy- ming of births.”9 These concerns go beyond those namic state of complete physical, Thus the pontifical representa- inherent to the beginning of human mental, spiritual and social well-be- tions to the United Nations pursue life. Thus Pope Benedict XVI noted ing and not merely the absence of every relevant occasion to insist on in Caritas in Veritate: “At the other disease or infirmity.”15 However, to respect for the sacredness of human end of the spectrum, a pro-euthana- this very day, the definition lacks life at every stage, from conception sia mindset is making inroads as an any reference to the spiritual di- to natural death, and to resist any at- equally damaging assertion of con- mension of health and very little tempts to insert ideology linked to trol over life that under certain cir- discussion on this matter can be the “culture of death” as “official” cumstances is deemed no longer heard during WHO proceedings. components of international poli- worth living. Underlying these sce- Clearly, our efforts at pontifical cies or practice. We confront con- narios are cultural viewpoints that diplomacy in the field of health stant attempts to insert language in- deny human dignity.”13 must be strengthened in order to as- to United Nations documents that In relation to this issue, the Holy sist experts, as well as the general later could be interpreted as recog- See is attentively following discus- public, to understand the statement nition of so-called “sexual and re- sions on a proposal to prepare a of Pope Benedict XVI that “… be- productive health and rights” or a “Convention” or other form of in- tween faith and science there is no so-called “rights to ‘legal and safe’ ternational binding agreement on opposition, notwithstanding some abortions”, or to “comprehensive aged or elderly people. In a similar episodes of misunderstanding sexual and reproductive services” manner, we have urged careful con- recorded in history,” since “[a] man (presumably including abortion). sideration of the ethical issues in- of faith and prayer … can cultivate For example, very late in the herent in consideration of “Expand- serenely the study of the natural sci- preparatory process for the 2009 ed Guidelines on Human Organ and ences and progress in the knowl- World Health Assembly, one State Tissue Transplantation” by raising edge of the micro and macro cos- introduced a Resolution on Birth the caution, at the WHO Executive mos, discovering the laws proper of DOLENTIUM HOMINUM N. 76-2011 41 matter, because all this concurs to supply the product only when and patent protection, in fact, does not feed the thirst for and love of where it is possible to recover, operate as an incentive to research God.”16 through pricing policies, the costs on so-called “no market” treat- of the investments contained in its ments, including those for HIV, tu- development, as well as the expect- berculosis, or malaria. In other The Holy See and Access ed revenues, while disregarding words, the market to be addressed to Medicines in the WTO those who cannot afford the prod- by such drugs, even if it is a large Framework uct’s prices. Within an open free one, is found primarily among poor trade system, intellectual property people and thus is unable to ensure 7. Another important area of ac- rights constitute an exceptional mo- a return on the R&D investments tivity concerns access to medicines. nopoly regime.”21 made by the pharmaceutical com- A fundamental distinction in human We are reminded by Pope Bene- panies. One group particularly de- rights law is between civil and po- dict’s latest encyclical letter: “…in prived of access to medicines is that litical rights (“first generation” the context of immaterial or cultur- of children. “Many essential medi- rights) and socio-economic rights al causes of development and un- cines have not been developed in (“second generation” rights). The derdevelopment, we find these appropriate formulations or former are “negative” rights that same patterns of responsibility re- dosages specific to paediatric use. curb state power by imposing a du- produced. On the part of rich coun- Thus families and health care work- ty on it not to act in certain ways; tries there is excessive zeal for pro- ers often are forced to engage in a the latter are “positive rights” that impose obligations on the state to secure for its citizens a basic set of social goods – education, health care, food, water. The most important international instrument related to socio-eco- nomic rights is the International Covenant on Economic, Social and Cultural Rights (ICESCR)17 of 1966, which has been ratified by some 130 States. One of the sub- stantive rights recognized by the Covenant is “the right of everyone to the enjoyment of the highest at- tainable standard of physical and mental health”.18 Parties are oblig- ed, in particular, to take the steps necessary for “the prevention, treat- ment and control of epidemic, en- demic, occupational and other dis- eases”,19 and “the creation of condi- tecting knowledge through an un- “guessing game” on how best to di- tions which would assure to all duly rigid assertion of the right to vide adult-size pills for use with medical service and medical atten- intellectual property, especially in children. This situation can result in tion in the event of sickness”20. the field of health care. At the same the tragic loss of life or continued The AIDS crisis, together with time, in some poor countries, cul- chronic illness among such needy the worrying and continuous spread tural models and social norms of children.”23 It is because of an ex- of longer-known infectious dis- behaviour persist which hinder the cessive focus on profit, therefore, eases, such as malaria and tubercu- process of development.”22 that we witness an orientation of losis, constitutes a global disaster of The current system interferes pharmaceutical research toward dramatic magnitude. Most poor with the right to health in two ways, strategic areas of less importance, people suffering from these dis- at least from the general and theo- such as for weight-loss treatments eases receive only very inadequate retical point of view. First of all, or remedies for impotence, which health care. In so many of the poor- people from the Least Developed have greater market potential in est countries, lack of basic medi- Countries (LDCs) cannot afford the wealthier industrialized countries. cines together with poor health in- very high cost of patented drugs, In relation to this issue the Holy See frastructure, prevents an appropri- which can be traced to the patent is carefully following the debate on ate response to urgent public health owner’s rights claimed for the pro- intellectual property and public care needs. The legal protection of duction of such medications. How- health in the Trade Related Intellec- intellectual property, especially ever, even in developing countries, tual Property Rights (TRIPs) Coun- through patents, gives to the paten- the high cost of patented drugs un- cil in the World Trade Organization. tees monopoly rights over the prod- dermines the budget earmarked for As Observer Member, the Holy See uct or process, during the patent public expenditure for health care. emphasizes the very creative and life-span. “Such a right may indeed The second obstacle relates to re- innovative impetus offered by the allow a patentee to produce and search and development (R&D): system of intellectual property 42 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE rights – especially in the health sec- Notes ing Session of the 21st Special Session of the General Assembly for the Overall Review and tor – as well as its primary function, 1 U.N. Secretary General, Princeton Collo- Appraisal of the Implementation of the Pro- which is to serve the common good quium, 17 April 2009. “The Imperative for a gramme of Action of the International Confer- of the human community. New Multilateralism.” ence on Population and Development New 2 POPE BENEDICT XVI, Address to the Gen- York, 2 July 1999, http://www.un.org/popin/ 8. In conclusion, the examples eral Assembly of the United Nations, New unpopcom/32ndsess/gass/state/holysee.pdf given should indicate that the York, 18 April 2008, http://www.vatican.va/ 12 http://www.un.org/disabilities/documents Church’s perspective transcends holy_father/benedict_xvi/speeches/2008/april/ /convention/convoptprot-e.pdf documents/hf_ben-xvi_spe_20080418_un-visit 13 Caritas in Veritate,n.75. borders and categories of people _en.html 14 Ibid., n. 76. and reaches out to the whole human 3 Charter of the United Nations, article 1.2- 15 World Health Organization (1998) Exec- family. In the area of health, her 1.4. utive Board 101st Session, Resolutions and 4 POPE JOHN PAUL II, Address to the Gener- Decisions, EB101.1998/REC/l, pp. 52-53. perspective is kept alive so as to al Assembly of the United Nations on the Oc- 16 POPE BENEDICT XVI, General Audience serve as a voice of conscience. The casion of the Fiftieth Anniversary of its Found- Address, 24 March 2010, Vatican City, diplomacy of the Holy See patient- ing, 5 October 1995, http://www.vatican.va/ http://www.vatican.va/holy_father/benedict_x holy_father/john_paul_ii/speeches/1995/octob vi/audiences/2010/documents/hf_ben-xvi_aud ly promotes life and the common er/documents/hf_jp-ii_spe_05101995_address _20100324_en.html good in response to the “ups and -to-uno_en.html 17 GA res. 2200A (XXI), 21 UN GAOR downs” of today’s circumstances. 5 Acts 3:6-8. Supp. (No. 16) at 49, UN Doc. A/6316 (1966); 6 POPE JOHN PAUL II, Dolentium Hominum, 993 U.N.T.S. 3; 6 I.L.M. 368 (1967) [here- The Holy See’s diplomatic activity 11 February 1985, Vatican City, http://www. inafter “ICESCR”]. It entered into force on 3 has been, and remains, a real part of vatican.va/holy_father/john_paul_ii/motu_pro January 1976, in accordance with Article 27. the international community, a prio/documents/hf_jp-ii_motu-proprio_11021 18 ICESCR, Art. 12(1). 985_dolentium-hominum_en.html 19 ICESCR, Art. 12(2)(c). presence at the multilateral level 7 20 POPE PIUS XII, Address to the World ICESCR, Art. 12(2)(d). that bears witness that its work is a Health Assembly, 1949. 21 Intervention by the Holy See Observer to service of love to the entire human 8 POPE BENEDICT XVI, encyclical letter Car- the December 2002 plenary Council of the itas in Veritate, Vatican City, 29 June 2009, World Trade Organization on Trade-related as- family. #28, http://www.vatican.va/holy_father/bene pects of Intellectual Property Rights, Geneva. dict_xvi/encyclicals/documents/hf_ben-xvi_en http://www.vatican.va/roman_curia/secretari H.E. Msgr. SILVANO M. TOMASI c_20090629_caritas-in-veritate_en.html at_state/documents/rc_seg-st_doc_20010620_ 9 Ibid., n. 75. wto_en.html Apostolic Nuncio, 22 10 Holy See Intervention at the 126th Execu- POPE BENEDICT XVI, encyclical letter Permanent Observer of the Holy See, tive Board Meeting of the World Health Orga- Caritas in veritate,n.22. to the United Nations and nization on Secretariat Report on “Birth De- 23 Intervention by His Excellency Mons. Sil- other international organizations fects” - EB126/10, 18-23 January 2010 vano M. Tomasi to the 14th Session of the Hu- in Geneva. 11 Statement of the Holy See at the Conclud- man Rights Council. DOLENTIUM HOMINUM N. 76-2011 43

REINALDO A. GARCIA Ethics and Access to Health-Care Technologies

Introduction no longer the case and that, cer- healthcare that addresses their tainly in the case of GE Health- needs in all parts of the world and Thank you. I very much appre- care, “location, location, location” circumstances. ciate this opportunity to share is the mantra for how we develop with you some thoughts about medical technologies today. We “Ethics and Access to Healthcare call this approach “in-country for Digital revolution Technology” ...though with a country” and it is already improv- small but significant addition to ing access to technology through- Over the last few decades we the title: out the world. have all witnessed the changing In recognition of how the field landscape of communication of medical and other technology technology… digitization, minia- has rapidly advanced, and because The pace of change turization and broadband have re- the healthcare challenges faced by sulted in the ubiquitous mobile countries around the world differ, As a medical technology phone. I believe it is more relevant for us provider we are very proud of the to consider: “Ethics and Access to advances the medical community Appropriate Healthcare Technolo- has achieved through the use of gy”. high-tech diagnostic imaging In my view, when discussing such as MRI, CT and PET. These Ethics and Access to Healthcare platforms have provided ever in- Technology it is essential to fully creasing diagnostic specificity, understand the local or regional and sensitivity, to the benefit of healthcare issues you are trying to millions of patients in Europe and address, together with local cul- throughout the world. tural, economic and social condi- The research community has al- tions. so used diagnostics coupled with The ‘access to healthcare tech- IT to better understand the causes nology’ challenges that face the of cancer, heart disease, stoke and businessman in Rome, the mother many more chronic diseases that of five in Botswana, and the rural we will need to address in the worker in Brazil are quite differ- coming years as our societies age ent. And so, it should come as no and the numbers of medical pro- These same influences are dri- surprise that the technology solu- fessionals and carers decrease – a ving the development of health- tions to these challenges will also major issue on access in itself but care technologies, where the pow- be different. Therefore, the key one that I shall not address today. er of medical imaging, informa- questions on ‘access to technolo- Yet, however remarkable these tion technology and biology are gy’ should be: achievements are, their effects fusing together, resulting in a new “Access to what?” and “for have been unevenly distributed wave of products that are trans- what?” throughout the world’s popula- forming healthcare delivery. Too often in the past, debates tion. Today 10% of the world’s It’s an exciting time when you regarding ‘access to technology’ population receives 80% of can hold in your hand an Ultra- have been generalized with dis- healthcare expenditure. We must sound device, no bigger than an cussions conducted without tak- address this. We must develop in- ipod, which uses nothing more ing into account local needs. novative technologies that not on- complex than sound waves to ren- Technologies were developed that ly match the different needs, but der highly specific and sensitive neglected areas that pose the also and the different budgets. images of the body. Products like greatest challenge such as rural I hope to show you that we have this have the potential to become communities, socially disadvan- the technical ability and are mak- the most widely used imaging taged populations and, of course, ing greater advances – particular- technologies in the world. developing nations. ly in increasing access for more We all have a role to play in har- I am happy to report that this is people to affordable quality nessing the power of this digital 44 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE revolution to improve access to Jeff Immelt highlighted two prod- sia, rapid abdominal and cardiac healthcare. Right now across the ucts that looked to the future. The examination, or trauma, and al- world, governments, companies, MAC 400 Electrocardiogram de- lows safer needle guided proce- NGOs and academics are working vice and the Venue 40 tablet sized dures. To drain a pleural effusion, together to reduce health inequali- portable ultrasound scanner. the patient no longer has to travel ties and make healthcare more These devices are battery pow- to the remote hospital, instead the sustainable. ered, portable, self contained and health assistant, nurse or local GE is working with them and so simple to use. They are examples physician, can do this procedure too is the Catholic Church and of using the consumer electronics at the patients’ home or local rural other faith based delivery organi- boom to miniaturize and adapt clinic. zations which have a long and proud history in bringing better health to some of the world’s most challenged regions and popula- tions. The type of technologies we are developing will be of little use unless they can be put into prac- tice in the areas of most need. Hence, we need to work closely with the delivery organizations to ensure that we meet their needs. Let me explain how we go about this.

HEALTHYMAGINATION – improving access, quality and cost

As a global, technology based, diagnostics and healthcare solu- tions business, GE Healthcare sees its critical role as making cost-effective life-saving technol- technology that was once the sole These examples of new genera- ogy more accessible in the semi- preserve of the hospital, and take tion products help save lives im- urban, rural and developing areas it into clinics and rural locations prove health care productivity, which often bear the brunt of the remote from mainstream medical and importantly increase access to disease burden. facilities. health care. This is epitomised by GE’s Both these technologies take healthymagination programme healthcare to the patient rather which aims to deliver technolo- than the patient to the healthcare New mindset – in country gies and solutions that improve provider, and both were devel- for country the quality, access and cost of oped and manufactured in the health in all parts of the world, markets for which they are de- In order to develop these tech- with a commitment to metrics that signed. nologies GE had to change its are validated by a third party. Even in poor emerging markets, mindset. Our healthymagination com- chronic disease remains the GE’s traditional “glocalization” mitment applies to the poorest and largest cause of health morbidity business model, where products richest countries alike: to those and mortality. The MAC 400 en- were developed in home markets places with underserved health- ables the district nurse or health like the USA and Europe, then care systems where technology assistant to run ECG in remote lo- adapted for sale elsewhere – often can improve access and patient cations, but still using the best and by reducing specifications and outcomes; and to places where most up to date algorithms, to manufacturing locally – worked technology is regarded as a driver screen and treat patients with to some extent, but frequently the of healthcare costs and where, in- heart disease. Just because some- products were not suitable for lo- stead, it needs be used to drive ef- one is poor, and lives remotely, cal circumstances – too big, too ficiencies and improvements in should not condemn them to an complicated, susceptible to power delivery. inferior diagnostic service. The fluctuations and difficult to use So, how does healthymagina- MAC 400 allows modern technol- and maintain in physical environ- tion apply to, say, rural Africa, ogy to be brought to the bedside, ments quite different from those Latin America or South East remotely. they were originally designed for. Asia? VENUE 40 delivers point of And, despite lowering the capital When healthymagination was care ultrasound in a wide variety cost of equipment, financial mod- launched in May 2009, GE CEO of applications such as anaesthe- els for its use and upkeep based DOLENTIUM HOMINUM N. 76-2011 45 upon home market experience did developed as well as emerging attainment by 2015. Prominent not work and were not sustain- markets allows the development amongst these were the chal- able. costs to be spread wider and lenges of Maternal and Newborn The company now increasingly hence the price point to the devel- Health researches, develops and manu- oping market can be set at an af- MDG 4 aims to reduce by two- factures the right technology for fordable level. This enables the thirds the mortality rate among local needs in the country or re- country to purchase and maintain children under five – and deliver gion of use as part of our “in coun- the technology – meeting GE’s this by 2015. Of the 139 million try for country” approach to new healthymagination commitments babies born worldwide every technology development. relating to quality, access and cost year, over 3 million die in the In short, GE teams with deep – and helps to create sustainable neonatal period, the main direct local knowledge and unprece- healthcare systems that work causes being preterm birth, severe dented autonomy in Latin Ameri- within local economic conditions infections and asphyxia. ca, India, and South East Asia and and do not have to rely on long The real tragedy is that most of a dozen other countries now man- term international aid or charita- these deaths are preventable. With age the development and produc- ble contributions. just five years to go, reaching the tion of new products to meet local MDG will require new levels of needs. cooperation amongst everyone In an interesting twist, because “Appropriate” technology concerned, from doctors to mid- these new products do not com- solutions wives, Governments to NGOs promise on quality, some are find- and researchers to businesses. It ing a use “back home” in the de- Innovative medical technolo- will also require a reappraisal of veloped markets. This has be- gies are now being developed for the ways in which healthcare come known as “reverse innova- almost all the diseases and condi- technologies are developed and tion.” tions found across developing na- deployed, especially in areas tions. Until relatively recently the where neonatal mortality rates are predominant focus was on medi- the highest. Reverse innovation cines, vaccines and prevention As part of GE’s global healthy- and awareness campaigns. This magination commitment, we shall Technologies designed to meet work has been critical to address expand our Maternal-Infant Care the specific medical needs and the acute challenge of communi- portfolio to offer more, targeted circumstances of developing na- cable disease such as Malaria, TB, technologies to over 80 lower in- tions are proving popular in more HIV/AIDs and other tropical dis- come countries and increase local developed markets, particularly eases. access to care. Included already where there are large rural, under- However, throughout the devel- are safety tested, affordable and served populations. oping nations it is now clear that easy-to-use infant care products The MAC series of electrocar- their populations are suffering that provide warmth for new- diograms (ECG) is a good exam- from massive increases in the borns, phototherapy to treat jaun- ple of this. Originally developed same chronic conditions affecting diced infants and incubators for in India, their ease of use and all countries- cancer, cardiovascu- premature babies. portability make them equally at- lar and respiratory disease and the Many of these products are de- tractive for primary care physi- many medical consequences of signed and manufactured in India cians and nurses in clinics and on obesity and diabetes. and Turkey. GE is now working home visits in other countries in- To help address these chal- on developing very simple warm- cluding the USA. lenges, there is an emerging shift ers and phototherapy devices for These machines are even used towards new and better technolo- developing nations at dramatical- by “flying doctors” serving the gies for screening, earlier diagno- ly reduced cost. A novel method Inuit populations in Northern sis, treatment assessment and for providing oxygen to mothers Canada, and data from examina- monitoring of chronic disease and in childbirth and to new born ba- tions can be viewed on the spot or equipping the healthcare system bies is also under consideration. transmitted to specialists in urban to provide this. There is also a re- Another very exciting new centres for analysis or second newed focus on working to re- product, I showed you earlier, is opinion. solve the global burden of mortal- the VScan – our hand held In today’s financially restrained ity and illness in maternal and portable ultrasound scanner, de- times, technology that enables newborn health. veloped in emerging markets. Its more diagnostic tests to be con- clinical applications are currently ducted outside of the hospital en- being assessed in both emerging vironment or at the patient’s bed- Maternal and newborn health and developed markets for a wide side, rather than referral and phys- range of diseases and conditions. ical transport, are likely to be at- In September, the United Na- These include assessing its capa- tractive in helping to improve ac- tions met in New York to consider bilities and clinical protocols for cess and drive healthcare system progress to date in implementing its use in maternal and neonatal efficiencies. the Millennium Development care applications in emerging Marketing these technologies in Goals set in 2000 with targets for markets. 46 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

Imagine you’re a doctor or to bring to anywhere powerful di- lation, the maintenance provision, health worker in one of the most agnostic technologies previously and a large education and training underdeveloped regions of Africa. the exclusive domain of the hospi- program. 40 miles from your clinic, a tal. This is just one example of pro- woman in her second trimester of jects that GE Healthcare is pro- pregnancy is in pain. You travel moting that leverage funding to her village. When you get Working with NGOS sources from the developed coun- there, you open your hand-held and delivery organisations tries toward the poorest ones. ultrasound. It only weighs 390 There are also many global and grammes, but it’s just as powerful Having designed new technolo- local NGOs experienced in this as the large machine found in the gies the next challenge to ensure type of work and we are keen to most advanced hospitals. It quick- better access, is to test, refine and join with them to provide the ly allows you to see that the baby deploy them in the field. Lessons training programmes and capacity has turned and is in some distress have been learned from the GE building in country for testing with a slow heart beat – the moth- Foundation’s keystone philan- new technologies. I would be in- er needs to get to the clinic for thropy programme “Developing terested to hear from you in dis- treatment. Alternatively, the scan Health Globally”. cussion afterwards whether there shows the baby is fine and the This programme is improving may also be opportunities to work pain is caused by a distended gall the healthcare capacity in Africa, through similar networks in de- bladder: the mother can be treated South East Asia and Latin Ameri- veloping countries operated by with antibiotics at home and avoid ca by equipping hospitals and the Church. the arduous trip. Is this just a vi- clinics with the technology they Through this type of partner- sion? Right now yes, but also need and ensuring staff are prop- ship we can better reach the end right now we are working with erly trained in its use. In this pro- users to determine if access to a several global NGOs to pilot gramme we draw on resources new technology really will be of training porgrammes for health from across the different GE busi- use on the ground. If yes, working workers in several African nations nesses, like GE Energy for power in a partnership could also allow to use VScan for this very pur- generation and GE Water for pu- us to develop clinical protocols pose. So the vision may soon be rification plants. and appropriate uses for the tech- reality. Using volunteers from GE and nologies, speed up delivery, pro- GE Healthcare the programme vide the right training and support has shown that what is actually re- needs and minimize costs. quired on the ground is often not what is perceived from afar and that what works in Rome may not Only the beginning in Rwanda. In short, the learning is that there is no substitute for Much remains to be done. GE is having people in situ on the not claiming to have all the an- ground. swers to ensure that all parts of the It is here that we actively seek world have access to innovative partnership with governments, technologies that improve health. professional organisations and in- We do however understand the creasingly NGOs with a presence problems and can see many of the in developing markets. While we obstacles in the way. may have design teams and sales Hopefully I’ve convinced you and marketing and business ex- that “yes it’s important to increase pertise in many countries, we people’s access to healthcare tech- Ultimately, our vision is for VS- sometimes lack the infrastructure nology”… but that healthcare can to be as ubiquitous as a stetho- on the ground to take the new benefits will only follow if that scope and to achieve that it must technologies out to the patients. technology is relevant to solving have a truly global reach. As in Another example of our part- local issues, and that this cannot consumer electronics, unit costs nership approach is a project be a one-size-fits-all technology will be reduced as more clinical we’ve just completed in Namibia. approach. We need to tailor our applications are approved, pro- This project was conducted for technology solutions to the local duction increased and other de- Namibia’s Minister of Health circumstances and use them in a sign innovations are deployed. with a 13M€special credit loan way that they become significant The goal is to reach a point from the Finland government. To- drivers of change. where the purchase, training and gether we renovated 46 main hos- Having spent the majority of upkeep costs can be recovered by pitals focusing on Maternal and my time talking about the health a sustainable pricing model in Infant Care. The program was issues, and technology enablers to even the lowest income countries about providing ‘a healthcare so- improve access to healthcare in of the world. This is a goal that lutions’ package which included the developing nations, we should was simply unimaginable only a the supply of the appropriate tech- not forget that closer to home Eu- few years ago and now promises nologies, the logistics, the instal- ropean healthcare systems are al- DOLENTIUM HOMINUM N. 76-2011 47 so under intense pressures. In Develop integrated health orga- fective treatment, inefficient ad- light of the financial crisis policy nizations that run more efficiently ministration, rampant medical er- makers are already attempting to through improved business opera- rors, and so on. And these aren’t balance health expenditure while tions. limited to one country or one con- improving quality and efficiency It’s the powerful unique combi- tinent. of healthcare delivery. nation of our clinical expertise Through healthymagination Here again GE has mobilised its and technologies, coupled with and the development of new tech- expertise to help our customers GE’s process excellence and nologies we are committed to here in Europe, and across the de- change leadership tools, which working to help overcome the veloped world, to redesign their help our global customers find challenges. It will require more businesses and address these de- new ways of organizing, measur- collaboration, partnerships, clear mands for higher quality and ing and managing health care de- thinking and the courage to do more efficient health care. Our livery over the full-cycle of care things differently. teams in Hospital and Healthcare to drive better cost, quality and The transformation of health- Solutions (HHS) provide services access. care is no doubt one of the tough- that help our customers in three est challenges we will face this major areas: century. But I’m optimistic that Increase the quality and safety In summary by using innovative technology of their patient care with treat- it’s a challenge we’ll overcome. ment pathway protocols and clini- Wherever we are in the world And when we do, history will cal decision support systems. we must all be smarter. We must record our achievement as one of Better understand how their op- use technology to transform the great triumphs of this century. erating performance affects the healthcare. We cannot afford not delivery of efficient, high-quality to. We all know the problems that Dr. REINALDO A. GARCIA health care through the continuum exist with healthcare today: soar- President & CEO, of care. ing costs, declining access, inef- General Electric Health Care 48 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

RENATO SALVATORE The Contribution of Catholic Health-Care Institutions to Improving the Conditions of Health of Peoples

The subject that has been entrust- transformed into powerful ‘signs’. to him... bound up his wounds... ed to me, in order to be addressed in Christ, the visible manifestation of took care of him” (Lk 10:32-34)’.4 a complete way, requires a discus- the infinite love of the Father, did The Church brings into play initia- sion that goes beyond the time lim- not come only to save ‘souls’but al- tives consonant with its own vision its that have been wisely estab- so to offer ‘full life’ to every person of man. In truth, those who know lished. I will not dwell upon the ad- in all his or her (spiritual, psycho- man are in a condition to provide mirable things that Catholic health- logical, physical and relational) di- the best ‘recommendations’ by care institutions (CHCIs) have been mensions.2 Thus he linked in an in- which to achieve the deepest human doing for decades in all the conti- dissoluble way not only the con- finalities. Jesus Christ, in revealing nents of the world but, rather, upon cepts, but also the true and defini- to us the Father and himself, re- their specific goals as works of the tive achievement itself, of health vealed to men their identities, their Church. and salvation: in him we are given a true needs and the way by which In my view, the crucial point is ‘health-inducing salvation’ and a these could be met. the concept of health that these in- ‘salvific health’. The involvement of the Church stitutions should promote. Every- The Catholic Church, in order in the social/health-care field is one knows that there are multiple not to betray the mandate of Jesus very significant from a quantitative definitions of health and as a conse- Christ, must care for everyone with- and qualitative point of view and it quent different strategies by which out any form of discrimination; the is also universally very much ap- it is in turn achieved. The Christian sole particularity is special attention preciated. The Church cares for a concept of health is different from being paid to the poorest. In addi- large number of people with the the others because it derives from a tion, inasmuch as it is the mystical contribution of thousands of pas- specific vision that Revelation has body of Christ and a community toral and voluntary social/health- given to man: man created in the healed by him, it becomes in its turn care workers and by drawing upon image and likeness of God, re- healing, that is to say an instrument various kinds of institutions. deemed by Christ, and open to tran- of health and salvation. In order to understand how rele- scendence. The practical and constant chari- vant the role performed by the A second aspect to be stressed is table activity of the Church down Church is, it is sufficient to look at that CHCIs have the task of the centuries should not be inter- its innumerable activities: for ex- ‘analysing the structural causes that preted primarily as a response to so- ample, in the sub-Saharan region cause pain, poverty and malaise and cial needs3 but, rather, as faithful- the Church is the first partner of of being able to plan adequate inter- ness to the example of Christ and to governments, even providing 60% ventions that seek to remove them, the mandate of the Risen Christ: of health-care services. promoting synergies and coopera- ‘Go and preach, the Kingdom of The Annuario Statistico della tion with all those who are sincere- heaven is near! Heal the sick, bring Chiesa provides the following data ly interested in the good of man’.1 the dead back to life, heal those on the year 2008 as regards the so- who suffer from dreaded skin dis- cial/health-care activity of the eases, and drive out demons’ (Mt Church in the world: hospitals: 1. Suffering Man: the Special 10:8). Very many documents of the 5.428 (of which 1,137 were in Way of the Church Church emphasise this basic belief: Africa, 1,717 in America, 1,130 in ‘In this meeting man ‘becomes the Asia, 1,288 in Europe, and 156 in The pages of the gospels demon- way for the Church’, and this is one Oceania); clinics: 18,025; old peo- strate to us the tender mercy of Je- of the most important ways. At this ple’s homes for the chronically ill or sus towards people who were ‘sick’ moment the suffering individual is invalids: 15,985; centres for social in body, in spirit, in social relation- the way of the Church because that education or re-education: 34.250. ships…For them he had words and person is, first of all, the way of When we add leper hospitals, or- approaches that expressed compas- Christ Himself, who is the Good phanages, nurseries, family coun- sion, understanding, forgiveness, Samaritan who “does not pass by”, selling centres and other charitable welcome, and they were frequently but “has compassion on him, went institutions one reaches a total of DOLENTIUM HOMINUM N. 76-2011 49

120,826 structures that are owned For its understanding of the iden- the right to be the promoter of this or administered by the clergy or re- tity, the vocation and the ultimate health through the Word of God, the ligious. destiny of man and mankind the sacraments and charity. The characteristics, challenges Church draws upon Revelation.8 Within this vision of man one un- and responses of these structures Each person finds the foundation of derstands that health cannot be iso- are obviously different according to his or her dignity in being generated lated from a scale of values in the continent involved and within in the image of God and his or her which the first place must be held each individual nation. It is not the destiny of eternal communion with by God, He alone who gives live aim of this paper to provide a de- God. We are made aware of this and can dispose of it to the utmost. scription of this. Those who are in- dignity by Christ himself who in From this point of view, life with terested can find a rich analysis in being incarnated joined himself in a God comes before earthly life; just the proceedings of the Third World certain way to every man and as as the person in his or her totality Congress of the AISAC (3-5 Octo- perfect man (the new Adam) ‘fully comes before his or her parts. Suf- ber 2007 published in Dolentium reveals man to man himself and fering and illness, as well, at times Hominum, n. 66, 207/3.5 makes his supreme calling clear’ can confer on a person’s existence The activity of Catholic health- (GS,n.22). depth and fullness of meaning be- care institutions are principally To take on board these facts cause health is a good that should characterised not by ‘what’ they do means for a Catholic health-care in- be spent/used within an approach to but by ‘how’they do it, that is to say stitution, for example, to uphold life lived in giving to other people: because they care for people in line and defend the transcendent value health is not a supreme good but an with the Christian anthropology, re- of every human being from concep- instrumental good; that is say a use- specting the special dignity of the tion until natural death and in every ful but not indispensable good, to person in a holistic vision of the condition of life and health. It also obtain other goods of a higher val- person and his or her needs, within involves the welcoming of the mag- ue.10 ‘The health of a person is dy- the framework of the social doc- isterium of the Church: for example namically inserted into a life project trine of the Church, with the promo- the appeal of the Supreme Pontiff in which all experiences, joys as tion and defence of rights… John Paul II ‘in the name of God: well as wounds, are integrated and In addition, there is a proprium (a are a part of a person’s own person- ‘motivation’) that must define each al history. It can, therefore, also be member of the Church in his or her present in sick or disabled people relationship with each person and who, physically, remain such, but which should never be forgotten: who are able to perform (with the love. The imperative for every help of grace and the support of a Christian is to love others as Christ com-forting community) the mis- has loved him or her. This belief of- sion that God has entrusted to them, fers all Christian health-care work- according to the moment of their ers in the world of health and health lives in which they find them- care a motivation and strength for a selves’.11 truly unique approach, pushing him The gestures of Jesus – addressed or her not only to give something to the least, the excluded, the poor but to ‘give himself or herself’! And and the sick – are emblematic of an love to be such must be conjoined integral health and of salvation: he with truth: ‘Truth needs to be is not only a healer, he is the Sav- sought, found and expressed within iour. His ‘health’ is offered to the the “economy” of charity, but char- sick and to the healthy! Christ is ity in its turn needs to be under- health: he is both physician and stood, confirmed and practised in medicine, healer and saviour; the the light of truth’.6 At this point I new man and the model of the new would like to draw attention to man.12 He heals us and enables us to some of the specific features of the heal other people who are prisoners CHCIs to which I have just re- respect, protect, love and serve life. of evil because the promotion of ferred. Only in this direction will you find health belongs to the work of the justice, development, true freedom, building of the Kingdom. peace and happiness!’.9 The large number of ways of con- 2. The Christian Vision of Man For our subject this means work- ceiving of human health reveal ing in a way that is consistent with those human needs that are held to History has taught us, at times the Christian concept of health. The be fundamental and thus mark the dramatically, the relevance and the specific contribution to the health consequent initiatives that are im- consequences of the idea (ideology) of the peoples of the world by the plemented in order to try to pre- that people have of man.7 The Church, through CHCIs, depends serve health, recover it or promote Church cannot escape the question on its faithfulness to the gospel and it. As witnesses to the merciful love ‘who is man’ when it decides to be- in particular to the health/salvation of Christ, physician and medicine gin, continue or transform activities that Christ wishes to give to all of souls and bodies, Christians are in the social/health-care field. men. The Church has the duty and called to understand and then 50 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE achieve the health that he offered to maintained that the creation of in- inspires them? Why are they in our the sick and the healthy. Catholic stitutions was sufficient to guaran- midst?’.18 health-care institutions are required tee the fulfilment of humanity’s Charity, as the Pope reminds us, to promote this kind of health.13 right to development... institutions is ‘always more than activity alone’ by themselves are not enough, be- (DCE, n. 34), ‘Practical activity cause integral human development will always be insufficient, unless it 3. The Deaconate of Charity and is primarily a vocation, and there- visibly expresses a love for man… Evangelisation: fore it involves a free assumption of My deep personal sharing in the Charity in Truth responsibility in solidarity on the needs and sufferings of others be- part of everyone. Moreover, such comes a sharing of my very self ‘As the years went by and the development requires a transcen- with them: if my gift is not to prove Church spread further afield, the dent vision of the person, it needs a source of humiliation, I must give exercise of charity became estab- God: without him, development is to others not only something that is lished as one of her essential activi- either denied, or entrusted exclu- my own, but my very self; I must be ties, along with the administration sively to man, who falls into the personally present in my gift’ of the sacraments and the proclama- trap of thinking he can bring about (DCE, n. 34). tion of the word: love for widows his own salvation, and ends up pro- ‘This love does not simply offer and orphans, prisoners, and the sick moting a dehumanized form of de- people material help, but refresh- and needy of every kind, is as es- velopment. Only through an en- ment and care for their souls, some- sential to her as the ministry of the counter with God are we able to see thing which often is even more nec- sacraments and the preaching of the in the other something more than essary than material support. In the Gospel. The Church cannot neglect the service of charity any more than she can neglect the Sacraments and the Word’ (DCE, n. 22).14 The Church is requested to move swiftly in the face of emergency, an urgent need, a need that requires a rapid response,15 but it also true that this response is not the ultimate re- sponse nor the most important one. CHCIs aim at health in an integral sense; they see the person in the to- tality of his or her needs, with a spe- cial consideration of those that are most foundational – spiritual needs. The development of a suitable social/health-care system is not on- ly a question of technological im- provement – it is also a question of greater and better attention being paid to the person, the bearer of non-material needs that are essen- just another creature, to recognize end, the claim that just social struc- tial for his or her wellbeing. The the divine image in the other, thus tures would make works of charity achievement of this goal involves, truly coming to discover him or her superfluous masks a materialist amongst other things, man being and to mature in a love that “be- conception of man: the mistaken able to benefit from love and truth comes concern and care for the oth- notion that man can live “by bread that liberate: there cannot be devel- er”’ (CiV,n.11). alone” (Mt 4:4; cf. Dt 8:3) – a con- opment without freedom and truth, Evangelisation is first of all wit- viction that demeans man and ulti- without fraternity and solidarity.16 ness in our lives17 which raises mately disregards all that is specifi- The proclaiming of Christ is the questions and as a consequence cally human’ (DCE, n. 28). first and principal factor of devel- produces adequate answers to them Thus it is all that all Catholic opment (CiV, n. 8) that is truly hu- through the service of the Word and health-care institutions become man and in the construction of a so- the Sacraments: ‘Charity makes us oases in which one can also receive cial/health-care system that is really more witnesses than teachers. The that look of love which every per- on a human scale. Here the follow- ‘prophecy of speech’ is not suffi- son really needs, beyond his or her ing observations of Pope Benedict cient: burning and humble, silent social status, race, religious, social XVI are illuminating: ‘the Church, and provocative witness is neces- difficulty or kind of illness. ‘Fideli- being at God’s service, is at the ser- sary… Through this wordless wit- ty to man requires fidelity to the vice of the world in terms of love ness these Christians stir up irre- truth, which alone is the guarantee and truth… authentic human devel- sistible questions in the hearts of of freedom (cf. Jn 8:32) and of the opment concerns the whole of the those who see how they live: Why possibility of integral human devel- person in every single dimension… are they like this? Why do they live opment. For this reason the Church In the course of history, it was often in this way? What or who is it that searches for truth, proclaims it tire- DOLENTIUM HOMINUM N. 76-2011 51 lessly and recognizes it wherever it violates the integrity of the person of every CHCI and ‘finds expres- is manifested. This mission of truth or offends human dignity ‘is both a sion in personal witness, various is something that the Church can disturbing symptom and a signifi- forms of volunteer work, social ac- never renounce. Her social doctrine cant cause of grave moral de- tivity and political commitment’ is a particular dimension of this cline…The end result of this is trag- (EV, n. 87) and in the awareness proclamation: it is a service to the ic: not only is the fact that of the de- that it is a work of the Church: truth which sets us free’(CiV,n.9). struction of so many human lives ‘Everyone has an obligation to be at Thus CHCIs are first and foremost still to be born or in their final stage the service of life. This is a properly ‘instruments to bear witness to and extremely grave and disturbing, but “ecclesial” responsibility, which re- preach Jesus Christ the only sav- no less grave and disturbing is the quires concerted and generous ac- iour. They are not instruments of fact that conscience itself, darkened tion by all the members and by all proselytism but of – often silent – as it were by such widespread con- the sectors of the Christian commu- fitness to that Charity in Truth that ditioning, is finding it increasingly nity’ (EV,n.79) the Church has received from her difficult to distinguish between Lord and which alone can construct good and evil in what concerns the b. Education in health a just and solidarity-based society’ basic value of human life’ (EV,n. (CiV,n.6). 4). Not only this but increasingly Every health-care system is what is a crime against life is per- based upon certain values which ceived as a right that the state form its basis as a foundation. Thus 4. Healing Communities: should recognise and whose exer- those who work in the world of the Pieces of a Single Mosaic cise it should protect. health and health care are called to In many ways Catholic health- understand what the values are to If Catholic health-care institu- care institutions, in communion which the state refers when it legis- tions see themselves as an expres- with the whole Christian communi- lates so that in this way they are sion of the care of Christ for the suf- ty and people of good will, can in- able to engage in an effective and fering, the least and those in need, volve themselves in a productive prophetic evangelisation. Indeed, then they should engage in their ac- way in the fight against what ‘can the state tries to provide to citizens tivity in the name of the Church and be described as a veritable structure those services that it believes to be thus by fully belonging to the action of sin. This reality is characterized suited to achieving the kind of of their local Churches and the uni- by the emergence of a culture which health that it wants. In the same versal Church. This is what I would denies solidarity and in many cases way, for that matter, as citizens like to stress in this last part of my takes the form of a veritable ‘cul- want from the state all those instru- paper by briefly listing the fields – ture of death’. This culture is active- ments that are required to achieve within the promotion of the health ly fostered by powerful cultural. those results that are in line with the of the peoples of the world – to economic and political currents standard of health that is expected which especial attention should be which encourage an idea of society (and at times requested).25 One can paid.19 excessively concerned with effi- offer and ask a little or a great deal, A Catholic health-care institution ciency’ (EV, n. 12).22 It is necessary just or unjust things, licit or illicit is a ‘piece’ of the great mosaic of to proclaim and bear witness to the things, moving from a lack of mini- charity-evangelisation: it consti- gospel of life, knowing that the ulti- mal means to the waste of public tutes an eloquent sign and valid mate root of this culture is to be and private money! And, above all, means of the Church in its task of found in the eclipse of the sense of ethical choices on the part of the transmitting the salvation/health God and of man:‘when the sense of state but also on the part of citizens given to us by Christ.20 The gospel God is lost, there is also a tendency come into play.26 message is the ultimate answer to to lose the sense of man, of his dig- Catholic health-care institutions the often unexpressed yearning of nity and his life’ (EV, n. 21). With- are required to be involved in pro- humanity for a full and definitive out God, life can no longer be seen moting, at all levels, a concept of health and thus concerns every per- as His gift and thus a sacred, invio- health that respects the dignity of son in his or her dimensions. lable and non-disposable reality; every person, the needs of the need- ‘Life itself becomes a mere “thing”, iest sick people and health-care ex- a. Human life and the person which man claims as his exclusive penditure that manages with the property, completely subject to his least cost to reach the greatest num- These are the first and fundamen- control and manipulation’ (EV,n. ber of people. ‘Educating in health tal values that CHCIs are required 22).23 To promote the health of peo- means, therefore, promoting the to respect, defend, serve and pro- ples and their healthy development value of health in parallel with the mote in line with their own status as CHCIs must, in every society, make value of life, sensitising people to works of the Church.21 This role is their own the urgent need to ‘redis- subjects such as the right and the today ‘especially pressing because cover those essential and innate hu- duty to health, the avoidance of of the extraordinary increase and man and moral values which flow styles of behaviour that threaten life gravity of threats to the life of indi- from the very truth of the human itself and promoting a moral educa- viduals and peoples, especially being and express and safeguard the tion that helps the person to locate where life is weak and defenceless’ dignity of the person’ (EV,n.71).24 health in a critical way within a (EV,n.3). Support for, and the promotion broader hierarchy of values’.27 Everything that goes against life, of, human life is a fundamental task Education in health should be di- 52 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE rected both to the subject and to the and ‘accredited’ expression of this) tend to ignore the cries of the poor community to which he or she be- we have been sent to ‘evangelise because it will never feel exonerat- longs (the family, parishes, schools, through healing’, following the ex- ed from struggling for justice:34 to social and health-care institutions, ample of he who of this was not on- its ministry belongs ‘the condemna- institutions of the local area), in- ly a messenger but also the great tion of evils and injustices… But it volving that community as a group message’.31 should be made clear that procla- and ordinary daily life with a view The variegated and growing mation is always more important to behavioural changes in the indi- search for health expresses a latent than condemnation, and the latter vidual but also with a view to insti- wish for fullness, for more, for go- cannot ignore the former, which tutional and organisational change. ing beyond what is frailty and pre- gives it true solidity and the force of This assumes both knowledge of cariousness. All of this can be inter- higher motivation’ (SRS, n. 41). the specific cultural heritage as re- preted as a request for ‘salvation’: The state has the duty to create gards health of the person/commu- this unconscious search should be conditions for a just social order nity and their participation in the grasped by the Church in order to and the Church has the duty to offer search for, and implementation of, a propose its gospel ‘therapy’ which ‘contents’ to the category of ‘jus- methodology of intervention. And it acts directly on lifestyles that are tice’: ‘Faith enables reason to do its involves a real involvement – in a not healthy. work more effectively and to see its circular communication – of ex- proper object more clearly. This is perts and users in a shared search c. The promotion of justice where Catholic social doctrine has for the meaning of health and for and solidarity its place: it has not intention of giv- how, therefore, to best promote it ing the Church power over the through the acquisition of greater There are many factors which State. Even less it is an attempt to knowledge and of responsible atti- can foster the emergence and the impose on those who do not share tudes and forms of behaviour. spread of conditions of malaise and the faith ways of thinking and Being educated in health requires make a healthy life arduous. modes of conduct proper to faith. an existential re-orientation and a Amongst these, the social, econom- Its aim is simply to help purify rea- re-orientation at the level of values, ic and political contexts deserve to son and to contribute, here and now, a welcoming of suffering as a part be carefully considered. An effec- to the acknowledgement and attain- of life, and a use of the personal val- tive promotion of health must reach ment of what is just’ (DCE, n. 28).35 ues and the context in which one these levels because it is here that it In this way, the Church by its lives. is possible to see the origins of a se- presence and action in the so- Promoting health means ‘affect- ries of problems that afflict many cial/health-care world ‘strives to ing and as it were upsetting, populations (poverty, illiteracy, un- build the earthly city according to through the power of the Gospel, employment, civil wars, marginali- law and justice. On the other hand, mankind’s criteria of judgment, de- sation, discrimination).32 charity transcends justice and com- termining values, points of interest, There is an intimate connection pletes it in the logic of giving and lines of thought, sources of inspira- between access to ‘goods’ (instruc- forgiving. The earthly city is pro- tion and models of life, which are in tion, work, food, water, housing, moted not merely by relationships contrast with the Word of God and peace, freedom to profess one’s of rights and duties, but to an even the plan of salvation,28 observing, own religious faith or to express greater and more fundamental ex- through prophetic and alternative one’s own opinions…) and health. tent by relationships of gratuitous- modes, non-respect for the com- But even more determining is an- ness, mercy and communion’ (CIV, pleteness of the request for health of other link: ‘the denial or the limita- n. 6). ‘On its own justice is not suf- people to whom one is committed tion of human rights… do these not ficient. It can even come to deny it- to treating’.29 impoverish the human person as self if it does not open to that deep- Amongst the tasks of the Church much as, if not more than, the de- er force which is love’;36 ‘the in this field there is that of ‘empha- privation of material goods? And is Church’s social doctrine places sising the therapeutic and health-in- development which does not take alongside the value of justice that of ducing value of preaching. Down into account the full affirmation of solidarity’,37 a value connected with the centuries the ‘medicinal’dimen- these rights really development on the principle of subsidiarity and sion of the gospel has weakened, the human level?’.33 which should be conjoined with the figure of Christus medicus has A careful and prior reading of re- that of the centrality of the human practically disappeared, and the ality is required in order to under- person and respect for local and tra- Church has developed models of stand the causes that are at the ori- ditional values.38 assistance (the protagonist for a gin of very many injustices and also Without any doubt, a Catholic great deal of time of a kind of the ‘economic, financial and social health-care institution has as a part ‘Christian management of health’) mechanisms which. although they of its mission ‘condemning all the but has not developed its model of are manipulated by people, often surrogates of life and health, attacks health based upon the Gospel’ 30. function almost automatically, thus on the dignity and the integrity of At the same time ‘we must recov- accentuating the situation of wealth the weakest, the unjust distribution er the evangelising force inherent in for some and poverty for the rest’ of health-care resources, mecha- our care because as an ecclesial (SRS, n. 16). nisms and structures that impede community (and Catholic health- The Church does not forget the the poorest from reaching the table care institutions must be a specific duties of the state and does not in- of life and health. This role, howev- DOLENTIUM HOMINUM N. 76-2011 53 er, requires an equally important ef- longer and adapted to notable local guished by the fact that they do not fort to promote a new culture of realities: – ‘integral assistance to merely meet the needs of the mo- health, on a human scale, able to the sick, with attention being paid ment, but they dedicate themselves heal the pathogenic, personal and to all the dimensions of the person: to others with heartfelt concern, en- structural elements of society… the physical, the social, the spiritu- abling them to experience the rich- Lastly, no less important is the chal- al and the transcendent…; – the de- ness of their humanity. Consequent- lenge to demonstrate, through one’s fence and promotion of unborn life, ly, in addition to their necessary own life and in dedication to others, commitment to the rehabilitation of professional training, these charity that the lived Gospel is the best the disabled, qualified assistance workers need a “formation of the source of health willed by Christ for sick people who are dying; – the heart”’ (DCE, n. 31). and given to the Church as a gift training of personnel at a human, Equally requested is an equidis- and a mission. This is the prophecy Christian and professional level; – tance from political parties in order of new health for a world thirsting a prophetic presence in the most to conserve the freedom to proclaim and hungry for fullness’.39 difficult and newest areas of medi- always and to everyone the require- ‘Through the gospel message the cine; quality and efficiency of the ments of the gospel and in particu- Church offers a force for liberation ministry of spiritual and religious lar to carry out with rigour and which promotes development pre- accompanying of the sick and their credibility prophetic action in cisely because it leads to conver- family relatives; the safeguarding favour of the less defended: ‘Chris- sion of heart and of ways of think- of the humanity of care and ser- tian charitable activity must be in- dependent of parties and ideologies. It is not a means of changing the world ideologically, and it is not at the service of worldly stratagems, but it is a way of making present here and now the love which man always needs’ (DCE,n.31).

e. Preferential love for the poor

The poor, the privileged subjects of the work of salvation, must be the first recipients of the care and apostolic commitments of a Catholic health-care institution: the works of the Church must take con- crete form in moving towards the human spaces of the poorest and the most marginalised, choosing the needs that are discovered, there where the presence of Christians clearly takes on the character of ing, fosters the recognition of each vices, humanising technology and prophecy (cf. DCE,n.34). person’s dignity, encourages soli- assuring a climate in which sick Just as God has always raised His darity, commitment and service of people feel accepted and their voice in defence of the poor, so the one’s neighbour, and gives every- rights defended; – the promotion in Church does this through its teach- one a place in God’s plan’.40 the areas in which they work of a ing and through a special proximity health-care culture based on au- to the poor both inside and outside d. Being an example thentic human and Christian val- her own communities.42 ‘You hear ues; – a healthy administrative rising up, more pressing than ever, The works of the Church must transparency’.41 from their personal distress and col- have the characteristic of setting an In addition to achieving excel- lective misery, “the cry of the poor.” example: as regards the quality of lence in assistance, in teaching and (cf. Psalm 9:13; Gb 34:28; Prov services, the qualification of per- in research, in the efficient use of 21:13) Was it not in order to re- sonnel, the human promotion of resources, Catholic health-care in- spond to their appeal as God’s priv- users, the absence of any discrimi- stitutions should be exemplary as ileged ones that Christ came,(cf. Lk nation between rich and poor and regards professional expertise, hu- 4:18; 6:20) even going as far as to the elimination of financial reward manity and love for all people, identify Himself with them(cf. Mt and profit (cf. DCE,n.34). which should be at a practical level 25:35-40)? In a world experiencing In a pastoral Note on health the at the centre of such institutions: the full flood of development this Italian Bishops’ Conference listed ‘while professional competence is a persistence of poverty-stricken certain features that define the primary, fundamental requirement, masses and individuals constitutes a identity and the service of Catholic it is not of itself sufficient…Those pressing call for “a conversion of health-care institutions; obviously who work for the Church’s charita- minds and attitudes,”(GD, n. 63).43 enough, this list could be much ble organisations must be distin- Taking the side of the poor con- 54 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE stitutes a criterion of the pastoral raising themselves to the awareness addition to the support of science discernment of the practice of the and reality of social subjects able to and human solidarity also the sup- Church, it is a ‘proof of her fidelity manage in a responsible way their port of the grace of the Lord’,48 ‘a to Christ, so that she can truly be the own existences and to contribute to unitary project of pastoral care in “Church of the poor”’.44 the common good. This is a charity health should be outlined, directing Catholic health-care institutions that implies justice and promotes the entire Christian community to- must engage in initiatives of soli- the construction of an authentically wards this type of apostolate’49 with darity towards the poorest, both on democratic society’.46 Justice must a view to choral action of a broad their own and by provoking the sol- be obtained for everyone within the spectrum which also bears upon the idarity of others. ‘Without this con- framework of the fundamental roots of the matter, Here, more than crete solidarity, without persevering rights of the every human being and elsewhere, one should avoid acting separately.50 The people who are present and work with Catholic health-care in- stitutions make up a ‘community’ that is open to an appreciated rela- tionship with the local Church51 and the other realities that are present in the local area with a view to syner- gies as regards shared objectives di- rected towards the defence, promo- tion and recovery of health. Catholic health-care institutions not only engage in activity involv- ing care for their guests, they also attend to health-care workers as re- gards their human, professional and Christian formation and involve them so that the institution itself is humanised and they are humanised. A Catholic health-care institution is a place that is open to the local area and to the Christian community in attention paid to the spiritual and every society. It thus becomes a du- particular (the state, the regional material needs of our neighbour, ty of everyone to engage in the de- government, other agencies) for a there is no true and full faith in fence and the promotion of rights series of activities: health-care in- Christ. Indeed, as the apostle James belonging to the field of health and formation, prevention, the protec- warns us, without sharing with the health care, in a special way of the tion of health, health-care educa- poor religion can be transformed in- poorest, through resort to all those tion, and education in health. to an alibi or be reduced to mere pathways that can be ethically fol- The subject of pastoral care in membership (cf. Jm 1: 27-2, 13)’.45 lowed. health is the whole Christian com- In order to be consistent with this At a local, national and interna- munity which is called to be faithful option, it is necessary to have the tional level, it is very important to to the example of Christ, the physi- courage to close those CHCIs that work for respect for all the rights in- cian of souls and bodies, and to his no longer meet urgent needs so as herent in health and health care that mandate to preach the gospel and ‘to be open to charitable, education- have already been affirmed, just as heal the sick. ‘So that the presence al and social works in the direction it is very important that those that of Catholic health-care institutions of the poorest geographical areas have not yet been recognised but can exercise a positive influence on and social strata’ ( ETC, n. 48). which derive from the dignity of the ecclesial community and soci- Paul VI (ET, n. 18), in inviting re- every human being should be ety, certain steps should be taken. ligious to answer the ‘cries of the adopted. And here Catholic health- The first leads these institutions to poor’, suggested certain paths valid care institutions can play a role of overcome isolation, making them for everyone: to avoid compromise great importance. increasingly visible within the ec- with any form of social injustice; to clesial community. The population provoke consciences in the face of f. Health-inducing alliances of the local area must be able to the drama of acute poverty and the recognise in them a point of refer- requirements of social justice; to re- The great challenges of the world ence, an instrument of sensitisation convert certain works for the bene- of health and health care47 cannot be as regards questions and issues con- fit of the poor; and a limited use of addressed through the involvement nected with health and health care, possessions. of few people or in a haphazard with death, with old age and dis- ‘To privilege the poor means, at way: ‘so that the values of life and ability’.52 an anthropological and social level, health are respected and directed to- ‘Obviously when charitable ac- to privilege ‘non-subjects’, offering wards salvation, and the moments tivity is carried out by the Church as them the concrete possibility of of illness and death can receive in a communitarian initiative, the DOLENTIUM HOMINUM N. 76-2011 55 spontaneity of individuals must be bution to the promotion of the 7 ‘Deeds without knowledge are blind, and knowledge without love is sterile… Charity is combined with planning, foresight health of peoples. This contribution not an added extra, like an appendix to work al- and cooperation with other similar can become of an unthinkable im- ready concluded in each of the various disci- institutions’ (DCE,n.31).53 portance and range both in the plines: it engages them in dialogue from the very beginning. The demands of love do not Amongst all CHCIs of the world North and the South of the world contradict those of reason. Human knowledge at a planetary level cooperation, when Catholic health-care institu- is insufficient and the conclusions of science sharing and communion must be tions adopt the mission to achieve cannot indicate by themselves the path towards integral human development. There is always a fostered. In an increasingly glob- the Christological model of health, need to push further ahead: this is what is re- alised world networks should be preaching and bearing witness to quired by charity in truth. Going beyond, how- created which allow the sharing of the Gospel of full and definitive ever, never means prescinding from the conclu- sions of reason, nor contradicting its results. In- human, financial, technological and health. Indeed, this ‘good news’ is telligence and love are not in separate compart- intellectual resources which, with- not only a message containing in- ments: love is rich in intelligence and intelli- out impoverishing those who give formation it is also a message that is gence is full of love’(CiV,n.30). 8 ‘The current condition of being creatures is them certainly enrich those who re- performed, that is to say that ‘the marked by original sin. With it ‘the harmony in ceive them. ‘It seems more neces- Gospel is not merely a communica- which they had found themselves, thanks to sary than ever before to think, tion of things that can be known – it original justice, is now destroyed: the control of search and work together… in order is one that makes things happen and the soul’s spiritual faculties over the body is 57 shattered; the union of man and woman be- to build together a therapeutic mo- is life changing’. comes subject to tension…Harmony with cre- saic, a fabric and a network of care ation is broken: visible creation has become alien and hostile to man…Death makes its en- for health, able to meet the requests Rev. RENATO SALVATORE, M.I. trance into human history’(Catechism of the for health of people in situations, to Superior General of the Order Catholic Church,n.400). educate them, to engage in preven- of St Camillus/Ministers of the Sick, Humanity was redeemed by Christ and is tion, to treat always and everyone Rome, Italy called to a ‘fullness of life which far exceeds 54 the dimensions of his earthly existence’ (EV,n. with competence and humanity’. 2). Amongst the many fields of co- The human person is a profound unity of soul and body. operation there emerges that of for- And needs relational life, needs society. mation where what should be privi- ‘the ultimate source of human rights is not leged is an ‘integrated local-area found in the mere will of human beings, in the Notes reality of the State, in public powers, but in man educational (or training) system and himself and in God his Creator’ Pontifical a network of intervention where 1 CEI, Ufficio Nazionale per la pastorale del- Council for Justice and Peace, Compendium of schools, families, services, groups la Sanità, La Chiesa a servizio dell’amore per i the Social Doctrine of the Church (Editrice sofferenti, 11 February 2010, Edizioni Camil- Vaticana, 2004, n. 153). For this reason, these and associations which in various liane, p. 6. rights are to be seen as universal, inviolable and ways work in the local area should 2 ‘Indeed, when the Word of God speaks inalienable. not be closed monads, ‘orchards to about healing, about salvation, about the health 9 JOHN PAUL II, Evangelium vitae (hereafter be cultivated’, but, rather, educa- of the sick, it means these concepts in an inte- EV]), 25.III.1995, n. 5. gral sense, never separating body and soul’: 10 ‘To live healthily means to modulate one’s tional realities in continuous inter- homily of Pope Benedict XVI of 11 February existence in line with an accurate hierarchy of action with each other and with the 2010. values and for the believer to wed the design of problems and resources of the com- 3 ‘For the Church, charity is not a kind of God. To follow His will, to adopt His life pro- 55 welfare activity which could equally well be ject, to find a meaning to the journey through munity’. left to others, but is a part of her nature, an in- this world’: F. ÁLVAREZ, ‘Teologia della In these alliances – directed to- dispensable expression of her very being’ salute’, in L. SANDRIN (ed.), Salute/salvezza wards the construction of the civili- (BENEDICT XVI, Deus caritas est (hereafter perno della teologia pastorale sanitaria (Edi- DCE) , 25.XII.2005, n. 25. zioni Camilliane, Turin, 2009), p. 160. sation of love, justice and solidarity 4 JOHN PAUL II, Christifideles laici, 11 L. SANDRIN, ‘Comunità sanante: modello and with a view to the universal 30.XII.1988, n. 53. di Chiesa’, in L. SANDRIN (ed.), op. cit.,p.194. promotion of health – there must be 5 Cf. A. BRUSCO ‘Hospital Católico’, in J. C. 12 ‘In Jesus salvation is offered as health and BERMEJO-F. ÁLVAREZ (ed), Diccionario de health is offered as salvation and his good news involved all people and agencies of Pastoral de la Salud y Bioética (S. Pablo, is the proclaiming of a saved-health and a good will, beginning with Chris- Madrid, 2009), pp. 812-823; M. PETRINI,‘Os- health-inducing salvation for man, for the tians. ‘To work for the health of pedale cattolico’, in G. CINÀ,E.LOCCI,C.ROC- whole of man and for all men’: CEI, Ufficio CHETTA,andL.SANDRIN, Dizionario di Teolo- Nazionale per la pastorale della Sanità, Doman- people, to treat illnesses and allevi- gia Pastorale Sanitaria (Edizioni Camilliane, da di salute, nostalgia di salvezza, 11 February ate pain means to construct the Turin, 1997), pp. 800-804. See also the pro- 1999, n. 3. kingdom of God, even though in ceedings of the twenty-seventh International 13 Cf. L. SANDRIN, Chiesa, comunità conference organised by the Pontifical Council sanante. Una prospettiva teologico-pastorale still partial ways, already in this for Health Care Workers on ‘The Identity of (Paoline, Milan, 2000); AA. VV., ‘Salute, gua- world. In their commitment to Catholic Health-Care Institutions’, 7-9 Novem- rigione e salvezza’, Credere Oggi, n. 145, health the various Christian ber 2002, published in Dolentium Hominum,n. 1/2005; D. CASERA, Chiesa e salute. L’azione 52, 2003/1. della Chiesa in favore della salute (Editrice Churches and confessions can more 6 BENEDICT XVI, Caritas in Veritate (here- Ancora, Milan, 1991). easily encounter each other’.56 after CiV), 29.VI.2009, n. 2. ‘Without truth, 14 ‘For the Church, charity is not a kind of charity degenerates into sentimentality. Love welfare activity which could equally well be becomes an empty shell, to be filled in an ar- left to others, but is a part of her nature, an in- bitrary way. In a culture without truth, this is dispensable expression of her very being’ Conclusion the fatal risk facing love. It falls prey to con- (DCE,n.25). tingent subjective emotions and opinions, the 15 ‘Christian charity is first of all the simple word “love” is abused and distorted, to the response to immediate needs and specific situa- Catholic health-care institutions, point where it comes to mean the opposite. tions: feeding the hungry, clothing the naked, when they are fully placed in the Truth frees charity from the constraints of an caring for and healing the sick, visiting those in work of evangelisation of the emotionalism that deprives it of relational and prison, etc.’ (DCE,n.31). social content, and of a fideism that deprives it 16 ‘The Apostolic Exhortation Evangelii Church (preaching, sacraments, of human and universal breathing-space’ Nuntiandi, for its part, is very closely linked charity), offer an important contri- (CiV,n.3). with development, given that, in Paul VI’s 56 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

words, “evangelization would not be complete bility of integral human development is radical- to take part in public life in a personal capaci- if it did not take account of the unceasing inter- ly called into question. In this most delicate and ty…The mission of the lay faithful is therefore play of the Gospel and of man’s concrete life, critical area, the fundamental question asserts to configure social life correctly, respecting its both personal and social.” “Between evange- itself force-fully: is man the product of his own legitimate autonomy and cooperating with oth- lization and human advancement — develop- labours or does he depend on God?... We are er citizens according to their respective compe- ment and liberation — there are in fact pro- presented with a clear either/ or…Faced with tences and fulfilling their own responsibility’ found links”: on the basis of this insight, Paul these dramatic questions, reason and faith can (DCE,n.29). VI clearly presented the relationship between come to each other’s assistance. Only together 35 ‘the formation of just structures is not di- the proclamation of Christ and the advance- will they save man. Entranced by an exclusive rectly the duty of the Church, but belongs to the ment of the individual in society. Testimony to reliance on technology, reason without faith is world of politics, the sphere of the autonomous Christ’s charity, through works of justice, doomed to flounder in an illusion of its own om- use of reason. The Church has an indirect duty peace and development, is part and parcel of nipotence. Faith without reason risks being cut here, in that she is called to contribute to the pu- evangelization, because Jesus Christ, who off from everyday life’(CiV, n. 74). rification of reason and to the reawakening of loves us, is concerned with the whole person’ 24 ‘These should not merely be institutions those moral forces without which just struc- (CiV, n. 15). where care is provided for the sick or the dying. tures are neither established nor prove effective 17 ‘Charity, furthermore, cannot be used as a Above all they should be places where suffer- in the long run’ (DCE, n. 29). ‘It is not a means means of engaging in what is nowadays consid- ing, pain and death are acknowledged and un- of changing the world ideologically, and it is ered proselytism. Love is free; it is not practised derstood in their human and specifically Chris- not at the service of worldly stratagems, but it is as a way of achieving other ends. But this does tian meaning’ (EV,n.88). a way of making present here and now the love not mean that charitable activity must somehow 25 ‘It is for that matter true that the difficul- which man always needs’ (DCE,n.31). leave God and Christ aside. For it is always ties experienced by legislators in responding in 36 JOHN PAUL II, Message for the World Day concerned with the whole man. Often the deep- an adequate way the needs for care and health of Peace,,n.10 est cause of suffering is the very absence of of citizens are more easily understood if one 37 PONTIFICAL COUNCIL FOR JUSTICE God. Those who practise charity in the considers that such efforts are often opposed by AND PEACE, op. cit.,n.203 Church’s name will never seek to impose the cultural and social visions that are incompatible 38 ‘Development programmes, if they are to Church’s faith upon others. They realize that a with the pursuit of the common good’ (CEI, be adapted to individual situations, need to be pure and generous love is the best witness to the COMMISSIONE EPISCOPALE PER IL flexible; and the people who benefit from them God in whom we believe and by whom we are SERVIZIO DELLA CARITÀ E LA SALUTE, ought to be directly involved in their planning driven to love. A Christian knows when it is «Predicate il Vangelo e curate i malati». La co- and implementation. The criteria to be applied time to speak of God and when it is better to say munità cristiana e la pastorale della salute, should aspire towards incremental develop- nothing and to let love alone speak. He knows pastoral Note, 4 June 2006, n. 7). ment in a context of solidarity — with careful that God is love (cf. 1Jn4:8) and that God’s 26 ‘Health care is only one of the ‘inputs’ in- monitoring of results — inasmuch as there are presence is felt at the very time when the only to the production of ‘health’, even not the most no universally valid solutions’ (CiV, n. 47). thing we do is to love. He knows—to return to important…The most important determining Aid ‘must be distributed with the involvement the questions raised earlier—that disdain for factors as regards the status of health would not only of the governments of receiving coun- love is disdain for God and man alike; it is an seem to be (1) the genetic inheritance of an in- tries, but also local economic agents and the attempt to do without God. Consequently, the dividual; (2) his or her socio-economic condi- bearers of culture within civil society, including best defence of God and man consists precisely tion; (3) the physical environment in which he local Churches…the most valuable resources in in love. It is the responsibility of the Church’s or she lives; and (4) the individual ability and countries receiving development aid are human charitable organizations to reinforce this aware- will to manage well his or her own health which resources: herein lies the real capital that needs ness in their members, so that by their activi- in turn is broadened by the formation of the per- to accumulate in order to guarantee a truly au- ty—as well as their words, their silence, their son (UWE E. REINHARDT and MAY T. M. tonomous future for the poorest countries’ example—they may be credible witnesses to CHENG, ‘In economia’, Dolenitum Hominum, (CiV, n. 58). ‘Cooperation for development Christ’ (DCE, n. 31). 52/2003, p. 63). must not be concerned exclusively with the 18 PAUL VI, Evangelii nuntiandi, 8.XII.1975, 27 M. T. CAIRO, Persona e salute. Itinerari economic dimension: it offers a wonderful op- n. 21. educativi (Editrice La Scuola, Brescia, 1994), portunity for encounter between cultures and 19 ‘The struggle against the exclusion of a pp. 78-79. An integrated (interdisciplinary) ap- peoples…Technologically advanced societies major part of humanity from health-care ser- proach to the subject of health leads to us ‘see- must not confuse their own technological de- vices and thus guaranteed access of everyone to ing the promotion of health as a unique sector velopment with a presumed cultural superiori- the medical products required for treatment; the of activities and interventions that includes ty’ (CiV,n.59). spread of compassion as a model for co-exis- within it different areas: health-care informa- 39 RELIGIOSI CAMILLIANI, Documento tence based upon Christian charity; the defence tion; prevention; health-care education; educa- Capitolare, Uniti per la giustizia e la solidari- of life through the protection of the dignity and tion in health; and the protection of health’ (Ibi- età nel mondo della salute. Religiosi camilliani the rights of the person at all points and condi- dem, p. 137). Cf. CEI, Educare alla salute, ed- e missione profetica, Rome, 2007, n. 67 tions of his or her life; and creativity in the ucare alla vita (Edizioni Camilliane, Turin, 40 JOHN PAUL II, Redemptoris missio, planning of local interventions open to local- 2009). 12.VII.1990, n. 59. area and multicultural support. These are the 28 PAUL VI, op. cit.,n.19. 41 CEI, Consulta nazionale per la pastorale defining points of the ‘decalogue’ recommend- 29 L. SANDRIN, Chiesa, comunità sanante,p. della sanità, La pastorale della salute nella ed by the Pontifical Council for Health Care 69. chiesa italiana (1989), n. 56. The Note of 2006 Workers to Catholic health-care institutions in 30 F. ÁLVAREZ, op. cit., p. 146. Cf. F. ÁL- (nn. 36-46) is also concerned with these, posing the world’ (Mario Ponzi). VAREZ, ‘El evangelio de la salud en una so- questions and pointing out certain steps that 20 ‘Every culture has burdens from which it ciedad plural’, Labor Hospitalaria, 293- should be taken: ‘The answers to these ques- must be freed and shadows from which it must 294/2010, pp. 60-80. tions requires Catholic health-care institutions emerge. The Christian faith, by becoming in- 31 L. SANDRIN, Chiesa, comunità sanante ,p. to be defined by their medical and managerial carnate in cultures and at the same time tran- 70. services; to be committed to responding with scending them, can help them grow in universal 32 ‘Today the picture of development has concrete initiatives to the challenges raised by brotherhood and solidarity, for the advance- many overlapping layers. The actors and the bioethics; to give primacy to the sick person, ment of global and community development’ causes in both underdevelopment and develop- integral care for the person and witness to char- (CiV, n. 59). ment are manifold, the faults and the merits are ity as suitable criteria of intervention; they 21 ‘The Gospel of God’s love for man, the differentiated’ (CiV,n.22). should be schools of communion and places Gospel of the dignity of the person and the 33 JOHN PAUL II, Sollicitudo rei socialis where the sick person can open himself to her- Gospel of life are a single and indivisible (hereafter SRS), 30.XII.1987, n. 15. self to hope; and they should know how to ‘ob- Gospel’(EV,n.2). 34 ‘The just ordering of society and the State tain spaces for solidarity-inspired activity in 22 ‘All this is aggravated by a cultural climate is a central responsibility of politics. As Augus- favour of categories of sick people who are ne- which fails to perceive any meaning or value in tine once said, a State which is not governed ac- glected by the public sector’ (CEI, COMMIS- suffering, but rather considers suffering the cording to justice would be just a bunch of SIONE EPISCOPALE PER IL SERVIZIO epitome of evil, to e eliminated at all costs. This thieves’ (DCE, n. 28). ‘The Church cannot and DELLA CARITÀ E LA SALUTE, op. cit.,n. is especially the case in the absence of a reli- must not take upon herself the political battle to 41). gious outlook which could help to provide a bring about the most just society possible. She 42 ‘the option or love of preference for the positive understanding of the mystery of suf- cannot and must not replace the State. Yet at the poor. This is an option, or a special form of pri- fering’ (EV,n.15). same time she cannot and must not remain on macy in the exercise of Christian charity, to 23 ‘A particularly crucial battleground in to- the sidelines in the fight for justice’ (DCE,n. which the whole tradition of the Church bears day’s cultural struggle between the supremacy 28). ‘The direct duty to work for a just ordering witness’ (SRS, n. 42). ‘Thus part of the teaching of technology and human moral responsibility of society, on the other hand, is proper to the lay and most ancient practice of the Church is her is the field of bioethics,wheretheverypossi- faithful. As citizens of the State, they are called conviction that she is obliged by her vocation – DOLENTIUM HOMINUM N. 76-2011 57

she herself, her ministry and each of her mem- also a responsibility for the entire ecclesial holding up lines of cooperation with all men of bers – to relieve the misery of the suffering, community at every level: from the local com- good will; both fare and near, not only out of her “abun- munity to the particular Church and to the – to support the integration of pastoral care dance” but also out of her “necessities”’ (SRS, Church universal in its entirety. As a communi- in health within the pastoral care as a whole of n. 31). ty, the Church must practise love. Love thus Christian communities; 43 PAUL VI, Evangelica testificatio, 29.VI. needs to be organised if it is to be an ordered – to promote greater integration between 1971, n. 17. service to the community’ (DCE, n. 20). ‘So- the spiritual assistance that is provided in 44 JOHN PAUL II, Laborem exercens, cio-economic problems can be resolved only health-care institutions and ordinary pastoral 14.IX.1981, n. 8. with the help of all the forms of solidarity: soli- care in parishes, developing forms of coopera- 45 CEI, Evangelizzazione e testimonianza darity of the poor among themselves, between tion between hospital chaplaincies and the ec- della carità. Orientamenti pastorali dell’Epis- rich and poor, of workers among themselves, clesial communities of the local are; copato italiano per gli anni ‘90 (hereafter between employers and employees in a busi- – to provide recommendations for the in- ETC), 8.XII.1990, n. 39. ness, solidarity among nations and peoples, In- volvement of all the components of the people 46 CEI, Evangelizzare il sociale, 22. XI. ternational solidarity is a requirement of the of God in pastoral care in health, strengthening 1992, n. 64. moral order; world peace depends in part upon bodies of communion and joint responsibility; 47 ‘The present organisation of the world of this (Catechism of the Catholic Church, n., – to promote a greater overall approach and health should also be understood in the light of 1941). the making of projects as regards pastoral care certain tendencies of contemporary culture and 51 ‘the true subject of the various Catholic or- in health, through specific training itineraries as scientific and technical progress which have in- ganizations that carry out a ministry of charity well’: (CEI, COMMISSIONE EPISCOPALE fluenced our way of conceiving of health and is the Church herself—at all levels, from the PERILSERVIZIODELLACARITÀELA illness, life and death’: (CEI, COMMISSIONE parishes, through the particular Churches, to SALUTE, op. cit.,n.4). EPISCOPALE PER IL SERVIZIO DELLA the universal Church’ (DCE, n. 32). 54 CEI, UFFICIO NAZIONALE PER LA CARITÀ E LA SALUTE, op. cit., n. 8). 52 CEI, COMMISSIONE EPISCOPALE PASTORALE DELLA SANITÀ, Le istituzioni 48 CEI, La pastorale della salute nella chiesa PER IL SERVIZIO DELLA CARITÀ E LA sanitarie cattoliche in Italia. Identità e ruolo italiana (1989), n. 2. SALUTE, op. cit.,n.42. (EDB, 2000), p. 6. 49 JOHN PAUL II, L’Osservatore Romano,n. 53 This is the approach of the Italian Church 55 M. T. CAIRO, op. cit.,p.174. 277, 29.11.1981, p. 2. ‘which intends: 56 L. SANDRIN, Comunità sanante: modello 50 ‘Love of neighbour, grounded in the love – to foster the discernment of the chal- di Chiesa, p. 200. of God, is first and foremost a responsibility for lenges raised in the world of health and health 57 BENEDICT XVI, Spe salvi, 30.XI.2007, each individual member of the faithful, but it is care to the presence and action of the Church, n. 2. 58 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

JOHN F. GALBRAITH The Vatican-CMMB initiative: Touching Lives, Bringing Health and Hope

Good Afternoon. It is always a ly they are ones that form the foun- address major healthcare problems. pleasure to visit the Vatican and dation of caring Catholics through- Let me begin with the volunteers your beautiful city of Rome, but I out the world. They are: and medical donations programs. am especially happy to be with you – Building Individual and Com- We call these our “legacy” pro- today. I welcome the opportunity to munity Capacity – In all the work grams because they have been in both tell you a little about my orga- we do, we always ask ourselves the operation almost since CMMB’s in- nization, the Catholic Medical Mis- question: “Will this activity be sus- ception. sion Board – or CMMB, as we call it tainable after we are gone.” Dr. Flagg was CMMB’s first vol- – and to announce an exciting new – Accountability – CMMB values unteer, traveling to Latin America to initiative that we are embarking up- greatly the trust given to us by our minister to lepers. on with the Pontifical Council for more than 40,000 donors. That trust From that beginning, the volun- Health Care Workers. is built on the diligence with which teer program has grown to one that, First, let me introduce you to we apply their generous and loving this year, has seen 68 volunteers Catholic Medical Mission Board. gifts. serving terms of six months to two CMMB will be 100 years old in – Social Justice – Everyone years, and an additional 1,595 on 2012, but for many who learn of our should have access to health care, shorter missions, to 24 countries work, we are regarded as the best- without discrimination. around the world. Over the last ten kept secret in the world of global –Integrity– Respect for the indi- years, that number for long-term health care. That is largely due to vidual is required in all that we do. volunteers has totaled 773respec- the fact that nearly 98 percent of our As we see the plight of those we tively. And, do you know what each resources are devoted to the pro- serve, many in the most wretched of and every one of them tells us when grams and services we deliver circumstances, we are always mind- they return? They tell us that, in throughout the world. ful that “there but for the grace of their volunteer work, they receive so We are so busy doing our work God go me”. much more than they give. It is a that we traditionally have not taken – Leadership –CMMBisavery life-changing experience for all of much time to promote our efforts. strong advocate of the effectiveness them. www. cmmb.org/healthcare- The notion of a Catholic Medical of Catholic and other faith-based or- programs Mission Board had its inception in ganizations, many of them deliver- Never were our volunteers need- 1912, and it was the result of one ing services in areas where a coun- ed so much as in January this year, man’s grief over the death of his try’s national government is unable following Haiti’s devastating earth- wife. That man was Dr. Paluel J. to reach. quake. We worked with our part- Flagg, a young anesthesiologist – Quality Collaboration – ners to send hundreds there in the working on the staff of a Catholic Catholic healthcare networks weeks following that disaster. For hospital in New York City. throughout the world are most often more information, please click on From his sorrow was born the our partners in our work. our Haiti Fact Sheet. dream of assisting missionaries de- – Courage and Risk-Taking – Our second “legacy” program is livering health care in underserved CMMB, like many of you in your called Healing Help, and that is a areas of the world. health care outreach, often go great name for it. It refers to our Dr. Flagg’s mission then is our where others will not or cannot go. program of soliciting and placing mission now: Rooting in the heal- And, we often start programs that donated medicines and medical sup- ing ministry of Jesus, CMMB works become best practices to be adopt- plies to serve those in need through- collaboratively to provide quality ed by others. out the world. And, it is the center- healthcare programs and services, – Compassion –ItwasDr. piece in our initiative with the Pon- without discrimination, to people in Flagg’s compassion and good heart tifical Council for the Pastoral Care need around the world. that saw the dream of CMMB. We of Health Care Workers and the His vision then is also our vision never forget that. Good Samaritan Foundation, which now: A world in which every hu- I will tell you more about shortly. man life is valued and quality By now, you must be wondering: Over the last decade, Healing healthcare is available to all. What exactly does CMMB do? The Help has delivered medicines and Throughout our history, we have short answer is that we send medi- medical supplies valued at more been guided by values that we think cines and medical volunteers around than $1 billion U. S. dollars. They Dr. Flagg would embrace. Certain- the world, and we run programs that have gone to more than 600 partners DOLENTIUM HOMINUM N. 76-2011 59 in 100 countries around the globe. they are the dominant decision mak- our partners in this important work Those medicines and medical sup- ers for their partners and family – are Bon Secours Health System, plies have been donated to us by education on HIV and AIDS was CHRISTUS Health and Caritas-Pe- major pharmaceutical and medical needed. This program, Men Taking ru. www.cmmb.org/unidos-contra- supply companies. www.cmmb.org Action, addresses male attitudes and la-mortalidad-infantil /healing-help-program behaviors that prevent women from Our work with mothers and chil- Those two legacy programs – our attending antenatal clinics and ac- dren is present in virtually all our volunteer and donated medicines cessing prevention of mother-to- initiatives: in our HIV/AIDS pro- programs – were of immense value child transmission services for HIV. grams, in food and nutrition pro- to us when, around 2000, we made The program empowers men to grams for orphans in South Africa, the decision to move into a new serve as positive change agents for and in our malaria programs, where realm of operations. It was then that family health, encouraging them to the provision of insecticide-treated we strategically branched out to educate their families about nets reduce morbidity and mortality tackle some of the world’s major HIV/AIDS and participate in volun- in pregnant women and young chil- health problems, namely HIV/AIDS tary counseling and testing for HIV. dren. and child survival. In doing so, we The program has now also moved A tropical disease, leprosy, was collaborated with many of the into South Africa and, in total, the first illness we faced, for work- healthcare facilities that we had 27,122 men and 50,275 of their part- ing with lepers was the first en- been serving for decades by sending ners have been tested for HIV. In deavor that our founder, Dr. Paluel them medical volunteers and donat- addition, 4,460 HIV positive preg- Flagg, engaged in almost one hun- ed medicines. nant women have been linked to dred years ago. Today, we continue Today, we continue to conduct treatment services. www.cmmb.org/ to battle this disease in such high- major programs in HIV/AIDS and men-taking-action incidence locations as India and child survival, but have recently al- Zambia. We have trained nearly so added as areas of focus neglected 500 community health worked and tropical diseases and the capacity healthcare professionals, strength- building and strengthening of health ening the capacity of local health systems in the countries where we facilities to diagnose, treat and care operate. for leprosy patients. In the past CMMB helps more than 500,000 decade, we have had a highly suc- of the underserved through these cessful program, in Ghana, that programs annually. In addition, our provided healing education about medicines and volunteers touch the and treatment of lymphatic filaria- lives of hundreds of thousands sis, or elephantitis, another tropical more. disease. The program became a na- For more than a decade, we have tional model, reading 444,957 peo- been doing everything we can to im- ple over five years. CMMB has al- prove these numbers, particularly so provided de-worming medicines with innovative programs in Africa. to countless children in Latin This includes helping to prevent the America. www.cmmb.org/zambia- transmission of HIV from HIV pos- leprosy itive pregnant mothers to their un- CMMB has reached out in other born children. We also, last year, areas also, for instance we are a provided life-saving antiretroviral What began as a child survival founding member of the Haiti Am- treatment to nearly 47,000 Kenyans initiative, we now often refer to as putee Coalition, which was estab- through a program called AIDSRe- CMMB’s maternal and child health lished following the earthquake to lief, as part of a consortium that in- outreach. There is much research treat and rehabilitate those who lost cludes Catholic Relief Services. that demonstrates that women are limbs as a result of this devastating In Kenya, South Sudan and Haiti the key to sustaining healthy fami- natural disaster. We have helped we operate a very creative program lies. more than 700 people who have suf- that we call Mentor Mothers. This In Latin America, more than half fered in this way and we will contin- puts HIV-positive “mentors”, who a million children die annually and ue to make this a priority of our have been helped often via our one-third of their deaths are attribut- work in Haiti. mother-to-child prevention pro- able to five preventable illnesses: In addition to our disease-specif- gram, to work in hospitals and clin- respiratory infection, diarrheal dis- ic, in-country programs, we have re- ics to counsel, provide education, eases, malnutrition, measles and cently adopted a programmatic area and work with pregnant women and malaria. Peru displays one of the of focus that we call Capacity Build- their partners to overcome stigma highest mother and child mortality ing and Health System Strengthen- and learn that they can take steps to rates in the region, so CMMB estab- ing. Our objective is to develop sus- improve their health and that of their lished Unidos Contra la Mortalidad tainable local capacity to address children. Infantil (United Against Infant Mor- major healthcare needs and build A few years ago, in Zambia, we tality) there. We work in three key strong systems. We accomplish this took a look at male heads of house- cities: Trujillo, Huancayo and through the design and implementa- holds and determined that – since Chimbote. We are very pleased that tion of high-quality, evidence-based 60 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE programs, directed by the following that aim to report to the U.S. gov- Pontifical Council for the Health goals: ernment and other donors by pub- Care Workers and the Good Samar- lic health outcomes. This is known itan Foundation to bring even more 1. Increase access to health as performance-based financing, health and hope to those in need services that improve quality of and CMMB is assisting in its ex- around the world. life and reduce preventable pansion to several countries, in- We are honored to be able to do- deaths cluding Kenya. nate, annually, medicines and med- ical supplies valued at $10 million In 2010, CMMB counseled and dollars to the Council to support tested 119,087 individuals for HIV, His Holiness’ and the Vatican’s reached 146,915 with HIV preven- health care efforts. These medi- tion messages, provided preventa- cines will be sent to designated tive antiretroviral treatment to 3,725 healthcare facilities in targeted expectant mothers, and cared for countries that are chosen based on 110,362 people living with HIV. priorities of the Vatican, national CMMB’s maternal and child health laws pertaining to importing of programs provided 16,273 young medicines and CMMB’s expertise. children and 79,959 pregnant Because CMMB has developed women with primary healthcare. nearly a century of expertise in ship- ping and delivering medicines to the 2. Strengthen human resources developing world, we will manage for health the supply chain for this project. I am deeply grateful to Archbish- CMMB is working to bolster the op Zygmunt Zimowski for his will- global health workforce by filling ingness to undertake this new initia- gaps for medical professionals. In 5. Support program monitoring tive and it will be a milestone in 2010, CMMB helped send 1,663 systems and key research that CMMB’s history as we move into medical volunteers to 24 countries, ensure quality programming and our second century of work. where they provided over $10 mil- adoption of best practices in In the course of our meetings to lion in donated services. Through global healthcare. plan and finalize this initiative, local partnerships, CMMB promot- Archbishop Zimowski and I often ed the training of trainers and moti- CMMB’s Monitoring & Evalua- were gratified to see that the Coun- vated health workers to serve in tion team works with implementing cil’s goals and CMMB’s were their home countries. partners to develop reporting proce- shared. When Archbishop Zimows- dures that ensure appropriate use of ki speaks of access to health care be- 3. Build supply chain capacity that resources and create lasting change. ing a question of justice and that it is will increase global access to Quarterly reviews of programmatic a basic human right, he could be lifesaving medications and data by technical staff identify chal- quoting from our vision and core technologies lenges, successes, and points for fur- values. ther research. CMMB is account- IamjoinedhereinRomeandat CMMB collaborates closely with able to its beneficiaries to provide this Conference by Adrian Kerrigan, its partners to develop efficient and quality healthcare services; there- CMMB’s Senior Vice President for effective supply chains for medi- fore CMMB engages local commu- Advancement. We welcome the op- cines and medical supplies. Over nity-based organizations, associa- portunity to meet with you, answer the last decade, CMMB has provid- tions of people living with HIV, and any questions you might have about ed over $1 billion of donated medi- mothers clubs in the review of pro- our work and our exciting new col- cines and medical supplies to 600 gram progress-to-date and future laboration with the Vatican. In addi- local partners in 100 countries. Be- planning. tion, we have brought literature that cause of its reputation for strong provides more specific information leadership in supply chain manage- 6. Increase the ability of local about our “best kept secret”, one ment and close relationship with its leadership to effectively design that has been bringing health and consignees, drug manufacturers and manage programs hope to those in need for almost one consider CMMB a trusted partner. hundred years. It is available as you CMMB’s Country Directors and leave the meeting. 4. Develop strong financial systems key staff members serve on techni- Thank you for your attention. in healthcare facilities cal advisory boards and work close- You can always learn more about ly with local Ministries of Health to our work by visiting our website at CMMB is helping many hospi- promote the needs of those we serve www.cmmb.org. To see videos of tals and clinics in Kenya go paper- around the world. our work in action, please visit less with integrated and computer- www.CMMBHEALS.org ized Health Management Informa- Now, I come to the part of my Dr. JOHN F. GALBRAITH tion Systems (HMIS). These sys- presentation where I have the plea- President & Chief Executive Officer, tems help the facilities bill patients, sure of announcing a major new col- Catholic Medical Mission Board (CMMB), track revenue, and build programs laboration: CMMB is joining the USA DOLENTIUM HOMINUM N. 76-2011 61

MAREK JUREK The Cooperation of Various Government Ministries in Health Care

Public health is one of the com- self through an allocation of funds question of artificial in vitro fertil- ponents of the common good of for its achievement. isation is seen by its proponents as every nation. According to the Eu- Solidarity means, and this a method by which to treat sterili- ropean Convention on Human should be well understood, not en- ty, although no woman who has Rights and a large number of sub- trusting the state with matters used this technique can become sequent national Constitutions, the which both families and individu- pregnant in a totally natural way as protection of health is a right of all als should assure through their well. In this case, the whole of the men and at the same time a foun- own efforts, just as the subsidiary responsibility falls on the Ministry dation of the duties of the state. role of the state requires that there of Health. The Minister of Health The same Convention recognises should be concentration on the so- (as the spokesman for public that actions connected with public cial contexts and situations that health) can present the question of health – because they serve every- most need help. One is dealing one – even prevail over individual first and foremost here with the political rights. most serious illness (which absorb Health-care policy, therefore, the greatest costs at the level of does not belong to the prerogatives treatment) and categories that par- of a concrete specialised institu- ticularly need help (such as numer- tion. The necessary model for the ous families). functioning of the state lies in the The field of the financing of fact that it concerns the entire ac- public health is therefore for the tivity of the state and the govern- state an essential choice. Indeed, ment. A Ministry of Health should the Ministry of Health always be the privileged initiator of their works within the frameworks indi- work and the spokesman of tasks cated by decisions of a general na- that should be performed through ture which determine the action of government and the legislative the entire state apparatus and power at the level of health-care which go beyond the responsibili- policy. ties of a single specialised institu- At the outset, budgetary ques- tion. tions had to be addressed, those in- Determining and recommend- volving the obtaining of the funds ing the right level of help to the necessary to assure resources for poorest of society as regards health public health, which should be ac- is the responsibility of the Ministry cessible to everyone. This requires for Social Policies. This is a cru- especial help from the Prime Min- cial question that concerns both in vitro fertilisation as something ister for the Ministry of Health those people who for no fault of that is purely technical in character when there is conflict between the their own find themselves in a sit- and also morally neutral, and can Ministry of Health and the Min- uation that is especially difficult, also recommend this method – as istry of Finance, which is charged and numerous families, namely unfortunately takes place in the with watching over budgetary people who, because of their own majority of cases in contemporary matters. wishes, have accepted greater du- liberal countries. In adopting this The subsidiary role of the state ties than those of other citizens and approach, the Ministry of Health means that its duties increase with which concern the good of the becomes not an executor of the the importance of the good that whole of society. This also con- common good but a representative people are not able to obtain with cerns in a particular way families of interests that are against the their own funds or through social who have responsibility for dis- common good, that is to say the il- organisations. From this point of abled children. legitimate interests of certain indi- view, the protection of health be- When one speaks about health- viduals. This Ministry should, in- longs to the primary tasks of the care policy one cannot ignore ethi- stead, cooperate with the Ministry state which here should express it- cal questions. For example, the of Science, which should recom- 62 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE mend research into sterility and re- directly through subventions and Health-care questions also con- al methods by which this can be indirectly through the reduction of cern foreign policy. The period treated, such as naprotechnology. taxes. The term ‘contraception’ is when I was the president of the Where one is dealing with fight- frequently abused in order to con- Polish parliament was also the pe- ing against social pathologies, ceal the reality of abortion-induc- riod when the Republic of China public health policy should be sup- ing substances. These substances of Taiwan tried to join the World ported by the action of the Min- aim at the destruction of the life of Health Organisation. Taiwanese istry of Justice and the Ministry for the child but ruin the health of the politicians justified such member- Internal Affairs. The complex ini- mother as well and not rarely aso ship by explaining that it would be tiatives which have been undertak- causes sterility. Abortion-inducing an effective element in steps taken en recently by the Polish govern- substances should simply be pro- against epidemics in East Asia, ment in the fight against the distri- hibited. As regards the Ministry of above all as regards the grave bution of what are called synthetic Health, it should inform people acute respiratory syndrome. We drugs, which are artificial substi- about the secondary effects of con- should be well aware of the fact: tutes for classic drugs, are an im- traception, in line with the obliga- the government of the People’s portant example of such coopera- tion to alert people about the ef- Republic of China wanted to iso- tion. The Ministry of Justice has fects of tobacco. late Taiwan in the international drawn up a law which makes their Unfortunately, Ministries of arena and was opposed to this de- producers responsible as regards Health are habitually obliged not velopment. However, a pragmatic the injurious effects on human only to spread contraception but, approach in the real sense of the health of these substances (even and this is even worse, to propose term made such cooperation op- though, nominally, they are for in- what is called VIP (the ‘voluntary portune. Nonetheless it was neces- dustry and not for consumption). interruption of pregnancy’). sary to give way in the face of the For a period of a year and a half, National education plays a pri- pressure exercised by this great this law compels the Ministry of mary role in the formation of the power. Health to examine such products pro-life approach. ‘Reparative’ With respect to health, there are in a laboratory before they are medicine (to employ the term) is many points which should be the placed on the market. The Min- nothing else but one of the factors subject of international coopera- istry for Internal Affairs is entrust- that contributes to the level of so- tion, and therefore of the efforts of ed with preventing the distribution cial health. Preventive medicine, national governments and of na- of substances which are recog- the promotion of health and the tional diplomacy. One may think nised as being drugs. prevention of the illnesses of here, for example, of the fight The protection of the environ- ‘civilisation’, such as hyperten- against paedophilia. ment is also a question of primary sion, obesity or diabetes, and as a In some countries the minimal importance which needs coopera- consequence their grave conse- age accepted for sexual relations tion between the Ministry of the quences such as vasco-cerebral ac- has been strongly reduced. What is Environment and the Ministry of cidents or heart crises, constitute a Denmark is seen as the freedom of Agriculture. In the first case, one is field in which it is constantly nec- young people (sex between young dealing with analysing possible essary to sensitise the conscience people aged thirteen), is seen in dangers for the safety of people in of citizens. The earlier this educa- Poland as paedophilia. Without the field of health. In the second tion is undertaken, the more effec- any doubt, what has also had grave case, of assuring healthy alimenta- tive will it be. effects has been the propaganda of tion and impeding the injurious ef- Schools have an opportunity to so-called sexual rights without ref- fects of the industrial production impede the propagation of the erence to ethical rules. This propa- of food, including genetic modifi- scourges that ruin health such as ganda certainly contributes to ear- cations. tobacco smoking, alcohol abuse or ly sexual initiation amongst young With respect to the new tech- drug addiction. Given its preven- people. How can all of this be rec- nologies of procreation, like those tive character, health-care policy onciled with the official condem- of food production, all govern- also concerns the Ministry for nation of paedophilia? ments must demonstrate the Sport which has the prerogative of The question of the fight against courage to resist groups that try to influencing – through practical en- paedophilia should also be the sub- exercise all kinds of pressure on couragement and positive motiva- ject of international cooperation, them. This capacity to resist con- tion – the healthy physical devel- addressed within the context of op- stitutes the real test of their politi- opment of young people. position to the pornographisation cal sovereignty, their authority and The question of sexual educa- of mass culture. Before the Sec- arbitration, which depend solely tion is an especially delicate ques- ond World War two conventions on the criteria of the common tion, and not only in Europe. Un- were ratified on the fight against good. fortunately, Ministries of Health pornography. In documents since The interests of the contracep- are often the spokesmen for so- the Second Wold War as well, in tives industry form a pressure called sexual rights and not those particular in the European Con- group which is particularly active moral values which constitute the vention on Cross Border Televi- and destructive. In all countries best protection against the sion of 1989, emphasis is laid upon this pressure group tends to con- scourges of prenatal murders or the safeguarding of decency and quer access to public funds, both the AIDS epidemic. public morality. Today this is noth- DOLENTIUM HOMINUM N. 76-2011 63 ing else but a forgotten law which work of a government should im- man. It equally requires authentic as a result of the efforts of coun- pede the Minister for Health from human solidarity with a view to tries which take into account the forgetting that the protection of impeding a formal or real exclu- common good should be retrieved. health is linked to the good of man sion of those who need support To conclude: the specific role of in his entirety and that this is not a from society. Responsibility is re- the Ministry of Health is to re- simple technical question, and quired on the part of the state. It member, within the context of the even less a field for the interests of follows that this is not a technical framework of duties of each gov- the technological lobbies. These problem of medical doctors or of ernment, the subsidiary function of last should be subjected to the con- medical managers. Technical skills the state which must intervene trol of man which is expressed in must help in this because they are when people themselves do not the sovereign power of a free state an indispensable element of politi- have the means to act. In perform- and a state that is aware of its cal realism, but they cannot re- ing this function of subsidiarity, moral responsibility before God. place it. the state implements the principle Health policy demonstrates how Public health policy cannot be of solidarity. The Ministry of topically relevant is the classic limited to the local frameworks of Health should be the spokesman idea of politics whose spokesman countries, but require, instead, in- for an approach that is right and in the contemporary world is the ternational cooperation. However, based upon natural law, as regards Catholic Church. Pope Pius XII it is the national state and the sense man who is the subject of moral was already warning people about of responsibility of its citizens that rules because of his purpose, upon a technocratic utopia which sought constitute the essential factor in the rights of other people and upon to implement the common good initiating and controlling, at a the common good. The Minister of without concerning itself about moral and democratic level, this Health should equally be the moral decisions and thus without cooperation. spokesman for the ethics of the taking into account moral respon- medical profession which are spe- sibility. Hon. MAREK JUREK cific to our culture and go back to Good health policy requires a Former President of the Lower House the Hippocratic oath. correct vision of man which allows of the Polish Parliament, On the other hand, the team us to recognise the real needs of Poland 64 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

friday 19 WILLEM EIJK november The Good Samaritan is the Greatest Justice

Obviously enough, one sees in ble of the Good Samaritan, who 1. The Christological the Good Samaritan of the parable bent down in front of his suffering Interpretation of the Parable told by Jesus in the Gospel of Luke and martyred neighbour and was of the Good Samaritan (10:25-37) a model that can inspire personally prepared to pay for every health-care worker. He felt him; they make us reflect on the The most fascinating interpreta- pity and washed the wounds of a incomparable dignity of the art of tion of the parable which brings out man ‘who was going down from medicine which is not only formi- in a very special way that the Good Jerusalem to Jericho when robbers dable technology, which requires Samaritan is a model or icon for attacked him, stripped him and constant updating and passion that health-care workers is the Christo- beat him up, leaving him half never goes out, but also self-giv- logical interpretation5 whichistobe dead’ (Lk 10:30). Jesus does not ing, mission, interior flame, and found in the writings of a number of say explicitly to which people or this acquires unique merit before the Fathers of the Church, amongst nation the victim belonged but it is men and inestimable merit before whom Origen,6 St. Ambrose7 and gradually shown that he was a God’.4 This parable acts to demon- St. Augistine.8 Putting to one side Jew.1 Two other Jews, one a priest strate the universality of ‘love to- the variations between these au- and one a Levite, who were travel- wards the needy whom we en- thors, the Christological interpreta- ling down the same road saw him counter “by chance” (Lk 10:31), tion says as follows. The man who andpassedby.Perhapsthey whoever they may be’ (Deus Cari- was coming down from Jerusalem thought that he was dead and thus tas est, n. 25). This universality to Jericho is Adam (Origen)9 or not wanting to be contaminated implies that we must also love an mankind (Augustine).10 Jerusalem they were unable to perform their enemy, according to the words of stands for heaven,11 Jericho is this ritual duties on the basis of a pre- Jesus in the Gospel of Luke: ‘love world (or our condition of mortality cept2 and so did not take care of your enemies, do good to those – Augustine). The robbers are dev- him. The cardinal point, however, who hate you’ (Lk 6:27). ils12 (or enemy powers, the thieves is that not his fellow countryman A health-care worker has pity and brigands of John 10:8, who but a person who belonged to a for a sick person, despite whether came before Jesus, the Good Shep- people that was an enemy of the liking him or her or disliking him herd, according to Origen).13 The Jews,3 a Samaritan, when he was or her. On a battle field, military priest and the Levite refer to the Old passing by saw him and had com- health-care personnel also attend Testament, the law according to the passion for him. ‘He went over to to the victims of the enemy army. Prophets. The Samaritan who him, poured oil and wine on his This conclusion is also shared by washed the wounds, the conse- wounds and bandaged them; then the contemporary secular world. quences of the sin of disobedience, he put the man on his own animal However, in confining ourselves is none other than Christ, the Re- and took him to an inn, where he to this conclusion alone, however deemer. The animal of the Samari- took care of him’ (Lk 10:34). right it may be in itself, we run the tan on which he places the wounded The washing of the wounds of a risk of failing to see the deeper man in order to go to the inn refers man who had been subject to a meaning which for Christian to the body of Christ by which bloody beating makes us immedi- health-care workers is specifically Christ, suffering on the cross, took ately think of the activities of the most fascinating aspect of the our sins upon himself. The inn is the health-care workers. Thus it Good Samaritan as a model for the Church and the innkeeper is the should not surprise us if Paul VI, greatest justice or better the great- leader of the Church (Origen) or the during an address that he gave in est love, ‘charity in Truth’ towards apostles (Ambrose14 and Augus- 1966 to a group of medical doctors the sick. On the one hand, a para- tine15), to whom the Samaritan or of the ENPAS (National Institute ble may appear to be a simple ac- Christ entrusts care for the wound- for the Social Security of Govern- count, and one that can be under- ed man. The declaration of the ment Employees), when referring stood at first sight, of an event that Samaritan that he will return refers to the high human values that their may have really occurred. On the to the return of Christ at the end of noble mission involves, spoke the other hand, a parable ha something the world. Although contemporary following words: ‘These values that is enigmatic. It has to be ex- exegetes no longer apply the alle- are not only human values they are amined and reflected upon so that gorical exegesis of the Fathers of also clearly Christian values; they its deepest meanings can be dis- the Church in general, some theolo- make us think of the gospel para- covered. gians, such as Barth16 and DOLENTIUM HOMINUM N. 76-2011 65

Daniélou,17 attribute great value to Love, expressed in this way, was Such icons are, for example, the the Christological interpretation. expressed in caring for sick people twins and physicians Cosma and One of the arguments employed by not only through providing medical Damian, who were born during the Daniélou to accept the Christologi- treatment to patients, that is to say seond half of the second century cal interpretation is the analogy the medical/technical aspect, but al- and beheaded because of their with the other parables of the New so in caring for them in a broad courageous witness to the Christian Testament which all reveal the mys- sense, in treating sick people who faith. They treated their patients teries of the Kingdom of God, and are poor for free and in looking af- free of charge. Such an icon is also above all the parable of the Good ter sick people during epidemics of St. Alois of Gonzaga (1568-1591) Shepherd where Jesus also speaks the plague in the form of a self-sac- who treated the victims of the about robbers and brigands (Jn rifice, at the risk of one’s own life. plague in a heroic way, as a result of 10:1-18).18 This is a sign that the In the view of Sigerist, Christian- which he himself caught the plague parable of the Good Samaritan must ity, inspired by Christus Medicus as and died at a young age. A more also involve, in the final analysis, a model, led to a radical change in contemporary example is Giuseppe the Kingdom of God. the position of sick people and in Moscati, an internist and lecturer in The identification of the Samari- the organisation of health care, of physiology at the University of tan, who acts as a physician, with which the foundation of hospitals, Naples who lived from 1880 to Christ, further strengthens the anal- which were unknown in antiquity, 1927 and was beatified in 1987 by ogy between the mission of Christ beginning in the fourth century, was John Paul II.27 This medical doctor, and the activities of a physician. By a clear sign.26 who was famous for his talents at an obvious analogy between healing the level of diagnosis, deliberately and redemption, the Fathers of the remained unmarried and practised Church gave Jesus the epithet medicine with great love and devo- ‘Christus Medicus’.19 A further rea- tion towards his patients without son was that Jesus healed many ill- asking fees from them. He lived in a nesses in a miraculous way as a sign very modest way. The Christian that he was the Son of God but also virtue of voluntary poverty out of as an external sign of that redemp- imitation of Christ was something tion from evil for which he was very dear to him. He often pointed made man. Origen (+185-254) out to his patients that the deepest speaks in his Contra Celsum of healing was in the ultimate analysis healing ‘the whole of rational nature the restoration of their relationship and of leading it to familiarity with with God, above all through the God the Creator of the universe sacrament of confession. On the ba- through the remedy of the Logos sis of his deep faith, he established a (that is to say Christ indicated as the relationship between redemption Incarnated Word of God)’.20 Am- and healing, between his faith and brose (339-397) refers to a physi- his profession. He often did this cian who imitated the physician with good results thanks to the great who came from heaven.21 Augustine confidence he inspired in his pa- (354-430) uses the term ‘physician’ tients through his sincere interest more frequently to describe what 2. The Samaritan as an and his personal care for each one Christ did for fallen humanity.22 Inspiring Icon of Christ of them. In his patients he perceived Christ, ‘the ‘true physician’,23 hu- the Physician for Christian the suffering figure of Christ (Mt miliating himself through his suffer- Health-Care Workers 25:31-46) and viceversa they en- ing and his death, became ‘the countered in him something of whole physician for our wounds’.24 The parable of the Samaritan, Christ the Physician. The title ‘Christus Medicus’to who is identified with Christ, is a Giuseppe Moscati, the other explain Christ’s mission as a min- source of inspiration for Christian above-mentioned medical doctors istry of healing was used above all workers who want in their profes- and those who cared for sick people until the sixteenth century, but it sional activity to follow Christ the in a heroic and self-sacrificing way was also employed afterwards by Physician as a model. The figure of were like the Good Samaritan, the both Catholics and Protestants.25 the Samaritan is in a certain sense icon of Christ the Physician and This image also acted as a stimulus an icon of Christ the Physician. An represented something of his care for medical doctors and Christians icon according to the eastern Ortho- for everyone which was full of love. in general to treat the somatic ill- dox tradition is an image which It is clear that not every health-care nesses and wounds of sick people makes present, after a certain fash- worker is called to such an intensive with love of neighbour and compas- ion, the person who is portrayed. imitation of Jesus. In addition, the sion. Love, the core of Christian Thus the saints who followed Christ organisation of health care has ethics, has its roots in the essence of the Physician are in a certain sense changed drastically. The arsenal of God Himself, who is love (cf. Jn icons of him, representing in their diagnostic and therapeutic instru- 4:8). This love was revealed in the behaviour and through the forma- ments that is now available to it has incarnation of Christ as being un- tion of virtues in their being, as grown, and this occurred above all limited, given freely, and sacrificial. well, something of Christ. starting in the 1930s. In today’s 66 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

Western Europe there is no need to Jesus really inverts the roles. subjects of love.29 The teacher of the treat patients without asking for a Contrary to what we would have Law thus does two things. He seeks fee and this is the result of the sys- expected at first sight, the neigh- to limit the number of people for tem of health insurance (although, bour is not the person who is in dan- whom he should feel pity; the ques- for example, a refugee who is in a ger and needs help but the person tion ‘who is my neighbour?’, in- country illegally is often not able to who brings help. It is noteworthy deed, implies that there is also a pay the costs of medical care). that the parable, seen from the point ‘non-neighbour’. In addition, he However, a person who acts as an of view of how Jesus ends it, is not places himself as a helper at the icon must not be copied literally a precise answer to the question of centre of everything. but, instead, can be a source of in- the teacher of the Law about who The parable, however, rather than spiration. his neighbour is. The answer of Je- being told from the point of view of How can one sum up the most sus is based upon a very different the helper is narrated from the point fascinating aspects of the figure of approach. The initial question of the of view of the man who became a the Good Samaritan as an icon of teacheroftheLawrevealsthathe victim of robbers. For this reason, Christ the Physician, or even some- sees himself as the person who the parable implicitly invites its lis- one who is identical with him, for brings help and sees the person who teners, including the teacher of the health-care workers? I would like to needs help as his neighbour. In- Law, to place themselves in the po- point to three noteworthy aspects: stead, Jesus defines as the neigh- sition of the victim. The wounded 1. the inversion of the roles of the bour the person who brings help man is presented as the centre of the person who receives care and the and makes himself a neighbour of movements of the priest, the Levite person who provides care; 2. au- the person who needs help.28 and the Samaritan: whereas the first thentic compassion; 3. being a cus- two in refusing to become his todian/protector of the person with- neighbour not only continue on the out any form of paternalism. their journeys but also pass by, the Samaritan draws near to the wound- 1. The Inversion of Roles ed man in order to wash his wounds, on which he pours oil and When replying to a question of a wine. teacher of the Law about what he Thechangeintheperspectiveof should do to achieve eternal life (Lk the question ‘who is my neighbour’ 10:25), Jesus referred him in the has a special purpose. Whereas the first instance to the famous dual teacher of the Law, placing his own commandment of love for God and own ego at the centre of things, asks love for neighbour (Lk 10:28). who should be the object of love for However, the doctor of the law, neighbour, Jesus, placing the per- wanting to justify himself, said son who needs help at the centre of “Who is my neighbour?” (Lk things, emphasises that one can on- 10:29). The answer of Jesus to this ly find a true answer to that ques- question is more surprising than tion by becoming the bearer of love perhaps one might think at first for neighbour, that is to say by mak- sight. Jesus did not give a direct an- ing oneself a neighbour to anybody swer to this question, namely who is in danger. The conclusion of ‘everyone, without any exceptions’ this parable is to be found in a sin- but instead tells the parable of the gle sentence: ‘wherever and when- Good Samaritan, where he inverts ever I am faced with the need of my the roles of the wounded person and This Jesus himself did. Just as the fellow, I am challenged to act as a the person who provides care. wounded man went down from neighbourtothatperson’.30 This is Superficially, we would have ex- Jerusalem to Jericho, Christ came an intrinsic element of the imitation pected the conclusion to be that the down from heaven to the world and of Jesus. We learn this from the wounded Jew was the neighbour of in making himself man made him- Samaritan who is identified with the Samaritan, that is to say of the self a neighbour to men who needed Christ and who, in seeing the person who helps him. In this case to be healed in soul and body. Jesus wounded man, ‘feels compassion, the only conclusion would be that placed the wounded man at the cen- draws near to him and becomes his one should also consider the mem- tre of this descent. neighbour’.31 ber of an enemy people as one’s The question of the teacher of the A person who helps another per- neighbour for whom one should Law about who his neighbour is re- son has almost automatically the have equal pity. However, Jesus did veals his individualistic and ego- tendency to place himself at the not end in this way but inverted the centric character. He places himself centre of the circle, seeing the sick roles. After telling the parable he at the centre of concentric circles: man as a neighbour who needs his asked the teacher of the Law: “In he is at the centre of a circle of peo- or her help. The parable of the Good your opinion, which of these three ple, each one of whom is his neigh- Samaritan invites all health-care acted like a neighbour towards the bour. Outside this circle there is an- workers to invert the roles – to see man attacked by the robbers” (Lk other larger circle of people who are not themselves but the sick person 10:36). not defined as neighbours, as the as a subject who is at the centre of DOLENTIUM HOMINUM N. 76-2011 67 the health-care world. The parable to carry the wounded man to the inn protector of Israel never dozes or exhorts us not to see the sick person a reference to the body of Christ by sleeps’.33 In this context Ambrose, as an object but as a subject of med- which Christ took on the burdens of in calling the Samaritan, who is ical care who is made a neighbour our sins. Whatever the case, the fig- identified with Christ, a custodian, by the health-care worker who is a ure of the physician, himself bases himself on psalm 116,6: ‘The bearer of love for him or her. wounded, is seen in Christ most in- Lord protects the helpless’.34 tensely when he gave his life for our The meaning of the term ‘custo- 2. Authentic Compassion redemption on the cross. Jesus, al- dian’ is expressed in a negative way though he was the Son of God, also by Cain who, after killing Abel, an- The reason why the Samaritan made himself man, subjected him- swers God’s question as to the makes himself a neighbour of the self to our human existence (Phil whereabouts of his brother in the wounded man is that when seeing 2:6-11), and came to identify him- following way: “I don’t know. Am I him he feels compassion for him. self with suffering man. Christ, in supposed to take care of my broth- This is, expressed by the Greek allowing the righteous to enter his er?” (Gen 4:9). word ‘εσπλαγνι′σθη’. This verb Kingdom, gives as a reason, We health-care workers, who are comes from the noun ‘σπλα′νχνα’, amongst others, that they visited called to follow Jesus in line with that is to say ‘innards’. One is deal- him when he was sick. To their the model of the Samaritan, are also ing, therefore, not with a superficial question as to when they did this, he called to become custodians of our compassion but a profound com- will reply: “I tell you, whenever brothers and sisters who are sick. passion that touches the interiority you did this to one for one of the Being such custodians excludes any of the Samaritan and leads him to least important of these members of form of paternalism and implies full act, that is to say to clean the my family, you did it for me! (Mt respect for the justified freedom of wounds of the victim and to take 25:40). sick people, just as Christ gives us himtoaninnwherehecanrecover The Good Samaritan as an icon all freedom to be healed by him or until the time when he can return to of Christ emphasises that the true otherwise. his journey. Here it is interesting to compassion that is needed to make point out that in Dutch and German oneself a neighbour to a sick person reference is made to the ‘compas- implies that one is able to put one- 3. Epilogue sionate Samaritan’, in the sense of self in his or her shoes. We also en- being charitable (‘barmhartige’ and counter this idea in a precise quota- In this context it has to be ob- ‘barmherzig’). tion from Hippocratic writings: served that unfortunately the pre- The compassion that is required ‘with the pain of the other a physi- sent bureaucratic health-care sys- should not be confused with super- cian receives his own pain’.32 tem does not make it very easy for ficial pity. It implies that we feel It is clear that for us it is often not the health-care worker to follow the sympathy for the person and where possible to place ourselves totally Good Samaritan as his or her mod- possible put ourselves in his or her in the shoes of another person. This el. Under the pressure of the ideolo- shoes. Compassion could not be requires both the experience and gy of the free market of the Western anything else given that it is a form maturity by which a health-care world, health-care institutions see of imitating Christ the Physician worker is able to look at his or her themselves forced to reduce costs, who was made man and thus shared suffering and impefections in the thereby reducing personnel to the our existence: ‘Let us, then, hold face and to integrate them into his utmost and employing them ac- firmly to the faith we profess. For or her own life. However, Christian cording to criteria that are unilater- we have a great High Priest who has care in a broad sense requires a cer- ally economic in character. gone into the very presence of God tain solidarity on the part of the Through protocols it is laid down – Jesus, the Son of God. Our High health-care worker towards the suf- how much time, calculated to the Priest is not one who cannot feel fering person that is analagous to last minute, a contract with a med- sympathy for our weaknesses. One the solidarity of the Samaritan to- ical doctor or a nurse for certain ac- the contrary we have a High Priest wards the wounded man and, in the tivities can last so as to be able to who was tempted in every way that ultimate analysis, the solidarity of control costs.35 It is clear that in we are, but did not sin…In his life Jesus towards all of us. such a system interpersonal rela- on earth Jesus made his prayers and tionships between health-care requests with loud cries and tears to 3. Being a Custodian/Protector workers are under pressure. Be- God, who could save him from without any Paternalism cause of this development a notable death. Because he was humble and number of health-care workers, and devoted, God heard him. But even A notable element is that the above all nurses, given that they no though he was God’s Son, he learnt Samaritan, who is identified with longer see the possibility of living through his sufferings to be obedi- Christ, is called in Latin a ‘custos’, their professional work as a voca- ent. When he was made perfect, he which in English can be translated tion, experience feelings of malaise. became the source of eternal salva- by ‘custodian’ or ‘protector’, of the On the one hand, we should not tion for all those who obey him’ wounded man. Origen saw in the underestimate the financial prob- (Heb 4:14-15; 5:7-9). Hebrew word for Samaritan (‘šôm- lems that health care is fighting The Fathers of the Church cited rôn’) a link with the participle against at the present time. On the above saw in the animal of the ‘šômêr’ which means ‘custodian’ or other hand, we should not, howev- Good Samaritan that this latter used ‘guardian’ in psalm 121, 4: ‘The er, become resigned to this situation 68 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

and thus abandon the Good Samar- 5 Cf. R. ROUKEMA,‘TheGoodSamaritanin 21 AMBROSE, De Helia e ieiunio 20,75 Ancient Christianity’, Vigiliae Christianae 58 (CSEL 32II, p. 458). itan as a model for health-care (2004), n. 1, pp. 56-74. 22 R. ARBESMANN, ‘The Concept of ‘Chris- workers. A health-care system that 6 ORIGEN, In Lucam Homiliae XXXIV tus Medicus’ in St.Augustine’, Traditio 10 does not sufficiently allow health- (Fontes Christiani 4/2, pp. 336/337-344/345). (1954), pp. 1-28. The homilies of Origen on Luke were con- 23 AUGUSTINE, De Civitate Dei 4,16 (CCSL care workers to realise their funda- served only in a Latin translation by St. 47, p. 112): ‘Ad quam (quietam) vacat verus mental vocation to become neigh- Jerome.Girolamo. medicus dicens: Discite a me, quoniam mitis bours to the people who are entrust- 7 AMBROSE, Expositio Evangelii Secundum sum et humilis corde, et invenietis requiem an- Lucam, VII, 69-84 (CCSL XIV, pp. 236-241). imabus vestris (Mat. 11,29)’. ed to their care in their professional 8 AUGUSTINE, Quaestiones Evangeliorum II, 24 AUGUSTINE, In Joannis Evangelium 3,3 activity implies in the final analysis XIX (CCSL XLIV B, pp. 62-63). (PL 35, col. 1397): ‘... totus medicus vulnerum a social injustice. According to the 9 ORIGEN, In Lucam Homiliae XXXIV, 3; nostrorum’, cf. Ibid., 25,16. Origen here cites an unknown presbyter Origen 25 H. SCHIPPERGES, ‘Zur Tradition des principle of subsidiarity (cf. denies that the man who waas going down from ‘Christus Medicus’ im frühen Christentum Quadragesimo Anno, nn. 79-80; Jerusalem to Jericho is everyman (ibid.,4). und in der älteren Heilkunde’, Arzt und Christ applied more to the international Roukema concludes that Origen as a Platonist, 11 (1965), pp. 16-19. without saying so explicitly, supposes that the 26 H. SIGERIST, Civilization and Disease, level in Caritas in Veritate nn. 47; coming down from heaven to the world refers (Chicago, University of Chicago Press, 1943), 57), state and health-care authori- to the fall of pre-existing creatures from heaven pp. 69-70. ties have the task of creating a because of sin; this would imply that Origen 27 G. INFUSINO, Un santo in corsia. understands heaven to be the sky (R. Roukema, Giuseppe Moscati (Cinisello Balsamo, Milan, health-care system where health- ‘The Good Samaritan in Ancient Christianity’, Edizioni Paoline, 1987); G. Papàsogli, care institutions and health-care p. 63). Giuseppe Moscati. Das Leben eines heiligen workers can fulfil their call to fol- 10 AUGUSTINE, Quaestiones Evangeliorum II, Arztes (Stein am Rhein, Christiana-Verlag, XIX, 2. 1982). low Christ the Physician par excel- 11 In the view of Origen probably the skyo 28 Cf. BENEDICT XVI, “Angelus” (11 July lence in line with the icon of the (see the footnote on p. 10), in the view of Am- 2010): ‘This time Jesus answers with famous Good Samaritan. brose and Augustine earthly paradise. parable of the ‘good Samaritan ‘(cf. Lk 10:30- 12 AMBROSE, Expositio Evangelii Secundum 37) to point out that it is our task to make our- Lucam, VII, 73; Augostine, Quaestiones Evan- selves a ‘neighbour’ to anybody who is in need H.E. Msgr. WILLEM EIJK geliorum II, XIX, 6-7. of help’. Archbishop of Utrecht, 13 ORIGEN, In Lucam Homiliae XXXIV, 4. 29 Cf. H. HENDRICKX, The Parables of Jesus, 14 AMBROSE, Expositio Evangelii Secundum p. 84. The Netherlands, 30 Member of the Governing Council of Lucam, VII, 81-82. Ibid., p. 89. 15 AUGUSTINE, Quaestiones Evangeliorum, 31 ORIGEN,InLucam Homiliae XXXIV, 6: the Pontifical Council for Life, II, XIX, 26-27. ‘...misertus accessit ad eum, ut fieret eius the Holy See. 16 K. BARTH, Die Kirchliche Dogmatik,Bd. proximus’. III, 2 (Zurich, A.G. Zollikon, 1948), p. 250; Bd. 32 De Flatibus,I,7-8,in:Hippocrates, IV, 1 (Zurich, A.G. Zollikon, 1953, p. 115. translated by W.H.S. Jones (London, William 17 J. DANIÉLOU, ‘Le Bon Samaritain’, in Heinemann, 1923), vol. II, pp. 226/227. Notes Mélanges Bibliques rédigés en l’honneur de 33 ORIGEN, In Lucam Homiliae XXXIV, 5; André Robert (Paris, Bloud & Gay, 1956), pp. cf. R. Roukema, ‘The Good Samaritan in An- 1 The quotations from the Bible come from 457-465. cient Christianity’, p. 64. the Good News Bible. Today’s English Version, 18 Ibid., pp. 460-461. 34 AMBROSE, Expositio Evangelii Secundum published by the American Bible Society, 4th. 19 In addition they also promoted this epithet Lucam, VII, 74. edn., New York, 1976. in order to combat the cult of Asklepios, the 35 Cf. W.J. EIJK, ‘Modelli etici per la ges- 2 J.J. KILGALLEN, Twenty Parables of Jesus Greco-Roman god of medicine who was also tione della salute’ (paper given to the Twelfth in the Gospel of Luke (Pontificio Istituto Bibli- venerated as a saviour and physician, according International Conference of the Pontifical co, Rome, 2008, Subsidia Biblica 32), pp. 33- to K.H. Rengstorf, Die Anfänge der Auseinan- Council for Pastoral Assistance to Health Care 34. dersetzung zwischen Christusglaube und Askle- Workers ‘Church and Health in the World: 3 Ibid., pp. 29-31. piosfrömmigkeit (Münster, Aschendorff, 1953). Hopes and Expectations on the Threshold of 4 PAOLO VI, ‘Discorso ai medici del- 20 ORIGEN, Contra Celsum 3,54 (SC 136, p. the Year 2000’), Dolentium Hominum 13 l’E.N.P.A.S’ (6 October 1966). 128; cf. 4,15). (1998), n. 37, pp. 58-63. DOLENTIUM HOMINUM N. 76-2011 69

MASSIMO PETRINI The World of the Future: Demographic Prospects and Heath Needs

In the encyclical letter of Pope ulation, with the consequences that people every year) and of more Benedict Caritas in Veritate there is this fact involves. This is a scenario than 2,498 million people in the a statement which should be seen as that began during the course of the South of the world (including the a preliminary warning about a read- twentieth century and which can be emigration of 2-3 million people ing of the demographic data on the described in the following way:1 a) every year). world’s population and in particular a world population that is still In particular, for the fifty poorest of the data that refer to the health growing in terms of numbers; b) a countries of the world it is calculat- needs of the world of the future. numerical decline in the popula- ed that for the period between the This statement is as follows: ‘The tions of many developed countries year 2008 and the year 2050 there risk for our time is that the de facto (which is mitigated in some cases will be an increase of 918 million interdependence of people and na- by sizeable immigration flows); c) a people (from 824 million to 1,742 tions is not matched by ethical in- decrease in birth rates which in million), equal to an increase of teraction of consciences and minds many countries has been going on 114%; as regards countries that are that would give rise to truly human for a long time and where birth rates at the present time developing development. Only in charity, illu- are ‘excessively low’; d) a decrease countries, the intermediate coun- mined by the light of reason and in death rates, in the elderly age tries, which include those with the faith, is it possible to pursue devel- bands as well, with a consequent in- highest economic growth rates, opment goals that possess a more crease and spread of long life ex- such as Brazil, China and India, it is humane and humanizing value’ (n. pectancy; e) a very major increase calculated that there will be an in- 9), and one could add that only in in those parts of the population of crease of 1.5 milliard people (from this way is it possible to use the in- working age in the less economical- 4,770 million to 6,200 million), formation that demographic and ly advanced countries of the world; equal to an increase of 32%; and health-care data can provide. These f) an increase in the elderly age with respect to the most developed data describe demographic, eco- band in particular, but not only, in countries it is calculated – albeit nomic, political, social and health- developed countries, with a drastic taking into account an immigration care situations, but behind these da- increase in the number of elderly from less developed countries of ta there are ‘people’. people and a drastic reduction in the about 2 million people a year – that This statement means that it is numbers belonging to the age bands there will be a growth of only 19 not possible to engage in a reading made up of children and adoles- million people (from 1,226 million that operates only at the level of cents; g) a more frequent and pro- to1,245 million), that is to say sub- knowledge. As this encyclical goes longed co-existence of three to four stantially a zero growth rate, or on to say: ‘The urgency is in- generations within the same popu- roundabout 2%. scribed not only in things, it is not lations; h) a notably more urbanised This an increase in the population derived solely from the rapid suc- population concentrated in vast of the world that should be read cor- cession of events and problems, megalopolises, above all in the rectly, quite beyond the concerned but also from the very matter that is South of the world, and sprawling concerns about a greater sharing of at stake: the establishment of au- urban areas of a notably large range existing resources. Indeed, Pope thentic fraternity. The importance above all in the North of the world; Benedict XVI observes that: ‘To of this goal is such as to demand and i) an increase in international consider population increase as the our openness to understand it in migrations and a rather strong in- primary cause of underdevelop- depth and to mobilize ourselves at crease in ethnic diversity within im- ment is mistaken, even from an eco- the level of the “heart”, so as to en- migrant populations. nomic point of view. Suffice it to sure that current economic and so- The complexity of these major consider, on the one hand, the sig- cial processes evolve towards fully and difficult challenges can be nificant reduction in infant mortali- human outcomes’ (Caritas in veri- summed up in two facts that relate ty and the rise in average life ex- tate, n. 20). to the demography of the world in pectancy found in economically de- The scenario of the world is char- the year 2050: it is calculated that veloped countries, and on the other acterised by notable mutations. For there will be a population increase hand, the signs of crisis observable the first time in history we are faced of more than 22 million people in in societies that are registering an with extraordinary demographic the North of the world (including alarming decline in their birth rate’ changes as regards the world’s pop- the immigration of 2-3 million (Caritas in veritate,n.44). 70 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

Although the decline in death tion of the world in the year 2005 year 2005 does not mean therefore rates and the decline in birth rates and the envisaged population of the to refer to abstract figures which ap- marked the demographic scenario world in the year 2050, by major pear in graphs or table. It means, of almost all countries and brought age bands (in millions). rather, to refer to a great extent to about what has been defined as the real people who are already alive on first demographic transition, for A clarification should be made: the planet earth.2 some decades now we have been to speak about the year 2050 means The relevant fact is the notable witnessing a second demographic referring to people who are present- deformation of the structure of the transition due to, and characterised ly already alive: a person born in world’s population in age terms by, lasting and very low birth rates 2000 will be 50 years old in the year and, in parallel with this, the very accompanied by a further decline in 2050, although a person born in great ageing of the population. At a death rates which has been espe- 2010 will be only 40. Taking into detailed level, the developed coun- cially concentrated in the elderly account that it is expected that aver- tries will have to face up to an age- age bands. This phenomenon has age life expectancy will increase to ing of very great intensity and re- led to the ‘ageing of populations’, 85, this means that a little more than duced velocity, given that the pro- in particular in the developed coun- 60% of the population that will be portion of people over sixty years of tries of the world. alive in the year 2050 will, with all age in their populations as a whole This situation is described in the probability, have been already alive should, in the year 2050, be over table 1 which describes the popula- in the year 2008. To speak about the 32%; countries of intermediate de- Table 1 Increase Increase %oftotal % of total 2005 2050 % 2005 2050

Part of the Population Aged Less that 15 World 1.844 1.829 -15 -0.8 28.3 19.9 Developed countries 207 189 -18 -8.6 17.0 15.2 Developing countries 1.637 1.637 0 0 30.9 20.6

Part of the Population of Working Age of 15- 65 Years of Age World 4.196 5.873 1.677 40.0 64.4 63.9 Developed countries 823 731 -92 -11.2 67.7 58.7 Developing countries 3.374 5.141 1.767 52.4 63.6 64.7

Part of the Population Aged 65 or More World 476 1.489 1.013 212.8 7.3 16.2 Developed countries 186 325 139 74.7 15.3 26.1 Developing countries 291 1.168 877 301.4 5.5 14.7 Source: Golini’s calculations based on data of the United Nations, 2007

Table 2 Area or Country 2000-2005 2005-2050 Increase Increase % World 65 75 10 15 Developed countries 78 84 6 8 Europe 78 83 5 6 Japan 82 88 6 7 United States 77 82 5 6 Canada, Australia, New Zealand 80 85 5 6 Economies in transition 65 74 9 14 Union of Independent States 65 74 9 14 South-east Europe 74 80 6 8 Developing countries 63 74 11 17 Latin America and Caribbean 72 79 7 10 East Asia and the Pacific 70 78 8 11 South Asia 63 75 12 19 West Asia 68 78 10 15 Africa 49 65 16 33 Source: Golini’s calculations based on data of the United Nations, 2007 DOLENTIUM HOMINUM N. 76-2011 71 velopment will have to face up to an up of 3,377 million people and the from one continent to another, the ageing of very great intensity and urban population to be made up of costs per capita of instruction, of very great velocity, with the number 3,294 people; it is expected that the housing, of health care, and of hy- of people over the age of sixty be- increase between the years 2007 giene systems are lower than in the ing a little over a milliard in number and 2005 will be only 49 million as countryside.3 The experience of (from 391 million people to 1,398 regards the rural population and China, however, demonstrates that million people), with a percentage 1,290 million as regards the urban a rapid and immense development increase of 239%; and countries population – 1,106 million of these of large cities can involve an in- with a minimal development will will be in developing countries. It is crease in poverty, pollution and so- have to face up to an ageing of low- calculated that after the year 2025 cial turbulence. er intensity but very great velocity, the urban population will increase An important role in demograph- with an increase of 320%. more but that the rural population ic transformations has been per- Table 2 describes average life ex- will decrease with greater intensity. formed, and will be performed, by pectancy in some regions of the The experts believe that this international migration, even world, taking life expectancy for trend should be adjudged positively though as regards this phenomenon the years 2000-2005 and envisaged given the importance of urbanisa- one cannot refer to specific demo- life expectancy for the years 2045- tion for economic growth and the graphic regimes. There is uncer- 2050. wellbeing of people, and indeed to tainty in assessing the role of this such an extent that they state that factor in the future because there To express a simple demographic the growth of cities will the princi- are many factors which can influ- fact: by 2050 there will have been pal factor influencing the econom- ence its evolution: from the most an increase of 1,300 million people ic-social development of the twen- relevant factor, which is connected of over sixty years of age whereas, ty-first century, and this despite the with the equilibrium of the interna- and this is another relevant phe- fact that a milliard people will live tional economy, to the migration nomenon, in countries of intermedi- in shanty towns in overcrowded policies of the host and departure ate development and in poorer conditions without access to essen- countries, and on to economic op- countries with a minimal develop- tial services such as drinking water portunities, not to speak of refugees ment there will be one and a half and sewerage. However, it is ob- who often constitute flows from po- milliard people of working age, a served, all the evidence demon- litically unstable countries to coun- development that will challenge the strates that the rural population has tries which are equally poor but po- possibilities of creating, and the less access to the key services of litically stable.4 ability to create, jobs, and jobs with contemporary life compared to the Here it is important to describe dignity. inhabitants of small cities, who in the decline in birth rates which is Another element that should be their turn have less services than still a worldwide phenomenon, as is considered is the development of their counterparts in the large cities. demonstrated by the table 3 which sustained urbanisation, although we As a consequence, levels of nutri- provides a comparison between the have to take into account that in the tion, of health and of instruction are average number of children for year 2008 the urban population was worse in rural areas than in small each woman in some regions of the already larger than the rural popula- cities, where, however, they are world (for the years 2000-2005) tion. In the year 2007 the rural pop- lower than in large cities where, and the corresponding number en- ulation was calculated to be made with notable differences existing visaged for the years 2045-2050.

Table 3 Area or Country 2000-2005 2005-2050 Increase Increase % World 2.6 2.0 -0.6 -23 Developed countries 1.6 1.8 +0.2 +13 Europe 1.4 1.8 +0.4 +29 Japan 1.3 1.9 +0.6 +46 United States 2.0 1.9 -0.1 -1 Canada, Australia, New Zealand 1.6 1.9 +0.3 +19 Economies in transition 1.6 1.8 +0.2 +13 Union of Independent States 1.6 1.8 +0.2 +13 South-east Europe 1.6 1.8 +0.2 +13 Developing countries 2.9 2.1 -0.8 -28 Latin America and Caribbean 2.5 1.9 -0.6 -24 East Asia and the Pacific 1.9 1.9 0. 0 South Asia 3.2 1.9 -1.3 -41 West Asia 3.5 2.0 -1.5 -43 Africa 5.0 2.5 -2.5 -50 Source: Golini’s calculations based on data of the United Nations, 2007 72 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

But here we should remember have gone from 2,450 people then trol over the causes and the conse- the reading of this phenomenon to 2,735 million today5. But the quences of the majority of patho- which is engaged in by Pope Bene- problem of poverty is not to be logical processes.7 dict XVI in his Caritas in Veritate confined to certain countries Although this applies to devel- when he observes that: ‘some alone. oped countries, where there is parts of the world still experience Pope Benedict XVI rightly ob- even discussion about an exces- practices of demographic control, serves in Caritas in Veritate that: sive use of new medical technolo- on the part of governments that of- ‘The world’s wealth is growing in gies which may compromise the ten promote contraception and absolute terms, but inequalities sustainability of existing health- even go so far as to impose abor- are on the increase. In rich coun- care systems without bringing tion. In economically developed tries, new sectors of society are about improvements in the state of countries, legislation contrary to succumbing to poverty and new health of the population, the situa- life is very widespread, and it has forms of poverty are emerging. In tion of countries in the South of the world is very different. In these countries, the majority of the pop- ulation is excluded from the possi- bility of having access to health- care services and to medical prod- ucts. An indicative fact is the compar- ison in the world rankings of aver- age life expectancy: over forty years of life separate men in those countries where men live longest (82-79 years in Australia, Iceland, Italy, Japan, Sweden, Switzerland) from those countries where men live the least (37-39 years in Sierra Leone, Swaziland and Angola). In the case of women, the gap is even greater, with almost fifty years of difference between the 86 years of Japan and the 37 years of Swazi- land.8 But on the other hand there is the high death rate of children under the age of five (the best doc- umented in terms of statistics). In the Countdown report of 2008, an already shaped moral attitudes and poorer areas some groups enjoy a independent initiative sponsored praxis, contributing to the spread sort of “superdevelopment” of a by the United Nations and by oth- of an anti-birth mentality; frequent wasteful and consumerist kind er international organisations, at- attempts are made to export this which forms an unacceptable con- tention is drawn to a dramatically mentality to other States as if it trast with the ongoing situations of grave situation in the mother/child were a form of cultural progress. dehumanizing deprivation. “The sector both in terms of health and Some non-governmental Organi- scandal of glaring inequalities” in terms of the organisation of zations work actively to spread continues. Corruption and illegali- health-care services for a signifi- abortion, at times promoting the ty are unfortunately evident in the cant part of humanity which pro- practice of sterilization in poor conduct of the economic and polit- duces a little less than ten million countries, in some cases not even ical class in rich countries, both deaths a year of children under the informing the women concerned. old and new, as well as in poor age of five and over half a million Moreover, there is reason to sus- ones’ (n. 22). deaths of mothers (about 50% of pect that development aid is some- As regards the health of the this death rate is concentrated in times linked to specific health-care world’s population, one should re- sub-Saharan Africa).9 policies which de facto involve the member the process of ‘health- In beginning her job at the be- imposition of strong birth control care transition’6 which has already ginning of 2007, the new Director measures’ (n. 28). been described in this paper and General of the World Health Or- From an economic point of which has led life expectancy to ganisation, Margaret Chan, from view, these data indicate a shift of reach general levels never imag- China, once again placed stress people who twenty years ago lived ined before in history and to which upon primary health care (PHC) as on less than one American dollar a have contributed, above all in re- a strategy for the strengthening of day (1,482 million people, now cent years, great scientific and health-care systems as the best 1,093 million people) to the cate- technological advances, which, in way by which to assure the sus- gory of those who live on less than their turn, have led medical sci- tainability of improvement in two American dollars a day, who ence to exercise an increasing con- health and best guarantees for fair- DOLENTIUM HOMINUM N. 76-2011 73 ness in access,10 albeit in a context of their development in a spirit of Health Organisation has tried to that is by now globalised which self-confidence’. This principle as- make operative two strategies and has new challenges that have to be signs to states and their agencies has done this since the beginning addressed: urbanisation, the age- tasks that go well beyond the sim- of the 1980s. These strategies go ing of populations, the contamina- ple management of health-care under the name, respectively, of tion of the environment, changes systems. They should take respon- ‘health promotion’ and ‘health in lifestyles and the consequences sibility for identifying, and trying strategy for all’, and seek to trans- of these changes for health, the in- to change through suitable al- form a principle into a practical crease in the incidence of chronic liances, those factors that have a plan at the level of individual gov- illnesses, obesity, the emergence negative influence on collective ernments. of new infectious diseases and the health, promoting at the same time The ten principal individual risk re-emergence of already known those factors that are favourable to factors at a global level indicated diseases which are resistant to an- such health. by the World Health Organisation tibiotics, migrations, the globalisa- Primary health care, that is to in its World Health Report are: low tion of the labour market and the say basic health care, must be an weight and malnutrition, unpro- removal of health-care personnel integral part of the health-care sys- tected sexual relations, arterial hy- from countries where they are tem of each country but above all pertension, tobacco smoke, alco- most needed, the growing gap be- of the overall social and economic hol, undrinkable water and hy- tween North and South, between development of society, in a vision giene deficiencies, excessive cho- urban and rural areas, between the based upon fairness, on communi- lesterol, lack of iron, and obesity. rich and the poor. tarian participation, on attention Even though there are many possi- Primary health care is defined in centred around prevention, on ap- ble definitions of ‘risk’, in this the following way: ‘basic care is propriate technology and on an in- field it is defined as ‘the likelihood essential health care based upon ter-sectorial approach which is in- of an adverse outcome or a factor practical methods and technolo- tegrated with development. that increases this possibility’. gies that are scientifically valid This definition certainly has a Table 4 lists the number of and socially acceptable, made uni- ‘utopian’ character inasmuch as is deaths (in millions) and their re- versally accessible to the individu- describes a situation of complete spective causes, comparing coun- als and to the families of a commu- satisfaction which is difficult to tries with low individual incomes nity through their full participation achieve, but it constitutes a point ($US 825 or less) with those where at a cost that the community and of reference for the direction of the individual incomes are high ($US countries can afford at every stage efforts that are made. The World 10,066 or more). Table 4 - Ranking of selected risk factors: 10 leading risk factor causes of death by income group, 2004

Deaths Percentage Deaths Percentage Risk factor (millions) of total Risk factor (millions) of total World Low-income countries* 1 High blood pressure 7.5 12.8 1 Childhood underweight 2.0 7.8 2 Tobacco use 5.1 8.7 2 High blood pressure 2.0 7.5 3 High blood glucose 3.4 5.8 3 Unsafe sex 1.7 6.6 4 Physical inactivity 3.2 5.5 4 Unsafe water, sanitation, hygiene 1.6 6.1 5 Overweight and obesity 2.8 4.8 5 High blood glucose 1.3 4.9 6 High cholesterol 2.6 4.5 6 Indoor smoking from solid fuels 1.3 4.8 7 Unsafe sex 2.4 4.0 7 Tobacco use 1.0 3.9 8 Alcohol use 2.3 3.8 8 Physical inactivity 1.0 3.8 9 Childhood underweight 2.2 3.8 9 Suboptimal breastfeeding 1.0 3.7 10 Indoor smoking from solid fuels 2.0 3.3 10 High cholesterol 0.9 3.4 Middle-income countries High-income countries* 1 High blood pressure 4.2 17.2 1 Tobacco use 1.5 17.9 2 Tobacco use 2.6 10.8 2 High blood pressure 1.4 16.8 3 Overweight and obesity 1.6 6.7 3 Overweight and obesity 0.7 8.4 4 Physical inactivity 1.6 6.6 4 Physical inactivity 0.6 7.7 5 Alcohol use 1.6 6.4 5 High blood glucose 0.6 7.0 6 High blood glucose 1.5 6.3 6 High cholesterol 0.5 5.8 7 High cholesterol 1.3 5.2 7 Low fruit and vegetable intake 0.2 2.5 8 Low fruit and vegetable intake 0.9 3.9 8 Urban outdoor air pollution 0.2 2.5 9 Indoor smoking from solid fuels 0.7 2.8 9 Alcohol use 0.1 1.6 10 Urban outdoor air pollution 0.7 2.8 10 Occupational risks 0.1 1.6 * Countries grouped by gross national income per capita - low income (US$ 825 or less), high income (US$ 10 066 or more). 74 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

Experience with anti-retrovirals – Type I diseases, which afflict with methods that are debatable at in the treatment of HIV/AIDS both rich and poor countries, an ethical level – the control of in- demonstrates that the obligatory everywhere causing a high number dividual diseases, etc.) has led in liberalisation of patents adopted by of illnesses and deaths. Amongst any countries to a disruption of the certain governments has allowed non-transmissible diseases, to this work of public health with a multi- the introduction of new general category belong: diabetes, cardio- plication of costs and a waste of re- medical products in a number of vascular diseases, dementia, tu- sources, without mentioning the poor countries. However, although mours and so forth; amongst trans- total breakdown of development all countries agree on the absolute missible diseases, to this category initiatives that should be carried need for an international agreement belong: measles, hepatitis B, etc. out in other sectors (public instruc- which, although not binding, would Many vaccines and many kinds of tion, agriculture, production, etc.). have an enormous political impact, treatment have been created to In the same way, divisions and the identification of concrete initia- combat some of these diseases but programmes directed at specific tives that go beyond declarations of they encounter obstacles at the lev- diseases have taken on a dispro- principle in favour of the protection el of their diffusion in poor coun- portionate role within the World of the health of poorest populations tries because of their high cost. Health Organisation itself as re- is slow to emerge. Here we also – Type II diseases, which are gards the resources allocated to the have to take into account the resis- widespread in both rich and poor development of health-care sys- tance of the pharmaceutical indus- countries but with a clearly higher tems and integrated action for the try which is motivated from the out- level of cases in poor countries. promotion of health. Attention has set by the costs of research.11 How- HIV/AIDS and tuberculosis are moved away from health and be- ever, one should add that it would examples of these kinds of dis- come focused upon diseases. For be ungenerous to attribute to the eases: both are present in rich example, the funds given by spon- laws of the market, to pharmaceuti- countries and in poor countries, sors to health-care sectors are of- cal multinationals and to the gov- but more than 90% of cases are to ten directed towards combating in- ernments of rich countries the be found in the poor countries of dividual diseases such as AIDS, whole of the responsibility for the the world. tuberculosis, malaria, polio, etc. lack of access to the most effective – Type III diseases, which exclu- Between the year 2000 and the medical products. The following sively afflict the poor countries of year 2004 funds for combating table demonstrates that none of the the world. Here we encounter Cha- HIV/AIDS more than doubled and players involved can escape criti- gas’ disease, dengue and haemor- funds for primary care were cism and it also shows how the rhage dengue, leishmaniosis, lep- halved.14 prices of medical products are also rosy, lymphatic filaria, malaria, How much this policy helps to influenced by policies of govern- river blindness (onchocerciasis), improve the state of health of ments which are not always under- sleeping sickness, and gangrenous whole populations, as many peo- standable. Table 5 illustrates the im- stomatitis. Many of these patholo- ple think happens, is debatable. pact of tariffs and taxes on the retail gies are completely unknown in The contribution of health-care prices of medical products in cer- developed countries or belong, services to an improvement in the tain countries:12 like leprosy or malaria, to a more state of health of populations is or less remote past, but they con- marginal and limited. The health Table 5 stitute a grave risk at the level of of entire populations depends Country Tariffs and Taxes illness for the poorest populations more on the availability of food, India 55 of the world. water, instruction, work and de- cent housing than on the availabil- Sierra Leone 40 These are the diseases that are ity and quality of health services. Nigeria 34 often defined as being ‘neglected Another misunderstanding that is Pakistan 33 diseases’ by scientific research frequently encountered, and which given that they do not produce a after a certain fashion contributes Bolivia 32 market of consumers (those peo- to exaggerated expectations, is that Bangladesh 29 ple, that is to say, who in addition in poor countries people fall sick China 28 to expressing a need also have ad- or die because of illnesses such as equate purchasing power) that is diarrhoea, measles, respiratory in- Jamaica 27 sufficient to justify investment in fections and others which could be Morocco 25 research. easily cured or prevented. If these Georgia 25 But the level of health of a pop- illnesses were easily preventable ulation does not only depend on or curable it would be easy to pre- Mexico 24 the level of health care – it is also vent or cure them. This is not the the result of a number of factors: case because even the simplest In order to define the needs at the health-care factors, economic fac- methods are difficult and expen- level of intervention in a more ef- tors, social factors and more gen- sive to apply in contexts of acute fective way, the World Health Or- erally cultural factors. A reorgani- poverty where a few litres of water ganisation drew up a classification sation of health-care systems of dubious quality can cost a four, which identifies three major groups through vertical programmes (vac- six or even eight hours’ journey; of diseases:13 cinations, family planning – albeit food is rarely sufficient; people’s DOLENTIUM HOMINUM N. 76-2011 75 homes are unhealthy huts, hygiene tions (the Committee on Econom- tions that are absolutely inade- is a luxury; and education is ab- ic, Social and Cultural Rights) quate, without access to drinking sent. When these (and other) fac- states that the right to health water, to hygiene services, to safe tors come to be corrected in line should not be seen as the right to food, to decent shelter and work, with justice and decency, the ill- be healthy, which is not possible, and which can only cause a deteri- nesses that kill the poor people of but as the right to have access to a oration in general living condi- the world will be easily pre- variety of goods, services and con- tions and an increase in health-care ventable and curable. But not be- ditions which are required for the risks as well. To all this is added fore.15 achievement of the highest possi- specific health-car risks which to- Pope Benedict XVI observes in ble standard of health. This com- day are obstacles in the way of a Caritas in Veritate that ‘In devel- mittee interprets the right to health further improvement in health opment programmes, the principle as an inclusive right that concerns care. The development of a grow- of the centrality of the human per- not only appropriate and speedy ing resistance on the part of mi- son, as the subject primarily re- health care but also a series of de- crobes to antibiotics and the con- sponsible for development, must terminants of health such as access stant need to resort to the acceler- be preserved. The principal con- to safe water and environmental ating development of new strains cern must be to improve the actual hygiene, to adequate alimentation, meant that during the second ses- living conditions of the people in a to housing, to safe employment sion of the Inter-Governmental given region, thus enabling them conditions, to instruction and to in- Work Group on intellectual prop- to carry out those duties which formation. erty rights of the World Health Or- their poverty does not presently al- In the absence of these condi- ganisation the urgent need low them to fulfil’ ( n. 47). tions, all the major risks to the emerged to develop drugs of the But, for example, the humanitar- ian ideology tends to see the vic- tims of wars and natural disasters as the mere objects of help rather than as individuals who find them- selves in a state of temporary diffi- culty but who are fully able to ad- dress the challenges raised by the environments, understood in a so- cial and political sense, in which they live. Just as the loans of the last three decades have put many poor countries into a state of debt, making them dependent on rich countries and international finan- cial organisations, so aid tends gradually to make the countries that depend on aid unable to deal with their own crises. Humanitari- an aid is often focused on the right to survival, forgetting about the right to life with all its economic, health of populations appear to be second and third generation to deal social and political aspects. Hu- destined to continue in the imme- with the increasing resistance of manitarian aid tends to come to the diate future. Armed conflicts and bacteria and viruses.17 aid of populations without asking their inevitable consequences in These situations also threaten very many questions about the net- terms of the destruction and weak- the developed countries of the work of causes that lead to a hu- ening of health-care systems and world. The growing interconnec- manitarian crisis.16 the rise of infectious diseases, and tion between countries and peo- Caritas in Veritate observes: large population movements and ples has brought about the rapid ‘Knowledge… can certainly be re- the concentration of great masses spread of epidemics, perhaps ones duced to calculation and experi- of people in refugee camps, are provoked by systems of food pro- ment, but if it aspires to be wisdom favourable terrains for the spread duction or animal rearing, and has capable of directing man in the of epidemics. Climatic changes destroyed the illusion of protection light of his first beginnings and his themselves, as the conference of that the richest populations of the final ends, it must be “seasoned” the FAO of November 2007 ob- world seemed to enjoy until a few with the “salt” of charity…Indeed, served, have a very strong impact years ago. At the same time the “the individual who is animated by on the availability and distribution rhythm with which new diseases true charity labours skilfully to of foodstuffs, with obvious conse- have emerged is creating wide- discover the causes of misery, to quences. And in addition regulated spread concern (since 1970 on av- find the means to combat it, to urbanisation, which is still under- erage one or two new diseases overcome it resolutely”’ (n. 30) way in a major part of the South of have been identified each year and A committee of the United Na- the world, involves living condi- today there are forty diseases 76 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE which were completely unknown lationships as well, it gives theo- 8 United Nations, Common Data Base (United Nations Statistic Division, New York, until a generation ago) and encour- logical and salvific value to all 2005; World Health Organization, World ages a push towards increasingly commitment for justice in the Health Statistics (Geneva, 2007). effective monitoring systems. The world’ (n. 6). 9 Countdown Working Group on Health Policy and Health Systems, ‘Assessment of appearance of new infectious dis- the Health System and Policy Environment as eases, such as AIDS and SARS, Prof. MASSIMO PETRINI a Critical Complement to Tracking Interven- and the threat of pandemics, such Vice-Dean of the International Institute tion Coverage for Maternal Newborn, and as that of bird flu (more or less jus- for the Theology of Pastoral Care Child Health’, Lancet 371(2008), pp. 1284-93. 10 M. CHAN, ‘Keynote address at the Inter- tifiably feared), have helped to in Health ‘Camillianum’, Rome, Italy national Seminary on Primary Health Care in make many people, if not every- Rural China’, Beijing, 1 November 2007. body, understand that health is a 11 V. EGIDI, ‘Popolazione e tecnologia: op- portunità e sfide per la salute’, in A. Golini, Il global possession. A strengthening futuro della popolazione del mondo (Il Muli- of the health-care systems of the no, Bologna, 2009), p. 108. poorest countries of the world, in 12 P. STEVENS, Diseases of Poverty and the Notes 10/90 Gap (International Policy Network, addition to being an act of justice, London, 2004); V. Egidi, ‘Popolazione e tec- helps to protect the whole of 1 Cf. A. GOLINI, Il futuro della popolazione nologia: opportunità e sfide per la salute’, in A. mankind. It is possible that pre- del mondo (Il Mulino, Bologna, 2009), pp. 16- Golini, Il futuro della popolazione del mondo 17. (Il Mulino, Bologna, 2009), p. 108. cisely because of these fears, 2 Cf. A. GOLINI, Il futuro della popolazione 13 V. EGIDI, ‘Popolazione e tecnolo- which do not avoid the richest and del mondo (Il Mulino, Bologna, 2009), p. 9; A. gia:opportunità e sfide per la salute’, in A. most developed countries of the Golini, ‘Demografia della popolazione Golini, Il futuro della popolazione del mondo anziana’, Dolentium Hominum 67 (2008), pp. (Il Mulino, Bologna, 2009), pp.10-110. world, a determination will arise – 17-30. 14 M. MURRU and F. TEDIOSI, ‘L’aiuto pub- something that hitherto has been 3 Cf. A. GOLINI, Il futuro della popolazione blico allo sviluppo e la cooperazione sanitari- rather lacking – to address the del mondo (Il Mulino, Bologna, 2009), p. 14. a’, in AA.VV., Salute globale e aiuti allo 4 Cf. S. SALVINI, ‘Popolazione, sviluppo sviluppo Diritti, ideologie, inganni 3° Rappor- health-care problems which afflict economico, mercati del lavoro e migrazioni in- to dell’Osservatorio Italiano di Salute Globale the world, even though the pursuit ternazionali’, in A. Golini., Il futuro della (Edizioni ETS, Pisa, 2008), p. 69. of a better state of health for (all) popolazione del mondo (Il Mulino, Bologna, 15 M. MURRU and F. TEDIOSI, ‘L’aiuto pub- populations must be engaged in 2009), pp. 69-94. blico allo sviluppo e la cooperazione sanitaria’ 5 A. ANGELI and S. SALVINI, Popolazione e in AA.VV., Salute globale e aiuti allo svilup- because this is a value in itself, a sviluppo nelle regioni del mondo (Il Mulino, po Diritti, ideologie, inganni 3° Rapporto del- fundamental human right. Bologna, 2007). l’Osservatorio Italiano di Salute Globale But ‘the earthly city’, Pope 6 A. R. OMRAN, ‘The Epidemiologic Transi- (Edizioni ETS, Pisa, 2008), pp. 65-66. tion: A Theory of the Epidemiology of Popu- 16 A. CATTANEO,C.DENTICO and A. STE- Benedict XVI observes in Caritas lation Change’, The Milbank Memorial Fund FANINI, ‘Gli aiuti umanitari: tra carità, ideolo- in Veritate, ‘is promoted not mere- Quarterly 8(1971), pp. 509-538; J. Frenk, J.L. gia, inganno’, in AA.VV., Salute globale e ly by relationships of rights and Bobadilla, C. Stern, T. Frejka, and R. Lozano, aiuti allo sviluppo Diritti, ideologie, inganni ‘Elements for a Theory of the Health Transi- 3° Rapporto dell’Osservatorio Italiano di duties, but to an even greater and tion’, Health Transition Review 1(1991), p. Salute Globale (Edizioni ETS, Pisa, 2008), pp. more fundamental extent by rela- 21. 113-127. tionships of gratuitousness, mercy 7 V. EGIDI, ‘Popolazione e tecnologia: op- 17 Cf. V. EGIDI, ‘Popolazione e tecnologia: portunità e sfide per la salute’, in A. Golini, Il opportunità e sfide per la salute’, in A. Golini, and communion. Charity always futuro della popolazione del mondo (Il Muli- Il futuro della popolazione del mondo (Il Muli- manifests God’s love in human re- no, Bologna, 2009), p. 95. no, Bologna, 2009), pp.115-116. DOLENTIUM HOMINUM N. 76-2011 77

ANTONIO G. SPAGNOLO Biomedical Technologies at the Service of Life

1. The Reference to Technology But this mutation is also located at without faith, attracted by pure in Caritas in veritate the level of the ‘technical’ possibili- technical action, is destined to lose ty of destroying humanity itself itself to the illusion of its own om- The reference to technology, and through a genetic-structural muta- nipotence. And, on the other hand, to its extraordinary applications in tion of man (enhancement, manipu- faith without reason runs the risk of the biomedical field, constitutes lation of the mind, etc.) or of other becoming estranged from the con- one of the crucial points of the en- living beings (biological weapons crete lives of people. cyclical Caritas in Veritate (CV)to or alterations in the environment). The ethical character of technolo- which is closely linked the question The growing power of technolo- gy, therefore, should not be seen of the development of man. The en- gy as regards intervening upon simply in terms of the stage of ap- tire development and the socio-cul- man’s body and mind – celebrated plication but also in terms of its rad- tural changes of man on earth are, in for its contribution to the wellbeing ical insufficiency, in its teleological fact, strictly linked with that tech- of humanity – also lends itself, in- ambivalence and in its dynamic of nological progress which has so ex- deed, to uses that could slide into knowledge/power which is increas- tended itself with its extraordinary dehumanisation, into what C.S. ingly growing and, therefore, in its applications in the biological and Lewis defined as the ‘abolition of explicative stage, its stage of mean- biomedical field as well. Technolo- man’, the title of his short but inci- ing. In other words, technology gy, as Benedict XVI observes, ‘is a sive volume.3 But it is above all needstobecompletedandtorefer profoundly human reality, linked to man in his very vulnerable embry- to itself within an overall anthropol- the autonomy and freedom of man. onic state of life who is threatened ogy in which it can find its role at In technology we express and con- by this biomedical technology the side of the dimensions of man. firm the hegemony of the spirit over when it is no longer governed, This assumes a project for man matter… Technology enables us to when unborn human life is seen as which backs up technological de- exercise dominion over matter, to being raw material which confuses velopment without man being de- reduce risks, to save labour, to im- procreation with production. humanised by this development and prove our conditions of life. It Thus the ethical question today without this development being ab- touches the heart of the vocation of can be formulated in the following solutised.5 human labour: in technology, seen way: what must one do or not do for Technology, to follow Jonas, as the product of his genius, man man to survive and remain man? contains in itself two basic ele- recognizes himself and forges his The birth of bioethics after a certain ments: a formal dynamic which own humanity’ (CV, n. 69). fashion sought to provide an answer should be understood as an ‘unin- More specifically, in technolo- to this question. In introducing the terrupted collective undertaking’ gies in the biomedical field, or termandingivingitaveryprecise which advances according to its biotechnologies as they are defined task, V.R. Potter spoke, indeed, own ‘laws of movement’ and a sub- in summarising fashion, the refer- about bioethics as the ‘science of stantial content ‘made up of things ence to ‘bios’ allows us to distin- survival’,4 fearing the negative im- that it places at the service of man, guish them, without separating pact of man were a control not es- by the opportunities and forces that them, from technology in a simple tablished over the development of it bestows on us, by the new goals sense, because as Pessina observes,1 such technologies. And Caritas in that it holds up or imposes, and by they constitute a practice mediated Veritate (n. 74) speaks about the changed modalities of acting by theories that interpret life itself bioethics as a ‘particularly crucial and human behaviour’.6 according to a precise approach. We battleground in today’s cultural Both these factors are inherent to should therefore reflect on a further struggle between the supremacy of the ethical dimension, indeed they question: whether, that is to say, technology and human moral re- constitute a new and singular case progress brought about by biomed- sponsibility’ in which is at stake the for this dimension which should be ical technologies also involves an very possibility of integral human analysed morally in the light of a automatic anthropological im- development. The fundamental ‘strong’ anthropology of reference, provement or whether, instead, question, indeed, is the choice be- that is to say centred around the on- such technologies are not translated tween two rationalities: that of rea- tological dimension of man. One is in some cases into an ‘anthropolog- son open to transcendence or that of dealing, in definitive terms, with ical mutation’, as Melina writes,2 reason closed in immanence. Rea- distinguishing – as Leon R. Kass which ends up by becoming no son and faith help each other in turn writes – between the perfection of longer governable by man himself. in this choice, given that reason means and the wisdom of ends.7 78 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

And referring to the essay of Lewis ployed; where the germinal cells of Academy of Sciences in faraway cited above, Kass emphasises that the couple were not able to bring October 1982, four years after the in the debate on biomedical tech- about fertilisation, steps were taken birth of Louise Brown, the first nologies there is a tendency to ne- outside the couple to use the ga- child born as a result of the tech- glect the anthropological implica- metes or embryos of third parties; nique that he had helped to create, tions that biotechnologies involve, where the female genital apparatus showed an explanatory table on the but even before this we should have was incapable of pregnancy there success rate in terms of the onset of a deep understanding of the human was a move to wombs for rent; and pregnancies after the transfer into values that we want to conserve and where the idea was to disassociate the womb of embryos that had been defend. completely the beginning of life fertilised in vitro. In an explanatory from the relationship of two people table in the publication that pub- of a different sex, relegating it to the lished the proceedings of that week 2. Unborn Life and the replication of one person alone, the of study, Edwards showed9 that af- Applications of Biomedical prospect of cloning was held up!8 ter in vitro fertilisation the percent- Technologies Biomedical technology drew up age rate for the onset of pregnancy all possible solutions to overcome in women who had received FIVET Starting in the 1970s, the bio- all the difficulties that could be di- was at the most 25%, that is to say medical technologies – which were agnosed, with the sole objective of only one embryo out of four of initially derived from fertilisation giving a child to those who wanted those that had been transferred gave with animals – developed in a no- it, without posing to itself the prob- rise to the onset of pregnancy. As table fashion in particular in the field of human procreation, inter- vening upon life at the initial stages of existence and raising by no means few problems of a moral character. The introduction of biomedical technologies applied to unborn life actually began with the prospect of providing an answer to the ‘treat- ment’ of sterility: faced by physio- logical alterations of the sexual or reproductive apparatus, biomedical technologies sought to overcome these obstacles and to meet – in some cases in an extraordinary way – the natural aspirations of married people to have a child. But after the initial enthusiasm linked to the pos- sibility of removing certain patho- logical failings which had been hitherto insuperable, there soon fol- lowed an awareness that human lem of the impact of these tech- would become clearer subsequent- procreation was losing its original niques on the meaning of genera- ly, however, the onset of pregnancy and originating character of genera- tion but above all on that being it- was not always followed by the tion and that one was confusing the self called at all costs into existence birth of a conceived foetus because procreation level with the produc- through those techniques. Indeed, of the ‘spontaneous’ interruptions tion level; conceiving with manu- those who first of all and more than of pregnancies that had begun, and facturing. Reproductive technolo- anybody else were subjected to the thus success in terms of ‘babies in gy allowed, indeed, the creation of consequences of procreative tech- arms’, to use the phrase, was even techniques to replace the biological nologies were specifically the em- lower. relationships of paternity and ma- bryos that were endangered by Today, after thirty years, however ternity. these techniques themselves, and to much this technique may have been The recovery in many cases of the point of being destroyed. improved (pharmaceuticals, the in- the functionality of physical appa- This evident consequence of re- cubation time of the spermatozoa ratuses connected with the repro- productive technologies was soon and the ovocytes, the means of cul- ductive process was not enough for manifested in all its dramatic char- ture, the number of embryos trans- biomedical technology which went acter as the results were gradually ferred…), the results are not signif- beyond those situations that were presented of FIVET as a success. icantly different from those of Ed- insoluble at a merely therapeutic Robert G. Edwards himself, who wards. In a recent review published level: where procreation could not recently received the Nobel Prize, in the NEJM10 one can see that in a take place through a conjugal act, when he was called upon to illus- cycle of FIVET with a percentage techniques of insemination and ho- trate the biological mechanisms and rate of about 33% of pregnancies mologous fertilisation were em- results of FIVET to the Pontifical that begin from the total of embryos DOLENTIUM HOMINUM N. 76-2011 79 transferred, only 25% witness the nologies was the sense of continuity (to eliminate the causes of in/hyper- birth of these children. These data between the embryo and the born fertility in couples), during (to treat indicate that this technique, today child. pathologies of the embryo/foetus as at the outset, has an intrinsic lim- In biomedical literature, in addi- and/or the mother), and after (peri- it which it appears cannot be over- tion to technologies applied to un- natal therapies and forms of treat- come. Hence the worrying ques- born life, many other finalities can ment) pregnancy and childbirth, in tion: how many other children, in be identified which go well beyond order to promote the life and health addition to those who are born be- the meaning of ‘true good’ for un- of conceived human beings and cause of reproductive technologies born life: the in vitro maturation mothers. I will refer to these briefly and have been taken up in their and manipulation of gametes, pro- below, inviting the reader to the ex- mothers arms, have not been born cedures for the fertilisation and the isting literature in the field for a de- even though they received an transfer of embryos into the mater- tailed analysis. ephemeral existence, because of re- nal womb, pre-implant and prenatal productive technologies, involving diagnosis, pregnancy and birth. In- 3.1 The treatment a few hours or days, or an existence deed, when using the above-men- of sterility/infertility. relegated for years to a freezer be- tioned terms in research through fore being destroyed? Very many, PubMed, articles emerge on experi- To return to the originality finali- too many to be able to justify – if ments on embryo stem cells or even ty of biomedical technologies, one one could ever justify – an interna- abortion-inducing procedures for has to recognise that they can really tional prize to the man who helped eugenic purposes! contribute to an overcoming – to introduce and apply those repro- It is, therefore, to be excluded where this is possible – in a fully ductive technologies. Perhaps dur- that any of these procedures, tech- therapeutic sense of the causes that ing the first few years after the ap- niques, pharmaceuticals and meth- lead to sterility/infertility. This plication of this technology to man ods can in any way or to any extent means that the most up-to-date bio- one could be enthusiastic about the produce, even potentially, any ben- medical technologies as well extraordinary photographs of in vit- efit for embryos/foetuses. Indeed, can/must respect the three funda- ro embryos or the birth of children they constitute with certainty or a mental goods that the recent In- conceived in vitro, but the dramatic great deal of probability a grave risk struction Dignitatis Personae refers consequences of those techniques to their lives and health. usto:a)therighttolifeandtothe were immediately very clear and in- physical integrity of a human being deed Edwards himself, after report- called to existence; b) the unity of ing on the scientific data in the pub- 3. Biomedical Technologies at the marriage which involves reciprocal lication referred to above, in rela- Service of Unborn Life respect for the right of the conjugal tion to the debate about the begin- partner to become a mother and a ning and the end of life described Side by side with the very prob- father only through each other; and without any shadow of a doubt in a lematic use of biomedical technolo- c) the specifically human values of very explanatory table that the tech- gies which have in various ways re- sexuality which ‘require that the niques of in vitro fertilisation were placed the biological relationships procreation of a human person must to be placed with post-coital contra- of paternity and maternity and be pursued as the outcome of the ception and IUD as being amongst which have placed at risk, and con- specific conjugal act of love be- the causes of medically induced tinue to place at risk, the lives of tween the spouses’ (DP, n. 12) death! This is a fact that certainly embryos produced in laboratories, Thus those techniques that are contradicts the high value of ‘ser- with their selection and their elimi- presented as a help to procreation vice to life’ which defines the activ- nation in large numbers, these very are not to be rejected ‘inasmuch as ities of health-care workers.11 Every biotechnologies, can, however, they are artificial’ but, in contrary honest biologist, indeed, should be hold up the prospect of service to fashion, they can constitute an in- struck by the fact that after fertilisa- unborn life. strument of real help to unborn life, tion (including in vitro fertilisation) In many circles people are think- just like all those therapies or forms there is a continuity with the subse- ing about responsibility in the use of treatment which can be practised quent development even tough the of procreative techniques, human before or during pregnancy and are location of the new living being dignity and unborn life itself which directed towards treating patholo- changes following implantation or is threatened by these techniques13 gies that cause a condition of hypo- birth, and thus one cannot deny that and so in this field as well one must /infertility in the couple or a risk or human life begins with fertilisation. think about the strategies for the a pathology for the embryo/foetus Kass observes that even Dr. Ed- achievement of more equitable and itself (embryo-foetal therapies), of wards – perhaps inadvertently – en- human ‘health care’, as we are re- the placenta and areas connected countered this truth when he spoke minded by the title of this interna- with it, during the pregnancy or at about Louise Brown and observed: tional conference organised by the birth. ‘The last time that I saw her was Pontifical Council for Health Care An example of technologies at when she was only eight cells in a Workers. the service of unborn life is napro- test tube. She was very beautiful In this sense, one can identify technologies which have as their then and she still is now!’12 Thus biomedical technologies (pharma- peculiar feature the capacity to what most seemed to be lost in the ceuticals, methods, surgical tech- function in agreement with the development of reproductive tech- niques, genetic tests…) used before menstrual cycles and the fertility of 80 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE the woman.14 One is dealing here a field that needs to be strongly im- morally licit. But since the possibil- with a research project that was be- plemented and this is one of the ob- ities of prenatal therapy are today gun in the 1990s in the United jectives that the International Paul still limited, it not infrequently hap- States of America through Prof. VI Scientific Institute of Research pens that these techniques are used Hilgers at the Paul VI Institute in into Human Fertility and Infertility with a eugenic intention which ac- Nebraska and which reached the and the Department for the Protec- cepts selective abortion in order to top of its first stage with the publi- tion of Maternal and Foetal Health prevent the birth of children affect- cation in 2004 of a large textbook of the Catholic University of the Sa- ed by various types of anomalies’ on the subject. cred Heart of Rome have been have (EV,n.63). On the basis of a standardised been pursing for many years with In reality this approach has been and outlined method for the obser- excellent results.16 implemented more often than one vation of the various biological pa- would have thought. In a study that rameters of the menstrual cycle and 3.2 Knowledge about the state we carried out a few days ago on of fertility, the existence of bio- of health of the embryo the data in the literature in the field- markers associated with women for the purposes of xviii it was clear that not all authors with reproductive disorders ap- treatment/prevention and health-care workers used in a peared to be evident. When study- consistent way the techniques of ing the basic reasons for the abnor- The technologies of prenatal di- prenatal diagnosis for the purposes mality of these biomarkers, through agnosis can help to improve knowl- of preventing of illness, or treating, hormonal studies, scanning assess- edge about the state of health of a the foetus. Looking at works which ments and diagnostic laparoscopy, foetus with a view to implementing between 1977 and 1990 had the key it was possible to draw up forms of therapy and prevention. In this field words of ‘prenatal diagnosis’ or intervention which allowed the as well one should assess well the ‘prevention or foetal therapy’, we identification of pathological con- goals and the risks connected with realised that only in about 50% of ditions, such as endometriosis, the use of these technologies.17 In- the articles the use of prenatal diag- which previously in many cases had deed, there are non-invasive tech- nosis to prevent complications or to produced negative results in the ex- nologies and more invasive tech- treat diagnoses illnesses was de- aminations that had been carried nologies that can endanger the life scribed. In the other about 50%, re- out and which allowed much of a foetus. In the Instruction Don- sort to prenatal diagnosis was em- greater success in treating infertility um Vitae of the Congregation for ployed to ‘prevent’ birth, that is to caused by endometriosis (56.7% of the Doctrine of the Faith of 22 Feb- say to interrupt pregnancy through births) than was the case with cen- ruary 1987 it is stated that ‘Such di- abortion. And this approach did not tres that used FIVET to by-pass the agnosis is permissible, with the change over subsequent years when problem of infertility caused by en- consent of the parents after they the use of prenatal diagnosis was dometriosis (21.2% of births). have been adequately informed, if much greater. Using the same key Similar successes have been the methods employed safeguard words, we found that between 1991 achieved with technologies of mi- the life and integrity of the embryo and 2010, 1949 publications met cro-surgery in cases of tubal and the mother, without subjecting the criteria of our search. In 1337 pathologies of notable frequency them to disproportionate risks. But the connection between prenatal di- but which today have become, this diagnosis is gravely opposed to agnosis and prevention or foetal ‘paradoxically’, pointers for choos- the moral law when it is done with therapy was clearly evident, and – ing FIVET techniques. This has led the thought of possibly inducing an once again – in 48.5% prenatal di- researchers to lose interest in the abortion depending upon the re- agnosis was used to prevent the surgical approach to female infertil- sults: a diagnosis which shows the consequences of the illness that had ity, with an increasing recommen- existence of a malformation or a been identified whereas in 51.5% dation of replacement techniques hereditary illness must not be the the diagnosis had been carried out rather reparatory ones. Couples, in- equivalent of a death-sentence’ in order to then proceed to the pre- deed, are more easily directed to- (DV, p. I, n. 2). Subsequently, this vention of birth through the volun- wards techniques involving artifi- approach was confirmed by the en- tary interruption of pregnancy. cial fertilisation, even when an etio- cyclical letter Evangelium Vitae of Let us now refer, lastly, to bio- logical diagnosis has not yet been 25 March 1995 in which the medical technologies with a pre- carried out and thus without at- Supreme Pontiff expressed the fol- implantation diagnostic purpose tempting all those medical, psycho- lowing warning: ‘Special attention that are carried out in a complemen- logical and surgical techniques that must be given to evaluating the tary way to the techniques of extra- could lead to the problem being morality of prenatal diagnostic corporeal artificial fertilisation. At overcome in a natural way. Here a techniques which enable the early the present state of things they do consultation, even an ethical con- detection of possible anomalies in not constitute a benefit for the un- sultation,15 could be useful which the unborn child…. When they do born child but, instead, – in opposi- provided all indications as regards not involve disproportionate risks tion to what is commonly believed the techniques available to over- for the child and the mother, and are – a grave risk for the life of the em- come sterility, including the ethical meant to make possible early thera- bryo because one is dealing with implications connected with the py or even to favour a serene and tests whose aim is to identify (with various technologies. The field of informed acceptance of the child margins of uncertainty of varying surgical technology, in particular, is not yet born, these techniques are degrees of importance) genetic DOLENTIUM HOMINUM N. 76-2011 81 pathologies or anomalies which at one can carry out a transplant of by technological progress in itself the present time cannot be treated maternal stem cells to treat certain but also by awareness that the foe- with therapies during pregnancy, as pathologies of the foetus. tus is a real patient in the full sense a result of which their use is often a In cases where there takes place of the term and this confirms the prelude to the selection and destruc- for pathological reasons a breaking fact that technology, as well, should tion of the embryo itself!19 of the membrane and the whole of recognise the ontological and axio- the amniotic liquid is lost at the logical meaning of reality, admit- 3.3. Intrauterine foetal therapies fourth/fifth month of pregnancy, the ting that there are certain constitu- current technological techniques al- tive limits which can be seen as For some time, thanks to the op- low the foetus to be treated in an in- good only because they correspond portunities offered by prenatal diag- vasive way through the introduc- to the specific being of the human. nostic techniques, methods have tion of a saline solution heated to been experimented to treat the foe- 37° through amniocentesis. With tus in the uterus. Invasive and non- this method the survival rate ob- 4. Conclusions invasive techniques, and ones that served in these pregnancies has in- are increasingly numerous, have creased over the last fifteen years Biomedical technologies can been used with various methods from 0% to 40-60%. This form of thus constitute a real service for un- and approaches.20 There are various treatment has also been used in the born life when they are applied with therapeutic approaches and they treatment of the hypothyroid goitre moral responsibility as well as with amply describe very many ways of of the foetus (the transamniotic ap- professional skill. treating the unborn child, with an proach) through the amnio-infusion Beginning with the fascination that technology has for human be- ing, one must retrieve the real meaning of freedom which does not lie in the drunkenness of total au- tonomy but in the answer to the call of being, beginning with the being that we ourselves are (CV, n. 70). And human freedom is specifically itself only when it responds to the fascination of technology with deci- sions that are the outcome of moral responsibility. Hence, as we are reminded by Caritas in Veritate, the urgent need for formation as regards ethical re- sponsibility in the use of technolo- gy. In this direction, today, is mov- ing that whole field which is called health technology assessment (HTA) which, within the frame- work of multidisciplinary research, welcomed from the outset, side by absolutely proportionate and ethi- of thyroxin and of foetal heart prob- side with technical (clinical, eco- cally acceptable risk. For example, lems (integrated foetal therapy: nomic and organisational) technical using the help of screening, a ‘foe- non-invasive approach – maternal assessments, also the idea of an as- tus doctor’ can reach the umbilical digitalisation and in uterus screen- sessment of an ethical character cord with a needle and carry out the ing-guided invasive approach). In which to the full can be placed in re- same tests that are carried out in this way the survival of foetuses has ports directed towards taking deci- adults: azothemia, glycaemia, increased from 10% to 60%. sions.21 In this context, which is haemachrome coagulation, and Data accumulated over twenty without doubt a frontier context, hormonal and genetic tests. years of experience of screening- ethical analyses could really per- If the foetus is anaemic, by the guided foetal therapies at the form the important task of dis- same pathway one can carry out a Gemelli Polyclinic demonstrate cussing the ethical character of the blood transfusion (the intravascular that ethically guided foetal medi- employment of certain biotechnolo- approach) to correct the anaemia or cine obtains unthinkable results, gies, verifying their conformity other pathological conditions. In ones of absolute clinical relevance, both with the integral goods of the this way, over the last fifteen years which restore dignity to prenatal di- person and with the culture of life. the survival rate of foetuses has agnosis as a preparatory moment The development of biomedical passed from 60% to 92%. In other for treating and not for selecting technology as well, therefore, cases it is possible to inject into the and eliminating! should be marked by a ‘spiritual di- circulating blood of the foetus med- These therapeutic successes, of mension’ for it to be authentically icinal products or albumin, when both a medical and surgical kind, human. And this development ‘re- this is necessary. In the same way have been made possible not only quires new eyes and a new heart, 82 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE capable of rising above a material- tecnologie riproduttive. Aspetti antropologici utazione e nel trattamento dell’infertilità’, in J. ed etici (Libreria Editrice Vaticana, Vatican VIAL CORREA AND E. SGRECCIA (eds), La dig- istic vision of human events, capa- City, 2005), pp. 114-125. nità della procreazione umana e le tecnologie ble of glimpsing in development the 3 C.S. LEWIS, The Abolition of Man riproduttive. Aspetti antropologici ed etici (Li- “beyond” that technology cannot (MacMillan, New York, 1965; Italian edition: breria Editrice Vaticana, Vatican City, 2005), L’abolizione dell’uomo, Jaka Book, Milan, pp. 271-279. give. By following this path, it is 1979). 15 M.L. DI PIETRO,A.MANCINI, AND A.G. possible to pursue the integral hu- 4 V.R. POTTER, ‘Bioethics. The Science of SPAGNOLO, ‘La consulenza etica nella sterilità man development that takes its di- Survival’, Perspectives in Biology and Medi- di coppia’, Medicina e Morale 2002, 6: 1019- cine, 1970, 14 (1): 127-153. 1038. rection from the driving force of 5 E. SGRECCIA, ‘Bioetica e tecnologia’, in ID., 16 R. MARANA, ‘Le terapie chirurgiche della charity in truth’ (CV,n.77) Manuale di Bioetica, vol. I, (Vita e pensiero, sterilità femminile’, in J. VIAL CORREA AND E. Milan, 2007), pp. 243-271. SGRECCIA (eds), La dignità della procreazione 6 H. JONAS, Tecnica, medicina ed etica (Ein- umana e le tecnologie riproduttive. Aspetti Professor ANTONIO audi, Turin, 1997), pp. 7-36. antropologici ed etici (Libreria Editrice Vati- G. SPAGNOLO 7 L.R. KASS, La sfida della bioetica (Lindau, cana, Vatican City, 2005), pp. 225-236. Full Professor of Bioethics Turin, 2007), p. 15 17 E. SGRECCIA, AND M.L. DI PIETRO, ‘Fon- and Director, 8 MELINA, ‘La logica intrinseca degli inter- damenti bioetica della diagnostica e della ter- venti di procreazione artificiale umana’, p.117 apia fetale’, in G. NOIA,A.CARUSO, AND S. the Institute of Bioethics, 9 the ‘A. Gemelli’ Faculty of Medicine and R.G. EDWARDS, ‘The Ethical, Scientific MANCUSO, Le terapie fetali invasive (Società and Medical Implications of Human Concep- Editrice Universo, Rome, 1998), pp. 1-27. Surgery, tion in vitro’, in C. CHAGAS (ed.), Study Week 18 A.G. SPAGNOLO,M.L.DI PIETRO,L. the Catholic University on Modern Biological Experimentation (Octo- PALAZZANI, AND E. SGRECCIA,‘Significato del- of the Sacred Heart, ber 18-23, 1982) Pontifical Academy of Sci- la diagnosi prenatale nella prevenzione delle Rome ences, Vatican City, 1984), pp. 193-249., malattie con-genite: aspetti etico-sociali’, in 10 B.A. MALIZIA, M.R. HACKER, AND A.S. Atti del LXVII Congresso della Società Italiana PENZIAS, ‘Cumulative Live-Birth Rates after In di Ginecologia e Ostetricia (Clas International, Vitro Fertilization’, N. Engl. J. Med. 2009; 360: Brescia, 1990), pp. 39-40. 236-243. 19 C.V. BELLIENI, ‘La diagnosi pre-impianta- 11 PONTIFICIO CONSIGLIO PER GLI OPERATORI toria in Dignitatis Personae’, in G. RUSSO (ed.), SANITARI, Carta degli operatori sanitari (Vati- Dignitatis Personae. Commenti all’Istruzione Notes can City, 1995), n. 1 sulla bioetica (Elledici, Leuman, Tu, 2009), pp. 12 KASS, La sfida della bioetica, pp 130-131. 164-172. 1 A. PESSINA, ‘L’uomo e la tecnica: anno- 13 See for example the report of THE PRESI- 20 G. NOIA,A.CARUSO, AND S. MANCUSO, Le tazioni filosofiche’, in M.L. DI PIETRO AND E. DENT’S COUNCIL ON BIOETHICS, Reproduction terapie fetali invasive (Società Editrice Univer- SGRECCIA (eds.), Biotecnologie e futuro del- and Responsibility: The Regulation of New so, Rome, 1998). For a updating on these tech- l’uomo (Vita e Pensiero, Milan, 2003), pp. 3- Biotechnologies (Washington, D.C., March nologies and the results see also the web site: 16. 2004); or also C.W. COLSON, AND N.M. DE S. www.noiaprenatalis.it 2 L. MELINA, ‘La logica intrinseca degli in- CAMERON, Human Dignity in the Biotech Cen- 21 S. I. SAAMI,B.HOFMAN,K.LAMPE, ET AL., terventi di procreazione artificiale umana. As- tury: a Christian Vision for Public Policy (Inter ‘Ethical Analysis to Improve Decision-making petti etici’, in J. VIAL CORREA AND E. SGRECCIA Varsity Press, Wisconsin, Illinois, 2004). on Health Technologies’, Bulletin of the World (eds), La dignità della procreazione umana e le 14 T. HILGERS, ‘Naprotechnology® nella val- Medical Organization, 2008, 86: 617-623. DOLENTIUM HOMINUM N. 76-2011 83

JOHN M. HAAS Health, the Safeguarding of the Creation and Justice

Justice is, classically understood, veritate, Pope Benedict lamented one smokes cigarettes, for example, “rendering to each his due”, redde- the fact that we have often lost sight one pays more for insurance since re suum cuique. In a strict sense, ju- of the obligations that must accom- smoking is high risk and dangerous stice is what I owe to the other in pany rights. He wrote: “Hence it is behavior. If one joins a fitness pro- accord with the other person’s important to call for a renewed re- gram at a health club, the cost of claim on me on the basis of his ri- flection on how rights presuppose health insurance is lowered. These ghts. Justice constitutes my obliga- duties, if they are not to become me- variable rates are based upon actua- tion to the other but also his obliga- re license.”5 rial tables but they reflect an at- tion to me. It implies community. In contemporary society there are tempt to achieve justice among tho- As St. Thomas Aquinas puts it: Ju- many claims to rights but not much, se in the insurance plan and indeed stice “consists in living one with if any, emphasis on duties. Bene- in broader society. And they show another”.1 dict has provided the appropriate that rights and duties are not ab- Injustice, on the other hand, re- balance in this encyclical: stractions but are grounded in the sults from not rendering to the other “[I]ndividual rights, when detached human person and his actions. what is his due, and injustice is ac- from a framework of duties which But justice is not simply what in- tually more grievous than what mi- grants them their full meaning, can dividuals owe to one another, which ght befall a person in the natural or- run wild, leading to an escalation of is known as legal justice. As indi- der. For example, unjustly to deny demands which is effectively unli- cated, it has to be seen in a broader one access to health care is hu- mited and indiscriminate. An ove- context. We also have duties to so- manly more heinous than the illness remphasis on rights leads to a disre- ciety at large and this is traditional- itself from which one is suffering. gard for duties. Duties set a limit on ly known as commutative justice. Illness is a disorder of nature but rights because they point to the But we must look at the concept of injustice is a moral disorder. anthropological and ethical fra- justice in an even broader context As Immanuel Kant observed: mework of which rights are a part. . still: the context of the created order “Man’s greatest and most frequent . Duties thereby reinforce rights and within which we find ourselves. troubles depend on man’s injustice call for their defense and promotion As Pope Benedict said in his more than on adversity.”2 And the as a task to be undertaken in the ser- encyclical, “The environment is German philosopher Josef Pieper vice of the common good.” In this God’s gift to everyone” and we mu- pointed out that “everything unjust brief passage Benedict points to the st acknowledge, in his words, “the implies that what belongs to a man profound and necessary relation- intrinsic balance of nature”. A vio- is withheld or taken away from him ship between rights and duties whi- lation of this “intrinsic balance of – and . . . not by misfortune, failure ch together ultimately serve the nature” affects not only ourselves of crops, fire or earthquake, but by common good. but also other human beings and man.”3 The complementarity of rights even the environment. In fact, a Magisterial documents have con- and duties is also true with respect violation of the created order has its sistently taught that there is a right to health care. For example, while adverse effects on the totality of to health care in the human commu- each person has a right to medical God’s creation. We can see this on nity. Pope John XXIII in his ency- care, he also has a weighty obliga- the macro-level and the micro-le- clical Pacem in terris wrote: “Man tion to avoid what will place his vel. has the right to live. He has the right health at risk. Indeed, positively If we look at the interplay of the to bodily integrity and to the means speaking, he has an obligation to do factors of health care, justice and necessary for the proper develop- what will foster and promote his guarding the creation on a macro- ment of life, particularly food, own health. Otherwise, the person scale we encounter innumerable clothing, shelter, medical care, rest, who does not care for himself could examples of their inter-relatedness: and, finally, the necessary social unjustly become a burden to the re- there are the illnesses and environ- services.”4 st of society, to one’s family and mental degradation resulting from However, rights are joined to peers through his own negligence. industrial pollution, the hazards obligations. Where there are rights, This basic principle of justice can from dangerously high levels of there must also be accompanying be seen in some of the health insu- green house gases, health and envi- duties. In his encyclical Caritas in rance plans in the United States. If ronmental threats from the moun- 84 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE tains of trash produced by a consu- change in order for agriculture to And as is known, smoking en- merist society. Pollution endangers flourish again in the region. This dangers not only the one smoking the environment and the health of plant was one of many others that but those around him because of the those who live in it. had been inadequately built during effects of so-called second-hand Some of the violations of the en- the time of a radical and godless so- smoke. In the United States, an vironment leading to the illness and cialism that unjustly subordinated estimated 54,000 people die each death of our fellow human beings the good of the individual to the year from having had exposure to are so shocking we stand in horror perceived good of the state. Such second-hand smoke.7 There is con- of them. In 1965 an unspeakable practices led to a degradation of the siderable dispute over what the ac- tragedy occurred in Bhopal, India. environment and significant risks to tual social costs of smoking are, but Toxic gases leaked from a Union the health of the citizenry. there is no question that society mu- Carbide plant leading to the deaths But the dangers to individual st assume very significant financial of thousands. Men, women and health and to the environment also and health care burdens because of children perished on the spot. The- exist on the micro-level. We can in- the illnesses contracted by those re has never been a final official dividually undermine our own who smoke. count but it is estimated that health and endanger broader so- Another modern health problem between 3,000 and 5,000 people ciety and the environment by our has become an increasingly grave died in that industrial accident. Go- actions. By not acting in accord problem and arises to a large extent vernments have an obligation to re- with our duty to ourselves we in from one’s life style for which the gulate enterprises and to impose sa- fact act unjustly toward the other, individual is responsible. Diabetes fety rules so as to protect the health toward the social order and toward has taken on epidemic proportions of citizens and the environment the environment. in some parts of the world. Diabe- which serves them. For example, it has been conclu- tes can be triggered in part from Just this year, there was another sively shown that smoking leads to obesity resulting from a lack of mo- industrial accident that destroyed li- debilitating diseases and deaths. deration and reasonableness in ves and wrought havoc on the envi- According to the American Cancer one’s consumption of food and ronment. In October a containment Society, almost 500,000 people in from a lack of exercise. India, for reservoir filled with caustic waste the United States die each year example, is experiencing an epide- mic in Type 2 diabetes.8 According to a report in Bloomberg Markets Magazine, which details the terrible economic costs of the diabetes epi- demic, more than 50 million In- dians suffer from the disease with one million a year dying from it. In October 2009 the International Dia- betes Foundation listed India as the country with the most diabetes worldwide. In India diabetes is leading to kidney failure, retina damage and the amputation of over 200,000 limbs a year. It is generally agreed that this epidemic has arisen becau- se of changed eating habits and life styles resulting from India’s rapidly growing economy and the fact that millions of Indians have subse- quently risen from poverty to af- fluence. There is now greater con- sumption of sugar and trans-fats, a from an alumna plant in Hungary from smoking, and smokers consti- significant decrease in physical ac- burst and a toxic sludge flooded se- tute 30% of all cancer deaths.6 In tivity, and subsequent weight gain. veral villages and spilled into the fact, smoking is the major single These are characteristics of life-sty- Danube River. Since 2006 this plant cause of cancer deaths in the United les in the developed world as well had been on a watch list of dange- States. It is estimated that over 5 which is also struggling with an rous industrial sites which was is- million die each year world-wide alarming increase in Type 2 diabe- sued by the International Commis- from the use of cigarettes. Smoking tes. While efforts must be made to sion for the Protection of the Danu- increases risks not only for lung make health care accessible to all, be River. The red sludge covered cancer but also for cancer of the without regard to their wealth or so- 2.000 acres of farm land and killed larynx, esophagus, stomach, pan- cial position, individuals also have off organisms that kept the soil creas, cervix, kidney, and bladder. a duty to one another and to society healthy. Experts maintain that there Emphysema is also a common and at large to care for their own health. will be a need for a complete soil deadly consequence of smoking. One can point to another indivi- DOLENTIUM HOMINUM N. 76-2011 85 dual practice having deleterious ronmental Protection Agency in the re a disease. Drug companies reap health and environmental conse- United States found that of the 123 huge profits through the sale of oral quences. The attempt to regulate fish they randomly caught in a river contraceptives which endanger the births through the use of oral con- near Boulder, Colorado, 101 were health and sometimes the lives of traceptives poses significant health female, only 12 were male, and ten the woman who use them and whi- risks to those who use them as well had strange male and female cha- ch also pollute the environment. as to the environment.9 According racteristics. They found these chan- This constitutes a profound injusti- the Gutmacher Institute, oral con- ges were being caused by high le- ce against the woman who is being traception, or the Pill, is the most vels of synthetic hormones associa- lured into taking these drugs as well commonly used means of birth con- ted with oral contraceptives in the as a violation of the environment. trol in the United States with almo- water. Scientists in Washington God’s creation is unspeakably st 30% of women of child-bearing State in the northwest of the United complex and magnificently beauti- age making use of it.10 There are States also found that high levels of ful and harmonious in its interrela- estimates that as many as 100 mil- estrogen were being found in the tedness. The word cosmos comes lion women world-wide are on the water resulting in the reduced ferti- from the ancient Greek and referred Pill.11 lity of male trout. to “good order” as well as to the As is well known, oral contracep- In April 2007 the journal Scienti- jewels adorning a woman’s dress. tives are usually comprised of a fic American ran an article repor- It is thought that Pythagoras was the combination of estrogen and the ting that fish caught in rivers and first to use it to refer to the universe, synthetic hormone progestin which, lakes had enough chemicals mi- perhaps because of the dazzling, when ingested and assimilated by micking estrogen as to make breast starry firmament. But the word the woman’s body, have the effect cancer cells grow. The article said “cosmos” speaks to the beauty of a of suppressing the release of an egg that the presence of the estrogen just order comprised of every facet each month from alternating ova- was also causing fish of undetermi- of God’s creation interacting with ries. In the normal course of events, ned sex to be born. Conrad Volz of the other in accord with His divine the natural hormone progesterone the University of Pittsburgh’s Can- plan. As Pope Benedict tells us in would be secreted by the egg folli- cer Institute’s Center for Environ- Caritas in veritate: “Nature expres- cle after its egg had been released. mental Ecology reported that ses a design of love and truth.”12 Progesterone sends chemical si- “estrogenic active substances” in Human flourishing and a just social gnals to the pituitary gland at the the water were causing male fish to order arise from acting in accord base of the brain to stop releasing be born which looked like female with that design of love and truth. the follicle stimulating hormone fish. He stated that there are “eggs and the luteinizing hormone. When in male gonads and males secreting Dr. JOHN M. HAAS, PH.D., S.T.L. these hormones are not secreted no a yolk sac protein.” The powerful President, egg matures and is released. The chemicals in oral contraceptives are The National Catholic Bioethics Center, synthetic hormone progestin, in a not being broken down in sewage Philadelphia, USA. sense, tricks the body into thinking plants and are making their way in- an egg has been released, thus stop- to the drinking water. ping the process of egg maturation As is well known, the Catholic and release. Church advocates a type of birth re- Regrettably there can be a num- gulation known as Natural Family Notes ber of severe risks to the woman Planning that poses no health risk to who ingests these synthetic hormo- the woman. There are certain phy- 1 Commentary on the Nicomachean Ethics nes, including the formation of sical signs in the female body whi- of Aristotle, 8, 9; No. 1658. 2 IMMANUEL KANT, Eine Vorlesung ueber blood clots that can settle in the ch indicate when the woman is fer- Ethik, Paul Menzer Berlin 1925, pg. 245. brain or lungs with sometimes tile. The couple abstains from ma- 3 JOSEF PIEPER, The Four Cardinal Virtues deadly effect, heart attacks, gall rital relations during that period if (University of Notre Dame Press: Notre Da- me), 1966, pg. 44 bladder disease, cervical and breast there is a grave reason to avoid ha- 4 JOHN XXIII, Pacem in terris, April 11, cancer, and benign liver tumors. ving a child. This approach of pe- 1963, 11. The risks of taking the Pill are so riodic abstinence poses no health ri- 5 BENEDICT XVI, Caritas in veritate, June 29, 2009, 43. great that women who are 35 or ol- sks to anyone or to the environ- 6 http://www.cancer.org/Cancer/Cancer der, smoke, or suffer from hyper- ment. It is a responsible, humane, Causes/TobaccoCancer/CigaretteSmoking/cig tension, diabetes or high cholesterol healthy and just means of regula- arette-smoking-who-and-how-affects-health 7 http://www.no-smoke.org/getthefacts.php are told not to take it at all. Since ting births. ?id=13 July 2005 the International Agency Through the promotion and 8 http://www.bloomberg.com/news/2010- for Research on Cancer of the marketing of contraceptives ferti- 11-07/india-s-deadly-diabetes-scourge-cuts-do wn-millions-rising-to-middle-class.html World Health Organization has li- lity has come to be viewed as the 9 There is a website by Watson Pharm which sted the combined oral contracep- equivalent of a disease which requi- manufactures oral contraceptives which ex- tion Pill as a carcinogen. res medication to combat it. plains how they work as well as the risks and benefits of using them: http://www.oral contra However, oral contraceptives po- Prophylaxis refers to medical or ceptives.com. se not only a health risk for the wo- health interventions to prevent di- 10 http://www.guttmacher.org/pubs/fb_ con man taking them but also constitute sease. Increasingly contraception is tr_use.html 11 http://contraception.about.com/od/con a danger for the environment. In being referred to a pregnancy traceptionmyths/tp/pillmyths.htm 2005 scientists funded by the Envi- prophylaxis as though the child we- 12 48 86 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

PAOLA GERMANO DREAM Treating AIDS in Africa: a Possible Challenge

I am a part of the Community of Indeed, the holistic approach en- creates hope, and brings AIDS suf- Sant’Egidio and I have had the ho- ables AIDS sufferers to undergo ferers to near to treatment. nour to participate from the outset the treatment in an effective way A decisive key in the efficacy of in the DREAM programme (Drug and this reduces the quantitative DREAM lies in the fact that it is a Resource Enhancement against level of the virus present in the programme that has a soul. If it AIDS and Malnutrition), a pro- various biological liquids of the had not had a soul, it would not gramme to fight, together, hunger body. Indeed, even to such low even have come into existence. and illness in Africa. levels as to make the transmission DREAM is rooted in spiritual and In 2002 DREAM was born in of the virus to other people rather human values, The approach of Maputo, Mozambique, out of the low, but above all else as regards DREAM was closely linked to the intellectual honesty of not wanting what is termed ‘vertical transmis- approach of the Community of to accept a reality that was widely sion’, that is to say from a mother Sant’Egidio: to work for a new shared but absurd and which im- to her child. world, feeling the responsibility to plicitly decreed that Africa had to From the outset one of the ob- construct with audacity and pa- be left with thirty million AIDS suf- jectives of DREAM has been to tience new pathways of coopera- ferers without any treatment: within been to prevent the transmission of tion that constitute a concrete and a few years one was dealing with the virus from the mother to the fu- practicable response to a great something on the scale of a geno- ture unborn child. The policy of problem to which the large organi- cide. One had, therefore, to work to DREAM has been not only to en- sations and African countries demonstrate that AIDS therapy, in sure that a HIV-positive mother themselves did not have any an- Africa as well, was a possibility, gives birth to a healthy child but swers. It is this soul which has en- with the same level of quality and also to make sure that she keeps it abled DREAM to create synergies with the same golden standard that and to assure the survival of the which were not always obvious had allowed major successes in the mother so that the newborn child and to become a model that can be West. From the outset DREAM has and any other previous children do reproduced and a model that is sought to treat, free of charge, all not become orphans. successful. those sick people who are in need, The therapy given to mothers The first guiding idea, from without any kind of distinction, during pregnancy is continued which the others come, is the cen- above all the poorest people and with throughout the period of trality of the patient. DREAM al- children, in the belief that treatment breastfeeding and this reduces, al- ways begins from real men and and care, in addition to being a fun- most to the point of elimination, women and not from institutions; damental human right, also consti- the transmission of the virus. The the patient is always seen in his or tute an important step in the preven- correctness of this approach is her entirety, in the totality of his or tion of infection by HIV. borne witness to by the high num- her needs. A person suffering from DREAM, therefore, was born to ber – more than 120,000 – of chil- AIDS has his or her complexity, he make available in Africa, as well, dren born healthy to HIV-positive or she is not a photocopy of the pa- therapies and technologies which mothers within the framework of tient who lives in rich countries, had already been tried in the rich the DREAM programme, that is to where he or she is known and stud- world but at the same time it chose say nearly all of the pregnancies ied, and one must respond to his or not to be only a programme for the that have been monitored. To give her specific needs in therapeutic distribution of medical products birth to a child when one was con- terms, in terms of prevention, and but also to care for AIDS sufferers demned to death by this illness and in social terms. He or she is char- in their totality. Thus: education in to go on being well so as to be able acterised by various opportunistic health, nutritional support, ad- to bring up one’s own children, is infections, amongst which one vanced diagnostics, the training of for a mother the most important may cite tuberculosis and malaria. personnel, the combating of malar- victory there is: it is a victory for Each patient must be assessed ia, tuberculosis and opportunistic the whole of the family, for the from a nutritional point of view infections and above all else mal- community and for health-care and he or she must be offered, nutrition. All of these are factors workers. This victory creates a when he or she needs it, this ali- that make treatment and preven- positive contagion that leads fear mentary support as a therapeutic tion themselves effective. and prejudice to be overcome, it treatment in order not to nullify the DOLENTIUM HOMINUM N. 76-2011 87 medical intervention. He or she is ly possible initiative possible need for long-term programmes often an illiterate person who seemed to be the prevention of the because the transition will be nei- needs to be educated in health in transmission of this disease. It was ther brief nor easy. To install and order to increase his or her protec- believed that this strategy on its maintain a programme for the con- tion against pathogenic agents; he own would have led to this epi- trol of HIV/AIDS is not a bridge or she has to be motivated to con- demic being controlled. But to us that has to be built, which is tinue adherence to the programme working for DREAM it seemed achieved in the space of a few of care and treatment; and he or immediately reasonable, as well as years, and the keys to which are she must be reintegrated into his or right, to associate action involving then handed over. In the epoch of her family and his or her social en- prevention with action involving globalisation we can easily ob- vironment. therapy. We believed that treat- serve how interdependence is a Anyone can have access to ment is a decisive element as re- fact of trade and the environment, DREAM because all the forms of treatment, the procedures of care and diagnosis are completely free. In the continent of Africa, which is marked by the presence of hun- dreds of millions of people who live below the threshold of ab- solute poverty, this policy seemed an obligatory one. To the inability to meet expenditure of patients must be added another observa- tion: the treatment involved is for life, at least for the moment, and the patient must remain loyal to that treatment. Now, the complexi- ty of the procedures of care, which express themselves at a practical level in a high number of appoint- ments so that the patient’s condi- tion of health can be followed, the handing over of medical products and the carrying out of analyses, have nonetheless a cost for the pa- tient. Very many patients, indeed, have to walk for a long way on foot to reach the health centres and gards prevention. Let us think here energy sources and work. The they have to allocate many hours of the case of the transmission of same, it seems to me, applies to of the week to this activity. the virus from mother to child: our health and cooperation: the results DREAM has chosen a system programme, after successfully of our efforts will depend to a large involving excellence at the level of adopting the same protocols that extent on our capacity to cooperate care, and this fact, above all during were in use on Western countries, over the long term. the early years of the programme, has almost eliminated the percent- For this reason, we conceived of has represented a strong element age of children born HIV-positive a programme of the long term, ro- of contradiction as regards the from mothers with the virus in our bustly placed within a framework policies of the international com- programmes. The adoption of the of real partnership with the coun- munity, which have been charac- triple therapy, for that matter al- tries involved and with their tech- terised by a certain ‘minimalism’. ready widely used in Western nical and political personnel. One To us it seemed fair and human to countries, not only demonstrated could say: ‘we will work together adopt in Africa, as well, the same its efficacy but became an authen- and for a long time, at least until diagnostics and the same proce- tic therapy for mothers, as well, new and more decisive therapeutic dures of care which go to make up and of great help in ensuring their answers to AIDS are available’. the standard level in the North of full adherence to this therapy. Another characteristic of this pro- the world. grammes is ongoing research in the field. The centrality of the sick Partnership and person requires the constant iden- Conjoining Prevention Working Research tification not only of the best in- and Therapy struments but also of those instru- DREAM constitutes a model for ments that are most suitable to the DREAM began its first steps ad- intervention that aims at develop- realities of Africa. This aspect of dressing a cultural and scientific ment and it is not a response of an ongoing research in the field is one climate opposed to the introduc- emergency kind. To be near to that has witnessed the greatest ef- tion of treatment in Africa. The on- Africa is a decisive fact: there is a forts at the level of cooperation of 88 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

DREAM: with universities, insti- DREAM is organised in line with t’Egidio to oppose AIDS in the tutes of research, pharmaceutical a series of protocols and flow land of Africa, has over nine years companies and other kinds of charts that are able to guide the produced extraordinary results, companies. medical and paramedical person- which have by now been recog- A further valuable aspect of the nel in the vast majority of situa- nised at a scientific level, but quality instruments involved is tions that exist. above all else this approach has certainly that aspect connected Every challenge to health in spread a new model for care and with software and in general with Africa has for this reason to start treatment in Africa. communications. Their applica- from the observation that a large At the present time DREAM is tion and their development in the part of the continent is essentially present in ten African countries: programme has produced two rural in character and thus a health Mozambique, Malawi, Tanzania, principal results: a completeness at programme, to be effective, has to Kenya, the Republic of Guinea, the level of information, which in be accessible to the majority of the Guinea-Bissau, Nigeria, the De- Africa I do not hesitate to define as sick people aimed at; it has to mocratic Republic of the Congo, being unique, and the possibility reach patients where they actually Cameroon and Angola. About a of sharing it with other people im- live. DREAM chose health care hundred thousand HIV-positive mediately. Our workers in this that one could define as being people are helped for no charge in sense are really never alone. As re- ‘light’ and able to constitute a re- thirty-two day hospitals distrib- uted throughout various countries. There are eighteen molecular biol- ogy laboratories for the monitor- ing of treatment; about twelve thousand children have been born healthy and without AIDS to HIV- positive mothers; and there have been seven pan-African training courses for about 3,600 health pro- fessionals. Today all the health- care personnel working in our cen- tres are African. More than a mil- lion people in recent years have taken advantage of the DREAM programme. These figures well demonstrate that AIDS is not in- vincible. It is possible to defeat AIDS. It is possible make life vic- torious. From the extraordinary effort in- volving welcoming, care and the promotion of health, which has gards the first aspect you will see source that is really widespread in been described above in this paper, in the slide certain displays that al- local areas; health care that is elas- there springs a new prospect as re- low medical professionals to ac- tic, flexible and able to discover gards the lives of patients. To ar- cede immediately to all the impor- needs even when these are without rive in a centre run by DREAM for tant information on the patient. a voice or without the energy that many people is an experience You should realise that an AIDS is needed to become a health-care where life is begun again, a life patient in general has an extremely request. In the place of the build- that is new and full. A life full of complex clinical history and one ing of large hospitals, architecture contacts and people but also of that is rather difficult not only to of a distributive kind was pre- new ideas and words. Just think remember but also to consult. You ferred, with centres of excellence what it means for a sick person to can see how the virus load, the and reference to which could come come to a centre where everything CD4 cells and many other clinical patients from second-level centres is free of charge, where you are re- parameters help to provide infor- located in more peripheral and rur- ceived with kindness and where mation to the medical personnel al areas where health-care services there is great interest in the sick with great immediacy. All the in- of an intermediate level, such as person! Through the approach of formation is shared and distributed the control and distribution of other people one comes finally to equally within networks of various medical products, and the carrying understand the value of one’s own levels: that of the individual cen- out of certain kinds of analyses, life, one discovers anew that digni- tre, that of the centre and the labo- are possible. In addition, mobile ty which has often been trodden on ratory and so forth until the con- clinic and home care make access in the humiliation of illness and nections with European experts to care and treatment possible for abandonment. who are able to provide specialist everyone. And then treatment improves consultations and second opinions This approach, which has been quality of life: a very large number on problematic situations. chosen by the Community of San- of symptoms and sufferings disap- DOLENTIUM HOMINUM N. 76-2011 89 pear, weight is regained and ener- this disease and their work is trans- can be reached. This is positive gies are restored, one returns to lated into a treasure for the coun- contagion between people who looking after one’s own home, tries they live in. have an opportunity to increase the one’s own children, and one be- Over recent years the role of our effectiveness of this battle which is gins to work again. Lastly, one re- activists has become increasingly decisive for the future of Africa. alises that one has entered a world public and many of them by now The great Teilhad de Chardin of friendships with the members of speak in television debates and on wrote: ‘Only love is able to unite the personnel and with other sick the radio. They are also inter- living beings so as to complete people. And then the patient him- viewed by newspapers. The person them and bring about their fulfil- self or herself becomes again a testimony of healing has achieved ment…because only love connects person, often with another gear: an increasingly large range; it them through what is deepest in the discovery of potentialities that combats the stigma that margin- them’. We must only imagine our were previously unknown to him alises the lives of a very large ability to love developed to the or to her and the desire to take ad- number of AIDS sufferers; and it point of embracing all men and the vantage of them for the benefit of has become a metaphor for a more whole earth’. people less fortunate than him or general healing – the healing of so- This is what DREAM tries to her, for other sick people who are ciety. do: humanitarian work requires still in a state of great suffering. It This is the ‘care community’: the creativity of love which be- is from rediscovered energy and not only health-care professionals comes an ability to unite and to re- from this new impetus to solidarity but also patients, women and men duce great distances. The first vic- that there has arisen the movement on the same level, brought back to tory is achieved in unity and the of the activists of DREAM which life but also to work which they are breaking down of isolation. It re- in recent years has undergone an passionate about and through stores and returns human dignity, extraordinary diffusion, always ac- which they can take part in saving it creates life, and in a very large companying the opening of new a very large number of people. number of cases it sets in motion a centres and the growth in the num- This soul, this philosophy as re- healing that was thought to be im- ber of sick people who are helped. gards AIDS, has led us to shoulder possible. Indeed, a very large number of pa- responsibilities that have often But today new challenges open tients, above all else women, have been shared with other men and themselves up for DREAM. In chosen to help other sick people women of faith, whom we have Africa there are still twenty-three and to no longer flee from this met in recent years during our million people infected with malady. journey down the roads of Africa. I AIDS, and at the present time These activists are not so much am thinking here of the very large about eleven million people are re- voluntary workers on the Western number of religious Congrega- ceiving treatment. The vaccine or model as authentic witnesses who tions, missionaries and members vaccines that are currently being are engaged in an irreplaceable of the local clergy with whom we studied are very far from produc- function involving support and share this soul and this project of ing relevant results. In the mean- counselling. They bear witness, love of God for the world. Even time, what should be done? through their words and their lives, though we find ourselves in differ- to the fact that AIDS is not a death ent places, we work together and sentence, that resurrection is possi- with the same spirit for the dream ble, that there is a future for one- of an Africa without AIDS. The self and for one’s family relatives. rapid spread of DREAM over al- They carry in their bodies the sign most six years has been due, in- of the effectiveness of antiretrovi- deed, not only to the capillary ral therapy and they agree to share presence of the Community of their experiences with other peo- Sant’Egidio in a very large number ple, thereby achieving a kind of re- of African countries, but also to the verse contagion, the communica- wish of a very large number of re- tion of hope as regards life; indeed ligious Congregations, non-gov- joy in being alive. ernmental organisations, lay men These activists engage in an ir- and women, and people of good replaceable work of health-care will to flank us in this strategy of education of the same kind which the struggle against the virus. But bears upon so many aspects of life. with the sixteen religious Congre- After recovering their strength, gations with which we work we do We believe that it is important to they become the mothers of other not only have a kind of functional implement as many interventions children and not only of their own cooperation but also a friendship involving prevention as possible in children, of a very large number of which, beginning with the poor order to curb this epidemic. We children who are orphans, and in and the sick, has touched the should expand prevention of the this way they expand their fami- depths of Christian communion. transmission of the virus from lies. Thus women, who are the This synergy allows us everyday mother to child in order to allow a principal victims of AIDS, become to increase the number of Africans healthy generation in the various the protagonists of liberation from who suffer from this disease who countries of Africa to be born. 90 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

We should extend the therapy to DREAM Bibliography IV Conferenza Internazionale “Anche noi vogliamo vivere: la cura dei bambini HIV+ in as many people as possible. This Africa” Roma 19 maggio 2006 (Rome, 2007). strategy, which was recently rec- DREAM – Comunità di Sant’Egidio, Cu- MAGNANO SAN LIO M., CAPPARUCCI S., ommended by the World Health rare l’AIDS in Africa, un modello di lotta al- MODOLO AM., SCARCELLA P., RENZI E., TINTI- l’HIV/AIDS e alla malnutrizione nei paesi a SONA G., MARAZZI M.C., Strategie di edu- Organisation to reduce contagion risorse limitate (Milan, 2009, in Italian, Eng- cazione sanitaria nel programma DREAM levels, is concentrated around more lish, French and Portuguese) per la buona aderenza alla terapia antiretro- complete coverage at regional and DREAM – Comunità di Sant’Egidio, Atti virale delle persone affette da HIV/AIDS in VI Conferenza Internazionale “Comunità e Mozambico Convegno Nazionale CIPES national levels of the treatment, and salute: DREAM, un modello per l’Africa” Ro- (Confederazione Italiana per la Promozione this should allow the almost total ma 15 maggio 2008 (Rome, 2009, in Italian, della Salute e l’Educazione Sanitaria) “Pro- eradication of this disease within English. French and Portuguese). mozione ed educazione alla salute fra global- DREAM – Community of Sant’Egidio, izzazione e individualismo: partecipazione, more or less twenty years. Long life to Africa: Defeating AIDS and Mal- integrazione, intersettorialità” Cagliari, 16- This is the new frontier of our nutrition (Leonardo International, 2008) 18 marzo 2006. dream and we are working on it, DREAM – Comunità di Sant’Egidio, Atti World Health Organization – Community V Conferenza Internazionale “Viva l’Africa of Sant’Egidio, Perspectives and Practice in looking for allies and supporters Viva: sconfiggere l’AIDS e la malnutrizione” Antiretroviral Treatment - DREAM an Inte- who will share this human and spir- Roma 10 maggio 2007 (Rome, 2008, in Italian grated Faith-based Initiative to Treat itual adventure: the fight against and English). HIV/AIDS in Mozambique (case study) AIDS in Africa. GERMANO P., BUONOMO E., GUIDOTTI G., (WHO, Geneva, 2005) LIOTTA G., SCARCELLA P., MANCINELLI S., Comunidade de Santo Egidio, Como Vai a PALOMBI L., AND MARAZZI M.C., DREAM: an Saude? (Milan, 2004, in Portuguese, English, Dr. PAOLA GERMANO, Integrated Public Health Programme to Fight French, Spanish, Swahili, Chichewa, Alban- General Co-ordinator of the DREAM HIV/AIDS and Malnutrition in Limited-Re- ian). Programme, source Settings WFP (Community of San- DREAM - Comunità di Sant’Egidio, Cu- Community of Sant’Egidio, t’Egidio, Rome, 2007). rare l’AIDS in Africa (Milan, 2003, in Italian, Rome, Italy DREAM – Comunità di Sant’Egidio, Atti English, French and Portuguese) DOLENTIUM HOMINUM N. 76-2011 91

EMILIO LA ROSA RODRÍGUEZ Traditional medicine

According to the World Health term ‘parallel and alternative med- mary health care both because of Organisation (WHO), by the term icine’ refers, instead, to a set of traditional culture and because of ‘traditional medicine’ we mean ‘a practices involving treatment other reasons (difficulties in hav- complex of approaches, knowl- which has no relationship with the ing access to conventional treat- edge and beliefs that are based, ra- traditions of those countries and ment, the higher costs of conven- tionally or otherwise, on the theo- are not integrated into their health- tional medical products, etc.). Re- ries, beliefs and experiences of a care services. For that matter, the sort to this kind of medicine is culture, applied singularly or in as- term ‘traditional medicine is em- above all a result of its proximity, sociation, in order to conserve ployed at times to refer to practices its ease of access, its availability, wellbeing, and to treat, diagnose or which, in the final analysis, do not its cost and its philosophical con- prevent physical and mental ill- belong, in a strict sense, to medical formity to native cultures. nesses’.1 Others believe that tradi- practice. In rich countries there are many tional medicine is ‘medicine based people who make use of various upon cultural beliefs and practices remedies that are called ‘natural’ handed down from generation to Complementary, Parallel, and which start from the principle generation. It includes mystical Alternative and Soft Medicine that what is natural has no risk. and magical rites, physiotherapy For that matter, traditional and/or and other treatments that cannot be According to the World Health alternative medicines also consti- explained by modern medicine’.2 Organisation,4 ‘the terms parallel, tute a path of action or a comple- In reality, traditional medicine is alternative or soft medicine are mentary path of action in the case a concept that greatly goes beyond synonymous with traditional med- of chronic, debilitating or incur- the field of health and is located at icine. They are related, therefore, able illnesses. a socio-cultural, religious, political to a vast set of health-care prac- A large majority of the popula- and economic level. It can be seen tices that do not belong to the tra- tions of Africa regularly use tradi- as a ‘system that is concentrated dition of a country and are not in- tional medicine. In sub-Saharan on (biological or not) malaise and tegrated into the dominant health Africa, for example, 85% of the which is based upon theories of the system’.5 population is said to turn to tradi- body, of health, of illness and of The term ‘alternative’ presup- tional healers. In Ghana, Mali, healing that are anchored in the poses the choice of an approach to Nigeria and Zambia, primary treat- histories of the cultures and of the health and illness that is different ment in 60% of children afflicted religions that have built and build from that of conventional medi- by strong fevers caused by malaria a country’.3 Indeed, we can say cine. The term ‘complementary’ or involves the use of medicinal that there are as many traditional ‘parallel’ describes a form of ther- plants that are given to these chil- medicines as there are cultures. apy used in addition to medicine dren at home.6 In China, tradition- The multiplicity of traditional (acupuncture, osteopathy etc.). al plant-based products constitute medicines, which differ according The World Health Organisation between 30% and 50% of the total to the regions of the world, to places these notions under the consumption of medicinal prod- countries, and even within coun- phrase ‘complementary and paral- ucts. In industrialised countries al- tries, is at one and the same time lel medicine’ (CPM). This term in- ternative medicine is equivalent to both riches and a challenge. To cludes various different approach- traditional medicine and over 50% give an example, whereas tradi- es which at times are mutually in- of the population uses, at least tional medicine in Africa and Latin compatible. They are the contents once, this kind of practice. In America is strongly characterised of a particular set, inasmuch as Canada 70% of the inhabitants of by oral tradition and a lack of they differ from the methods and the country use parallel medicine training as recognised by medical treatments that are taught in med- at least once. In Germany 90% of doctors, traditional medicine in ical schools. the population, takes during the China has a more structured and course of a lifetime, a natural rem- documented character. In the same edy. In the United States of Ameri- way, in some countries the appel- The Situation Today ca 158 million adults have used the lations ‘parallel medicine’, ‘alter- products of alternative medicine native medicine’or ‘soft medicine’ About 80% of the populations to and according to the Commission are synonyms for traditional medi- be found in developing countries for Alternative and Complemen- cine, whereas in other nations the turn to traditional medicine for pri- tary Medicines, in 2000 the popu- 92 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE lation of America spent 17 billion nal fibrosis12 13 after taking, in or- traditional medical practice is tol- dollars on traditional remedies. In der to lose weight, a manufactured erated and the health-care system the United Kingdom annual ex- product based on the wrong plant. is based upon conventional medi- penditure on parallel medicine The development of the market cine. But despite this tolerance, in amounts to 230 million American in officinal plants has enormous some countries traditional medi- dollars.7 effects at a commercial level as cine is completely ignored. well, and this raises problems at Countries should recognise the the level of biodiversity because of importance of the connections be- the looting of those raw materials tween the history and the medical that are needed for the production practice of native communities of medicinal products or other nat- inasmuch as traditional medicine, ural health-care products. This sit- however much it varies as regards uation, if it is not regulated and its technical expression, is always disciplined, runs the risk of leading based upon native beliefs and ex- to the extinction of species at risk periences. as well as the destruction of natur- In order to integrate traditional al resources and habitats. In addi- medicine into health-care systems tion, the international and national what is required first of all is that laws that exist are insufficient to traditional knowledge and healers protect the genetic resources of should be recognised. This as- biodiversity and traditional knowl- sumes the application of regula- edge. tions to control the sale of products and an alleviation of the lack of re- sources in the sector of research Traditional Medicine and training. The creation of re- and Health-Care Systems search and study centres that deal with traditional medicine consti- The world market for medicinal According to the way it takes tutes an important instrument by plants is expanding rapidly and at part in health-care systems, tradi- which to advance in the recogni- the present time it is worth more tional medicine is integrated into, tion of this practice in order to al- than 60 billion American dollars included by or tolerated in such low it to co-exist with convention- every year. This increase in de- systems. al medicine within a single system. mand deserves to be analysed and In Africa, for example, because studied seriously in order to pro- Traditional medicine recognised of the importance of traditional pose suitable measures whose goal by and integrated into medicine, the African Union estab- should be to assure the efficacy health-care systems lished the Decade of Traditional and harmlessness of these medical In a certain number of countries, Medicine in Africa (2001–2010), practices. According to the World traditional and complementary seeing traditional medicine as ‘the Health Organisation, in the year medicine is recognised by and in- system of health care that is most 2000 only sixty-four countries in tegrated into their health-care sys- accessible for the most of African the world had a system for the tems and forms a part of the forms rural communities’.14 This criteri- regulation of plant-based medici- of treatment that are offered to on has the objective of associating nal products.8 The absence of regu- people. There are too few coun- all of the promoters of traditional lations or a bad use of traditional tries where we can say that this medicine in order to ‘make avail- procedures, practices and medici- level has been reached: China, the able, to the vast majority of the nal products can have effects that Democratic People’s Republic of people of Africa, traditional med- are injurious to, and dangerous for, Korea and Vietnam. ical practices and medicinal plants health. For example, ephedra9 is that are safe, effective, accessible traditionally used to treat conges- Traditional medicine recognised and of high quality’.15 tion of the respiratory tracts. This by but not integrated into The integration of traditional plant has been commercialised in health-care systems medicine into the health-care sys- the United States of America as an Some countries recognise tradi- tems of countries passes by way of food complement and its excessive tional and complementary medi- the application of a series of rec- dosage has provoked, on the one cines but these forms of medicine ommendations proposed by the hand, cardiovascular disturbances are not integrated into their health- World Health Organisation. These (arterial hypertension, tachycardia, care systems (treatment offered, recommendations relate to regula- arrhythmia, myocardial heart at- education, formation, regulation). tions, safety, efficacy, quality, ac- tack, heart attack and instant Amongst these countries we find cess and rational use. The regula- death) and, on the other, neurolog- Equatorial Guinea, Nigeria and tory framework must take into ac- ical disturbances (cerebral vascu- Mali, but also Canada and the count training, qualification, prac- lar injury and convulsions).10 11 In United Kingdom. tice and research in relation to the Belgium, about seventy people traditional medicine. Research and had to have a kidney transplant or Tolerated traditional medicine practice require a suitable level of dialysis because of interstitial re- In a large number of countries, safety, efficacy and quality. DOLENTIUM HOMINUM N. 76-2011 93

Lastly, a rational use of this form http://www.nlm.nih.gov/cgi/mesh/2010/MB_c Texte.do?cidTexte=JORFTEXT00000079477 gi. Consulted 24 June 2010. 2&dateTexte= . Consulted 21 March 2010. of medicine depends on the vari- 3 A. EPELBOIN, ‘Médecine traditionelle et 11 The French agency for the safety of ous factors mentioned above but in coopération internationale’, Bulletin health care products. A decision of 8 October particular it depends on training, AMADES, 50, 2002. 2003 which involved the banning of the im- 4 OMS, ‘Strategia dell’OMS per la medici- portation, production, prescription and admin- qualification, authorisation as re- na tradizionale per il 2002-2005’ (Organiz- istration of teaching, officinal and hospital gards practice, the correct use of zazione Mondiale della Salute, Gineva, 2002). products. http://www.legifrance.gouv.fr/affich products of quality, information, 5 OMS, ‘Medicina tradizionale. Definizio- Texte.do?cidTexte=JORFTEXT00000079477 ni’, consulted 22 June 2010. http://www.who. 2&dateTexte= . Consulted 21 March 2010. and the complementariness of al- int/topics/traditional_medicine/definitions/fr/ 12 This illness caused by Chinese herbs is a lopathic medicine and traditional index.html grave kidney condition that was described for medicine. 6 DANIELA BAGOZZI, ‘Medicina Tradiziona- the first time in 1993 in patients who had fol- le’, OMS. http://www.who.int/mediacentre/ lowed a diet based upon extracts of Chinese factsheets/2003/fs134/fr/index.html. Consult- herbs (Aristolochia fangchi) containing aris- Dr. EMILIO LA ROSA ed 25 June 2010. tolochia herbs. RODRÍGUEZ 7 DANIELA BAGOZZI, ‘Medicina Tradiziona- 13 DEBELLE,FRÉDÉRIC, ‘Modèle expérimen- Vice-President of the international le’, OMS. tal de fibrose rénale interstitielle induite par 8 Organizzazione Mondiale della Salute, les acides aristolochiques («plantes chinois- Committee for Bioethics, ‘Strategia dell’OMS per la Medicina tradizio- es»)’, Thèse, Faculté de Médecine, 2005. http: Paris, France nale per 2002-2005’, (OMS, Gineva, 2002). //theses.ulb.ac.be/ETD-db/collection/available 9 Ephedra or Ma Huang (Ephedra sinica /ULBetd-10182004-224123/ . Consulted 21 Stapf, E equisetina Bge, E intermedia Shrenk et March 2010. CA Mey) contains ephedrine which constitutes 14 Decisions and declarations adopted by 40% to 90% of the total alkaloids of the plant the 37th. Ordinary Session of the Conference and which has an indirect simpatomimetic ef- of Heads of State and Government, 9-11 July Notes fect which acts at a cardiovascular level (an in- 2001. http://www.africa-union.org/Official_ crease in the heart beat), at a pulmonary level documents/Assemblee%20fr/ASS01.pdf Con- 1 OMS, ‘Principi metodologici generali per (bronco dilation), and at a central level. sulted 21 March 2010. la ricerca e la valutazione relative alla medici- 10 The French agency for the safety of 15Decisions and declarations adopted by the na tradizionale’ WHO/EDM/TRM/2000.1, health care products. A decision of 8 October 37th. Ordinary Session of the Conference of Organizzazione Mondiale della Sanità, (Gine- 2003 which involved the banning of the im- Heads of State and Government, 9-11 July va, 2000). portation, production, prescription and admin- 2001. http://www.africa-union.org/Official_ 2 National Library of Medicine - Medical istration of teaching, laboratory and hospital documents/Assemblee%20fr/ASS01.pdf Con- Subject Headings. MeSH Descriptor Data. products. http://www.legifrance.gouv.fr/affich sulted 21 March 2010. 94 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

ROUND TABLE: Equitable and Human Health Care

MARIO FALCONI 1. Equitable and Human Health Care at Home

I personally, and also on behalf every field of collective life but in The ageing of the population of the Council of the Provincial particular as regards the defence of brings with it an exponential in- Order of Rome of Doctors, Sur- health, to assure uniform and es- crease in chronic-degenerative geons and Dentists, keenly thank sential levels of care for everyone, pathologies and this imposes the you, President of the Pontifical but today we are witnessing a need, today more than yesterday, Council for Health Care Workers, growing increase in the differences for effective and courageous poli- not only for your greatly appreciat- between the north and the south of cies. The real emergency in our ed invitation but also for the sub- the country. country, as is the case with the oth- ject which was entrusted to me, a In a country such as ours, where er advanced countries of the subject that is very dear to us: ‘Eq- for years the average age has been world, is specifically the organisa- uitable and Human Health Care’. increasing, and thus the number of tion of health care at a local level We are an auxiliary organ of the elderly people has been increasing and above all at home, with a vi- state which defends citizens and as well, the health-care supply sion that cannot and must not cor- above all the frailest amongst should have been planned afresh in respond to a hospital-centric logic. them. As Monsignor Zygmunt Zi- a broad and structural way in the In the light of the encyclical mowski said in his introduction to face of a demand for health which Caritas in Veritate of Pope Bene- the twenty-fifth international con- had changed profoundly: more dict XVI as well, an encyclical that ference on ‘Caritas in Veritate:To- home, residential and semi-resi- concentrates in the integral devel- ward an Equitable and Human dential care and in particular the opment of the person, it does not Health Care’, we should, all of us paying of more attention to elderly seem to us that our health service together, address the burning and people living alone. is going in he right direction. topical question of parity in access A society that is really based on to health-care services if we want solidarity cannot exclude anyone to act in conformity with human from health care or continue to tol- dignity. Unfortunately, profound erate deep inequalities. inequalities exist between the However, we are convinced that health-care services of rich coun- public economic resources will not tries and the health-care services be able, unfortunately, to grow in of poor or developing countries, parallel with the exponential but at the same time in rich coun- health-needs of citizens and thus, tries themselves there is discrimi- in order to achieve ‘authentic fra- nation against very many citizens ternity’, we should, all of us to- as regards access to care and treat- gether, encourage that marvellous ment. and rich reservoir made up of so- For have for years fought to en- cial voluntary work in all its ex- sure that in our country unforgiv- pressions, starting, obviously able geographical differences as enough, with Catholic social vol- regards health care in general, and untary work. health care provided at home in Professor MARIO FALCONI particular, are reduced and steadily President of the Provincial Order of Rome eliminated. of Doctors, Surgeons and Dentists, The task of politics should be, in Italy. DOLENTIUM HOMINUM N. 76-2011 95

W. HENRY CHIANG 2. Equitable and Human Health Care in Hospices: The Taiwanese Experience

Life is precious. Death is in- ed network for hospice care cen- lic on the concept of end-of-life evitable. And, as the late Supreme tered on patients and their families. care, as well as practical informa- Pontiff John Paul II stated in the Regardless of where you are, what tion and assistance to patients and apostolic letter Salvifici Doloris, care you need or how much you their families. Their efforts have death causes suffering, including are suffering, you will receive a advanced the hospice care move- physical pain and moral suffering. uniform and decent standard of ment, as well, by bridging the dis- Modern medical therapy, no service. We are proud of this tance between public awareness of doubt, can ease physical pain, but achievement. I would like to share proper end-of-life care and tradi- it seems less able to treat moral our experience with everyone. tional Chinese culture which em- suffering. The hospice care movement in phasizes a good ending for the dy- In 2010, the Economist Intelli- Taiwan began 27 years ago: in ing and a good farewell from the gence Unit released a study of 1983, Prof. Chantal Chao of the family. Families must have the ‘quality of death’ by ranking end- Catholic Sanipax Foundation set courage to face the reality that of-life care around the world. The up a home care program. In 1990 death is approaching their loved study identifies some crucial prin- and 1994 respectively, the Mackay ones. ciples and difficulties in end-of- Memorial Hospital and the Cardi- Lastly, the government has sup- life care. It indicates that a high nal Tien Hospital initiated inpa- ported the hospice care movement quality of death depends on four tient services. Since then, hospice in Taiwan in at least three ways. factors: the basic environment, care has prospered in Taiwan: First, it has declared that palliative quality of care, the availability of there are now 77 hospice care care is a “must have” service under care and the cost of care. While teams serving the country’s 23 the National Health Insurance some developed countries rank million people, providing inpatient plan. As a result, most hospitals low due to problems connected share care and consultation, home not only provide some kind of pal- with one or more factors, the visits and a total of 683 inpatient liative care services, but provide BRIC (Brazil, Russia, India, Chi- beds. This year, the government these services for free because the na) and other developing countries began funding a training program National Health Insurance plan re- rank lowest.1 Notably, while more to equip caregivers in nursing imburses their costs. This helps to than 150 countries provide hospice homes with the skills to provide ensure that all persons who need care, the services are mostly local- palliative care to residents in the the services will receive them, and ized and inaccessible to the gener- last period of their lives. is a demonstration of equitable al public; only thirty-five countries Besides the vast and detailed health care. Second, the govern- integrate hospice care into main- network of service providers that ment has partnered with, and pro- stream health care.2 has been established, there are two vided funding to, private groups to Taiwan ranks fourteenth among professional associations that con- educate both medical profession- the forty countries and first among duct specialist training programs als and the public to establish a the eight Asian countries surveyed for doctors and nurses, as well as standard of care, as well as to ex- in the quality of death comparison. appraisal and accreditation of hos- pand services. This is evident in We also offer hospice care as part pice care teams. These associa- the new training program for of regular health services. The tions have advanced the hospice workers in the nursing homes World Health Organization main- care movement in Taiwan by help- mentioned above. In addition, in tains that the integration of pallia- ing medical professionals to devel- 2000, the Legislative Yuan passed tive care into the health care sys- op expertise in treating terminally- the “Hospice and Palliative Care tem requires appropriate policy, ill patients, and more broadly, by Act,” which enables patients to adequate medication, education ensuring that service providers choose DNR (do not resuscitate). and the implementation of service. reach a standard of excellence. This represents a big step in pro- Taiwan has relied on the coopera- There are also several local non- tecting human rights and a demon- tion of service providers, profes- governmental organizations in- stration of respect for life. sional associations, non-govern- volved in advocacy, education and I have discussed how service mental organizations and the gov- family support. These organiza- providers, professional associa- ernment to construct a sophisticat- tions provide education to the pub- tions, non-governmental organiza- 96 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE tions and the government have unique characteristic of our model care. They can also urge medical each shaped the development of is the inclusion of a pastoral care professionals to become more in- hospice care in Taiwan. To con- person in our hospice care team. volved in end-of-life care, and ad- clude, I would like to emphasize The inclusion of a pastoral care vocate to the public and to the gov- how Catholic institutions have re- person is significant because hu- ernment the need for more equi- sponded, and could respond, to the man health care should involve not table and human hospice care. hospice care movement. only acute medical care, but also Given such efforts, I believe that As the leading Catholic hospital spiritual care. Modern medicine no excellent hospice care with love in Taiwan, guided by the core val- doubt has focused on the physical could one day be provided in every ue of “Love God, Love People and demands but often has seemed to corner of the world. Respect Life,” the Cardinal Tien neglect the emotional and spiritual Hospital has put a lot of energy in- needs of patients and their fami- Dr. W. HENRY CHIANG, MD, to our long-term care and end-of- lies. This neglect may double their Chief of Palliative Medicine, the Cardinal Tien Hospital, life care services. The concept of suffering. Taipei, Taiwan. “holistic care” is central to our ser- As was stated in the encyclical vices. It entails four aspects: whole letter, “there cannot be holistic de- person care (not only physical care velopment and universal common but also mental and spiritual care); good unless people’s spiritual and whole journey care (care from the moral welfare is taken into ac- beginning of illness to the end of count.” Guided by this, local Notes life); whole family care (such as Catholic churches can thus con- 1 Economist Intelligence Unit. (2010). The bereavement counselling); and tribute by relieving pain and pro- Quality of Death: Ranking End-of-life Care whole team care (a multidiscipli- moting well-being in the spiritual across the World. nary professional approach). This dimension of life. They can collab- 2 International Observatory on End of Life Care. (2006). Mapping Levels of Palliative care model has become the stan- orate with medical authorities to Care Development: A Global View.Ascited dard of practice in Taiwan, but the provide holistic, human health in Economist Intelligence Unit (2010). DOLENTIUM HOMINUM N. 76-2011 97

CHRISTOPH VON RITTER 3. Equitable and Human Health Care in Prisons

Equitable and human health care the reintegration and rehabilitation by men. The forgiving God looks in prisons is associated with major of a prisoner. for a chance to forgive guilt. challenges. More than other pa- Forgiveness has to involve all Therefore, the Christian gospel tients, prisoners suffer from both aspects of the guilt which affect may constitute an important and mental and somatic illnesses. In the prisoner. How can such com- very helpful part of the complex this context, the problem of guilt plete forgiveness be achieved? therapy needed to cure a sick pris- plays a central role. An effective First, the prisoner has to accept oner. The certainty that God has therapy needs to address this prob- the guilt he has caused himself never left him and will never let lem and liberate the prisoner from through the crime he committed him down will help to free the pris- his guilt. Forgiveness, therefore, and undertake whatever is possible oner from his self-generated must be an essential part of equi- to relieve that guilt. The prisoner prison of guilt. This will then pro- table and human health care in may have suffered injustice him- vide the basis to return to society prisons. self and this injustice may possibly as a full and healthy member. The question of guilt plays a be part of the circumstances that If complete forgiveness and re- central role in any illness. Like al- led to the crime. So the second part spect for the dignity of the prison- most all other patients, the sick of complete forgiveness is that the er is missing, the prisoner becomes prisoner asks himself whether he prisoner needs to forgive the injus- a helpless victim who can be ex- bears responsibility for his illness. tice inflicted on him and abstain ploited in numerous ways. A horri- To ask this question is reasonable from any feeling of revenge. Re- ble and extreme example of such since an analysis of the risk factors cently, the value of forgiveness has treatment of prisoners was the con- may, at least in part, clarify the been explored in the scientific lit- centration camp in Dachau, Ger- cause of the illness, thereby pre- erature of psychological research. many. Innocent people were kept venting recurrence and supporting The studies present evidence on with no respect for their human rehabilitation. the powerful healing capacity of a dignity. The prisoners were ex- The prisoner is guilty because of personal attitude that includes ploited and used for forced labour. the crime he has committed. The complete forgiveness.1 Instead of health care, medical time in prison is meant to redeem Finally, and most importantly, treatment was perverted in such a his guilt and is also meant to in- the prisoner, in general, and so manner that prisoners were forced duce the rehabilitation necessary much more the prisoner as a pa- to participate in pseudo-scientific to reintegrate the prisoner into so- tient, needs treatment that is based experiments. The protocols of the ciety. on forgiveness and tender care. Nuremberg trials indicate that the Exposed to this double form of This is based on respect for the medical staff did not recognize guilt, the prisoner may end up in a person and the dignity of the pris- their victims as equal human be- situation in which he is locked up oner. This respect for the inherent ings and perceived them as Unter- in his own prison of guilt. Unre- dignity of the prisoner must be un- menschen who did not deserve re- lieved, guilt causes desperation conditional and not related to the spect and dignity.2 Treatment of and neurotic alterations. These past and present life of the prison- prisoners in Nazi concentration mental problems may lead to an er. Such an unconditional respect camps dramatically illustrates how aggravation of the somatic symp- for the prisoner is ideally rooted in absence of respect for human dig- toms of the prisoner, a deteriora- the Christian faith which respects nity generates an unrestrained ex- tion of his illness and, finally, gen- all men as being in the image of ploitation of prisoners. erate a vicious cycle which perpet- God. Secular society, on the other Completely different is the treat- uates psychosomatic illness. hand, runs the risk of modifying ment of female prisoners in the Forgiveness is the appropriate human dignity according to the prison of Repy in the Czech Re- means to interrupt this vicious cy- aims of society. At worst, individ- public. The prison, which is in a cle. Only complete forgiveness ual groups such as prisoners are suburb of Prague, forms a part the will create a resolution of guilt and thereby excluded from the full convent of the Sisters of Mercy of lead to sustained health, i.e. health benefits of human dignity. St. Charles Borromeo. The that aims to achieve complete re- The Christian tradition of heal- monastery was originally founded covery from mental and physical ing on the basis of forgiveness is in 1858. In 1865 the sisters started illness. Such a complete recovery ample. Through the sacrament of working with women prisoners. In is necessary to restore the balance confession, God grants complete 1948, under Communist rule, the of a prisoner and is the basis for forgiveness of the sins committed monastery was closed, the sisters 98 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE were incarcerated, and the build- useful members of society. The restore physical and mental bal- ings were used for a Research In- prisoners are offered training ance, complete forgiveness is an stitute of Agricultural Technology. courses in nursing and are entitled essential precondition for sus- Forty years later, in 1989, the to achieve a diploma as medical tained cure. The prisoner has to buildings were again taken over by orderlies. This is additional valu- seek forgiveness for his crime, for- the Sisters of Mercy of St. Charles able assistance to achieve their give himself and has to be granted Borromeo With the help of many successful reintegration into soci- forgiveness. Forgiveness is based sponsors, the convent was beauti- ety. Finally, for some the caring on unconditioned respect for the fully restored. It again serves a love and spiritual life they witness dignity of the prisoner. The firm twofold purpose: as a nursing around them helps to lead them basis for such respect is the Chris- home and day care centre for back to the Christian faith which tian faith which sees the prisoner chronically ill and disabled people may become the basis of their fu- as being in the image of God. and as a prison for female prison- ture lives. ers. The female prisoners work to- The relapse rate of prisoners re- Prof. CHRISTOPH VON RITTER, gether with the sisters and the lay leased from Repy prison is signifi- MD PHD staff in different sectors of the cantly lower then elsewhere in the Medical Director, RoMed Klinik Prien, Teaching Hospital, nursing home. They are occupied country and some of the former Ludwig-Maximilians-University, in the kitchen, the laundry, in prisoners stay in close contact with Munich, Germany. housekeeping and in the garden. In the convent after their release. So, addition, they may also help in the after functioning for several years wards and assist the nursing staff. this unique project has proved to For some of them this is the first be highly successful and deserves time that they encounter illness wide application all over the and physical and mental disability. world. Notes The possibility of helping the el- In conclusion, the treatment of derly patients offers a unique op- prisoners in prison is a good exam- 1 F. LUSKIN, Forgive for Good: A Proven portunity to practise kindness and ple of the need for equity and hu- Prescription for Health and Happiness (Har- per, 2002); 2. S. Sarinopoulos, ‘Forgiveness understanding. This, in turn, pro- manity in health care. More than and Physical Health: A Doctoral Dissertation motes the process of forgiveness other patients, the prisoner suffers Summary’, World of Forgiveness n. 2 (2000), for themselves and others, restores from somatic and mental illness in 16-18 2 EBBINGHAUS/DÖRNER ,Vernichten und self-esteem, and generates the cer- part caused by an overwhelming Heilen, der Nürnberger Ärzteprozeß (Aufbau tainty that they will again become and unrelieved feeling of guilt. To Verlag, Berlin 2001). DOLENTIUM HOMINUM N. 76-2011 99

STANISLAW SZCZEPAN GÓŹDŹ 4. Equitable and Human Health Care in Factories

One of the basic human rights is this respect. The focus was on the ever, when introduced into the access to health care. However, the protection of the employee’s health care system, these free mar- violation of these rights, including health. Many medical doctors were ket mechanisms can easily convert the right to basic medical services, being specially trained to become the patient into a product (a thing). is a worldwide practice. This paper work medicine consultants. Rele- A question arises here: is such a will deal with the topical issues re- vant legislation was being formed situation normal? Can such a sys- lating to access to health care in simultaneously, the aim being to factories, the purpose being to de- regulate those processes in a highly termine to what extent the afore- logical and consistent manner. mentioned right is respected. I will Thus, employees regularly re- start by presenting this problem ceived medical examinations, with the example of my home which not only determined their country, Poland, being used, then I ability to continue work but also will make reference to western Eu- provided highly effective and com- rope and emerging economies, prehensive prevention measures. It and, subsequently, I will go on to is worth emphasizing that owing to touch on the situation in low-in- the insignificant unemployment come and slowly developing coun- rate, the majority of the population tries. No statistical charts will be was covered by this health care included in this paper, as the avail- system. Twenty years ago Poland able data are fragmentary or ap- saw extensive transformations. proximate only. On the other hand, Unfortunately, in some areas, in- my paper is supposed to provide a cluding health care, these changes global outline of the problem. brought unanticipated and unac- Poland boasts a long tradition of ceptable outcomes. Transforma- health-care services provided in tions in the sphere of politics en- factories. One of the originators of tailed large-scale economic tem, which is still maintained in this system was a Catholic priest, changes. Most of the state-owned many highly developed countries, Stanisław Staszic, the founder of industrial plants were transformed including those in Europe and the so-called Industrial District lo- into private enterprises while many America, be acceptable? The more cated in central Poland. It was as of the remaining ones collapsed, so as these countries claim to be in early as in 1809 that in the steel with no new entities being estab- the vanguard of civilization, with a mills and foundries that he had es- lished to take their place. A high deep sense of humanism being tablished, a physician was em- rate of unemployment appeared cherished there. Where in a free ployed in order to provide workers and became a major issue. Those market is there the necessary space with the necessary health services. changes also had a significant im- for compassion, selfless help, a The health-care system introduced pact on health care, which, while moment of contemplation, and, after World War II was based on quite effective and well-function- first and foremost, the willingness the universal availability of med- ing in the previous economic sys- to offer a helpful hand to those in ical services that were completely tem, failed to meet the challenges need? Free market mechanisms free of charge. In each major facto- of the free market economy. are destructive of the essential rela- ry, there was a medical doctor, a Is a free market beneficial for tionship between the patient (man) dentist and nurses, and thus em- health care, as advocated by liber- and employees of the health care ployees had unrestricted access to als? I would like to draw your at- system (people) because ‘time is high quality medical services. The tention to the very term ‘health money’, because the number of pa- system of health care in work- care’, which is in itself in contra- tients (or, perhaps, dehumanized places organized in the 1960s was diction with the mechanisms of a things) received and the revenues very effective indeed. Work medi- free market. The free market excel- generated in the process constitute cine institutes were also being es- lently regulates the operation of the superior goal. What has tablished, which placed our coun- factories where some commodities emerged is a heartless following of try among the world’s leaders in (things!!!) are manufactured. How- all stages of an impersonal, auto- 100 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE mated procedure, concluded with employ even a limited number of quence here but also considerable the phrase “Goodbye – the next, medical doctors or nurses to meet costs incurred by society, as pa- please”. Hence, I would like to ask their employees’ needs. Instead, tients with chronic occupational whether such a system brings any they outsource such services to ex- illnesses are usually taken care of value to society, as this society, in ternal, often private, institutions – by the state-owned health-care sys- order to function properly, has to out-patient clinics or work medi- tem. Treatment in the case of an be provided with healthcare ser- cine units. It should, however, be advanced health condition in- vices beginning with the place in noted that employees are still cov- volves expenses which are dozens which every man spends a third of ered by the national insurance sys- of times higher than the cost of his earthly life – the workplace. tem, with periodic medical exami- procedures to be carried out at the A case in point is the situation in nations as well as other aspects of onset of the illness, not to mention some European and North Ameri- work medicine being effectively the insignificant amounts of mon- can countries which, notwithstand- regulated by relevant laws. ey necessary for prevention efforts. ing their unquestionable affluence, Unfortunately, this status quo Prevention is much better than have come to face major difficul- seems to be under threat. With the cure, in terms of finance as well. ties in the functioning of their ongoing globalization processes, This applies not only oncology but health-care systems. Despite the new tendencies, being awkwardly also illnesses associated with the official statements as to the high justified by the necessity to cut progress of civilization. quality of medical services provid- costs, have emerged with the aim The situation is much the same ed there, these systems are ineffi- of “optimizing” the health-care in other European countries, in- cient, with the poorer classes’ ac- system. This simply means that the cluding the highly developed ones, cess to adequate health services be- health-care system has to be poor- with migrant workers from the so ing hindered. In most cases, people er. For instance, efforts are being called “new Member States” or are left unassisted as regards their made to impose limits on the scope from beyond the European Union, health problems, because, being of preventive examinations, with who, being usually hired illegally, poor, they offer no opportunities laboratory tests being eliminated. agreeing to be paid low rates, with- for someone else’s further profits. This brings instability within rele- out any social insurance, are espe- This is the way in which liberals vant legislation, which is danger- cially exposed to these problems. try to push through the rules of free ous, as it results in an outflow of Such workers, in addition to earn- market in the health-care system. professional, highly qualified med- ing much less money, do not have Isn’t it, by any chance, a step-by- ical personnel. In fact, work medi- access to basic health-care ser- step journey towards the civiliza- cine has ceased to be a field in vices. A common reason for them tion of death? “This patient is which medical doctors want to spe- returning to their home countries is worth receiving treatment and that cialize. What testifies to this situa- their ruined health, with the ulti- one isn’t, as he is severely ill. From tion is a large number of unused mate result of such a situation be- the economic point of view, he is specialist training opportunities in ing an even bigger burden on the unprofitable, and he had better pass this area, which, as compared with inadequately financed health-care away on the quiet, or, if only possi- other specialties, applied for by systems in these countries, which ble, (which would be more reward- many candidates, is a new phe- are economically weaker anyway. ing in terms of finance) let some- nomenon. If the pursuit of profits is Now, I would like to briefly ad- one generate some revenue on his supposed to be the only determi- dress the situation in emerging death.” And who is supposed to nant here, the pressure on labour economies, whose impact on the make this profit? It is, obviously, a costs results in the unfortunate global economy, including Euro- commercial company, a liberal en- mothballing of the idea of compre- pean countries, is increasingly sig- terprise, which, at a low expense, hensive health-care services being nificant. According to the Amnesty will help you to organize a “human widely available to employees. International report of March 2007, death” – modern and financially Another topical issue in Poland the violation of fundamental hu- sound – euthanasia. The question is the illegal hiring of workers, man rights is a common occurrence that has just been asked should be without registering them, as well as there. Potential foreign investors, answered by all of us. Are we all forcing employees to continue with huge profits being their supe- still human beings? Or do we tend work on a self-employment basis, rior goal, regard these countries as to treat others as if they were mere whereby they carry on de facto the highly attractive places. In these commodities – things? Or, per- same services as they did on the countries rates of pay are very low. haps, have we already ceased to basis of an employment contract. Hiring children is widespread. think and perceive life and death in Such self-employed “employees” Work conditions are generally very the manner we used to? (employees and employers in one bad, with no basic health-care ser- The extensive transformations person) are not offered periodic ex- vices being provided. In most tex- that the health-care system under- aminations and other basic health tile factories young women from went instantaneously triggered ma- services, which results in a wide rural areas are employed. Regarded jor changes within the organization range of illnesses developing in as being more obedient, they accept of work medicine services. Most of this group of people, in addition to the harder work and inadequate the clinics operating as part of in- a general deterioration of their conditions, as the economic situa- dustrial plants were simply closed. health. At the end of the day, not tion in the areas from which they Nowadays, large companies do not only human suffering is a conse- come is even worse. In general, DOLENTIUM HOMINUM N. 76-2011 101 these employees work 12-14 hours Your Holiness, in your encycli- darity with their brothers and sis- a day, having only one day off per cal Caritas in Veritate, you empha- ters who are afflicted by these de- month. They develop a vast array size the idea of replacing the nar- structive processes! Without their of occupational illnesses and relat- rowly-understood “logic of the reliable information, many politi- ed health conditions. According to market” with the logic of gift and cians in many countries will not this report, 90% of women em- global solidarity. take decisive steps towards provid- ployed in the textile industry do not What we should call for today is ing employees with the necessary have access to social welfare facili- a fundamental thing – the logic of health care. ties, including basic health-care humanism: respect for the man- Equally important is appealing services. Thus, incomparably employee as a person, who, having to some representatives of the cheap goods are manufactured in been given one life, is unique and medical profession, who, realizing this process, unrivalled in terms of invaluable in the eyes of God. Man the potential of their expert knowl- price. The world is being flooded cannot be reduced to the level of a edge and political strength, should with such products which often manufacturing machine. That not turn a blind eye to the tragedies causes serious disturbances in local would mean the fall of the civiliza- of the “common people”. What (e.g. European) labour markets, tion of the twenty-first century. should be invoked is their account- which cannot fight a competition At the same time, a voice should ability to the Creator, with docile based on social injustice and hu- be raised – less money spent on ar- and obedient collaboration with the man suffering. maments and new killing technolo- merciless exploitation instruments Europe, the cradle of modern gies (defence industry) and more being the evil here, as they realize civilization, should use all its avail- money spent on protecting health, what they sometimes fail to do able economic instruments (e.g. especially in those places where even though they have the neces- embargo) or exercise political health is most often damaged and sary knowledge and capacities to pressure with the aim of improving wasted – the workplace! perform their duties to the full. The work conditions in factories and Politicians should invariably be public should be shown these med- ensuring that health-care services reminded of their vocation to build ical doctors and ministers whose are widely available in developing the civilization of life, solidarity, minds are set on providing medical countries. There is no denying that and international co-operation services to each person, poor and awareness among the Europeans rather than promoting fierce and the rich alike, and who try to build and citizens of the USA and Cana- heartless competition which ruins a health-care system that will sup- da as to the blatant injustice regard- employees’ health and dignity! port people like them in doing do. ing the availability of health-care Press journalists and TV/radio The viable idea of health-care ser- services in emerging economies is reporters should be more involved vices being provided in work- accompanied by their unrestrained in exposing these grave situations places should be given priority. use of the “benefits” of a cheap and human tragedies, as their scale labour force through the purchased and extent are often larger than in Prof. STANISLAW of a wide range of goods manufac- the time of the darkest capitalism SZCZEPAN GÓŹDŹ tured there, beginning with design- (considering the higher level of Director of the Oncology Hospital er shoes and finishing with high- knowledge and information flow of Kielce, tech electronic products. nowadays)! Let them show soli- Poland 102 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

JEAN-MARIE LE MÉNÉ Health-Care Workers Faced with Certain Questions of a Deontological, Ethical and Legislative Character

Why should health-care person- Whence comes the fact that be- jective criteria of morality, based nel have to face up to certain ques- tween these three normative upon objective truth and upon tions of a deontological, ethical and sources there is a contradiction awareness of good in itself. In this legislative character? Let us try to which can prejudice sound practice way formulations similar to the understand this question: it suggests in the service of patients? It seems Hippocratic Oath were present in a that deontology, ethics and law can to derive principally from two caus- number of cultures. contradict each other. This disac- es: the fracture of positivist law and Christianity, for its part, not only cord can be at the origins of diffi- the epistemological fracture of the involved a strong acceptance of culties encountered by health-care status of science. Hippocratic ethics but never ceased personnel. One thus understands to innovate, basing the concept of how these people feel the need for a a. The fracture of positivist law the human person above the dual- clarification which is necessary for ism of the soul and body, upon the the practice of their profession, in In order to understand fully the concept of help for the sick (‘you the best conditions for their patients fracture of positivism, it is useful to did it to me’) and the medical pro- and for themselves. remember the historical itinerary of fession (the Good Samaritan). In the first part of this paper, I ethical reflection in medicine. ‘At Christianity always sought dialogue have thought it useful to explore the the origins of medical ethics, in ar- between faith and science through causes of the contradiction between chaic societies and also in the more the mediation of reason, which is deontology, ethics and law. In the evolved societies of antiquity, three their common reference point. second part I will examine the con- elements were always present: the In contrary fashion, the principle sequences of this contradiction. requirements of an ethical character of autonomy, derived from the phi- that a medical doctor had to respect, losophy of the Enlightenment the moral meaning of help for sick thinkers, bases moral action solely 1. The Causes of the people, and the decisions that the on the autonomous choice of the in- Contradiction between state had to take in relation to the dividual, independently of truth: his Deontology, Ethics and Law problems that its citizens had to ad- or her freedom is practically limit- dress in the field of public health. less, it stops only where the free- The disaccord between deontol- The Code of Hammurabi of 1750 dom of others began, but on the ogy, ethics and law seems to be at BC, which itself was influenced by condition that other people have the the origins of difficulties encoun- previous Sumerian rules, contains means by which to take advantage tered by health-care personnel. In- norms that govern medical activity of their freedom. For ‘others’, such deed, when these three normative and an early regulation of taxation as embryos, foetuses, handicapped sources are in agreement, health- as regards help for health. In addi- children, the elderly or sick people care personnel have no reason to tion, in the outlining of Western eth- at the end of their lives, who are no subject themselves to such a coher- ical thought in the medical field, longer seen as persons, this freedom ent corpus unless they themselves one cannot ignore Hippocrates is not recognised. The scission of want to be excluded from their own (460-370 BC) and his Oath’, ob- the tandem truth/freedom made dif- communities. The problem, there- serves Cardinal Sgreccia.1 Here he ficult the defence of the notion of fore, comes from the fact that shows how this oath based the the common good. Subjective inter- health-care personnel may have to morality of medical action on the est became of primary importance deal with the prescriptions of deon- principle of doing good, that is to and provoked ethical relativism. tology, ethics and law which go in say the good of the patient, which Law in no way any longer depend- the same direction. They can also was placed above law itself, and not ed on truth and no longer had jus- be tempted to oppose these various upon the mere morality of a caste of tice as its purpose – it was reduced prescriptions, exonerating them- physicians. to an act of normative will by those selves from respect for some of Thereafter, with Plato, Socrates who govern. This was juridical pos- them. In this case, they are as and Aristotle, efforts were directed itivism which recognises as law on- blameworthy as they are victims. towards establishing the non-sub- ly what is to be found in laws, DOLENTIUM HOMINUM N. 76-2011 103 whether their contents are right or with tragic consequences, a long deontology and morality. The feel- not. historical process is reaching a turn- ing of dizziness, drunkenness and The consequences of this posi- ing-point. The process which once omnipotence felt by the whole of tivist approach were extremely led to discovering the idea of “hu- society acts as a powerful accelera- grave. Law became a simple mech- man rights” – rights inherent in tor of transgression. Medical sci- anism for regulation, for arbitrating every person and prior to any Con- ence, therefore, has entered a new between individual interests, a way stitution and State legislation – is phase under the impact of the accel- of searching for consensus, a formal today marked by a surprising con- erated developments of technology. procedure by which to defend the tradiction. Precisely in an age when Nothing is any longer predictable as interests of a changing majority. A the inviolable rights of the person regards the application of these dual contrary phenomenon was the are solemnly proclaimed and the technologies, inasmuch as the very result: on the one hand, law was value of life is publicly affirmed, finality of science, at the service of amoral in that it was no longer irri- the very right to life is being denied the common good, is no longer as- gated by morality, and, on the other, or trampled upon, especially at the sured. As a consequence, the ethical law and morality tended to be con- more significant moments of exis- boundaries invoked in a bewitching fused in the minds of citizens who tence: the moment of birth and the way in social debates, continue to no longer had normative reference moment of death’.3 move forwards, increasingly rapid- points other than law. What was le- ly, according to legislative frame- gal became moral. One needed only b. The Epistemological Fracture of works that follow one another. to change the rules to be in a sound the Status of Science Governments and parliaments try position. In reality, the result was clumsily ‘to frame negative tenden- the same: law was the law of the The recent advent of genetic and cies by the law’ but in practice ‘it is strongest and was arbitrary. It be- cellular discoveries, that is to say of the law that becomes a negative came, above all, toxic, inasmuch as the scientific laws that govern the tendency within the framework’.4 it by now appeared to be able to pollute morality and traditional de- ontology which were not the prod- ucts of synthesis. As Evangelium Vitae observes: ‘But the value of democracy stands or falls with the values which it em- bodies and promotes. Of course, values such as the dignity of every human person, respect for invio- lable and inalienable human rights, and the adoption of the “common good” as the end and criterion regu- lating political life are certainly fun- damental and not to be ignored. The basis of these values cannot be pro- visional and changeable “majority” opinions, but only the acknowledg- ment of an objective moral law which, as the “natural law” written formation of life, has provoked a Law’s function of regulating in the human heart, is the obligatory kind of conceptual devolution that demonstrates its ineffectiveness, As point of reference for civil law it- has strengthened the separation of the philosopher Michel Serres ob- self. If, as a result of a tragic ob- morality and law. Indeed, with serves,5 science does not aim sim- scuring of the collective con- these discoveries man has believed ply at knowledge about reality – it science, an attitude of scepticism that he can create and destroy him- has become the realisation of every- were to succeed in bringing into self, seeing life being born at the thing that is possible. By now it is question even the fundamental bottom of a test tube or under the borrowing its epistemological sta- principles of the moral law, the de- lens of a microscope. Lastly, he has tus from politics – the art of the pos- mocratic system itself would be come to control his own destiny sible. shaken in its foundations, and from the beginning to the end of This phenomenon is striking be- would be reduced to a mere mecha- life. His power has become that of a cause of its newness. It comes from nism for regulating different and demigod. Dazzled by these under- after the Second World War. Ab- opposing interests on a purely em- takings, he no longer needs a tran- solute evil was put aside, closed up, pirical basis’.2 scendent reference point. What is surrounded once and for all within The modern negative movement requested is solely a utilitarian and the perimeter of Nazi crimes. The of law towards positivism has thus economic reference point, and a concert of sentences, of contesta- dug a deep ditch which increasingly justification based upon the search tions, of indignations, exhausted its separates it from medical deontol- for an eternally unsatisfied happi- resources, dulled its competences, ogy at the service of the sick and ness which has still to be defined. dried up its streams in order to avert personalist ethics. ‘In this way, and All of this carries us very far from the errors of genocide. Paradoxical- 104 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE ly, the Nuremberg trials, rather than same time because of the normative services thanks to the combination intensifying our vigilance as re- relativism that I have already de- of scans and biological markers, the gards the future, closed the dossier scribed, but also because of the bringing forward of the test for of the divorce between law and abandonment of positions which trysome 21 from the second to the morality and sent it back to a fin- has already been allowed and which first three months of pregnancy, the ished past. Politics was seriously are not always perceived as such. analysis of the karotype beginning discredited by its tradition and in- The situation is often characterised with the cells of the foetus circulat- competence. Morality signed a con- by the fact that society has already ing in the blood of the mother, fession of weakness faced with the accepted a transgression that we greater information being provided concrete taking place of the un- could define as ‘primary’, within to the expectant woman in order to thinkable. God appeared to be which ‘secondary’ questions are help her in the choice she takes, strangely absent during this period posed. This takes place, for exam- etc.6 The very purpose of screening and the Church’s opinion was no ple, with the techniques of in vitro has never been called into question longer asked for. In this context of fertilisation with third part donors or discussed anew, although it is disillusion and cynicism, it appears which constitute illegitimate acts in constantly directed towards abor- to our contemporaries that only the themselves. This is primary trans- tion. And there are a large number myth of an objective science, a fac- gression. We then raise the question of people, among whom Catholic tor of renewal and of peace, a pre- of knowing whether, within the health-care personnel or health dictive magic, a progressive dream, framework of in vitro fertilisation heads, who do not realise that in is able to reopen the field of hope. with third party donors, it is neces- taking part in these discussions, or In the name of what can one forbid sary to accept some arrangement or choosing a fortiori to align them- this utopia to prosper if nothing else other, such as the ending of the selves in favour of an improvement remains? ‘Scientific research anonymity of the donor. It is worry- in such techniques, they help to in- should be allowed to work freely’, ing to pronounce on a secondary stall in an easier way, and thus to we can read everywhere. This is point that runs the risk of conceal- strengthen, a perverse approach. virginal, redemptive and almost de- ing the true problem, which is the It is important to observe here ified science which will save us very possibility of in vitro fertilisa- that resort to article 73 of Evangeli- from everything and will make us tion with third party donors. It is um Vitae, which is at times request- happy because politics is corrupt, disquieting to see health-care per- ed, is ineffective. This article allows morality has disappeared, and God sonnel or chiefs who belong to the support for a more restrictive law is silent. In brief, people believe in Catholic Church align themselves intended to replace a more permis- nothing anymore except in a sci- in favour of anonymity or the re- sive law but certainly not to im- ence that calmly occupies the place moval of anonymity since their ef- prove the component parts of a bad left vacant by religion, by philoso- forts – at least at the level of forma- system whose negative effects, at phy and by the art of governing the tion and arguments – should above the level of respect for life, would city. all concern the elimination of in vit- not in the least be reduced. ro fertilisation with donors. This is why one should constant- In the same field, one can make ly remember the need to find crite- 2. The Consequences an identical observation on the ria for judgement not only in scien- of the Contradiction between freezing of ovocytes for vetrifica- tific research and medical technolo- Deontology, Ethics and Law tion which is a technique of rapid gy themselves, returning to an onto- freezing as opposed to the tech- logical, axiological and teleological Deprived of objective morality nique of slow freezing which has vision of the reality involved: the and drugged by technical perfor- been used hitherto. The merits or human being at all the stages of his mance, medical and scientific activ- dangers of vetrification are thus as- or her life, from conception to ity is like a drunken ship whose en- sessed within the framework of the death. gine is increasingly competitive but collection of gametes, which in it- ‘In order to take a decision begin- which is no longer on course. The self is already a morally contestable ning with these criteria, one should consequence of this are to be per- activity where we should go into re- as a consequence answer in a clear ceived in the action of health-care verse. This secondary technical de- way to the three following ques- personnel. On the one hand, there bate, however seductive it may be tions: what is man (ontology)? arises great confusion as regards the from the point of view of an im- What is his value (axiology)? What decisions that are to be taken. On provement of medically assisted is his destiny (teleology)?’7 the other, the burden of these deci- procreation, in particular eliminates sions falls upon health-care person- the fact that one should not experi- b. The Isolation of health-care nel who are increasingly out on ment on the effects of the vetrifica- personnel their own. tion of ovocytes on human embryos which are not intended to be placed When confusion rules as regards a. Confusions as regards in the female womb. the decisions to be taken, health- the decisions to be taken In another field, that of prenatal care personnel feels the responsibil- screening, it is very common for us ity weighing on their shoulders The situation has become very to see the emergence of debates on more heavily. If the direction pro- confused because of an increasing the development of these practices: vided by law contradicts deontol- technical complexity and at the for example the improvement in ogy and morality, the task of recre- DOLENTIUM HOMINUM N. 76-2011 105 ating a hierarchy of applicable thy of the name. It is thus the task of tific advances at the service of med- norms falls, in the final analysis, on ecclesial structures to mitigate this ical decisions which are in confor- the actors themselves of the health- shortcoming by proposing moral mity with the common good. care world. For the health-care per- formation for Catholic health-care Respect for the human being sonnel, most of the time, one is personnel. This task would be does not stop where the freedom of dealing, therefore, with being able greatly facilitated if in school insti- technology/science begins: the to engage in a judgement of con- tutions of the Catholic Church a for- freedom of technology/science science, that is to say assessing an mation in bioethics was already stops where respect for the human action in relation to moral princi- provided. It would also be facilitat- being begins. ples and norms. To engage in a ed if couples who asked for mar- judgement of conscience appears at riage were to receive a specifically Prof. JEAN-MARIE LE MÉNÉ the same time a right but also a du- bioethical formation – and not only President of the Jérôme Lejeune ty. Here it is important to remember formation of a conjugal character – Foundation, that in a judgement of conscience in the field of the grounding provid- France, Member of the Pontifical Academy although the exercise of freedom is ed to them by the Church. for Life, necessary it is not sufficient. In- Lastly, Catholics who are respon- the Holy See deed, for us to be able to speak sible for formation in bioethics are about a true conscience, there must recommended not to hesitate to be a correspondence between moral place themselves within a logic of judgement and conformity with an fracture – and not of accompanying act with a good end. For this reason – with the legislative framework of Notes there is an obligation for the person countries which dissociate deontol- 1 E. SGRECCIA, Manuel de bioéthique involved to receive a moral forma- ogy, ethics and law. If this will to (Mame-Edifa, Paris, 2004), pp.13 ss. tion that is the more demanding the break with a system of deviant 2 Evangelium Vitae,n.70. more goods are involved. norms is not clearly established, it 3 Evangelium Vitae,n.18. 4 J.M. LE MÉNÉ, Nascituri te salutant – La Unfortunately, in countries where is impossible to dispense with a for- crise de conscience bioéthique (Salvator, Paris, law no longer pursues a good end mation that is able to form con- 2009). and where a contradiction between sciences, to break the isolation of 5 J. TESTART, L’œuf transparent, preface by Michel Serres. deontology, ethics and law is perva- health-care personnel and to hope 6 J.M. LE MÉNÉ, La trisomie est une tragédie sive, a real difficulty exists as re- that the members of this personnel grecque (Salvator, Paris, 2009). gards finding moral formation wor- will place technological and scien- 7 E. SGRECCIA, Manuel de bioéthique,p.47. 106 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

BARRY L. DUNCAN The Question of the Use of Psychiatric Pharmaceuticals in Paediatrics

A 2004 US review concluded ard, 2010). A study of foster care Children and Antidepressants that spending for medications for children (on Medicaid) found that childhood behavior problems now 57% received three or more drugs Two randomized controlled trials eclipsed expenditure for any other (Zito et al., 2008), six times the na- of fluoxetine (Prozac) (Emslie et drug category, including antibi- tional average. Finally, the use of al., 1997; Emslie et al., 2002) otics (Medco Health Solutions, antipsychotics with privately in- gained approval for young people Inc.). While the US continues to sured children, aged 2 through 5, aged 8-17 diagnosed with depres- lead the world in psychiatric pre- has doubled between 1999 and sion (FDA, 2003, January 3). How- scriptions to youth, global use of 2007 (Ofson, Crystal, Huang, & ever, both Emslie studies failed to ADHD drugs has increased by Gerhard, 2010). About 1.5% of all find a statistical difference between 274% (Scheffler et al., 2007) as privately insured children between Prozac and placebo on primary out- prescriptions for antipsychotics the ages of 2 and 5, or one in 70, come measures. Additionally, in doubled across Europe (e.g., the received some type of psychiatric both trials, manic reactions and sui- UK: Rani, Murray, Byrne, & drug in 2007 despite the fact that cidality were notably higher in the Wong, 2008; and Germany: Schu- there is little to no evidence in this drug group compared with placebo bert & Lehmkuhl, 2009). The age group. (Sparks & Duncan, 2008). An inde- number of youth taking 1 or more While psychotropic drug use has pendent analysis by the FDA con- psychiatric medicines has hit risen, community behavioral inter- cluded that only 3 out of 15 pub- nearly 9% in the US, 6% in the vention has remained flat or de- lished and unpublished trials of SS- UK, and 3% in Australia – al- clined (Case, Olfson, Marcus, & RIs showed them to be more effec- though not one clinical trial has Seigel, 2007). Several questions tive than placebo on primary mea- examined polypharmaceutical in- arise: First, are the skyrocketing sures (Laughren, 2004). None of tervention with children (dosReis rates of prescription justified by the 15 found differences on patient et al., 2005). clinical trial evidence? Are physi- or parent rated measures. Prescriptions for antidepres- cians who routinely prescribe psy- The NIMH funded Treatment of sants for youth have increased at a chotropic medications following Adolescent Depression Study rate of 11% per year from 1994 to the scientific mandates of evi- (TADS) (TADS Team, 2004), again 2000, and 5% per year since, total- dence based medicine (EBM)— evaluated Prozac for the youth age ing to over 11 million prescrip- the integration of the best research group. TADS compared the effica- tions written annually. The number evidence with clinical expertise, cy of four treatment conditions: taking antipsychotics soared 73% including patient values, to make Prozac alone, cognitive behavioral in the four years ending in 2005 – informed decisions about individ- therapy (CBT) alone, CBT plus over 2.5 million youth per year are ual cases (Sackett, Rosenberg, Prozac, and placebo. Despite media prescribed antipsychotics (dosReis Gray, Haynes, & Richardson, claims, (The New York Times front et al., 2005). A study of 11,700 US 1996)? Next, are children, by page headline, “Antidepressant children under age 18 covered by virtue of their powerless position Seen as Effective in Treatment of Medicaid (program for the poor) and dependence on adults, the vic- Adolescents,” Harris, 2004), the found that the number of children tims of an industry motivated by FDA did not count TADS as a pos- newly treated with antipsychotics greed rather than social conscious- itive study for SSRIs due to the increased from 1,482 in 2001 to ness? Finally, are the differential negative findings on its primary 3,110 (or 26%) in 2005 (Mathak, rates of prescription of psychiatric outcome measure. Other end-point West, Martin, Helm, & Hender- drugs to poor children a violation comparisons in TADS favored the son, 2010). Another study found of equitable and human health combined medication/CBT arm. that children covered by Medicaid care? This presentation addresses However, treatment was unblind, were prescribed antipsychotics at a these questions via a risk/benefit and only the combined group re- rate four times higher than chil- analysis of the major drug classes ceived all intervention components dren with private insurance, and and provides a template for health (drug, psychotherapy, psychoedu- were more likely to receive an- and pastoral professionals to eval- cation and family therapy, and sup- tipsychotics for unapproved uses uate the drug literature and facili- portive pharmacotherapy monitor- (Crystal, Olfson, Huang, & Ger- tate medication decisions. ing), creating a significant disparity DOLENTIUM HOMINUM N. 76-2011 107 in favor of the combination arm. sures, all un-blinded, found differ- tant use of antidepressants, anticon- The TADS recorded 6 suicide at- ences favoring methylphenidate vulsants, and benzodiazepines, tempts by Prozac takers compared (Ritalin). Neither blinded class- compromising even these disap- to 1 by non-Prozac takers, with room observers, the children them- pointing findings. A 17-year old more than double the incidence of selves, nor their peers found med- boy committed suicide and an un- harmful behavior in the Prozac ication better than behavioral inter- specified number of participants conditions compared to placebo ventions. Moreover, 14-month end- were hospitalized due to suicidality groups (despite the exclusion of point assessments compared those or worsening psychosis. These youths deemed at high risk for sui- actively medicated and those who events are particularly disturbing in cidal behavior). Nevertheless, the had ended therapy (4 to 6 months light of the fact that youths consid- authors recommended that “med- after the last, face-to-face, thera- ered at risk for suicide were exclud- ical management of MDD with flu- peutic contact) (Pelham, 1999). ed from the study. Weight gain was oxetine, including careful monitor- Given this unfair comparison, the deemed serious enough to warrant ing for adverse events, should be fact only 3 un-blinded measures suspension of the Zyprexa arm. Ad- made widely available, not discour- found an advantage for Ritalin is verse events were “frequent” in all aged” (p. 819) – a challengeable telling. At the same time, 64% of three groups. Only those youth who conclusion given its inconsistency MTA children were reported to “responded” during the initial eight with the study’s own harm data. In have adverse drug reactions: 11% weeks – 54 of the 116 – were en- the 36-week follow up study (The rated as moderate and 3%, severe. tered into the 44-week maintenance TADS Team, 2007), all treatment At 36 months, treatment groups did study (Findling et al., 2010). Forty conditions converged by 30 weeks not differ significantly on any mea- of the 54 youth dropped out during with significantly more suicidal sure (Jensen et al., 2007). Decreases this period because of “adverse ef- ideation in the Prozac alone group. in growth in medicated children av- fects” or “inadequate response.” The percentage of suicidal events eraged 2.0 cm and 2.7 kg less than Thus, only 14 of the 116 youth who for those on Prozac was nearly not medicated groups, without evi- entered the study responded to 12%, double the 6% in the CBT dence of growth rebound at 3 years the medication and stayed on it for group. (Swanson et al., 2007). as long as one year – only 12%. The risks noted in published and In March of 2006, a safety advi- unpublished data prompted the sory committee of the FDA urged FDA to issue a black box warning stronger warnings on ADHD drugs, on all antidepressants for youth for citing reports of serious cardiac increased risk of suicidality and risks, psychosis or mania, and sui- clinical worsening (FDA, October, cidality. The FDA elected to forgo a 15, 2004). Further support of the black box warning for most ADHD warning emerged from an analysis drugs, choosing instead to highlight of placebo-controlled trials of nine risks on the label and include infor- antidepressants, a total of 24 trials mation with each prescription. involving over 4,400 children and adolescents (Hammad, Laughren, & Racoosin, 2006). The investiga- Children and Antipsychotics tion revealed an average risk of sui- cidality of 4% in drug treated The APA Working Group found youth, twice the 2% placebo risk. that studies supporting the use of antipsychotics to treat children were plagued with methodological Children and Stimulants limitations. Consider the NIMH funded Treatment of Early Onset The American Psychological As- Schizophrenia Spectrum Disorders sociation (APA) Report of the (TEOSS) (Sikich et al., 2008). Working Group on Psychoactive TEOSS sought to examine the effi- Medications for Children and Ado- cacy, tolerability, and safety of two lescents (hereafter Working Group) second generation antipsychotics A Critical Flaws Analysis (Working Group, 2006) noted the (SGA) (risperidone or Risperdal lack of data supporting long term and olanzapine or Zyprexa) for The former editor of the New efficacy or safety. Further high- youths diagnosed with early-onset England Journal of Medicine lighted was that stimulants, while schizophrenia spectrum disorder called attention to the problem of reducing symptoms, show minimal and to compare these to a first gen- “ubiquitous and manifold ...finan- efficacy in general life domains of eration antipsychotic (FGA) cial associations” authors of drug the child, including social and acad- (molindone or Moban). At the end trials had to the companies whose emic success. Stimulant advocates, of eight weeks, the response rate drugs were being studied (Angell, however, point to the Multimodal was 50% for those treated with 2000, p. 1516). Given the infiltra- Treatment Study of Children with Moban, 46% for Risperdal, and tion of industry influence, discern- ADHD (MTA) (MTA Cooperative 34% for Zyprexa. Participants in ing good science from good mar- Group, 1999). Only 3 of 19 mea- the study were allowed concomi- keting requires a willingness to en- 108 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE gage primary source material, and a drug, potentially distorting find- conclusions. The 1997 Emslie et al. critical flaws analysis. ings. For example, measures in an- study, published prior to disclosure tipsychotic trials, like TEOSS, fa- requirements, did not identify au- Flaw # 1: vor medications with sedative thor affiliations. Emslie et al.’s sec- Compromises to the Blind properties and many trials add ond fluoxetine trial for child and sedatives or use drugs with sedative adolescent depression (Emslie et Fisher and Greenberg (1997) as- effects (Moncrieff, 2001). al., 2002) lists author affiliations on sert that the validity of studies, in the first page. Here, readers learn which a placebo is compared to an Flaw # 3: that Emslie and Wagner are paid active medication, depends upon Time of Measurement consultants for Eli Lilly, who fund- the “blindness” of participants who ed the research and whose product rate the outcomes. They note that Psychiatric drugs are often pre- was being investigated. The re- inert sugar pills, or inactive place- scribed for long periods of time. maining six authors are listed as bos, do not produce the standard This suggests that most clinical tri- employees of Eli Lilly and “may side effect profile of actual drugs— als, which last for 6 to 8 weeks, are own stock in that company” (p. dry mouth, weight loss or gain, not measuring how well the drugs 1205). dizziness, headache, nausea, in- do in actual settings or the long somnia and so on. Since study par- term side effects. Additionally, dif- Flaw # 5: ticipants must be informed of the ferences between medication and Minimization of Risks possibility and nature of side ef- other treatments or placebo groups fects in giving consent, they are often dissolve over time (Fisher & Many psychiatric drug studies necessarily alert for these events, Greenberg, 1997). Without longer downplay or fail to assess adverse enabling them to correctly identify term follow-ups, conclusions about drug reactions. As a result, rates of their study group. In addition, inter- effectiveness in real life cannot be side effects may be substantially views that listen for or elicit side ef- determined. Authors of many under-reported (Safer, 2002). In- fect information easily reveal ac- short-term clinical trials fail to dis- stead of detailed tables, adverse tive versus inactive pill takers, ef- cuss time-frame limitations or to events may be described in a narra- fectively un-blinding the study for modify accordingly claims made in tive rather than tabulated formats clinical raters and skewing results. conclusions. For example, Emslie (e.g., Emslie et al., 1997). Authors Moreover, many trial participants et al. (1997), an 8-week study, con- of trials often confidently assert in placebo groups have previously cluded that “fluoxetine in 20 mg/d that the drug is safe when the data, been on drug regimens, even some is safe and effective in children and in fact, show otherwise. In a study just prior to entering the trial, and adolescents,” (p. 1036) without of Risperdal with youth diagnosed are therefore familiar with medica- mention of time. The MTA, TADS, with disruptive behavior disorders tion effects. All of the studies de- and other studies show that differ- (Reyes et al., 2006), the literature scribed above used inactive place- ences with non-drug treatments review asserts that “Risperidone bos or none at all. tend to dissipate over time, and that has consistently demonstrated effi- initial effects of drug treatment cacy and safety in both controlled Flaw # 2: must be weighed in terms of long short-term and open-label long- Reliance on Clinician Measures term tolerability and impact be- term studies” (p. 402). Five studies yond symptom remission. The are cited to back this claim—two In the Emslie studies, the MTA, TEOSS one year follow-up of only short-term (Aman, De Smedt, De- and TADS, client-rated measures 12% showing benefit offers a dra- rivan, Lyons, & Findling, 2002; found no difference between the matic example. Snyder et al., 2002) and three, placebo and SSRIs and among the longer-term (Croonenberghs, conditions in the MTA. The lack of Fegert, Findling, De Smedt, & Van endorsement of efficacy by clients Flaw # 4: Dongen, 2005; Findling, Aman, in clinical trials begs the question: Conflicts of Interest Eerdekens, Derivan, & Lyons, If clients don’t notice improve- 2004; Turgay, Binder, Snyder, & ments, how significant can those Richard Smith, who resigned as Fisman, 2002). rated by others be? In addition, editor-in-chief of the British Med- The two short-term trials showed clinician-rated scales are often cat- ical Journal because of rampant in- significant differences between the egorical, allowing a subjective dustry influence in academic re- Risperdal and placebo groups for range of responses to participant in- search, explains that the number key adverse events: somnolence, el- terviews and potential bias due to one aim of industry-sponsored tri- evated serum prolactin (for boys), compromised blind conditions. als is to find favorable results for and weight increase. The three Moreover, continuous data are of- the company drug (Smith, 2003). longer-term studies were open-la- ten converted into discrete cate- Most academic journals now rec- bel extensions of the shorter term gories (e.g., response and non-re- ommend transparency regarding trials and examined the long-term sponse), further magnifying differ- funding sources and author affilia- efficacy and safety of Risperdal in ences (Kirsch et al., 2002). Finally, tions. With these as caveats, readers children ages 5 to 12 with lower some clinician-rated measures tilt can approach the study with a war- than average IQ scores. In all three toward specific domains of dis- ranted skepticism and a more care- trials, the top reported adverse comfort that favor the investigative ful analysis of trial methods and event was somnolence, ranging DOLENTIUM HOMINUM N. 76-2011 109 from 20.6% to 51.9%. Weight gain interventions have a strong track chised; 2) no off label prescribing; was another frequently reported record with virtually no adverse as- 3) no polypharmacy; 4) immediate problem (from 17.3% to 36.4%). sociated medical events, leading separation of the pharmaceutical The pattern of increased prolactin the Working Group (2006) to con- company influence from science levels was observed across the three clude their massive review with the and practice; and 5) monitoring trials. Five participants in Croonen- recommendation: “Thus, it is our treatment response with patient rat- berghs et al.’s study required an- recommendation that in most cas- ed measures. tiparkinsonan medications, six es, psychosocial interventions be The belief in the power of chem- withdrew due to EPS, and two de- considered first.” (p. 16.) istry over Church, community, so- veloped tardive dyskinesia, while This conclusion, however, does cial and psychological process – fu- 26% of participants in Turgay et al. not eliminate medication as one eled by unprecedented promotion experienced EPSs. Overall, 76 of choice among many but rather from the drug industry that targets the 77 participants in Turgay et al. frees health and pastoral profes- all players in health care – forms reported adverse events, close to sionals to put other options on the the basis of pharmacology’s grow- 92% in Croonenberghs et al., and table and draw in the voices of ing centrality in treatment, re- nearly 91% in Findling et al. those they serve: to engage in a search, training, and practice. It Yet, the authors of all 5 studies risk/benefit discussion and help promotes prescriptive treatments of report the drug’s safety: “generally families choose treatments in con- questionable sustainability, fraught safe” and “well tolerated” are cert with their values and cultural with potentially dangerous effects, found in every abstract and conclu- contexts, including Church and often aimed at those most unable to sions section for all the studies. The community – thereby enacting the refuse. This presentation called for claim that “risperidone has consis- call of EBM to integrate the best a higher standard of care for our tently demonstrated efficacy and available research with patient most vulnerable and precious com- safety” (p. 402), with the five stud- preferences. modity, our children, that invites unity among all concerned health and pastoral professionals. It is time to no longer accept prescrip- tive practices that do not follow the evidence and increasingly put clients at perilous risk for serious health consequences, dependence, and disability. The Catholic Church, in addition to spiritual leadership, has a rich history of benefiting humanity, comforting and empowering the frail and disenfranchised, protect- ing the sanctity of human life, and strengthening families. The Church and her vessels hold great interna- tional influence and perhaps may ies reviewed here as evidence is, at Where children are concerned, be the only power on earth that can best, misleading, and at worst a the stakes are higher. They are, es- counter the forces of corporate rhetorical construction revealed on- sentially, mandated patients—most greed that have no moral or ethical ly via examination of the data. The do not have a voice to say no to conscience. The Church, via FI- problems of sedation, weight gain, treatments or devise their own, and AMC, Catholic Medical Associa- increased serum prolactin, and depend on adults to safeguard their tions and Catholic hospitals, movement disorders have been ef- wellbeing (Sparks & Duncan, Catholic schools, Catholic Church fectively swept under the rug, and 2008). Moreover, poor children of- communities, the Catholic media, the efficacy and safety case, over ten have fewer adults watching in conjunction with bishops, time, becomes undisputed (Sparks, over them and are vulnerable to priests, and sisters in religious Duncan, Cohen, & Antonuccio, dangerous drugs used as interven- communities, can assist individuals 2010). tions of control rather than therapy, and families in need of guid- and therefore require more care to ance/education in alternatives to ensure equitable treatment. The ev- medication as well as the appropri- Conclusions and idence demands that the trend of ate risk/benefit discussions regard- Recommendations rising prescriptions and lower psy- ing the use of medication. chosocial intervention be stopped For there to be social justice and The clinical trial evidence does and a higher standard of care im- equitable care for youth, health not justify current prescribing prac- plemented: 1) psychosocial inter- professionals, pastoral workers, tices and is antithetical to evidence vention should be considered and families need access to accu- based medicine. While pharma- first—families and youth should rate data – to the truth untainted by cotherapy involves considerable have a voice in decisions about corporate influence. The risks pre- risk for young people, psychosocial their care, especially the disenfran- sented here as well as the dangers 110 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE of psychotropics emerging with Journal of the American Academy of Child and I. (2008). Epidemiologic features of antipsy- Adolescent Psychiatry, 41(10), 1205-1215. chotic prescribing to children and adolescents other vulnerable populations (e.g., EMSLIE, G.J., RUSH,A.J.,WEINBERG,W.A., in primary care in the United Kingdom. Pedi- birth defects and spontaneous abor- KOWATCH, R. A., HUGHES,C.W.,CARMODY, atrics, 121, 1002-1009. tions in pregnant women on antide- T. et al. (1997). A double-blind, randomized, REYES, M., BUITELAAR,J.,TOREN, P., AU- placebo-controlled trial of fluoxetine in chil- GUSTYNS,I.,&EEDEKENS, M. (2006). A ran- pressants; increased heart attacks dren and adolescents with depression. Archives domized, double-blind, placebo-controlled and strokes in the elderly with de- of General Psychiatry, 54(11), 1031-1037. study of risperidone maintenance treatment in mentia on antipsychotics), offers a FINDLING,R.L.,AMAN,M.G.,EERDEKENS, children and adolescents with disruptive be- M., DERIVAN,A.,LYONS, B., et al. (2004). havior disorders. American Journal of Psychi- call to action to all of you attending Long-term, open-label study of risperidone in atry, 163, 402-410. this conference. Although a clinical children with severe disruptive behaviors and SAFER, D. J. (2002). Design and reporting trial will never address it, the use of below-average IQ. American Journal of Psy- modifications in industry-sponsored compara- psychiatric drugs in paediatrics chiatry, 161, 677-684. tive psychopharmacology trials. J Nerv Ment FINDLING,R.,JOHNSON,J.,MCCLELLAN,J., Dis 190:583-592. begs yet another question: How FRAZIER, J., VITIELLO, B., HAMER, R., et al. SCHEFFLER, R. M., HINSHAW, S. 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Pediatrics, 113, April, Archives of General Psychiatry, 64(10), 1132- emy of Child & Adolescent Psychiatry, 44(1), 754-761. 1144. 64-72. OLFSON M., CRYSTAL S., HUANG C., & GER- TURGAY,L.,BINDER,C.,SNYDER,R.,&FIS- CRYSTAL S., OLFSON M., HUANG C., PINCUS HARD T. (2010). Trends in antipsychotic drug MAN, S. (2002). Long-term safety and efficacy H., & GERHARD T. (2009). Broadened use of use by very young, privately insured children. of risperidone for the treatment of disruptive atypical antipsychotics: Safety, effectiveness, Journal of the American Academy of Child behavior disorders in children with subaverage and policy challenges. Health Affairs, 28, 770- Psychiatry, 49,13-23. IQs. Pediatrics, 110. Accessed June 9, 2007 781. PATHAK,P.,WEST,D,MARTIN,B,HELM,& from http://www.pediatrics.org/cgi/content/ DOSREIS,S.,ZITO, J., SAFER,D.,GARDNER, HENDERSON, C. (2010). Evidence-based use of full/110/3/e34 J., PUCCIA,K.,&OWENS, P.. (2005). Multiple second-generation antipsychotics in a state U. S. Food and Drug Administration (2003, psychotropic medication use for youths: A Medicaid pediatric population, 2001–2005. January 3). FDA approves Prozac for pediatric two-state comparison. Journal of Child and Psychiatric Service, 61, 123-129. use to treat depression and OCD. Retrieved Adolescent Psychopharmacology, 15, 68 –77. PELHAM, W. (1999). The NIMH multi- January 25, 2003 from http://www.fda.gov/ EMSLIE,G.J.,HEILIGENSTEIN,J.H.,WAGN- modal treatment study for attention-deficit hy- bbs/topics/ANSWERS/2003/ANS01187.html ER,K.D.,HOOG,S.L.,ERNEST,D.E.,BROWN, peractivity disorder: just say yes to drugs ZITO,J,SAFER, D., SAI,D.,GARDNER, J., E. ET AL. (2002). Fluoxetine for acute treatment alone. Canadian Journal of Psychiatry, 44, THOMAS,D.,COOMBES, P., et al. (2008). Psy- of depression in children and adolescents: A 981-990. chotropic medication patterns among youth in placebo-controlled, randomized clinical trial. RANI,F,MURRAY,M.,BYRNE,P,&WONG, foster care. Pediatrics, 121,157-163. DOLENTIUM HOMINUM N. 76-2011 111

BONIFACIO HONINGS The Blessed Don Carlo Gnocchi: a Heroic Figure of Charity of our Time

I have the very pleasant task of stantly need: the strength to hope seamstress, looking after her chil- presenting, within the context of which in its turn makes them able dren, and her intense and sober the subject of this international to love. To this need for a loving love for her husband. Theirs was a conference on ‘Caritas in veritate: hope blessed and saints have serene family solid in faith. At that Toward an Equitable and Human known how to respond as witness- time this was no small achieve- Health Care’, one of the heroic fig- es and ministers. As witnesses, be- ment: the society in which they ures of charity of our time – the cause Jesus did not come to offer a lived or at least ‘legal society’, Blessed Don Carlo Gnocchi. En- doctrine but to offer a life that which lived in the corridors of nio Apeciti characterises the figure ‘speaks’ of what one believes, power, of government and of par- of Don Gnocchi with the follow- hopes and loves. As ministers be- liament, had for some time and in ing words: ‘he loved them to the cause they place themselves at the various ways, sought to ‘destroy’ very end’. These are the words of service of the dream of God, to the family and its meaning, its way the solemn introduction to the Last bring it to every brother and sister of being. Carlo was baptised in the Supper of Jesus with his apostles. of theirs, to every human being. Church of San Colombano in ‘It was now the day before the Ministers and not so much teach- Lambro five days after his birth, Passover Festival, Jesus knew that ers because not only do they bring on 30 October 1902, and was the hour had come for him to leave the words of he who alone is the called ‘Carlo, Fortunato, Domeni- this world and go to the Father. He Teacher – they also bring him, he co’. He received his confirmation had always loved those in the who is living and real, in the Bread world who were his own, and he that is broken and the Wine that is loved them to the very end’ (Jn poured. Amongst these ‘blessed 13:1). The commentators of this witnesses and ministers’ has been beginning of the Gospel of love since 25 October 2009 also Don according to John observe that Carlo Gnocchi, an Ambrosian from Chapter 13 until chapter 15 – priest, who like his Lord and that is to say until the end – the tan- Teacher wanted ‘to love to the dem ‘light, darkness’ disappears very end’. And he managed to do whereas the verb ‘to love’ and its this.2 It is thus helpful to know him derivatives are to be found thirty and to draw near to him in order to times. St. John thus seeks to em- learnfromhimthepaththatheads phasise that the Eucharist refers to to the Light, to that Dwelling love, presupposes it, and is its where there are no longer any tears completion. By this change to the but only joy and peace, forever. To tandem ‘love-life’, the Evangelist that Dwelling where the heroic fig- makes clear that the gift of life that ures of charity of all epochs live, on 19 May 1911 in the parish of Jesus makes to his disciples, to including those of our time, such Santa Eufemina in Milan. This men, because ‘God loves them’, is as Don Carlo Gnocchi. At the out- change of setting is not without the crowning, the summit of the set I would like to describe him as significance because of the singu- whole of a life, of the whole of his he was on the pathway of pain lar experience of pain of the little life’.1 which led him to the priesthood. Carlo. Indeed, the life of Carlo was soon marked by pain. When he was still five years old he lost his The Saints: Witnesses A Convinced Priest father who died on 9 April 1907 of and Ministers to Hope-Love at the School of Pain silicosis. The difficulties encoun- tered in living in San Colombano Ever since Jesus revealed this Carlo was born on 25 October for a widow with children led the tandem of love and life, it has been 1902. He was the third child of En- family to move. His mother incumbent for it to be repeated, to rico Gnocchi, a marble craftsman, Clementina was helped by her sis- be shouted out aloud, in order to and Clementina Pasta, who spent ter who lived in Montesisto near give human beings what they con- her time between working as a Bressana Brianza and she began to 112 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE spend long periods in that place newspaper La Sera declared on 14 rate of Ars, to Jean Eudes. He re- which seemed to strengthen the February 1894: ‘Msgr. Ferrari be- turned to this eight years later dur- lungs of her first child, Andrea. longs to that most terrible category ing the first Holy Year of Redemp- Carlo was a promising child in of priests, the category of con- tion of 1933 by canonising other his life and at school, above all af- vinced priests. He knows that with figures: Bernadette Soubirous, ter attending the school year of sweetness one can also tame tigers Giovanna Antida Thouret, John 1914-1915 of his second ‘ginna- and thus he is sweet; he knows that Fischer, Thomas More, Alberto sio’ – today we would say upper with tenacity one can also perfo- Mago, Giovanni Bosco, and secondary school – which was run rate mountains, and thus he is tena- Giuseppe Benedetto Cotolengo. by the Salesians in Milan. He nev- cious. But he never gives himself There is a red line that they all er forgot their educational impact. away and never forgets his goal’. share. They are all saints who lived In order to illustrate whom he In a paper that he gave on 23 April through difficult times. But they based himself on in the develop- 1895 Cardinal Ferrari said: ‘the fu- did not become disheartened, in- ment of his Work he explained ture is a Christian science, of deed they were in granite fashion many years later (on 7 January gospel brotherhood, of religious faithful to terrible daily life, trans- 1949 ): ‘in the search for funds for light’. Now, Carlo Gnocchi want- forming the hardship of the times the lives of my poor people (in- ed to be a priest of that category of into intense and hard-working valids with major disabilities, or- convinced priests that never sur- charity that changed the societies phans, mutilated children, those render to the powers of evil and al- in which they lived. Charity al- with bad housing) I tried to base ways use sweetness, tenacity and ways wins. Indeed, this is the truth myself more on Don Bosco than charity. He always wanted to be an of charity or charity in truth. on Cotolengo’. But his house com- optimistic priest convinced that For this reason, Pius XVI want- panion, pain, had also moved to victory was on the side of good. ed to exhort people to hope, edu- Montesisto, because on 3 August This is why Carlo did not rebel cating the faithful, priests and sem- 1951 Andrea also died, He was against God but wanted to enter inarians – like Don Gnocchi – to twenty years old, given that he had the seminary to become a con- expand the horizon of their faith been born on 25 March 1898. vinced priest, for the Church in the and their Christian experience. For However, it is was precisely this world of his time. this reason on 28 October 1926, companion that had a determining the first anniversary of the Holy reason to exist in his life. For some Year, he ordained the first six Chi- months Carlo had convinced his A Priest in the Church nese bishops and one Indian bish- mother to allow him to enter the of his Time op. The next year, on 30 October seminary so that he could fulfil a 1927, he ordained the first Japan- dream, a dream that he had had for DonCarlobecameapriestdur- ese bishop. The same hope led him some time, and to placate the wish ing the Holy Year of 1925 and to ordain four unnamed bishops that he had always felt in his heart. more precisely on 3 January when for Russia. The epoch when the But how could he leave specifical- everything pushed towards holi- Church was barricaded in the pe- ly at that moment? His mother ness as a ‘norm’ of the style of life ripheral peninsula of Europe (cer- would have been left alone. In of priests. This was a time of tainly glorious as regards its histo- those circumstances he was a courage and of hope. It was no ac- ry but peripheral as regards its lo- teacher of Christian charity and su- cident that Pius XI, immediately cation) was over. The Church had, pernatural prudence. When writ- after his election as the Bishop of and had, as its horizon the whole ing to Don Luigi Orione, to Rome (6 February 1922), wanted world, and Pius XI did everything whom he was bound by sincere af- to appear for his first blessing Urbi to open people’s eyes as regards fection, it was no chance that Car- et Orbi not within the Basilica of that great reality which allowed lo observed: ‘She was an excep- St. Peter’s as had been done since people to trust in the future and not tional mother’ and to the Dames of 1877 but outside it, where the Pope to be resigned registrars of a sunset St. Vincent of the Conzaga Insti- always appeared (and appears). He that could never take place and can tute he added: ‘I feel every day wanted to give the Holy Year of never take place.4 Don Carlo more her strong love, her silent de- 1925 a clearly missionary impress. Gnocci was truly one of these peo- votion to duty, her Christian holi- Indeed, he wanted an exhibition on ple who trusted in the future and he ness’.3 missions to be created for that was certainly not the resigned reg- After these praises for his moth- Holy Year. It was so beautiful that istrar of a sunset. He was a priest er who was opposed to him enter- it was never taken down and be- who loved God and men. ing the seminar, and above all after came the present ‘Ethnological the dramatic events of the death of Missionary Museum’ of the Vati- his father and of his brother An- can Museums. The year 1925 was APriestwhoLovedGod drea, it is interesting to know why to be a year of hope and a historic and Men Carlo wanted to become a priest. period for Christians. For this rea- He had the good fortune, or better sonPiusXImarkeditbyanim- Don Carlo answered ‘Adsum’, the grace, to meet Andrea Carlo pressive and valuable series of ‘here I am’, to the call to the rite of Ferrari, the holy bishop and future canonisations from Teresa of the priestly ordination because he Cardinal of Milan. As soon as his Baby Jesus to Pietro Canisio, and loved the age that God had given appointment was made known, the from Maria Jean Vianney, the cu- him to live in. In his work entitled DOLENTIUM HOMINUM N. 76-2011 113

‘Education of the Heart’ he wrote: regretted not being a poet ‘because for Albania and Greece and then ‘We love with a jealous heart our I would like to raise up on the for Russia. This was a ‘voice’ time, which is so great and so dis- powerful wings of poetry the hum- which had become even more pre- couraged, so rich and so desperate, ble figures of our assistant priests, cise and stronger when he returned so dynamic and so pained, but these obscure and unknown in- from the first period of war at the whatever the case always sincere fantrymen of the trenches of Christ Greek-Albanian front from which and impassioned. If we had been who consume the burning torches he had been recalled as a result of able to choose the epoch of our of their youth in order to bring the pressures applied by his broth- lives and the field of our struggle, light in the world to so many ers of the Gonzagna College. After we would have chosen the twenti- young groping hearts who provide four months the ‘voice’ made itself eth century without hesitating for a yeast through the greatness of their heard with such intensity as to lead second’. In the tragedy of the war sacrifices to the generations of to- him to ask Cardinal Schuster to be on the Russian front he was led to morrow, unknown and broken by able to return to the front because think anew about the Letter to the the world, but great before God, it seemed to him that that was the field of charity to which he was called in concrete terms at that mo- ment. Then he added: ‘I wish that the Lord after the end of this war would make me see things more clearly and assign to me a job in this chosen sector of the aposto- late’. At this point it is important to make clear that his chosen aposto- late was not military service but the field of charity. Of determining importance in his journey as a priest of charity was his experi- ence at Gonzaga College, not only because of the educational aspects but also and above all else because of his so much wished-for voca- tion to charity. In particular, it was his experi- ence of the Dames of Charity of St. Vincent. He himself said: ‘The Hebrews on the ‘High Priest’ ‘cho- who animates their youth’. To sum ‘Dames of Gonzaga’ group was sen from his fellow-men and ap- up: Don Carlo placed his hands in working with you when I felt irre- pointed to serve God on their be- those of his archbishop, Cardinal sistibly led to dedicate myself so half, to offer sacrifices and offer- Tosi, and bent his head under those much to a work of charity which I ings for sins. Since he himself is hands that consecrated him be- am happy about today, albeit serv- weak in many ways’ (Heb:1-2). cause he was convinced that there ing it unworthily’. While he was These words inspired his ministry. is no greater form for a human be- marching towards Greece he re- Indeed, he confessed ‘when I man- ing than to be a priest, a minister of peated to the Dames of Charity of age to share my life fully with the love for his brothers out of love for St. Vincent: ‘How much good in alpine troops, then, moving out of God.5 life and how much security in the ranks for the Holy Mass held in death is given to us by doing the field I seem to taste and to love A Priest who was Mature something good for the poor of Je- like never before the fullness and for Works of Charity sus or better for Jesus in the poor’. the rich truth of the definition ‘the Even more incisive is what he priest is chosen from amongst men The choice of the lifestyle of a wrote to these Dames on the occa- and appointed to serve God on priest of charity was a wish in the sion of the feast of St. Vincent de their behalf’. And if I am not heart of Don Carlo. It had grown Paul (19 July 1941): ‘You should wrong, I seem to see on the male slowly during his years of pastoral know how in recent days the Lord faces of my people a tenuous smile ministry amongst the young peo- has made me understand – for me of satisfaction and pride. As ple of Cernusco and San Pietro in but also certainly for you – that it is though one of them were chosen Sala, amongst the young members not enough to work, to engage in for everyone, to go up to the altar of the Balilla and the students of charity, it is necessary first of all and offer the sacrifice of everyone the GUF and at the side of the and above all else pray for charity. to the Almighty God’. Don Carlo, young people of the Gonzaga In- It is from him, from the Holy Spir- who loved God and men, was al- stitute. It was a wish that had been it, that charity comes to our hearts, ways a great optimist and enthusi- very strongly expressed during that charity of which the world and ast as regards his epoch and his war when he had heard as though our souls have so much need to be priestly vocation. it was a ‘divine voice’ the need to saved’. And he ended as a priest In his work ‘Go and Teach’ he leave as a military chaplain first who was mature enough for his 114 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE works of charity: ‘It is therefore of ly survivor of four children who in The message of Blessed Don the Holy Spirit that with insis- ignorance and without a care in the Carlo Chocchi is clear: pain finds tence, I would say in a overbearing world were playing in the mine its true meaning only in participa- way, one should ask for the in- field, immediately underwent a tion in the redemption of the cruci- creasingly abundant diffusion in surgical operation. Both his legs fied Christ. Here the question aris- our minds of the luminous visions were amputated, his eyeball was es as to why Don Carlo chose mu- of charity and in our troubled removed, and the large and numer- tilated children? The answer is hearts the sweetness of the love of ous wounds which racked his frag- simple: because he was answering God for our brethren’. ile palpitating body were dealt the call of the Gospel. Indeed, our with…I saw him a little time after Saviour, although he was sent by the operation when the daily med- the Father on a mission that was ication made him suffer a great strictly supernatural, wanted to es- deal and I asked him: “When they tablish the incontestable signs of take off your bandages and put his messianic nature: ‘the blind their fingers in your wounds and can see, the lame can walk, the make you cry whom do you think deaf hear, those who suffer from about?” “About nobody”, he dreaded skin diseases are made replied with an element of amaze- clean, the dead are brought back to ment in his voice. “But do you not life and the good news is preached think that there is Someone to to the poor’ (Mt 11:5). And he whom you could perhaps offer up wanted in a tireless way to journey your pain, for love of whom you down all the roads of Palestine to could repress your lamentation look for and to welcome all the dif- and swallow your tears and who ferent kinds of sick and suffering could also help you to feel the pain people in order to apply to them Don Carlo was by now a mature less?” Marco stared with his dev- that ‘force which went out from priest of charity. In the summer of astated face into emptiness, look- him and healed them all’ (Lk 1942 he wrote to the Dames: ing with his only good eye, and 6:19). And this is why in the deca- ‘Nothing is difficult for the Lord if then, slowly shaking his head, said logue of the apostolate, outlined we have faith and do our best’. “I do not understand” and went for those who were to actualise re- ‘The Lord will attend to the work back to playing idly in a distracted demption down the ages, he clear- of the Lord and initiatives will be way with the edge of his sheet. It ly and imperiously commanded: gradually suggested and blessed was at that moment that I had the “Go, heal the sick and proclaim to by him directly’. ‘Works of charity precise almost physical sensation them that the Kingdom of God has are of the Lord and he will take of an immense irreparable misfor- arrived’ (Lk 10:9). This need for care of making sure they tune of the loss of a very valuable charity and gospel love led Don progress…One must have a steady treasure, which inwardly was Gnocchi to the discovery of the faith in him who will complete a much more painful than the burn- face of Christ, the beloved of God work that is born in his name and ing of a painting by Raphael or the and men by definition. And with for his glory. We are certain of this destruction of a diamond of ines- this I will end. and we will work’.6 Don Carlo act- timable value. It was the great in- edandworkedaboveallelseasa nocent pain of a child who was pedagogue of innocent pain. falling into the void, which was Discovering the Face useless and without meaning, lost of the Crucified Christ in supernatural times for him and The Pedagogies for mankind because not directed The Blessed Don Carlo Gnocchi of Innocent Pain towards the only goal where the offers us a page in which he de- pain of an innocent person can lose scribes his discovery of the face of He wanted his guests to experi- value and find justification: the the Crucified Christ. ‘Willingly or ence not only charity that looks af- crucified Christ. And through all otherwise, we are all of us men on ter and serves with love but also those hospital beds, in those suf- the earth, troubled, impassioned that charity that provokes and fering children, and through them and never sated searchers for the challenges and promotes. He all the suffering children of the face of God. At the bottom of wanted charity of the heart to be world (what a Mass of pain was every faith, even the steadiest and accompanied by charity of sci- imposed on children during the most compact, it is easy to find the ence. In order to understand at a war and in those tragic years of audacious impatience and the deeper level this pedagogic wish tormented peace!), I seemed to see feverish search for the Named of his we are helped by his medita- expand inordinately this mad One: “God, God, God! If I could tion ‘Suscipe, Sancte Pater hanc waste without Christian educators see Him. If I could hear Him”. The immacultam hostiam’. Published opposing it by perceiving the value vast and solemn pages of the Bible after his death with the title ‘Peda- of this pure treasure and the urgent implore ‘Show us your face O gogy of Innocent Pain’, it became need to recover it avariciously and lord’. They stubbornly propose: his public testament. ‘After the ex- make a gift of it to Christ and the ‘Always look for the Lord, always plosion of a bomb, Marco, the on- Church’.7 look for His face’. They longingly DOLENTIUM HOMINUM N. 76-2011 115 sigh ‘When will I come to see your ly took off his jacket, his shirt was essential and deep mask of every face, O Lord’. I, too, have always atrocious and covered in blood, man shaken and made naked by looked for signs of Christ on the which like a liquid and living veil pain’.8 Dear Blessed Don Carlo earth with an avid and insistent bound and made shining his vigor- Gnocchi intercede for all of us so hope and I was resigned to seeing ous limbs. Without speaking he that everyone, in their own way, his look flash in the chaste and looked at me. His eyes were full of can actualise redemption through saved eyes of small children and in pain and pity, of a strong will and our epoch, and so that your pre- the pale and tired smiles of old childlike sweetness. The light of cious mutilated children can give people, already illuminated by the blessed and distant visions trem- themselves as a gift to Christ and peace of remote and sweet regions. bled, slowly decreasing, in the his Church! I had tried to hear the accent of his background. Like a child that was voice in the painful and equal gradually falling asleep. Jesus Prof. BONIFACIO HONINGS, O.C.D. speech of the poor and the afflicted could not have looked down in a Professor Emeritus of Moral Theology, and it seemed to me that on a num- different way from the cross. That the Pontifical Lateran University and ber of occasions his light shadow clear and manly face of the alpine the Pontifical Urbanian University, Rome, Consultant to the Congregation for the had touched me during the twilight soldier. Under the dark frame of Doctrine of the Faith of the dying. Those eyes anxious dishevelled hair and with the very and to the Pontifical Council for Health for light, that face furrowed by convenient ornament of an uncut Care Workers, pain, that troubled weight of beard, he spoke such a virgin and the Holy See. breathing, were things that were so strong pain, such a conscious and much ‘his’…But these were only modest offering, such a humble different and distant aspects of and regal dignity, such a discreet your face, O Jesus, and I was not request for compassion and help, Notes able to make them into a form with that I suddenly experienced the 1 ENNIO APECITI, L’amò sino alla fine. Vita permanent unity. Perhaps it was joyous and intense trembling of di Don Carlo Gnocchi (Centro Ambrosiano necessary for the great hour of war Veronica when she saw the mirac- 2009), p. 5. I have drawn much on this study to describe the figure of our Blessed. to strike. The hour of your most ulous face of Christ emerge on her 2 Ibid.,p.13. acute agony, O Lord. And yet the white and folded linen. From that 3 Ibid., pp. 19-20. hour of your irresistible manifesta- day, my exact memorial of an ir- 4 Cf. ibid., pp. 67-69. 5 Cf. ibid., pp. 69-70. tion to the world. He was a gravely revocable encounter, I was instinc- 6 Ibid., pp. 114-115. wounded men and was already tively guided to discover the char- 7 Ibid., pp.161-162. . near to dying. When I duly careful- acteristic signs of Christ under the 8 Ibid., pp. 138-139. 116 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

ANNA BRZEK An Example of Heroic Charity of our Time: Sr. Marta Wiecka, a Daughter of Charity of St. Vincent de Paul

24 May 2008 was the day of the care for sick people and to draw a father with a family, when she beatification of Sr. Marta Wiecka near to them, that is to say to see took his place when the disinfection and this took place in Lvov, in the the suffering Christ in their per- of a room had to take place. She Ukraine. Cardinal Tarcisio Bertone, sons. The founders of this Order, contracted typhus and died on 30 in his homily of beatification, ad- St. Vincent de Paul and St. Louise May 1904. Public opinion saw her dressed the following words to the de Marillac, continuously laid death as a sacrifice born out of Daughters of Charity and to the lay stress on the fact that the vocation heroic love for her neighbour. Her medical personnel that were there: of the Daughters of Charity was to funeral was an expression of grati- ‘The Blessed Sister Marta Wiecka serve all sick people at a corporeal tude by people of different national- generates in you solicitude, care, and spiritual level. In drawing near ities and confessions who perceived and dedication to those people who to sick people, these sisters were in her the saint of Sniatyn. suffer in illness. Man is body and not to be hurried in their approach, The message that Sr. Marta hands spirit: in caring for the pained phys- but were, rather, to express a great down to us is not that a message of ical do not forget that to achieve deal of affection for them, to speak words but a message of actions. The true and deep healing of the whole to them and to serve them with all cult that continues to be alive after a of man it is indispensable to bear in their hearts. Sr. Marta had kept hundred years talks to us about the mind the spiritual needs of the hu- these recommendations in her prophetic power of her witness. It man creature as well. How impor- heart and implemented them should be emphasised that the polit- tant, therefore, for the sick and suf- throughout her whole life. Subse- ical events of her epoch were not at fering, is their encounter with God! quently, she was sent to the hospi- all propitious for the conservation How important it is for the culture tals of Podhajce, of Bochnia and, of the memory of the heroic life and of life and love always to be de- lastly, of Sniatyn. After Christmas the death of Sr. Marta Wiecka. In fended and promoted, effectively eve, which she spent amongst the 1920 the war between the Poles and opposing the culture of death with sick of her hospital, she wrote: ‘I the Bolsheviks forced the sisters its sad and worrying expressions, have spent these days with my dear and other people to leave Sniatyn. amongst which I will confine my- sick people in serenity and in a In 1945 the borders and the political self to citing the increase in abor- pleasant way, praying and singing forces in Europe underwent a series tions and in cases of euthanasia. with joy near to the crib’. St. Marta of changes. The territory of eastern This humble sister from Sniatyn, felt real joy in serving sick people. Galicia was annexed by the USSR. who today dwells in heaven The director of the hospital of Sni- The communist system forced peo- amongst the Blessed, launches to atyn observed: ‘She had the gift of ple to deny their faith, and especial- all of us a hymn to Life, she exhorts influencing her entourage. She ly the Catholic faith. As a conse- us to love human life and to defend generated in others, in the sisters, quence, a very large number of peo- it at all its stages, from conception in the personnel and in the medical ple were put in prison and deported until its natural end’. doctors, the desire to care for the to Siberia. Churches and crosses Who was this young Daughter of sick in the best way possible’. She were destroyed and hospitals were Charity who, in an act of heroic served them all, without caring devastated. charity, gave her life for another about their nationalities or reli- In this context, it is admirable to person, at the age of just thirty, and gious confessions. She had the ex- record that despite the absence of twelve years after her vocation? traordinary charism of perceiving the Daughters of Charity from that She was born in 1874 in Poland, in their spiritual needs. In her service, region and the complex political sit- Nowy Wiec in Pomerania. At the nobody died without first being uation, the cult of St. Marta re- age of eighteen she entered the reconciled with God. mained alive. People did not fear Company of the Daughters of The final event of her brief life the threats or the possible conse- Charity of St. Vincent de Paul, in was a heroic act of charity towards quences of what they did and went Krakow. The hospital of Leopoli her neighbour. Like Fr. Maximillian to pray at her tomb. In moving let- was her first destination. The sis- Kolbe, she gave her own life for an- ters of the epoch, written by mem- ters of her community taught her to other person, a clerk in the hospital, bers of the lay faithful, we read: DOLENTIUM HOMINUM N. 76-2011 117

‘people pray and light candles. An and sensitivity towards other peo- Today, the Blessed Sister Marta hour after midnight they are already ple, without looking at their beliefs, calls us to bear witness to unity at the tomb of St. Marta. One can seeing not only their physical needs amongst us in the Church and in the easily say that here could be built but also their spiritual needs as world and to participate actively in not only a chapel – this place could well. This wish is expressed in a va- intercultural and inter-religious dia- also be transformed into a church’. riety of ways, for example through logue. She also invites us to see not Let us now listen to an excerpt from the decision to name the public hos- only the corporeal needs of sick another letter: ‘I returned from the pital of Bochnia after the Blessed people but also the needs of their Soviet Union… at the cemetery of Sister Marta Wiecka. The ceremony souls. She encourages us to love Sniatyn there is the tomb of a for this took place this year. Or by and to serve sick people following Daughter of Charity, Sister Marta naming the primary school of the example of Christ, to the ut- Wiecka, who is famous for her mir- Skarszewy after her; or by the most, to the point of giving our own acles. The graces obtained through building of the ‘Blessed Sister Mar- lives. the intercession of Sister Marta are ta Wiecka’ Social Centre in Sni- Blessed Marta, pray for us! many in number’. atyn; or by the creation of prayer And such remains the case today. groups. Sr. ANNA BRZEK The tomb of Sr. Marta attracts a A question arises, namely to Representative of the Archdiocese large number of people: Catholics, know whence such a power and the of Leopoli, Orthodox, Jews…We can say that it very great constancy of her witness the Ukraine has become a modest ecumenical come. Perhaps people see in her the temple. It is always decorated with embodiment of charity, that is to flowers, with lit candles and with say the essence of the Gospel. In re- traditional Ukrainian drapes. ality, love is what most unites be- Thanks to the power of attraction of lievers, and it is also what is impor- the witness of life of Sr. Marta, tant in the care that is provided to Bibliography many people today ask for graces sick people. It is impossible to un- BOMBA WLADYSLAW C.M., Le charisme de through her intercession. Many re- derstand the charity of Sr. Marta to- Fille de la Charité réalisé dans la vie de sœur quests and expressions of gratitude wards her neighbour without be- Marta Wiecka. Mystique du service, Colloque reach here not only from Poland but lieving that her life was entirely en- consacré à la Servante de Dieu Sœur Marta Wiecka (ITKM, Krakow, 2008). from other countries as well. And trusted to the love of Christ the XAVIER ALVAREZ, ‘Homélie au cours de then many people follow her exam- Spouse. How much, today, do we l’Assemblée générale des Filles de la Charité’, ple and decide to live according to need to refer to Christ and to be Paris, 140 rue du Bac, Sunday, 30 May 2009. ZELEK SABINA S.M., L’opinion de sainteté the Gospel and its values, through, aware of the fact that in Christ de Sœur Marta Wiecka (Archives des Filles de for example, devotion, self-giving, every man is our neighbour! la Charité, Krakow). 118 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

PASCUAL PILES FERRANDO Welcoming: a New Paradigm of Humanisation

1. Introduction how it was received in a very pre- founded upon law, upon justice cise way through the word of God. and upon mercy for the less The peoples of the world, with There are any examples of ac- favoured: the weak, orphans, the their various cultures, have always tion by the protagonists of the texts homeless, foreigners, etc. made welcoming one of the atti- of the Bible in whose lives this val- The Incarnation of Jesus Christ tudes that has most characterised ue was present. On other occasions is an act of hospitality. Mary is the them and something that they have as well, through the description of protagonist of this when she re- demonstrated is a value of their anthropological categories in the ceives in her womb the Son of God way of being and living. figure of Jehovah, there appear in who from the moment of her ‘fiat’ When they have acted, the re- Him or in Biblical figures, attitudes was to be her son (Lk 1:38). sponse that has spontaneously of violence, of punishment and of The figure of Jesus of Nazareth sprung from their hearts is that of war in which one clearly perceives is the figure of a very welcoming marking themselves out by their the theologisation of historical re- person: he welcomes, he listens, he hospitality. alities as manifestations of the understands, he respects, he invites When this has not taken place, presence of God in the life of the people to change their lives, he en- there was something that justified People of Israel. courages mercy, he bases his life this, such as, for example, the de- In the book Genesis we can al- on love for other people, and all fence of their own identities or ready encounter a gesture of hospi- this with wonderful pages of the wars with other peoples in order tality by Abraham towards three gospels. We may remember, for to defend their own territories or men who appear at his side at the example, the parable of the Good because of ambitions involving oak tree of Mamre, Without know- Samaritan (Lk 10) and the parable power. ing who they were, he invited them of the last judgement (Mt 25). All religious traditions have to draw near, to enter his home and Jesus himself, at the beginning been marked by this approach to rest: he gave them fresh water so of his public life and his mission, which is the outcome of consisten- that they could be refreshed and he when reading the Book of Isaiah in cy between one’s own creed and gave them food to eat and a place the synagogue, identifies with this one’s own way of living. to sleep. Thanks to this gesture, to the full and feels called to be Hospitality derives from the Sara came to expect a child, even Good News with his words and his concept that one has of God as though on her part there was a re- actions (Lk 4). Mystery, as the Almighty, but also sponse of incredulity and irony The letters of St. Paul refer to the as the Father who has loved His (Gen 18). importance of hospitality in their children and asks love and respect Moved by Jewish hospitality, exhortations to practise hospitality. from them. Tobit welcomed the archangel In his letter to the Romans (12: 9 This ennobles our being human, Raphael and entrusted him with the and 13), St. Paul clearly urges that independently of the fact that on mission of accompanying his son hospitality be given much consid- many occasions we have distanced Tobias; with this, blessing de- eration: ‘Love must be completely ourselves from this concept. Wars, scended on his house and he was sincere. Hate what is evil, hold on- holocausts, exclusions, injustices, cured of blindness (Tob 5 and ss). to what is good. Love one another abuses, murders, differences in the The Book of Job, who is a sym- warmly as Christian brothers and distribution of wealth etc. are all bol in Biblical theology of the real- sisters… open your homes to expressions of a lack of hospitality, ity of suffering and an expression strangers’. In the first letter to Tim- of a lack of conscience and a lack of human frailty, abandoned the othy, he sees hospitality as being of fighting for the dignity of each belief that suffering had to be required in the lives of widows: ‘a person. linked to a moral cause, brought woman who brought up her chil- about by bad behaviour by a per- dren well, received strangers in son, without condemning him, her home’ (1 Tim 5:10). He exhorts 1. Hospitality in Biblical therefore, to a punishment by God, Titus to encourage bishops who are Language which puts the faith of believers to ‘hospitable, and love what is good’ the test but with their trust makes (Tit 1:8). It is impossible to make a list and them grow in humanity, in trust Lastly, in the letter to the He- engage in an analysis of what hos- and justice. Chapter 31 is in praise brews he speaks about hospitality pitality meant in times past and of hospitality. The life of Job is and exhorts his readers to embody DOLENTIUM HOMINUM N. 76-2011 119 it: ‘Remember to welcome this gift. We are not the only ones suffer, these professionals must be strangers in your homes. There to have this gift but we refer to it as professionals who are competent were some who did that and wel- our charism. Hospitality is a uni- (Benedict XVI, Deus caritas est, comes angels without knowing it. versal gift that all believers can re- n.31). Theirs will be a style, a dif- Remember those who are in ceive and which each believer can ferent way of doing things, because prison, as though you were in live according to his or her own they will have made of welcoming prison with them. Remember those identity: bishops, priests, men and the essence of their lives, but we al- who are suffering, as you were suf- women religious, and members of so see them as being humanly and fering as they are’ (13:2-3). the lay faithful. professionally trained, some of We define hospitality as a gift them in a Christian sense as well, that the Spirit has granted to us for the practice of hospitality. With 2. What Hospitality Consists of and which enables us to engage in them we share a mission; with that mission which we are called them we live life. In this sense can Hospitality is a positive attitude upon to exercise in the Church and we state that hospitality for the which denotes a quality of our be- in society. Church and for society is a para- ing. It is a personal, ethical and re- According to the doctrine of St. digm of humanisation. ligious value. It is a concrete way Paul we feel theologically touched

4. Our Society Needs to Promote the Approach of Hospitality

We have witnessed many phe- nomena during our lifetimes. A radical change has taken place and we are living through an epoch of great transformations. Globalisa- tion has meant that in many of our countries we live with people who come from different realities, and to such an extent that a high level of interculturality now exists. This fact facilitates the experi- ence of the phenomenon of reli- gion in a plural form. Different eth- nic groups today live together in the same cities and have different religious expressions which they defend as an experience of their of understanding and projecting by the Spirit which enriches us and own identities, thereby creating in- life, even though, in cases such as makes us able to engage in a rather ter-religiosity. those that I have just referred to, it anthropological engagement. It re- There has also been a growth in seems to be not very much culti- quires of us concrete training autonomy and secularity. Not all vated, if not even lacking. which we must follow for the de- the results of this have been posi- This attitude is expressed velopment of our mission. tive, and to such an extent that through welcoming, the capacity to But many other people, as well, some people think that the nega- listen, respect, service, humility, can be anthropologically charis- tive results have outweighed the simplicity, tenderness, responsibil- matic, professionals of care with positive. ity, solidarity, love, sensitivity, their own qualities, with a sense of In this world, as a paradigm of nearness, rectitude, justice… humanisation as a paradigm, which humanisation we must embody Francesco Tollalba defines it as includes both the ethics of respon- hospitality as an ethical category ‘welcoming the other, who is a sibility and respect for religious that illuminates our way of behav- stranger and vulnerable, to one’s values and beliefs, even though ing. own home’. In the case of profes- these people may not believers. We are a part of this society and sional assistance, we could find They also feel that they are called within it we have been called to new values that it contains and em- to engage in a mission within soci- live and to be witnesses to the pro- bodies. This is an expression of its ety because of the fact that they are found experience of our commit- greatness. persons or because of their profes- ment to the Church: from Christ, sion. from ecclesial traditions based up- Professionals, like ourselves, on love for God our Father, we 3. Hospitality as Charism must develop this gift in order to know how to be at the side of peo- have a sufficient training to be able ple who suffer, doing this starting Many of our religious Orders to perform the mission to which we from a project based on the person and Congregations feel that they are called: as regards the service which comes from the Gospel. We are enriched within the Church by that is offered to those people who know how to have the same feel- 120 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE ings that Christ had, with condem- to bring to us a humanising force Through what we do we seek to be nations and appeals in certain con- for our lives and he wanted to lead signs of the merciful and healing texts, to act in a worthy way, and in us towards care that is performed Christ for those who are near to us, other contexts with all of the love by placing the person at the centre doing good, evangelising, al- and understanding for those people of things. His phrases were: ‘the though we always find ourselves who, because of illness or exclu- sick person is at the centre of our in a world in which this evangeli- sion, are suffering. ‘Despite the ad- lives’ and ‘the sick person is our sation, starting with the care insti- vances made in science and tech- university’. tutions of the Church, becomes nology…Our times call for a new In health-care hospitality we ‘Ad gentes’. readiness to assist our neighbours need approaches that define it, we To discern how our daily pres- in need’ (Benedict XVI, Deus Car- need to achieve a process that ence can and must be today is our itas est, n. 30). makes us become people who im- task. We want to perform this task plement a form of care that is hu- like Christ who denounced but man, that places the sick person drew near; we want to perform it who is in front of us, and his or her like Christ who at times kept silent family, at the centre of our atten- but invited people with a benevo- tion, which attends to the instru- lent look; we want to perform it ments employed, professionalisa- like Christ who drew near to peo- tion, but which also attends to the ple who were not socially correct fulcrum of hospitality, that is to say according to the religious criteria humanisation. ‘The suffering per- of the time but who proclaimed son – every person – needs… lov- that they would be the chosen of ing personal concern…[the] love the Kingdom of Heaven and for [of the Church] does not simply of- whom he wanted to be the bearer fer people material help, but re- of living water, with his salvation freshment and care for their souls, which provided the real meaning something which often is even of existence. more necessary than material sup- Those of us who engage in hos- port’ (Benedict XVI, Deus Caritas pitality in our centres of care and est, n. 28b). assistance often feel that we are in a frontier zone. We have accumu- lated a great deal of experience 6. The Challenges of our Society from our services of spiritual and in Performing religious assistance; we have the 5. Complicity between the Task of Care testimonies of people to whom we Hospitality and Humanisation have done good and who have We know about the world in communicated this by written or It often happens that in our lan- which we live; the advances that spoken words. We always feel hap- guage we speak about the complic- have been achieved; the relation- py to be the Church but we feel this ity of individuals and also of ideas. ship between faith and science and in a particular way in these situa- I believe that we can state the same its implications for the world of as- tions. thing about the two terms that are sistance; the actions which with Probably we will not convert at the centre of my brief paper. various criteria those who work them to the real meaning of our We have seen that hospitality is a with suffering people can engage faith but we will have drawn them gesture and an attitude, an instru- in; and the effects that all of this near to God, whom they often with ment of the presence of God in the has on the bioethical field. To try to difficulty manage to see as their texts of the Old Testament that I look after, to care for and to ac- Father, as Truth, as Good, and to have referred to. We have observed company when one cannot heal; to whom we wish to be witnesses. hospitality in the way that Jesus help people to be born and live The Church in its Magisterium, Christ behaved. It is also present as with dignity; to help people die certain of its statements, in the evo- an invitation in the letters of St. with dignity; today all of this is the lution of its criteria. We feel that Paul and in his letter to the He- subject of great concern for us as a we are a part of the Church and we brews. Church and for those who surround love the Church as it is. But in our To make hospitality germinate in us: scientists, politicians, profes- usual practice we at times feel our beings makes us grow as peo- sionals of the service of assistance, called to discern motivated by the ple, it makes us human, it humanis- patients, and family relatives of pa- love of God which was expressed es us. Our society, our service of tients. in Jesus Christ and involved in a care, need humanisation. A famous We are a part of this world and mission that comes from hospitali- phrase of our Superior General, we wish to bring our hospitality to ty which in my paper I have de- Fra. Pierluigi Marchesi, written in this world within the context of the fined as being a paradigm of hu- 1981 in his document entitled ‘Hu- Tradition of the Church, its Magis- manisation.Wewanttolivechari- manisation’, exhorts us to engage terium, beginning with the word of ty in truth, truth that is enriched by in this way of living: ‘Humanising God and our presence as hospitali- the power of charity. ourselves to humanise’. He wanted ty, which must be humanised. DOLENTIUM HOMINUM N. 76-2011 121

7. Conclusion from hospitality, a paradigm of hu- God’s presence is felt at the very manisation, which in our case al- time when the only thing we do is We feel pride at having been ways wants to be in its implementa- to love (n. 31c). called by God through the gift of tion evangelisation as well. Like Christ we want to bring sal- hospitality. With a great deal of en- The words of Benedict XVI in vation to the world so that every- thusiasm we experience the fact of his Deus Caritas est give us great one can achieve knowledge of being the Church of mercy and try- strength in the performance of our truth. For this we pray and in this ing every day to do good to people mission: ‘We contribute to a better we trust. We try to do this with hos- whom we did not previously know world only by personally doing pitality as a new paradigm of hu- and whom illness, exclusion or im- good now, with full commitment manisation, conscious of the fact migration have brought to us. and wherever we have the possibil- that we draw near to God and to For them we want to be human- ity’(n. 31b). ‘Charity, furthermore, people always and when God ised, near, understanding and pro- cannot be used as a means of en- wants this and it is appropriate, and fessional hospitality. For them we gaging in what is nowadays con- we do this with true evangelisation. want to be the presence of the sidered proselytism. Love is free; it With Benedict XVI we proclaim Church of people who are a part of is not practised as a way of achiev- ‘Caritas in Veritate’. the Church and specifically by the ing other ends’. Those who prac- Church feel pushed towards this tise charity in the Church’s name Fra PASCUAL PILES FERRANDO, mission. If only we could transmit will never seek to impose the O.H. the value of the contribution of Je- Church’s faith on others’. ‘A Chris- Prior General Emeritus, the Hospital Order of St. John of God, sus Christ and his Church to their tian knows when it is time to speak Spain, lives and to history in general! of God and when it is better to say Member of the Pontifical Council for At every moment we want to rec- nothing and to let love alone speak. Health Care Workers, oncile truth, good and love, starting He knows that God is love and that the Holy See 122 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

MANUEL DE LEMOS The Contribution of Volunteers to the Humanization of Health: the Portuguese Reality

I would like to begin by express- tion, of the Misericordias’commit- represents, first of all, a commit- ing thanks, both I myself, and on ment to health care? This, indeed, ment to oneself, and to society in behalf of all the Portuguese Santas goes beyond the borders of conti- general, to helping others with no Casas de Misericórdia (the ‘Holy nental Portugal, as the Portuguese further interest, through specific, Houses of Mercy’), for the invita- took this movement across the continued action and, as much as tion of the Pontifical Council for globe, from Brazil to Angola, from possible, within an adequate Health Pastoral Care to come here S. Tome and Principe to Timor, framework. From the ethical point and to reflect on the contribution and more recently to the Por- of view, it indicates not only a of volunteer work to the human- tuguese communities in France growing consciousness of dispari- ization of health and, indeed, to its and Luxemburg. ties and differences but also a ethical dimension. First and foremost, I would like search for the values and refer- It seems relevant to mention that to stress their character as move- ences that define an individual and although founded in 1498 by a ments of volunteers dedicated (in his or her social environment. group of a hundred ‘good men’ un- accordance with carrying out For Catholics, the social doc- der the auspices of the Portuguese ‘works of mercy’) to providing trine of the Church provides the monarchy, the mission of the Mis- selfless care to those who suffer ethical framework within which ericordias has always been to en- and those who are in need of help. volunteering takes place. Here the gage in ‘works of mercy’ – in line It is thus appropriate to remember recent Encyclical Letter Caritas in with their definition as associa- the words of St. Peter the Martyr, Veritate captures the essence of tions of the faithful by canon law. in the original statutes of the Mis- volunteering for Catholics. In par- Moreover, it seems imperative ericordia of Florence: ‘no brother ticular, it maintains that charity to refer to the fact that since 1516, can expect more for his contribu- proclaims the truth of Christ in so- when the Portuguese king, Em- tion than a glass of water.’ ciety and that development, social manuel II, bestowed upon the Mis- In fact, we have every reason to well-being and the overcoming of ericordias of Lisbon the adminis- believe that the ethical dimension social-economic problems present tration of the Hospital de Todos os of those who altruistically occupy a demand for ‘caritas’ – in other Santos (the ‘All-Saints Hospital’), their time and attention in caring words, Love, understood here as the Portuguese Misericordias – for others makes a world of differ- Love for neighbour. without interruption – have active- ence in the field of health; and who- The same message permeates ly engaged in the management of ever acts in this manner, places the statutes of the first Portuguese hospitals and other health services. himself or herself in a dissimilar Misericordia – the Santa Casa de They have thus fulfilled the ‘work position to those who provide Misericordia of Lisbon – which of mercy’ that orders them to ‘take health care for institutional reasons, states that ‘God gave heart, reason, care of the sick.’ such as the state through National strength and charity to a few good The Misericordias possess an Health Services, or those who pro- and faithful Christians to create a expertise as regards health care vide health care with the legitimate brotherhood and a confraternity... which, although on the one hand it aim of obtaining profits, such as so that by this brotherhood all extends beyond the horizon of private hospital enterprises. works of Mercy, both corporal and memory, on the other, translates It is not by mere chance that the spiritual, could be performed as into a constant concern with quali- caregivers from the so-called much as possible.’ ty. With regard to the latter, to cite third-sector or social sector are fre- In the specific field of health, in- one example, a study undertaken quently cited among the best in the sofar as it corresponds to an activ- in 2010 by the Joint Commission field of acute health care. It is also ity that aims to help those who suf- International and Siemens, ranked not pure coincidence that the fer and hence are unprotected, vol- the hospitals of the Portuguese aforementioned humanization di- unteering is the noblest of all an- Misericordias as being among the mension of care services has swers to the deepest moral de- best in the country. gained increasing prominence as a mands of individuals. How can one explain the criterion for quality. The five-century-old presence longevity as well as the recogni- The concept of the ‘volunteer’ of Portuguese Misericordias in the DOLENTIUM HOMINUM N. 76-2011 123 health sector represents, for Por- I called your attention to this cir- care compels us to ‘do everything tuguese society in general and the cumstance not only as an illustra- that can be done, when nothing Catholic community in particular, tion of our efficient answer to the else can be done.’ the embodiment of this ethical re- problems that afflict modern soci- Humanization is precisely what sponsibility towards people. In eties, but also because we found can be done, when science and practice, this responsibility trans- here the clearest confirmation for technology are no longer able to lates into volunteering and the ful- the ‘humanization’ dimension of do anything. Hold a hand, listen to fillment of that ‘Work of Mercy’ volunteering. The proximity to a story, draw a smile. This is the which prescribes that we should death, the implications of chronic demand for humanization which, ‘take care of the sick’. illnesses, and the overall weakness despite the good efforts of profes- I would like to finish my paper of the individual at this stage of sionals, can only be met in a per- by describing our role, over the life, make human contact a partic- manent, sustained and effective last five years, in the creation of ularly relevant part of providing way by a volunteer. the National Network of Integrat- care. Though it is true that many pro- ed Long Term Care in Portugal. In contrast with acute care hos- fessionals today recognize and Ageing, and the subsequent ex- pitals, where the plethora of tech- adopt this human dimension of plosion of chronic illnesses and nology reduces the human being to care provision, it also evident that mental disorders, along with the his or her most material dimen- the efforts of volunteering teams fragmentation of families, the in- sion, in our services of continued have helped to impose this ethical eptitude of existing hospital facili- care persistence, nurture, affection approach in health-care services. ties and the limited financial re- and understanding for the patient Ladies and Gentlemen: the Por- sources of the state, has become an define our activity. The volunteer, tuguese Misericordias have been increasingly pressing issue in Por- in the ethical and practical position providing services for 511 years. tuguese society. Imbued in the of a ‘companion’, adopts an ap- We adopt, as far as is possible, the Christian spirit that characterizes proach that is certainly different notion of volunteering and thus our activity, the Misericordias ac- from that of a more technical, and we always place people above cepted the responsibility of estab- hence, colder, health-care management. Indeed, if we start lishing a highly qualified and effi- provider. Clear evidence for this by helping people, taking care of cient proximity network, provid- claim is that the volunteers in our people, managing the institutions ing care services at reasonable services have more time at their that serve people will come natu- prices. disposal than professionals in oth- rally. Today, with more and more Today, the Portuguese Miseri- er health-care services. management efficiency, we return cordias have in opera- I believe that developments in to people. It is thus my privilege to tion/construction close to 150 fa- medicine in the near future, and be the bearer of this example, an cilities, spread throughout the the introduction of high technolo- example for Catholic and Christ- country, which correspond to more gy in acute care hospitals, will fur- ian communities in the modern than 70% of the National Network ther contribute to strengthening world. of Integrated Long Term Care. In the role of volunteers in continued this decisive manner, they have as- health services. This will further Dr. MANUEL DE LEMOS sumed a central position in the Na- corroborate Cecily Saunders’ vi- President of the Union of Misericordias tional Health Service. sion that palliative and terminal of Portugal. 124 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

M. BENEDICTA Health-Care Centers and Care for the Poor

The Missionaries of Charity rose from the dead. The work of Poverty becomes more and more were founded by Blessed Teresa Redemption continues. The Cal- the scandal Pope Paul VI de- of Calcutta with the special varies of our world are where also scribed. Underlying this scandal charism of quenching the infinite today Christ thirsts for the love of are other more fundamental in- thirst of Jesus Christ on the Cross every man created to live in Him, equities that may have prompted for love of souls by the profession with Him, through Him in the uni- Mother Teresa’s refusal of an oth- of the evangelical counsels and a ty of the Holy Spirit to the glory of erwise noble offer. Let us see fourth vow of “Wholehearted and the Father – on earth and in heav- three truths: free service to the Poorest of the en. Poor.” On the Cross, Jesus became 1. It is the fundamental right of In 137 countries we “partake of THE Poorest of the Poor and THE each person to be given undivided that special mission of the Church Savior; the fountain of the mys- attention and love, be received to shed on the whole world the ra- tery of God’s love – to be received and treated as he is – coming from diance of the Gospel message; to and to be allowed to flow also to- God and going to God, with a dig- ‘unify under one Spirit all men of day from the Cross in each per- nity demanding a reverence whatever nation, race or culture, son’s life: visible and crying out which is sacred and absolute. standing forth as a sign of that God’s thirst at all the Calvaries of Health is a good that must be safe- brotherliness which allows honest our world, invisible and resound- guarded to be sure, but it is not an dialogue and invigorates it’” (GS, ing in each person’s heart. absolute good (EV, n. 47). It is n. 92) (Const.,n.1). Ours must be a holy life, a mys- subordinated to the absolute good We live our life in all different tical life which translates, if true, of each person’s eternal vocation cultures, situations and agonies of into love in action: “love received and destiny as a child of God. our world – in the hospitals of and given” (CV, n. 5) in our life of Medical technology has greatly London AND in the war zones of prayer and profound union with advanced in recent years. But the Middle East and Africa; Christ – most expressed and im- must we not also admit that med- among the drug addicts of Frank- pressed in the Eucharist AND ical practice has often become furt AND the street children of “love received and given” (CV,n. more depersonalized? Must we Rio de Janeiro; at the side of those 5) in our life of presence, compas- not say that the respect for human given apparent mercy through eu- sion, service and profound union dignity – the right to life being the thanasia by depriving them of with Christ – most expressed and first expression of this – has de- food and water in nursing homes impressed in the suffering Poorest creased for the greater part of hu- in Melbourne AND those de- of the Poor. We live both dimen- manity, even as technology has prived of food and water in sions, prayer and service (cf. CV, progressed? Do not technological famine relief camps in Ethiopia; n. 79), to be Missionaries of Char- advances, not only in medicine, in prisons in Poland AND in night ity in truth. sometimes come at the price of shelters in Cuba. Mother said: Once a man came to Kalighat, the poor, the unwanted, the “Jesus is re-living His Passion in the home for the dying “Nirmal unloved, the unborn? (cf. CV,nn. our poor people. It is Jesus in the Hriday” (= pure heart) in Calcutta. 70, 71) Abortion, euthanasia and poor that we feed, clothe and take He was sincerely moved and in organ trafficking constitute the in. We are to do it all with a great the generosity and goodness of his biggest destroyers of society. undivided love.” heart offered Mother Teresa to Not giving each person the God did not create poverty. help her in this beautiful work. love, attention and care due to him Man’s selfishness and greed have He would be able to provide the threatens the good of humanity in allowed poverty to separate peo- best available hospital beds and a way that is far more dangerous ple. It is man’s unwillingness to other useful medical equipment of than illness or injury or even the love and live as God wills. It is the the latest technology. Mother lack of proper medical care. The accumulated result of sin. Yet God Teresa bowed and kindly refused. most important response for all of loved the world so much that He Our conference is concerned us is to give our full love and at- gave His only Son to conquer sin with the issue of equity in health tention in a Christ-like manner to and turn the force of evil into Re- care. Equity is a term of justice: everypersonwecomeincontact demption precisely where it was to give a person what is his due. In with, especially the poorest of the at its worst – on the Cross. Man our world the inequity between poor, first and foremost through killed God’s Son, who died yet the rich and the poor is increasing. our own human touch and of DOLENTIUM HOMINUM N. 76-2011 125 course, where the concrete situa- could speak like this without heroin, towards the Sister. tion needs, with professional blaming anybody, without com- By one child in our home ca- medical knowledge and skills. paring anything. Like an an- ressing the cheek of the smaller Mother Teresa relates: “One gel…” one crying beside him. evening we went out and picked By the giving of a cup of water up four people from the street. 2. Another fundamental right of one mentally ill woman to an- And one of them was in a most of each person is the right to love other one in our home . terrible condition. I told the Sis- as a member of the human family. By the giving away of his share ters: ‘You take care of these three; We do not have regular hospitals, of rice by a starving boy for his I will take care of the one who clinics or schools, etc. We cooper- dying mother. looks worse.’ So I did for her all ate with others who run them The poor are wonderful. that my love can do. I put her in when our poor need access to Health, wealth, family, name, bed, and there was such a beauti- them. Our houses must be simple prospect in life and even life itself ful smile on her face. She took and modest where the poor feel are taken from them. Stripped of hold of my hand, and she said one welcomed and at home. We have all they have left only to be hu- word only: “Thank you” and she HOMES for: *abandoned, physi- man. And this makes them so hu- died. I could not help but exam- cally and mentally disabled chil- man – so much what God intend- ine my conscience before her. dren; *AIDS homes for children ed us all to be: able to be loved And I asked: What would I say if I and adults; *sick and dying desti- and to love in response, also in had been in her place? And my tutes; *mentally ill; *leprosy and and through suffering, pain and death towards the new life in Christ. That is why our houses must be homes where all rejected by everyone else can fit, no one shall be excluded; the great human family is growing from small seeds. In our homes, everyone is called out of himself to take part, to give in whatever way possible an expression of love and concern for all. Often there is much misery in our homes at first glance. Yet on the second look, there is much joy in the misery – fruit of the Spirit for all.

3. The most fundamental right of each person is to know God’s love, that God is our Father on whom we depend, that we have come from Him and are sustained at each moment by Him, that we answer was very simple. I would TB patients (including rehabilita- are redeemed by Him through His have tried to draw a little attention tion centers); *drug addicts and Son, and that we will be going to myself. I would have said: I am alcoholics; *girls in danger, un- home to Him for all eternity. This hungry, I am dying, I am cold, I wanted mothers, women in dis- might have been Mother Teresa’s am in pain, or something. But she tress; * malnutrition or food dis- main concern in refusing the offer gave me much more – she gave tribution centers and soup of the gentleman in Kalighat. me her grateful love. And she kitchens; * relief centers in times Technical means can narrow our died with a smile on her face. of famine or other disasters. vision of God, or cause us to for- Then there was that man we Everyone contributes in his way get Him entirely. Such means can picked up from the drain, half eat- to making the place a home.This make us forget that we are created en by worms and, after we had is the new life in Christ, on earth and redeemed by love and can brought him to the home, he only already as one day fully in heav- make us forget that God is at work said: “I have lived like an animal en. We learn from the poor by ac- in our concrete personal lives – in the street, but I am going to die tions not measurable by technical here and now. like an angel, loved and cared data, but: It can make us forget that we for”. Then after we had removed By the smile of that dying man are only instruments of His love all the worms from his body, all he and the woman Mother spoke of. for each other; that God, not man, said with a big smile, was: “Sister, By a tear falling from the eyes is the author of our own and oth- I am going home to God” and he of a prostitute. ers’ life, that it is His gift and that died. It was so wonderful to see By the turning of his face of a He wants to make us ‘an everlast- the greatness of that man who youngster, after an overdose of ing gift to Himself’, through each 126 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE moment lived in love and also means of His divinity to show us tions it gives life to in different ex- suffering, pain and death. His love and to lift us up to Him- pressions. When all is said and The Holy Father writes, “The self, emptied Himself, made him- done, there is the certainty that in fundamental question asserts itself self our servant, gave Himself up His wisdom God wants all to be forcefully: Is man the product of for all – that all might live and together in His kingdom, where his own labors or does he depend give themselves to Him in love. He will be all in all. Every in- on God?” (CV, n. 74). “When Technology promotes a spirit of equity will be wiped away. We technology is allowed to take over, usefulness. While this is good, the will be His beloved children in the the result is confusion between Gospel requests more from us: Son. Our world needs our Christ- ends and means.” (CV, n. 71) self-donation following the exam- ian message of sharing together That is why we Missionaries of ple of Jesus Christ. the good of all our different gifts Charity choose deliberately sim- God’s providence includes on the way to the Father’s home. ple and humble means in our ser- many wondrous gifts, including Thank you. vice to the Poorest of the Poor. advances in medicine and science. God bless you. Though we meet crowds of poor; But all these gifts remain always our dealing with them is always at the service of the good of all Sr. M. BENEDICTA MC MD, personal, that one person whole and at the service of what remains former Regional Superior in Ethiopia and entire. We live poor our- everyone’s greatest due: to be for Sr. M. Prema MC, selves. God’s precious child. Superior General of the Missionaries of Charity, We want to imitate Christ who We thank God for our vocation Kolkata, India. though He could have used all the in the Church and all other voca- DOLENTIUM HOMINUM N. 76-2011 127

MARIO BONORA A Challenge that has Just Begun

‘The earthly city is promoted not In this sense, I cannot but point cal roots which are connected with merely by relationships of rights out with pleasure the ‘experiential’ the administration of the ôikos,the and duties, but to an even and more background that has animated the ‘habitation’. And we well know that fundamental extent by relationships itinerary of these days. Even in at the centre of every ‘habitation’, of gratuitousness, mercy and com- those papers that were intellectually of every ‘home’, there is a person, a munion’ (Caritas in veritate, n. 6). most dense and demanding I family, a human community. These words of Pope Benedict XVI seemed always to perceive an out- say a great deal to all those people look projected ‘beyond’ mere theo- who, in various ways and with vari- retical analysis: an outlook focused ous functions, are involved as be- on man, the image of God, and thus lievers in activity involving clinical the focal point and reason for the help, care and treatment, and reha- existence of the role of every bilitation that is carried out every health-care worker. The riches of day beginning with hundreds of various papers, offered to us by thousands of health-care centres skilled and competent speakers, which in Italy and the world were were grafted onto this shared pri- created because of a strong impetus mary approach. These papers were of Christian charity. They indicate, scientific, pastoral, philosophical, indeed, in a very clear and essential economic and legal in character. If I way, what should be the basic can paraphrase the words used by guideline, the approach at the level Benedict XVI to describe the recent of ideals, the fact that connotes and Synod of Bishops for the Middle defines the attitude of those who East, I would say that this was a sig- Analysed from this perspective, bend – this is the exact etymology nificant experience of ‘polyphony Caritas in veritate appearstousas of ‘clinical’– at the side of a patient, in unity’. Various voices but a sin- it really is: a textbook of humanity, of a brother who asks for our help gle dynamic of ideals towards the a vademecum for that ‘good life ac- and our solidarity. sources of charity that nourish our cording to the Gospel’ (Message to mission. the Plenary Session of the Pontifi- cal Council for Justice and Peace, 3 1. The Riches of Dialogue November 2010) which constitutes 2. On the Course of Man the concrete horizon of the social During these two days of intense teaching of the Church. To outline work we have listened to analyses I feel that it is my duty to stress the coordinates of this coexistence, and recommendations made by em- one thing in particular. Keeping the the encyclical suggests a series of inent speakers – experts, scholars, rudder of our reflection steady on key words. workers and volunteers – who have the course of man, we enucleated We recalled these at the begin- taken us by the hand through the what in my view remains the most ning: gratuitousness, mercy, com- pages of the encyclical of Pope authentic and faithful key to read- munion. And we could add: frater- Benedict XVI. This has been an ex- ing Caritas in veritate, which can- nity, giving, solidarity, reciprocity, cursus that has been far from sum- not be reduced to a simple, albeit subsidiarity. I would like to invite marising and approximate. I believe authoritative, economic-social tract you to spell them mentally, one by that I can say that none of the multi- or a banal anti-crisis handbook. one: gratuitousness, mercy, com- ple aspects of this document have Professor Ettore Gotti Tedeschi, munion, fraternity, giving, solidari- been neglected: from those that are one of our most distinguished ty, reciprocity, subsidiarity. And I most evident to a rapid and shallow speakers, some time ago launched a am certain that you, too, as hap- reading, and on to those that are provocation/proposal: to award the pened with me, will spontaneously most profound, I would say almost Nobel prize for economics to Bene- ask yourselves: are these not exact- intimate, because in the most hid- dict XVI. Behind this call I read ly the modalities that our service at den folds of the thought of the Pope above all an appeal to know how to the side of those who suffer requires it is really possible to understand all look with new eyes at the ‘econo- every day? I say this not to underes- the features that the exercise of my’, as the Pope explicitly suggests timate the work of Catholic health- charity must have in relation to the in his encyclical: beginning, that is care workers but rather to entrust man of the third millennium. to say, with its original etymologi- them with a further responsibility. 128 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE

Our witness as believers in the that ‘The economic sphere…must and relief for the spirit, scientific in- world of human health – and the pa- be structured and governed in an novation and gospel charity, and pers of recent days have helped us ethical manner’ (Caritas in veritate, technical excellence and Christian to understand this – can truly con- n. 36). witness. A model that should be stitute a prophecy and a paradigm When our eyes are not only fixed plausible not only from a med- for that ‘good society’ founded on on numbers, statistics, and analyses ical/health-care point of view but ‘true integral human development’ of costs and benefits, but also re- also – and here is the decisive wa- (Caritas in veritate, n. 4) to which main fixed on the lode star of the in- ger and challenge – one which is the encyclical addresses itself. On violable and unrepeatable dignity of fully sustainable from the economic the condition that, naturally every creature, even the smallest and social point of view. enough, we do not abandon being and most insignificant creature, we This is no small task. In this, as I nourished by the gospel sources of then demonstrate in concrete terms have observed, the encyclical love towards those who suffer – in that ‘the primary capital to be safe- comes to our aid by suggesting to us particular that ‘euntes docete et cu- guarded and valued is man, the hu- a sort of ‘vocabulary of humanity’ rate infirmos’ (Matthew 10:6-8) man person in his or her integrity’ made up of words that after a cer- about which Archbishop Gianfran- (Caritas in veritate, n. 25). tain fashion are an integral part of co Ravasi spoke admirably – and our DNA. A vocabulary that we we do not forget that what is at have leafed through together over stake is always and in all contexts 3. A Prophetic Task recent days thanks to important and man in his wholeness. We want to enlightening testimonies. I will re- say this without boasting or pre- In a technological and globalised call here only that of Cardinal Peter sumption, with humility, almost society, like the one we live in – Kodwo AppiahTurkson who in his submissively. When we take care of which is still paying the price for an dual capacity as African pastor and a sick person going beyond the log- economic and financial crisis which President of the Pontifical Council ic of do ut des, refusing to measure has been shown essentially to be an for Justice and Peace offered us a ourselves solely with the yardstick ‘ethical crisis, as the papers of the number of interesting approaches of gain or profit, removing our- authoritative economists who con- for the promotion of health that is truly on the human scale. It seems to me that the greatest value of these papers was specifi- cally that of explaining the econo- my to us in terms of humanity and at the same time telling us about hu- manity in terms of the economy. Thus we were able to understand, for example, that fraternity is not a residue of the sacristy or at the most an optional confined to noble souls, but an element that allows the mar- ket to function and to prosper: this was intuited eight centuries ago by St. Francis and was emphasised subsequently by those ‘economists’ based on his school (we should not forget that thanks to the minor friars during the fifteenth century the ‘hills of piety’ were created), as Professor Stefano Zamagni, who selves from the law – which is only tributed to our deliberations con- helped us with the summarises of apparently ineluctable – of the pre- firmed – our task is to certify that the papers of the first day, loves to vailing of the strong over the weak, caring for man is not a rearguard emphasise. In the same way we un- we than demonstrate in concrete mission or a hobby for philan- derstood that what Pavel Florenski terms that ‘ economic activity can- thropists. It is our task to demon- defined as ‘the art of gratuitous- not prescind from gratuitousness, strate that what Caritas in veritate ness’ (Letter from the Gulag, 11 which fosters and disseminates sol- affirms more generally as regards May 1937) – on the basis of which idarity’ (Caritas in veritate, n. 38). the poor applies to sick people, that we look at people and things as an When, with our style of a loving is to say they ‘are not to be consid- end and never as a means for mere and disinterested presence, we ered a “burden”, but a resource, goals involving profit – remains a break down the iron calculations of even from the purely economic fundamental ingredient by which to competitiveness without compas- point of view’ (n. 35). In definitive humanise the economy and civilise sion, of exaggerated professing terms, it is our responsibility to of- social relationships. And we also re- without professionalism, and of ca- fer the world a model of health care alised that growing quotas of com- pacity without responsibility, we that is able to conjoin competence munion grafted onto a mercantile then demonstrate in concrete terms and humanity, relief for the body logic create sociality, develop fair- DOLENTIUM HOMINUM N. 76-2011 129 ness, and construct solidarity. In However, a no less attentive n. 70). But we also heard from Pro- other words, they assure that justice stress must be placed on a second fessor Arduini about the dangers to which every society aspires but profile of our analysis. The strong that can come from an exaggeration which, on the other hand, is con- technical/scientific approach which of technology that particularises stantly completed and surpassed by today drives medicine seems to be sick people: the brain, the liver, the charity. destined to ineluctably direct us to- lungs and the heart. One runs the ‘Charity goes beyond justice’ wards political-financial conditions risk of losing sight of man in his en- writes almost at the beginning of his of such a character as to make it dif- tirety. Professor Arduini spoke encyclical Benedict XVI (Caritas ficult to defend total coverage about fairness in care, relating it to in veritate, n. 6). This is an assertion health systems. And as a direct con- the level of its humanity which is which for us has a fundamental im- sequence – and this is something that of humanisation, that aspect portance. It means that we have first we heard about in the paper given which should be looked for with and foremost the duty to have au- by Dr. Luis Gomes Sambo of the greatest emphasis. It is no accident thentic and real professional com- World Health Organisation – there that he made the observation to us petence, just as the right of a patient is in objective terms the risk that we that to be fair care must be first and to take advantage of this compe- will go towards a situation where foremost human. tence is authentic and real, with full certain pharmacological and non- It is on the terrain of medicine confidence. But the very profes- pharmacological centres, however and the connected biological sci- sionalism of a clinic should be ex- essential they may be for the innov- ences that today is manifested an pressed in a humanly rich personal ative and advanced treatment of ‘anthropological’ pressure that has relationship, in a relationship of di- certain pathologies, will have such an enormous impact in how we alogue and sharing which ‘goes be- a high price that they will not be ac- conceive of ourselves, of life and of yond’. And we can thus draw near cessible to everyone. the history of humanity which the to illness not in the abstract but with We are living, that is to say, in a ‘post-modern’ age is unceasingly a precise and concrete reference to historical stage of profound trans- re-elaborating. It is above all else the person of the sick individual, re- formations, a time that is rich in genetics, so-called ‘procreative’ ceived in his or her irreducible sin- challenges and authentic provoca- ethics, that is to say the set of tech- gularity. There is, to sum up, an tions, of authentic epochal changes. niques that intervene in the field of ‘economy of charity’ (Caritas in This is an age, for that matter, that is assisted fertilisation, the subjects veritate, n. 2) which cannot but list compelling and fascinating, and connected with the terminal stages amongst its most convinced and im- that will be decisive for the – who of life and the ‘pro-euthanasia passioned creators those people knows how long – centuries-old un- mindset’ denounced vigorously in who, in the name of the Church, of- folding of human affairs. the encyclical (n. 75), that com- fer care and health. We all perceive Specifically for this reason, we mands our attention. And it is here the responsibility of this call. And are worried when we see around us that, albeit in a diversity of roles in basic terms we know that the suc- the champions of a reductionist and institutions, we feel pushed cess of our works certainly depends ‘scientism’ that blows on the fires constantly to re-elaborate a shared on so many situations that constrain of a purported and incurable con- and unitary perspective of ‘Christ- us and condition us externally but in flict between science and religion ian humanism’ within which to de- the final analysis finds in faithful- and between reason and faith. There cline health-care activity. ness to its original charism its in- is a match underway which in- But even more compelling ques- eluctable, unassailable and thus volves us and whatever the case tions will continue to beset us on a truest source. commits us, even against our will. number of fronts: for example, When every day, with the scruples from ‘predictive medicine’, always that we always have, we carry out within the framework of the so- 4. Towards a New Stage our work at the bedsides of our pa- termed ‘genetic revolution’; from of Medicine tients, we must be aware that this the new dimensions which it may match is above all in our hands. be presumed will be taken on by Medicine has by now entered a This match is played out, that is to conscientious objection; and by the new stage in its history. I believe say, first and foremost, in the field most advanced applications of bio- that everyone realises this. We are of so-called ‘new medicine’, in the engineering in many varied fields. by now fully inside a season of a face of the enormous potentialities And perhaps the most intriguing strong technological declination of of a ‘biotechnology’ which only in and disturbing provocation that we the health-care act. We must, there- an integral and profound respect for must expect in the short terms fore, examine this aspect and ask life and the person can find that (from certain points of view we ourselves how we can govern the yardstick and that rule that will have already arrived, even though thousand fronts that derive from it, safeguard it against itself, against not specifically in such an explo- being concerned to ensure, as be- an uncontrolled explosion of its un- sive way) relates to the ‘ethics of lievers, that the relational value of precedented and immense power. health-care expenditure, within the that ‘therapeutic alliance’between a There is the risk that we will be- general framework of public expen- medical doctor and his or her pa- come the prisoners of that ‘techno- diture and welfare which is in diffi- tient which always constitutes the cratic cultural perspective’ accord- culty to varying degrees in almost leading axis of caring for and taking ing to which ‘truth’ coincides with all developed countries and which care of people, never disappears. ‘the possible’ (Caritas in veritate, encounters difficulty in redefining 130 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE itself in the new economic-financial draw up a richer concept of what When the time comes to make an context that is imposed by globali- ‘health’means: not only the homeo- assessment so as to approach again sation. static and feeling equilibrium of our the story of such a broad, profound We are rapidly walking towards a organisms, but, at an even deeper and detailed dialogue as that which technical-scientific development of level, self-awareness. Not an exag- we have witnessed in recent days, medicine that could soon turn out to gerated view of health or a general there is always the risk that the be incompatible – without certain technical-formal acceptance of so- temptation of self-satisfaction, of suitable policies, but it is difficult to called ‘lifestyles’, but the active intellectual reward for its own sake, imagine which – with the mainte- shouldering of responsibility for will prevail. But none of us believe nance of health systems offering our personal existential journeys. that we have completed our task universal coverage. But this is a This is a goal, our goal. here, however brilliantly. At the problem that goes decisively be- very moment when we agreed to yond the traditional boundaries of ‘give life’ to this assembly, we medicine and its connected health- 5. A Challenge that Begins Now agreed to go on ‘giving it life’ there care policies and bears upon the di- where our technical, professional mension of democracy as such, and ‘When we come to the end of that and spiritual capacities are called the values of freedom, of justice story, we have not even begun’. Al- every day to deal with human suf- and of equality, whose guarantor it low me to end my paper with the fering. Our real testing bench is is called to be. ancient – but always familiar to what comes ‘afterwards’. For us the Our work in the health-care field men of all ages and latitudes – wis- challenge has just begun. is therefore to be the bearers of a dom of this sentence from the Book great responsibility that goes be- of Sirach (18:7). These are words Fra MARIO BONORA yond the boundaries of institutions. that each one of us should bear in National President of the ARIS (Religious Association of Social/Health- It also bears upon, for example and mind now that our conference is Care Institutes), in the first instance, the need to about to end. Italy. DOLENTIUM HOMINUM N. 76-2011 131

Concluding Paper by Prof. Filippo Boscia

The encyclical Caritas in veri- finance, without, however, ever los- this international conference that tate may be seen as an authentic ing from sight the person and the was given by His Excellency Msg. Christian manifesto for the gover- environment or neglecting positive Zimowski, the President of the Pon- nance of global development; in- and virtuous actions as regards so- tifical Council, stressed how the en- deed, it is the only document on po- cial and economic dynamics, and cyclical is the ideal instrument by litical economy of worldwide im- promoting suitable regulation of the which to assess economic and so- portance and proposes giving as an laws of the market. cial systems from the perspective of instrument for development, of- It seems to me that reflection on charity and truth in order to achieve fered in the name of charity. these subjects has characterised the the integral development and the In this encyclical a new model deliberations of all the sessions of welfare of individuals and the for development is proposed in this twenty-fifth international con- whole of mankind as a social body. which the role of giving and gratu- ference entitled ‘Caritas in Veritate: During the preparations for this itousness are placed in an organic Towards a Fair and Human Health conference we were asked: ‘who way, in a way that is different from Care’. When engaging in these de- will remove the ongoing inequali- that of those economic and social liberations, the person has always ties between the health systems of circles which, unfortunately, often been at the ‘centre’ of things: the rich countries and of developing defend the interests of the holders spirit of truth has sensitised those countries or those which in absolute of power. taking part to assuring in institu- terms are less developed?’ This encyclical invites us to a tions fair an human care which Who will remove the different new responsibility, that is to say the could not be implemented without levels of access to basic health-care construction of the earthly city; it the emerging roles that are attrib- services, to medical products and to leads us to generate fraternal rela- uted to the family, to charity, to sol- lifesaving technologies? tionships, social cohesion and polit- idarity, to subsidiarity, to mission- Who will supplement the scarce ical engagement in order to build ary work and to voluntary work. health-care institutions that exist in the ‘great human family’. There emerged a major effort to the various ‘poor or impoverished Caritas in veritate upholds a new look for a renewed paradigm of hu- countries’? need for social ethics at a global manisation to achieve increasingly This international conference has level based upon the rules of justice forceful and audacious attention be- provided a precise answer: the an- and solidarity, overcoming all ing paid to new forms of poverty swer is charity in truth and truth in temptations linked to financial and the very many situations of charity, charity illuminated by the speculation and the exploitation of abandonment and denial of the light of reason and of faith, open to men, women and children, with most elementary rights. achieving objectives of human de- their related short-term advantages. The social question of equality velopment in a plurality of contexts. This encyclical lays emphasis in access to basic health-care ser- During the various sessions of upon the subjects of work, the fight vices is not an optional – it is a cat- this international conference we against poverty and the various egorical imperative that has its have listened to important testi- conditions of marginalisation and roots in the Gospel of charity. Man monies of people who are animated of social exclusion, drawing atten- is the passion of the living God and by charity and have worked to re- tion to certain new elements on for this reason our attention must move injustices, to establish more which we believers, but also all be centred on man, striving to cre- human and healthier relationships, people of good will, are called to ate a more welcoming and more as well as the testimonies of very reflect. just world. From our productive many groups, movements and asso- At the twenty-fifth international work has emerged the need to have ciations of Christian commitment conference of the Pontifical Coun- credible witnesses and people ded- whoworkinthefieldofhealthcare cil for Health Care Workers reflec- icated to charity, missionaries of in the world. tion has focused on cogent ques- charity who are able to implement The moving papers and testi- tions and issues connected with the new forms of intervention amongst monies of the very many speakers global economy, the authentic the poor, that is to say healthy nu- whom we have listened to have meaning of development, social trition, prevention, fair, human and had the function not only of being justice, the rights and duties of citi- solidarity-inspired care for every- open denunciations of failings in zens as regards the promotion of one, welcoming through organisa- the health-care world and of the life in all countries, the role of states tions of various kinds belonging to strong imbalances that can be per- in assuring fair and solidarity-in- local areas or in the form of hospi- ceived in the world of needs, but spire care, hospitality, justice, char- tals, and suitable health-care insti- also in a positive way of calling for ity in harmony with truth, develop- tutions and centres. resources to nourish the hope for ment and progress, technology and The introductory description of an improvement in those criteria 132 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE that currently govern the choices Council, the whole of the world of Increasingly often there emerge that are made in the world of care Catholic associations and all the new transversal phenomena that but which also run the risk of mar- Catholic health-care workers in the bear upon the economy and fi- ginalising the poorest and most world so as to address with greater nance, the environment and the needy sick people (for example incisiveness the complex and nu- family, cultures and religions, mi- mothers who are abandoned and merous needs that exist. grations, the health and the defence not cared for, newly born children This is a matter of building of the rights of workers, child exposed to neonatal illness and ‘citadels of charity’ in which au- labour and the defence of the rights death, malnourished children, thentic fraternity is achieved (CV, of children, with the need to prevent abandoned children, the gravely n. 20) as well as an improvement in forms of exploitation, and the re- physically and mentally handi- the so much wished-for parity of cruitment of minors for war or work capped, disabled adults and elderly access to basic health care that is re- or prostitution. people, men, women and children spectful of the inalienable dignity Many problems have to be ad- who are in pain and dying without of man. dressed in this epoch of globalisa- the prospects of humanitarian and The calling to repair in sick peo- tion: compassionate accompanying: ple the wounds of the Holy Face of 1. The welcoming of life. Con- men, women and children who are Christ is the real, convincing and temporary development is closely the orphans of medical products, powerful impetus that is able to ful- connected with this subject: the perhaps of those medical products fil missions of truth and charity in greater importance that it has ac- of which there is a surplus in opu- the world, starting with perception quired compels us to expand the lent nations). of, and deep knowledge about, suf- concepts of poverty and underde- All the very valuable papers fering. velopment to questions connected have been an invitation and a call This is a proposal, a recommen- with the welcoming of life. to global charity, to place the per- dation, not to engage in a dispersal 2. The reconstruction of social son, the poor, at the centre of our of those vital forces that promote communities (families, intermedi- attention, to be in communion with commitment that is not only a mat- ate groups) that have been lost be- them, to promote missionary activ- ter of care but also cultural in char- cause of internal migrations or mi- ities designed to create structures acter. grations towards richer countries. of voluntary work which by voca- Because of their very great num- 3. The loss of cultural and reli- tion serve man during his season of ber, it is difficult to list the institutes gious identities. pain: men and women who bend of male and female religious that 4. Hunger and inequalities. before the wounds of this suffering are all present in the most margin- 5. Therelocationofworkandof humanity without ever failing to alised areas of the world and, ani- the production of goods and ser- respect human dignity, so that the mated by their specific charism, act vices. face of Christ may be seen increas- in various fields: the health-care 6. Violence in general, civil wars ingly in the poorest, the aban- field, the agrarian field, the field of and conflicts provoked by religious doned, the oppressed, and in all schooling, the cultural field and the fundamentalism. sick people. field of training. 7. The precariousness of employ- All the papers have pressingly in- Many responses are awaited and ment. vited men of good will to make amongst these are specifically those 8. The autonomy of ‘economic available their professional skills at a cultural level and the level of arguments’. and their time, their resources, for training, through the to-be-hoped- 9. Violence against people who service to health that is more coor- for creation of universities in criti- are poor in resources who are even dinated and organised in depth. cal countries as well – a further driven to sell, or to have used, parts They have also called for responsi- challenge and demonstration of the of their own bodies (for example bility, generosity and witness to special role of culture in the field of the exploitation of the body through charity towards men in pain who re- that global charity connected with surrogate motherhood, prostitution, ceive care and they have stated that development, with progress, with the supply of organs, etc.). pain and suffering can release love the drawing up of the supply of 10. Exploitation of people in the and strengthen the role of those training in all fields but especially field of work. who work in a good spirit to defend in that special one of solidarity-in- 11. An unacceptable devaluation and support life in extreme situa- spired finance which works through of life. tions, from birth to death, and in sit- microcredit. 12. Varying levels of availability uations of malaise, poverty and ill- What we are now going through of goods and their distribution or, ness. is the first great post-globalisation even worse, corruption and domi- Although, on the one hand, the crisis. The current world is already nance by organised crime. problems of the health-care world profoundly different from the one 13. Mechanisms of development are vast and complex, on the other previous to it: the scenario is poly- and economic democracy altered the answers to them are often partial centric. It has already been invaded through the hypoactive destruction and not organised. by risks and damage that were pre- of goods and products in order to We should, therefore, work in viously unknown, all of which are maintain a market economic logic. synergy to outline a unitary project connected with planetary interde- for pastoral care in health that in- pendence and the variation in Marginal welfare or emotional volves, together with the Pontifical geopolitical equilibriums. charity is no longer enough. There DOLENTIUM HOMINUM N. 76-2011 133 is a need for a full commitment at Many Italian centres have agen- planet, the commitment of states to all levels to fighting against poverty cies abroad and promote very grave assuring fair and solidarity-inspired and in favour of human promotion. reproductive tourism. care, hospitality, justice, charity and We must go beyond individual ar- In Italy we can witness problems truth, development and progress, eas of knowledge, work for accul- connected with the exaggeration of technology and solidarity-inspired turation, assure the right to commu- the self-determination of patients finance, never losing sight of atten- nicate (through ICT instruments as and as a part of this a reduced au- tion being paid to the person and to well), and promote the need for an tonomy and responsibility on the the environment and never neglect- interdisciplinary approach ordered part the part of medical doctors ing positive and virtuous actions as by knowledge and skills at the ser- which makes the relationship be- regards social and economic dy- vice of human development. tween medical doctors and patients namics, and promoting suitable reg- We need to denounce here the ac- more fragile. ulation of the laws of the market to tive trade in reproductive cells In this context are to be located achieve health and safety. which is promoted by certain Euro- the abuses or delays that take place A final observation: in recent pean countries in relation to women as regards diagnosis, the abuses or days I have perceived the Pontifical and men in less favoured countries delays that take place in relation to Council for Health Care Workers as (the Ukraine, Romania, Bulgaria, treatment, and the exaggerated re- a natural structure for the work of Poland, Russia, India and Pakistan). sort to psychotropic drugs. lay people, of all health-care work- ers (medical doctors, nurses, phys- iotherapists, obstetricians, x-ray di- agnosis technicians, etc.). I have experienced this Pontifical Council as a body of the universal Church of which lay people are an essential and participating compo- nent. Lay people have not been passive spectators: they have felt them- selves protagonists, an active part of the life of this dicastery! Personally, I have lived, together with this Pontifical Council, in that great cathedral, the world of health and health care, in which there is God, the only begotten Son, the apostles, bishops, priests, religious, deacons and the lay faithful and where there come and go, calmly or in emergencies, all the creatures of Men and women induced to sell Very often there is an overdose of the world, believers and non-be- their own gametes or even who prevention, an overdose of the med- lievers, those that see the Father and have their gametes taken away, or icine of what people want, with a those that do not see the Father. even worse couples whose surplus consequent waste of public re- This dicastery is for the world embryos are expropriated and then sources to the detriment of those and deals with all the urgent prob- frozen so as to be allocated to other people who are most in need. lems of the world. women of advanced age, or in It is absolutely the case that we In this ideal church, in this cathe- menopause, or in early menopause, must propose anew the perspectives dral, all the creatures of the world or with pathologies involving an of an integral humanism to give im- look for hospitality, compassion, early absence of ovules, who up- portance to the value of fraternity: nearness, religious consultation and hold and wish to meet their need for we should try to go beyond exces- comfort, but above all they look for motherhood at any price. sive individualism, selfishness, rel- listening, for care (even though one Surrogate mothers, wombs for ativism, nihilism scepticism, and cannot always get better), and they rent, without any form of regula- consumerist and excessive materi- find hope, mercy, a sense of shar- tion, have emerged in the countries alism, and give value to life as a ing, a therapeutic alliance. of Eastern Europe. gift. Within this great cathedral there This trade adds poverty to pover- At the origins of underdevelop- are ‘workers of the Lord’ who en- ty and today constitutes a grave ment there is always a lack of fra- gage in medicine with love and out emergency that is connected with ternity and of charity, of hospitality. of love. globalisation and the breaking International society will pro- If used with wisdom, technology down of frontiers. mote the authentic meaning of de- for man is wisdom, a merciful Any state law can be by-passed if velopment if it brings to the fore so- heart, and hope. fundamental rights are ignored or cial justice and the rights and duties Personally, I am profoundly con- non-negotiable principles are over- of citizens and states for the promo- vinced of this. turned. tion of life in every corner of the In the large structure of the 134 CARITAS IN VERITATE - TOWARD AN EQUITABLE AND HUMAN HEALTH CARE health-care world we increasingly An incumbent expression of ty, to subsidiarity and to charity in need the work of active chaplains thanks goes to the President of the truth means to care for relationships who dedicate their actions to the Pontifical Council, Msgr. Zimows- between men and to care for the sick and their family relatives but ki, for wanting and organising this hope that is in the world and in each also to medical doctors, to nurses international conference, to the one of us. and to the whole of the health-care Secretary of this Pontifical Council, The words of the Holy Father staff. Msgr. Redrado, and to the Under- which we have listened to through All of this personnel must bear Secretary, Msgr. Jean Marie Musivi the voice of the Secretary of State, witness to charity, patience and hu- Mupendawatu. Msgr. Tarcisio Bertone, call us to mility and must call for updating To them go my feelings of grati- respect for the human person, and training so that their actions can tude for the confidence that they above all in extreme situations – be more effective. havehadinmyperson. birth, pathways of suffering, situa- Hospitals and health-care insti- My gratitude also goes to all tions at the end of life and the natur- tutes near to the ecclesial world those speakers who with their al decline of life. have a greater responsibility in as- analyses have borne witness to the We wish to keep in our hearts the suring respect for the dignity of the need for, and also the fecundity of, words of the Holy Father which are person and in accompanying the ex- conjoining theory and practice in deeply rooted in the Gospel of char- perience of suffering and of pain. the pathways of the humanisation ity so that they may be giving, help, Everywhere in the largest church of medicine and to all those who support and guidance in our daily in the world, in the world of suffer- have constantly expressed the ur- conduct. ing, of frailty, there is a demand for gent need to always place the per- justice, love, assistance, for the joy son at the centre of action in health Prof. FILIPPO M. BOSCIA of giving and those riches of com- care. Consultant in Gynaecology fort and light that spring from the To give a voice to medicine, to and Obstetrics, mystery of Christ who died and the humanitarian undertaking, to the ‘Di Venere’ Hospital, rose again. thought about bioethics, to solidari- Bari, Italy. DOLENTIUM HOMINUM N. 76-2011 135

Concluding Observations by H.E. Msgr. Zygmunt Zimowski

We have come to the end of our health the so-termed ‘Salus ani- spiritual closeness of the entire twenty-fifth international confer- marum’isabsentfromtheprimary Christian community. It is important ence on the subject ‘Caritas in veri- mission of the Church. not to leave them abandoned and in tate. Toward an equitable and hu- The right to health, which is solitude while they try to face a very man health care’. We give thanks to recognised by national and interna- delicate moment in their life. Praise- God for its successful outcome and tional legislation, must be matched worthy are those who with patience above all for its conclusions and the by the duty of government, to en- and love place their professional recommendations. sure the fair access of citizens to skills and human warmth at their First of all we thank the Holy Fa- health-care services; there is also service. I think of doctors, nurses, ther Benedict XVI for the Message the responsibility of each one of us health-care workers, volunteers, Re- that he gave us and in which he em- to protect personal and collective ligious and priests who without phasised how justice in health care health. sparing themselves stoop down to and the protection of life must be a Solidarity and subsidiarity are them like the Good Samaritan, not priority in the action of govern- cardinal principals in assuring the considering their social condition, ments. access of citizens to essential skin colour or religious affiliation, I would like to thank all those health-care services, ensuring that but only their needs. In the face of who gave papers and all the partici- the resources or services available every human being, and still more if pants, beginning with His Emi- are managed not only with humani- tried and disfigured by sickness, nence Cardinal Tarcisio Bertone, ty but also with charity, and having shines the Face of Christ, who said: the other Cardinals, the Archbish- as an objective the protection and “As you did it to one of the least of ops, the Bishops, priests, and men the appreciation of human dignity. these my brethren, you did it to me” and women religious. In a special The question of intellectual prop- (Mt 25: 40). way I thank health-care workers erty rights in the field of biomedi- I would like to finish with the who are ministers and ‘servants of cine should be addressed by taking words of the Holy Father Benedict life’, good Samaritans. into account both the evident right XVI from his Message of yesterday A heartfelt thanks goes to the of companies to enjoy the fruits of to those taking part in this interna- Secretary, H.E. Msgr. José L. Re- their innovative results and the right tional conference: ‘To suffering drado, the Under-Secretary, Rev. of populations to be treated so as to brothers and sisters I express my Msgr. Jean-Marie Mupendawatu, safeguard their lives and health. closeness and also the appeal to live all those who work with me at the Everything that has been said illness as an occasion of grace to Pontifical Council for Health Care over the last few days can be sum- grow spiritually and participate in Workers, and the interpreters. marised in the phrase ‘nearness of the sufferings of Christ for the good I would like to emphasise certain hearts’. On this point I would like to of the world, and to all of you, com- points that deserve the attention of quote the words of Pope Benedict mitted in the vast field of health, I everyone: XVI pronounced on the occasion of give my encouragement for your The mission of the Church in the the World Day of the Sick of 2007: precious service’ health-care field is born from the ‘And it is precisely to these our par- command of the Lord ‘Euntes do- ticularly tried brothers that today’s H.E. Msgr. ZYGMUNT ZIMOWSKI cete e curate infirmos’ and finds its World Day of the Sick is dedicated President of the Pontifical Council paradigm in the figure of the Good with special attention. We would for Health Care Workers, Samaritan. Without pastoral care in like them to feel the material and the Holy See. http://www.vatican.va/roman_curia/pontifical_councils/hlthwork/index.htm