Dolentium Hominum N

DOLENTIUM HOMINUM N. 44 — Year XV — No. 2, 2000

JOURNAL OF THE PONTIFICAL COUNCIL FOR HEALTH PASTORAL CARE

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

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Spedizione in a.p. - art. 2, comma 20/c, legge 662/96 - Roma Contents

4 Greetings from His Holiness Pope John Paul II 77 II: The Transmission of AIDS through the Maternal Foetus: New Possibilities in the Field of Prevention Dr. Massimo Fantoni THE CATHOLIC CHURCH AND THE Dr. Guido Castelli Gattinara CHALLENGE OF HIV-AIDS, 9-11 DECEMBER 1999 78 III: Psychological Aspects Dr. Rosa Merola 6 Greeting and Introduction H.E. Mons. Javier Lozano Barragán 83 IV: Ethical and Moral Aspects Dr. Antonio G. Spagnolo 8 AIDS in the World Today: the Current Situation and Challenges for the Future 87 V: Spiritual Aspects of Accompanying Dr. Peter Piot People with HIV-AIDS Rev. Arnaldo Pangrazzi 12 Presentation of the Work of the Research Group H.E. Mons. José L. Redrado PAPERS IN THE PROGRAMME “ACCESS TO HEALTH CARE TREATMENT, 13 Results of the Inquiry into: ASSISTANCE IN THE FIELD, THE PASTORAL “The Realities, Problems and Proposals EXPERIENCES OF CERTAIN LOCAL CHURCHES” of the Local Churches in Relation to Socio-Health Care Services and Pastoral 89 I: Asia - The Pastoral Experience in Thailand 2 Action for People with HIV-AIDS in the World Dr. Kumnuan Ungchusak Dr. Fiorenza Deriu Bagnato 90 II: Africa - the Congo Dr. Kapepela Kakicha Marie SECTION I PREVENTION 92 III: South America - Brazil Dr. Maria Inez Linhares de Carvalho 25 Life as a Founding Value Carlo Casini 94 IV: Central America - Haiti Dr. Jean-Marie Caidor 29 Education in Values? Rev. Stanislaw Grygiel 95 V: North America The United States of America ROUND TABLE Rev. Robert Vitillo THE PLACES OF EDUCATION IN VALUES 98 VI: Europa - Poland 37 I: The Family Don Arkadiusz Nowak H.E. Mons. Francisco Gil Hellin 100 Conclusion 41 II: Schools H.Em. Card. Pio Laghi

44 III: The Communications Media SEMINAR H.E. Mons. John P. Foley “THE IDENTITY OF THE CATHOLIC CHAPLAIN IN PASTORAL CARE IN HEALTH AND HEALTH CARE ROUND TABLE ON THE THRESHOLD OF THE THIRD MILLENNIUM” EXPERIENCES AND FUTURE PROSPECTS 22-23 NOVEMBER 1999 FOR ACTION AND PROGRAMMES OF A PREVENTIVE NATURE BASED UPON EDUCATION IN VALUES 103 The Ordained Ministerial Priest, 46 I: Italy, the CUAMM Bishop and Presbyter in the Dr. Giovanni Putoto Health Care Ministry in the Light of the Apostolic Exhortation “Pastores Dabo Vobis” 50 II: India H.E. Mons. Javier Lozano Barragán Dr. Gracious Thomas 108 The Identity of the Catholic Chaplain and the 58 III: Spain: the Foundation Dimensió SIDA Health Care Ministry on the Threshold of the Dr. Antoni Mirabet Third Millennium - A Theological Reflection Rev. Don Juvenal Ilunga Muya 63 IV: AIDS and Caritas Internationalis Mons. Fouad T. El-Hage 117 The Catholic Chaplain of Pastoral Care in Canon Law 72 V: AIDS in Africa Mons. Martin Vivies Dr. J. Agness-Soumahoro 127 The Identity of the Catholic Chaplain and the Health Care Ministry on the Threshold of the SECTION II Third Millennium - Emerging Problems ACCOMPANYING Rev. Renato Di Menna

PAPERS IN THE PROGRAMME 136 Conclusion “ASSISTANCE AND PEOPLE WITH HIV-AIDS” Rev. Felice Ruffini The illustrations in this edition are taken from the book: 75 I: Health Care Aspects L’Antica Spezieria della Santa Casa di Loreto Dr. Massimo Fantoni Colapinto, Grimaldi, Bettini Editore Croce Azzurra, Bologna “Come away to some lonely place all by yourselves and rest for a while”

(Mk 6:31) Greetings from His Holiness Pope John Paul II

His Holiness John Paul II cordially greets the participants from various countries summoned by the Pontifical Council for Health Pastoral Care to study the questions and issues connected with the scourge of HIV-AIDS. 4 In this circumstance the Holy Father encourages everybody to work together, beginning with the resources of their own skills and responsibilities, in taking care of those who suffer from this disease, employing the resources of science to alleviate their suffering. These people are accompanied by the solidarity of the Church and the fraternal generosity of very many men and women of good will who are moved by the example of the Good Samaritan to come to the help, with suitable instruments, of these sick people, being responsible for them until their complete cure or a serene death. With these keenly-felt feelings he asks the Almighty, through the maternal intercession of the Virgin of pain and hope, to enlighten, and concede abundant fruit to, those who work in this specific field of human pain, while he imparts with affection to those present the requested Apostolic Blessing.

Cardinal Angelo Sodano, Secretary of State of His Holiness The Catholic Church and the Challenge of HIV-AIDS

9-10-11 December 1999 Nova Domus Sanctae Marthae the Vatican city Greeting and Introduction

I greet with affection the Churches with regard to the for America those of Brazil, participants at this conference situation of HIV-AIDS in the Haiti, and the United States of on AIDS organised by the world. Thereafter our studies America; for Europe the expe- Pontifical Council for Health will be concerned with three riences of Poland; and lastly, Pastoral Care. I greet and main areas of interest: preven- for Oceania, we will study the thank all the speakers for their tion, accompanying, and en- experiences of Australia. presence. They are really mak- lightenment. With regard to the enlight- ing a great contribution to the In discussing the question of ening of these realities with cause of health and health care prevention we will discuss life reference to the Word of God, in the world and to an intensi- as a fundamental value, educa- we will reflect upon pastoral fication of the health care min- tion in values, the place of ed- theology and HIV-AIDS. We istry. ucation in values, the family, will conclude with an exami- This conference wants to schools, the mass media, the nation of the necessary guide- 6 achieve three principal objec- experiences and the future lines for future, and better, pas- tives. They are as follows: 1. prospects for action and initia- toral action and care. the promotion of help to those tives and for programmes in- During our conference it is who are afflicted with HIV- volving prevention based up- our intention to motivate and AIDS; 2. guidance of the on education in values. These encourage the ground-level questions and issues associat- experiences will be presented Churches to exercise greater ed with HIV-AIDS in line by the following countries: influence on national health with the Magisterium of the Italy, India, Spain, Senegal, as care policies in relation to Church; and 3. the co-ordina- well as by “Caritatis Interna- HIV-AIDS. We expect a more tion of the movements and tionalis”. significant presence of workers groups belonging to the With regard to accompany- connected with the health care Catholic Church which work ing we will study caring for, ministry within public and pri- in the field of HIV-AIDS. and looking after, people af- vate health care structures Ð a We will begin by examining flicted by HIV-AIDS by pay- presence which should be the contemporary situation of ing attention to the health marked by a clear orientation the world as regards HIV- care-medical, psychological, with regard to the health care AIDS and what this situation moral-ethical, and spiritual as- ministry and HIV-AIDS. It is is likely to lead to. This subject pects of the question. We will our hope that this conference will be dealt with by UN- then deal with access to pro- will help in particular to pro- AIDS, the organisation of the grammes of care and treatment mote policies involving the United Nations which is re- in this field. This will be fol- protection of life by challeng- sponsible within that body for lowed by the pastoral experi- ing the contemporary policies the question of HIV-AIDS. ences of a number of local of prevention now operating We will then present the re- Churches of the five conti- which are based, often exclu- search which has been carried nents: for Asia we will consid- sively, on promoting the wide- out by our Pontifical Council er the experiences of Thailand; spread use of the condom. on the reality, the problems for Africa those of the Democ- We want to promote the cre- and the proposals of the local ratic Republic of the Congo; ation of a credible network of selfless groups of bodies and non-governmental organisations involved in the struggle against this illness. We want to support the actions of national governments in this area; lend our weight to the initiatives of Catholic and non-Catholic non-governmental organisations; help in the acquisition of funds and financial means for projects which envisage facili- tating access to anti-retroviral drugs and treatment for opportunistic infections; we hope that there will be initiatives directed towards the promotion of the socio-economic growth bigotry, of mere prejudice, HIV-AIDS and most of whom and development of those when considered in relation to were in turn infected by this countries which are more af- a terrible reality which over- disease, we urgently need to flicted by HIV-AIDS; and, flows the confines of morality. make the whole world aware lastly, we want to learn how to However, there can be no of, and sensitive to, the fact use the social mass media in a doubt at all that for the pastoral that it must immediately come more mature and appropriate action of the Catholic Church to their aid. A recent initiative way Ð in particular the press, the virtue of chastity is at the has taken place which we be- television, and Internet. It has present time the most urgent lieve it would be right to en- been said that the Church has appeal which can be made in courage: the official creation not made her voice heard with this field. It must be intensified throughout the world of a day regard to the question of AIDS both at the level of suitable es- dedicated to children infected and that her silence is proof of pousal and at the level of prac- by HIV-AIDS. This day is to her powerlessness in the practical implementation. take place on 28 December, tical field of a reality which is The virtue of chastity seems, the day when the Catholic one of the most wounding that it is true, something which Church celebrates the feast of presently exists. Nothing could goes against the tide in a pan- the Holy Innocents. be more false! As is evident sexualistic society such as that This Ministry has adopted from the research which we which exists today. But it is the this initiative and has sent an will present at this conference, real solution to sexual conta- appeal to this effect to the 9.4% of the bodies who look gion. It brings with it an an- bishops who chair the episco- after people afflicted with thropological vision of love pal conferences of the world. HIV-AIDS are Church entities and sex, and must be under- In this appeal we ask them to and 15.1% are Catholic stood in all its social, familial, present, if they so wish, this 7 non-governmental organisa- individual and personal range. initiative to the people of God tions. The financial means at It is to be understood in terms who are in their local Church- their disposal, compared with of the need for marital chastity es and to send as a Christian such means considered as a and it is to be lived out in an- present to those who are most whole, amount to 20.6%, and other form in celibacy. With- afflicted by this infection in in great part these bodies are out the acceptance of this vi- the six countries of Sub-Saha- not public but private in char- sion accepted through faith ran Africa their prayers and acter. To all these data it is ob- one can well understand how economic offerings for food vious that we should add the for many people the use of the and medicines for these chil- clear positions enunciated by condom is a practical thing. dren. The help given can be of the Pope, to which reference Without faith, one can also un- many kinds. A help which is will be made below, and the derstand why for many people often forgotten about, as is very large number of pastoral it is absurd for the Catholic more than evident in this secu- communications and declara- Church not to accept the prac- larised world, is that of prayer, tions made by the bishops of tice of prevention through the and upon this we place great the whole world which were use of condoms. insistence. This will be a very recently published together in With regard to the treatment special instrument with which different forms. of people who are seropositive, to combat this plague Ð a We hope that during this at this conference importance plague with which we have conference there will be clarity will be given to the action of been inundated at the end of with regard to goals and thus the governments of various the second millennium and the with regard to the direction of countries Ð actions which we beginning of the third. You pastoral work as well. All this must recognise and encourage. will be able to find the relevant can be found in the doctrine of We need to intensify the action documents in the material the Holy Father on the ques- of all those who are concerned which has been given to you, tion of HIV-AIDS which has with these sick people. In all and we hope that you will be already been expounded Ð in- people we need to intensify the able to be the spokesmen for deed at the previous confer- solidarity-inspired conscience this initiative in your local ence organised by our Ministry of the Good Samaritan so that Churches. on this subject. We would like in these sick people we can see May the most Holy Virgin, to draw attention in particular our poor and least protected salus infirmorum, come to the to the action of prevention and brethren who have fallen prey aid of the very many children to something in this area which to this terrible evil, and in rela- who are constantly dying as a is specifically Christian and tion to whom special action by result of this terrible evil, and which has been emphasised by everyone (and in particular the bear in her heart in motherly the Pope in a clear fashion Ð professionals of the world of fashion all those who are af- we must bring out the force health and health care) is re- flicted by HIV-AIDS! which the virtue of chastity quired. must have nowadays. There Faced with the frightening H.E.Mons. JAVIER LOZANO can be no doubt that in the sec- drama experienced in particu- BARRAGÁN, ularised context of our world lar by the two million children Archbishop-Bishop Emeritus of Zacatecas, this answer can appear to be an of Sub-Saharan Africa, the or- President of the Pontifical Council illusion, and in certain cases it phans of parents who died be- for Health Pastoral Care. can appear to be a matter of cause they were infected by The Holy See AIDS in the World Today: the Current Situation and Challenges for the Future

Let me begin by thanking and children infected with larly among drug users, and His Excellency, Monsignor HIV live in the developing the potential for HIV to Lozano, for a much inspiring world. Yet 9 out of 10 people spread beyond the injecting presentation. in the world living with HIV drug use population to other On behalf of the Joint United do not know that they are in- vulnerable populations is Nations Programme on HIV- fected. great. On the other hand, AIDS (UNAIDS), I would like Over 16 million adults and Thailand has shown evidence to thank you for giving me the children have already lost of a fall in new infections, opportunity to address this im- their lives to this devastating largely due to sustained pre- portant Congress on AIDS, disease, and the death toll ris- vention efforts that addressed which I hope will further con- es each year. This year saw factors affecting both HIV tribute towards closer co-oper- the highest number of deaths risk and vulnerability. ation between UNAIDS and all from HIV-AIDS since the be- The Caribbean is the sec- 8 levels of the Catholic Church. ginning of the epidemic Ð 2.6 ond most affected region in I would like to begin by million. AIDS now kills far the world, with countries outlining the extent of the more people world-wide than such as Haiti reaching levels HIV-AIDS epidemic as it af- any other infectious disease. of HIV infection parallel to fects the world today, and In Asia, the most densely those in Sub-Saharan African looking at the prospects for populated part of the world, countries, and rising infection the near future. there is cause for serious con- rates in the Dominican Re- cern. For example there has public, Guyana and Barba- been rapid progression of the dos. In Brazil and Mexico, Overview of the global virus in some countries such AIDS has been listed as the AIDS situation as Myanmar and Cambodia, second cause of death, after where the epidemic is well violence, among men under The spread of HIV-AIDS established in the general 45, surpassing traffic acci- has by far exceeded our worst population with almost 4.5% dents. In Central America in- fears. There are over 33 mil- of male blood donors infect- creasingly high levels of in- lion men women and children ed. Perhaps the biggest worry fection are being found at who are currently living with is how the epidemic will surveillance sites among HIV-AIDS Ð a number equiv- evolve in the two largest pregnant women, men having alent to nearly the whole pop- countries of the region and sex with men, and migrant ulation of Poland. And half of the world Ð China and India. populations. While in the these are young people under Already, it is estimated that in Southern Cone, infection the age of 25. Over 1 million India alone, there are over 4 rates are increasing among children are infected with million people living with those most vulnerable, partic- HIV, most of them perinatal- HIV, not only in urban cen- ularly drug users and their ly, and most of them in tres but many of them in rural partners. Africa. areas. In China, almost half a The world’s steepest HIV Let me say from the outset million people are estimated curve in 1999 was recorded that we are not helpless to be HIV positive, particu- in the newly independent against this epidemic. I can point to countries and communities from every region of the world where infection rates have been stabilized or even reversed. However, overall, the epidemic continues to grow re- lentlessly. Approximately 16,000 people are newly infected each day. Most of the new infections occur in those between 15 and 24 years old and increasingly the epidemic is affecting women. The over- whelming majority (some 95 per cent) of the men, women states of the former Soviet and economies. As President Union, where the proportion Nelson Mandela warned at of the population living with the 1997 Economic Forum in HIV doubled between 1997 Davos: “AIDS kills those on and 1999. In the larger region whom society relies to grow comprising these nations and the crops, work in the mines the remainder of Central and and the factories, run the Eastern Europe, the number schools and govern nations of HIV infected persons rose and countries.” Today, in by more than a third in 1999 many African countries, alone, to reach an estimated AIDS has already wiped out 360,000. major gains in development In developed countries, registered over the past great progress was made in decades. Economists at the the early years of the epidem- World Bank conservatively ic. However, prevention has estimate that countries with stagnated for a decade. This high HIV rates will lose one year, as in earlier years, living with HIV-AIDS and per cent of GDP growth an- 75,000 people were newly in- those dying from the disease nually. fected and there is worrying are only the tip of the iceberg: AIDS affects almost every evidence that unsafe behav- a much larger number of peo- aspect of social and economic iour is again on the rise. But, ple are affected by the epi- life. nowhere has the impact of demic and are having to cope Ð Health care systems are HIV-AIDS been more devas- daily with its consequences. stretched beyond their limits 9 tating than in sub-Saharan One of the hardest hit groups as they deal with a growing Africa, where today it poses are orphans. As adults get number of AIDS patients and the foremost threat to devel- sick and die, the number of the loss of health personnel opment. orphans has increased due to death and illness. They At the regional level, near- tremendously. By the end of also have to cope with rising ly 14 million Africans have 2000, over 13 million chil- cases of tuberculosis, the already died Ð over 2 million dren will have been orphaned most common infection asso- this year alone. Nearly 4 mil- by AIDS, most of them in ciated with AIDS. In Côte lion Africans were newly in- Africa, and over 10 million d’Ivoire, Zambia and Zim- fected with the virus in 1999, will still be under the age of babwe, HIV-infected patients bringing the total number of 15. In the past, the traditional occupy 50 to 80 per cent of infections in Africa to over 23 family and community struc- all beds in urban hospitals. million. In no fewer than 13 tures would step in to care for On average, treating an AIDS African countries, more than orphans Ð but that was before patient for one year is about a tenth of the entire adult AIDS. Their grandparents are as expensive as educating 10 population is living with often old and poor and cannot primary school students for HIV-AIDS. And in some take on their care. They are one year. countries, such as Botswana, part of a new and growing Ð The education sector is Namibia, South Africa, Zam- phenomenon: the child-head- also highly affected. A World bia and Zimbabwe, one of ed household. These are chil- Bank study in Tanzania esti- every five adults is infected. dren who have seen their par- mated that AIDS would kill Life expectancy at birth in ents die; they are children almost 15,000 teachers by the countries such as Botswana is without hope, with none to year 2010 and 27,000 by anticipated to fall below the teach them how to fend for 2020. The cost of training re- levels seen in the 1960s (from themselves, to become re- placement teachers would be 61 years in the late 1980s to sponsible adults and parents nearly $40 million. In Côte 47 years today, and it is ex- in turn. d’Ivoire, around one school- pected to plunge to 38 years AIDS is one of the greatest teacher dies of AIDS every by 2005 to 2010). The glim- development crises of our school day. The quality of the mers of hope in Africa are time. Clearly, AIDS is more education provided is also seen in Uganda and Senegal. than an epidemic; it is a mas- suffering as less experienced Both countries have demon- sive development catastrophe personnel are pushed to re- strated that early and compre- affecting many countries. place those who fall sick and hensive prevention efforts in While most infectious dis- die. combination with the provi- eases kill off the weak Ð the Ð The HIV-AIDS epidemic sion of essential services very young and the very old Ð is stretching the capacity of have kept HIV infection rates HIV targets people in the social safety nets to the limit. low. This success was driven prime of their working and The impact on households by proactive political leader- parenting lives. This age fac- begins as soon as a member ship that, from the outset, en- tor profoundly disrupts the of the household starts to suf- gaged civil society groups economic and social bases of fer from HIV-related illness. around actions to curb the families. This results in loss of income spread of the epidemic. More than this, AIDS of the patient, a substantial But the millions of people threatens whole communities increase in expenditures for medical expenses, and other must do much more. We are breast-feeding. Many govern- members of the household, not only united by our comments are now looking into usually daughters and wives, mon desire to do more, but the feasibility of providing missing school or work to also by the painful dilemmas this intervention to HIV-in- care for the sick person. that this disease brings. We fected pregnant women. Death results not only in ad- experience anguish and pain While it is not yet a perfect ditional expenses for funeral when we lose members of solution, working on the pre- and mourning costs, but in a our community or when we vention of mother-to-child permanent loss of income are unable to respond to the transmission will also help from less labour on the farm needs of those infected and build the infrastructure need- or from lower remittances. In affected by AIDS. ed for care and treatment, as Côte d’Ivoire, in urban fami- One of the key areas where well as strengthen access and lies where a member has the Church makes a big dif- quality of the voluntary coun- AIDS the average income ference is care of those living selling and testing services drops by 50-65 per cent, fam- with and affected by HIV- which are required for the in- ily spending on education is AIDS. The Catholic Church tervention to work. halved, and food consumption drops by 41 per cent, while individual expenditures on health care more than quadruples. Other consequences include the dissolution, or part dissolution, of 10 families: children are sent away to live with relatives; a spouse or a child migrates to earn an income; and sometimes, on the death of her husband, the widow and her children are forced to move to a brother’s house relin- quishing any rights to property or inheritance . Ð Economic productivity falls. AIDS primarily af- has played an exemplary role Discrimination and stigma fects people who are at the in supporting people living associated with HIV-AIDS most productive stage of their with HIV-AIDS and their remains a major obstacle, in- lives, often those from higher families. A particular strength creasing vulnerability to the socio-economic brackets and has been the spiritual and spread of HIV. In a setting those who have benefited emotional support the Church where stigma and prejudice from many years of invest- has offered to people faced are present, people are less ment in their training. As with the immense suffering likely to accept the presence skilled workers and managers brought by this illness, partic- of HIV in their community of sectors such as mining, pe- ularly to those who have been and to be open to prevention troleum and agriculture, be- rejected by their families and initiatives. The Catholic come sick and die, the disrup- communities as a result of Church’s belief in the dignity tive effects on production their HIV infection. In the fu- of all persons and her promo- may even exceed the more ture, with the increasing num- tion of a just society are most easily measurable costs in ber of people infected and af- relevant in reducing the medical benefits, sick days fected by the epidemic, the shame and alienation experi- and training of replacements. services provided through the enced by people with HIV- In the private sector, AIDS- Church, which already con- AIDS, their families, and related costs are eating up as stitute approximately 25% of those considered to be at risk much as one-fifth of all prof- the care given to AIDS pa- of infection, such as sex its in some countries. tients in most countries, will workers and injecting drug be facing new challenges in users. trying to keep up with in- In many countries, the What must we do creasing demands. Church was the first to open to respond to the The reduction of HIV trans- its arms to people with HIV- challenges ahead? mission from mother to child AIDS who were rejected by is a breakthrough in the epi- their communities Ð regard- Much is already being done demic. Recent research has less of their past history, their throughout the world to meet shown that an effective and sexual orientation, or their the challenges posed by this affordable antiretroviral inter- mode of infection. The chal- devastating epidemic, and the vention can reduce by half the lenge was expressed by Pope Roman Catholic Church is a transmission of HIV infection John Paul II: “God loves you key partner in efforts to stem from mother to child when all without distinction, with- its progress. But all of us combined with avoidance of out limits… He loves those of you who are sick, those who work around the issue of gious communities in Africa are suffering from AIDS. He HIV-AIDS. and a survey and analysis of loves the relatives and friends Each organization will do involvement of Buddhist, of the sick and those who this from its own perspective Christian and Hindu religious care for them.” Ð CARITAS Internationalis communities in Asia have By creating a safe environ- from the spiritual, moral and been produced. UNAIDS al- ment for dialogue Ð without social teaching of the Roman so helped support the First In- judgement, without prejudice Catholic Church and UN- ternational Symposium on Ð the Church community can AIDS from its pluralistic AIDS and Religion in Dakar, make it more acceptable to standpoint as an organ of the Senegal. At this conference, all. By talking about HIV United Nations. participants from a variety of more openly and in more ac- In Latin America, in March religious backgrounds includ- cepting terms, the Church can 1998, the Episcopal Confer- ing Islam, Christianity and reduce the terrible need to ence of Argentina held a re- Buddhism, exchanged practi- hide the illness and reduce gional Symposium on HIV- cal experience in AIDS care the stigma and injury of re- AIDS prevention, where rep- and support and discussed jection. In this regard, we can resentatives of the Catholic prevention through absti- all work together with other Church from several Latin nence, mutual fidelity within partners to influence national American countries, a senior marriage, and responsible policies on human rights, on Vatican official, the UNAIDS condom use. gender issues, culture, ethics Secretariat, and the World Let me say in conclusion and the law. Bank participated. A follow- that we are very much in this An essential partner in up conference was held in together. All faith traditions meeting this challenge is March 1999 to build on the are struggling with how to 11 achieved through the Greater momentum of the sympo- address the issue of AIDS and Involvement of People living sium, which has contributed particularly how to reach with HIV-AIDS in all aspects further towards a more open young people with some of of prevention, care and com- and continuing dialogue on the messages I have earlier munity life. People who live AIDS issues in the region. In referred to. Sometimes we with HIV-AIDS or are direct- Argentina, this collaboration have identical approaches, ly affected by the disease resulted in support from UN- sometimes complementary bring personal experience to AIDS for the inclusion of approaches. We must contin- planning and carrying out a HIV-AIDS awareness mes- ue to seek mutual understand- response to the epidemic. sages in church publications ing and reinforce the dialogue Those who are open about that reach some 150,000 between church and secular their own HIV status can help parishioners every week, as authorities, and not hinder others to appreciate the need well as the broadcasting of each other’s efforts. Our abil- for solidarity between those messages concerning HIV- ity to find ways of working living with HIV and those AIDS by some 35 Catholic together may constitute our fortunate enough to have es- radio stations. truest hope of reducing the caped infection so far. UNAIDS is also actively tragic consequences of the collaborating with other de- AIDS epidemic. The next nominations to support their generation of young people, How can UNAIDS efforts to increase awareness and the next generation of our work with the Church? of HIV-AIDS and expand leaders, depend on us to find prevention, care and support the way. We must not fail. Collaboration with the services in their various com- Catholic Church and its orga- munities. A few examples of Dr PETER PIOT nizations has been ongoing at such collaboration include as- Executive Director, the global, regional and coun- sistance to the World Council UNAIDS try levels. In 1998 a formal of Churches (WCC) to build partnership was established the capacities of their mem- between the UNAIDS Secre- ber churches to carry out val- tariat and Caritas Internation- ues-based HIV-AIDS preven- alis committing us to work tion, care and support Ð a pro- together to: gramme to build a core of na- Ð promote HIV-AIDS tional and community train- awareness, responsible be- ers on HIV-AIDS within the haviour and care and dignity WCC membership on HIV- for those affected by the epi- AIDS is being piloted in In- demic; dia and Zimbabwe. Ð address the wider devel- An inter-faith alliance in opment issues highlighted by Africa to act as a focal point the epidemic while always for information exchange, re- keeping the human being at source sharing, and capacity the centre of development building is also being estab- and lished. Case studies on the Ð to promote advocacy HIV-AIDS activities of reli- Presentation of the Work of the Research Group

1. The appearance of AIDS faithful so that they could be tled ‘Work Plan’. AIDS is ex- provoked a strong reaction present Ð as Christ himself was amined under the heading of within society, a reaction Ð amongst the weak, the sick, ‘emergency illnesses’. which was made up of aggres- and those in need, and so that With the goal of engaging in sion, panic, and fear. they could be ‘protagonists’ thought about the subject we 2. Immediately afterwards with a welcoming, healing and established within the Pontifi- there was an explosion of ser- salvific presence. cal Council a work group vices and concern both on the The Church calls upon peo- whose work, indeed, forms the part of professionals and of in- ple to ‘evangelise illness’, to basis of this Symposium. The stitutions, and a bursting forth place it within its true whole, to path followed by the work of witness, solidarity and pro- give it meaning, to ‘celebrate group began with the meeting fessional commitment. We the sacraments, the source of of 25 June 1997. This first could say that AIDS has be- grace, and to bear witness to meeting was followed by come a disease of the world. service (diaconia) and commu- meetings held on the following Certainly we have begun to nion (koinonia), the therapeutic dates: 12 give value to life, which we see strength of charity’. Ð 14.7.1997 as being so fragile and mortal, 5. The Pontifical Council for Ð 2.3.1998 as indeed this disease has Health Pastoral Care Ð the right Ð 24.3.1998 shown us that it is. hand man of the Holy Father in Ð 21.4.1998 3. A fact I would like to em- the field of pastoral care in Ð 14.5.1998 phasise is the care and concern health Ð could not remain at the Ð 20.5.1998 demonstrated by the Church margins of this broad set of Ð 29.5.1998 which in such circumstances questions and issues. I would Ð 16.6.1998 has become a pioneer both like to observe here in this as- Ð July 1998. Questionnaires through its word and through sembly that there have been were sent to all the episcopal the number of institutions and two important stages in the conferences and nine of them people who have dedicated work and initiatives carried out were asked to send a represen- themselves to the service of by our Ministry in relation to tative to belong to an enlarged those who have been afflicted the subject of AIDS. study group. by AIDS. Such an approach re- Ð 18-19 December 1998. A flects a historically constant at- meeting took place with the titude. The First Stage whole of the study group and 4. In the meeting which took the nine new appointed mem- place in Geneva in May 1988 Ð The international confer- bers. on the subject of AIDS, stress ence which was held in No- In 1999 a number of meet- was placed upon the impor- vember 1989 was dedicated to ings were held: tance of the Church with regard this subject and had the title: Ð 23.4.1999 to the definition of its point of ‘Why live?: AIDS’. The read- Ð 13.7.1999 view on the ethical questions ers of our journal Dolentium Ð 26.10.1999 and issues connected with, and Hominum will find in number Their goal was to prepare for raised by, this disease. 13 Ð which has been sold out Ð the Symposium which we are It was said that the drawing the acts of this important con- now celebrating and to follow up and diffusion of documents gress. from close at hand Ð to study which could clarify the posi- Ð During this first stage we and to assess Ð the answers tion of the Church, and its re- visited many institutions in the which we received from this sponse at a social, health care, United States of America, in questionnaire. The result of and spiritual level, for a hetero- India, and in Italy, in addition this path taken is this Sympo- geneous public Ð in terms of to hospitals and special centres sium. denomination and culture Ð for these sick people. In the name of the Pontifical was something which could be Ð We also took part in other Council I would like to thank useful. meetings dedicated to this sub- the work group and the secre- We can say that the Pope has ject. tariat. Everybody, at each lev- on a large number of occasions el, has made this meeting pos- enlightened us with his Magis- sible, which we hope will be a terium when talking about this The Second Stage trampoline for the continuation subject. of our work on this subject. There are a large number of During this stage we began the planning of the work of our H.E.Mons. JOSÉ L.REDRADO documents which the episcopal Secretary of the Pontifical Council conferences and numerous lo- Ministry whose programmes for Health Pastoral Care, cal bishops have written for the are indicated in the book enti- the Holy See Results of the Inquiry into: “The Realities, Problems and Proposals of the Local Churches in Relation to Socio-Health Care Services and Pastoral Action for People with HIV-AIDS in the World”

The Framework young people), and the training istry so that it could be filled up of the Project of workers in this area. by them. B) The identification of the The questionnaire was or- HIV-AIDS has become a issues and difficulties which ganised into seven areas based global epidemic which is no have emerged in the implemen- upon different subjects: social longer associated with the tation of these initiatives and fabric, ethical-moral aspects, stereotype of homosexual be- programmes; pastoral action, social and haviour (as was believed for a C) The listing of the propos- health care services, projects long time after its emergence in als and suggestions of the local and experiments, emerging is- 1981) because it is now preva- Churches subject to the inquiry sues and difficulties, and pro- lently spread by heterosexual in order to proceed to the appli- posals and suggestions. 31 Au- channels. A large number of in- cation of new strategies in the gust 1999 was fixed as the final 13 ternational research institutes approach to these issues and date for the return of this ques- and international organisations, difficulties. tionnaire. together with the ministries of The inquiry was conducted By 31 August 1999 this Min- health of many countries, are through 112 episcopal confer- istry had received 56 duly filled involved in the arduous task of ences of the same number of up questionnaires from episco- trying to monitor this phenom- countries (these conferences pal conferences from countries enon both in order to achieve a were contacted through the lo- belonging to the five continen- more exact idea of its diffusion cal apostolic nunciatures) in or- tal areas. Thirteen episcopal and to contain that diffusion, der to reach the bishops within conferences, instead, sent sum- and in order to study suitable those conferences who are spe- mary reports on the subjects of strategies for action for the pur- cially responsible for the health the questionnaire but which pri- poses of prevention and assis- care ministry. These are people marily contained information tance. who have a profound, but at the on the specific nature of the po- In this context the Church same time broad, knowledge of litical situations and socio-cul- has asked questions about the the subject of research. tural contexts of their countries. nature of her action, both from In order to guarantee a high Six episcopal conferences said the point of view of care and qualitative level in the reliabili- that they were not able to pro- treatment and in terms of pre- ty of the answers it was provide answers because the ques- vention, education, and pas- posed to use small groups of tion was of marginal impor- toral accompanying. The experts placed within each lo- tance to their social reality. Church has also dwelt upon cal area of the inquiry where Thirty-seven episcopal confer- what is known about the great- the project of research was or- ences failed to reply. In est difficulties which afflict the ganised. The role of those analysing the distribution in local Churches in the very sen- whom we interviewed should terms of major geographical ar- sitive area of pastoral care for not therefore be undervalued. eas of the countries which filled those afflicted by this disease This is because the ‘subjects’ up the questionnaire it is possi- and upon the future prospects interviewed have a role and a ble to observe that with the ex- for action and intervention. representative character within ception of the Middle East and the local Churches or interna- North Africa the answers which Definition of Objectives tional bodies which means that were sent in were sufficiently at the Level of Knowledge they have a reliable, qualified representative of the countries and trustworthy knowledge of of the areas which had been This inquiry, which had an the information which was nec- identified by the inquiry. exploratory and descriptive essary to this research. It is important to emphasise character, sought to: In order to carry out this in- that the results of this inquiry A) learn about the pre- quiry we drew up a question- are results which cannot be ex- sent-day situation concerning: naire organised in paper form tended to all countries because Ð programmes of social and with questions requiring a this was an inquiry based not health care assistance for closed standardised answer or upon a probability sample but seropositive people and those multiple open answers. From upon a reasoned sample. How- suffering from AIDS; July onwards of this year this ever, these results nonetheless Ð pastoral action; questionnaire was sent through remain valid and useful for the with special reference to ac- the apostolic nunciatures to the Churches which were question aimed at prevention, edu- 112 episcopal conferences to tioned and for the launching of cation, informing the popula- be given to the bishops respon- future action and the drawing tion (and in a special way sible for the health care min- up of more general guidelines. The Social Fabric given the general trend in favour These data are to a great ex- of an increase in the proportion tent matched by the answers to In the first part of the ques- of the population which receives the second question we asked tionnaire an attempt was made schooling. in the questionnaire which to throw light upon: Those interviewed were also sought to identify the areas Ð the most urgent problems asked to place these questions where the greatest failings are perceived by the local Churches and difficulties in a decreasing to be encountered. From the (illiteracy, poverty, unemploy- order of importance. The result graph it is evident that the ment, immigration, the loosen- was the following. Poverty was greatest failings are connected ing of family ties, etc.); the modal category of both the to the lack of social policies Ð the most evident failings (in first and second positions and and initiatives (85.7% of cas- the political, economic, cultural has the highest frequency at es) and economic policies and etc. arenas); these two positions. It was initiatives (74.9%), followed Ð the kinds of bad conditions placed in the first or second po- by failings in educational and most widespread amongst the sitions with a frequency respec- cultural policies and initiatives sections of the population most tively of 33.9% and 28.6% and a (73.2%). associated with forms of behav- total of 62.5%. The view that In this case as well the peo- iour at risk in terms of infection poverty was the prevalent prob- ple who were interviewed by the HIV-AIDS virus (prosti- lem was also widespread in most were asked to establish a de- tution, drug-addiction, alco- of the Churches which were increasing order of importance holism, juvenile delinquency, terviewed and this was to be for these areas of failure. The etc.); found throughout the countries highest percentage frequency Ð the institutions or the bodies of the various geographical areas in this hierarchy was achieved 14 which are most involved in the which are very different from by the lack of social policies social or medical-health care each other in terms of growth and initiatives (32.1%), a fact problems of the country and development. which confirms what was (whether of a public or private Unemployment and the loos- brought out by the previous character, ecclesial bodies and ening of family ties were placed question where major criticism associations, and Catholic and in third position with a percent- was felt in relation to social non-Catholic non-governmental age of 26.8% and in fourth posi- policies. organisations); tion with a percentage of 16.1%. As regards the second posi- Ð and finally the direction in The perception of both prob- tion, on the other hand, the which the social and med- lems is clearly very high but highest percentage score ical-health care situation is go- emphasis is prevalently placed Ð 21.4% Ð was obtained by ing (improvement, deteriora- on unemployment, a phenome- economic failings which, al- tion, or stasis). non which is linked to the more though in this graph are to be practical and thus more visible found at a lower level, are seen Some descriptive statistics difficulties of daily life. Howev- as constituting very serious er, the phenomenon of the loos- problems indeed. This fact al- Those interviewed were ening of family ties constitutes a so confirms what was previ- asked to refer to the questions serious alarm bell because of its ously revealed with reference and difficulties of their social consequences for the social fab- to the problems of poverty and context which they thought ric as a whole (see Graph 1). unemployment (see Graph 2). were most urgent and prevalent in their countries. Of the cate- Graph 1 - Social Problems gories referred to, poverty together with the inadequacy of social policies constituted those Discrimination against women most cited Ð each being indicat- Armed civil conflict ed in 82.1% of cases. This asso- Presence of refugees ciation of poverty and the inade- Political Instability Inadequacy of social policies quacy of social policies invites Loosening of family ties us to reflect upon the situation to Immigration be found in all those developing Urbanisation countries where poverty is still Kind of problems Unemployment not seen as a problem of society Poverty which should be tackled by all Illiteracy of its members. Frequency % Unemployment followed with Problems % present 80.4%, the loosening of family Illiteracy 53,6 ties with 76.8%, and the process Poverty 82,1 of urbanisation with 64.3% Ð a Unemployment 80,1 phenomenon correlated with a Urbanisation 64,3 progressive emptying of the rur- Immigration 53,6 al areas, in particular in the areas Loosening of family ties 76,8 of the countries of Sub-Saharan Inadequacy of social policies 82,1 Africa. It should be noted that il- Political Instability 46,4 literacy, indicated in 53.6% of Presence of refugees 42,9 Armed civil conflict 35,7 the returned forms, was not seen Discrimination against women 60,7 as being of primary importance Areas of Greatest Failings % tion, with percentage figures of In political structures 58,9 26.8% and 19.6% respectively. In educational-cultural policies and initiatives 73,2 Of no lesser importance, in In social policies and initiatives 85,7 third position, is juvenile delin- In the economy 74,9 quency and the exploitation of Graph 2 - Areas of Greatest Failings minors, factors which have a strong impact on the models of

In the economy behaviour of the young. Concentrating on the initia- In social policies and initiatives tives of a social character which In educational-cultural policies and initiatives had been promoted in order to In political structures deal with the social difficulties

areas of failings encountered by people who live with HIV-AIDS, the people Frequency % who were interviewed were In the next question those Drug-addiction is the modal asked to indicate the percentage interviewed were asked to indi- category with regard to the sec- contribution made by certain cate the kinds of social evil as- ond position with a percentage public/state, private, Church, or sociated with forms of behav- level of 28.6%, which was international bodies. As can be iour at risk in terms of infection matched by prostitution which observed from the graph, 45% by the HIV-AIDS virus. As achieved the third position with of the average percentage con- could well be expected, a percentage figure of 21.4% in tributions for social interven- drug-addiction and prostitution terms of the order of general tions is sustained by the pub- obtained the highest percent- preferences, as can be observed lic/state sector, followed by the 15 ages Ð 89.3% and 85.7% re- in the graph. non-Catholic NGOs with 17%. spectively Ð followed at a short These data are confirmed by However, if one takes an overall distance by juvenile delinquen- the subsequent question which view of the average contribu- cy with 83.9% and by alco- asked which groups display the tions made by Church bodies holism with 82.1%. Although highest number of people with (12%) and by Catholic NGOs they did not achieve similarly HIV-AIDS. Indeed, the modal (13%), a total of 25% is high scores, marginalisation levels corresponding to the first reached, something which and the exploitation of minors and second positions corre- makes the Church the first part- were social evils which are spond to the categories of ner of the state in the social field seen to be deeply rooted in a drug-addiction and prostitu- (see Graph 4). large number of countries. When those interviewed were % then asked, as with the previous Public/state social service 44,5 questions, to place these social Private social services 13,2 evils in a decreasing order of Social services of Church organisations 12,3 importance a very interesting Catholic NGOs social service 12,7 fact emerged upon which the Non-Catholic social service 17,3 replies of the Churches which Graph 4: Average Percentage Contributions had been interviewed notably as Part of Overall Social Services converged. The highest percentage frequency placed in the number one position was alco- Public/state social service

holism which had 23.2% of Private social services preferences. This brings out Social services how much this factor influences of Church organisations sexual behaviour, especially Social Services amongst young people, and this of Catholic NGOs Social Services is something which exposes of non-Catholic NGOs them more easily to the risk of becoming infected by the virus (see Graph 3).

Kinds of Social Evils Graph 3: Kinds of Social Evils which Involve Exposure which Involve Exposure to Forms of Behaviour at Risk in Relation to Infection by HIV-AIDS to Forms of Behaviour at Risk in Relation to Infection by HIV-AIDS Prostitution Drug-addiction % Alcoholism Prostitution 85,7 Juvenile delinquency Marginalisation % Presence Drug-addiction 89,3 of social evil Exploitation of children Alcoholism 82,1 Juvenile Delinquency 83,9 Marginalisation 67,9 Exploitation of minors 64,6 Kinds of social evil If we then use the same cri- Africa, and a marked improve- fabric which is well known to teria to consider health care ment is also to be found in everybody they offer an empir- provision it is to be observed Sub-Saharan Africa. ical demonstration that the lo- that in this specific area the The picture is very different cal Churches have a perception role of the state is much in relation to the medical-health of the widespread questions greater with 60% of the aver- care situation whose distribu- and difficulties of the social age contributions, and once tion is very much concentrated context which is very near to again we find that the Church on the modality which express- actual facts. It means that the is the first source of back-up es the perception of an im- Church is integrated into the with 19% Ð a figure which rep- provement (66.1%),which in connective fabric of society de- resents a third of the state con- turn is much more marked in spite and in the face of all the tributions and double the con- the countries of Eastern and objective difficulties which in tribution of the non-Catholic Western Europe, in the coun- some cases it comes up against NGOs (10%) and private indi- tries of Eastern African and the (as reported for example by the viduals or bodies (11%) (see Pacific, whilst it is deteriorating Churches of Lesotho and Cu- Graph 5). in the countries of Sub-Saharan ba). The work of the Church is not, therefore, based upon theo- % retical assumptions but takes Public/state health service 59,9 place within the living fabric of Private health services 11,3 society, and in perceiving its Health services of Church organisations 10,4 difficulties the Church acts in Health Services of Catholic NGOs 8,7 consequence. Health Services of non-Catholic NGOs 9,7 16 Graph 5: Average Percentage Contributions as Part of Overall Health Services The Ethical-Moral Dimension Public/state health services Certain descriptive statistics: Private health services Health services In this part of the question- of Church organisations Health services naire the phenomenon of social of Catholic NGOs discrimination is examined, to Health services of non-Catholic NGOs. which people afflicted by HIV- AIDS are often subjected, in particular in the family, school and health care environments. From the graph it can be ob- With regard to the social sit- Africa and those of Central and served that the spheres in which uation taken as a whole, the Northern America. such forms of discrimination perception of the phenomenon The inequalities in health are most take place are primarily by those who answered the due in large part to the inade- the family and the work envi- questionnaire is distributed quacy of social policies as well ronment, both at 91.1%. These rather equally between the as of health care policies and are followed by the school envi- three available options: 37.5% are thus to be found in poor ronment with a percentage of answered that it is continually countries in addition to those 71.4%, a figure which brings increasing, 28.6% that it is which are rich and developed. out the difficulties involved. worsening, and a substantial It is important to emphasise The Churches were asked to es- 32.1% noticed no change. The that these results express the tablish an order of decreasing improvement in the social situ- perceptions of bishops or their importance in relation to these ation is more evident in the collaborators concerning these spheres where forms of discrim- countries of Eastern Europe, in questions and because they de- ination towards people with the Middle East and North scribe a picture of the social HIV-AIDS are manifested. The modal category of the first position was the work environment with 41.1%, with the school environment occupying the second position (25%), followed by the family environment in the third position (32.1%). It is important to emphasise that we are dealing here with social contexts within which the most important processes of sociali- sation take place, namely the family, schools and peer groups, and work. The worry which is most frequently encountered is that of becoming infected (85.7%), something which is linked, above all in the countries of the is the case, as we have seen, In all the great geographical Asian area and Sub-Saharan with poverty. However, it is a areas and in particular in Asia Africa, to a low level of infor- good idea to ask ourselves at (16%), in South America mation about the ways in which what level of familial relations (21.4%) and in Sub-Saharan this disease is transmitted and this phenomenon most mani- Africa (17.9%) in order to deal to phenomena which are of a fests itself. with and tackle the problem of more specifically cultural char- Within the nuclear family the HIV-AIDS initiatives dealing acter. A fact which should lead ties between parents and chil- with information and training us to reflect is that in 24.1% of dren and between marriage have been activated which are cases this fear is present in the partners seem to hold up in the largely directed towards pre- countries of Western Europe face of the manifestation of this ventive health care (67.9%), to- correlated in an almost mathe- disease whilst in 64.3% of cas- gether with educational con- matical correspondence with an es it is the so-called wider fam- cern with the emotional ties of equally high level of prejudice ily, that is to say the realm of the couple (21.4%) and the (21.4%) towards those people second or third degree ties of overcoming of the barriers of who are afflicted with this dis- kinship, which expresses forms discrimination. ease (see Graph 6). of discrimination and marginal- The entities which have promoted these initiatives are gov- % ernment agencies (60.7% of Discrimination in the family environment 91,1 cases), followed by very active Discrimination in the school environment 71,4 voluntary associations (44.6%). Discrimination in the work environment 91,1 Discrimination in the health care services 62,5 b. Schools Discrimination in the hospital environment 64,3 17 Discrimination in institutions of forced detention 67,9 With regard to the phenome- Graph 6: Contexts in which Forms of Discrimination are Encountered non of discrimination in the school environment, the other

Discrimination in institutions important context of socialisa- of forced detention tion, there is to be observed Discrimination Ð differently from the family in the hospital environment environment Ð a greater oscilla- Discrimination Contexts in the health services tion between the different geo- Discrimination graphical areas, not least bein the work environment cause of the varying impact of Discrimination in the school environment the social policies which have been adopted. It is to be seen Frequency % Discrimination in the family environment that in the Asian area Ð with regard to the school environment a. The family isation towards a sieropositive Ð this phenomenon is on aver- member of the family. age less widespread than in Family discrimination does The reasons behind these other countries. Indeed, it is to not seem in the least to be forms of discrimination are to be observed that in India, for something characteristic of one be found first and foremost in example, the Church is intense- culture or another. It is a phe- the allocation of blame (71.4%) ly committed in the sphere of nomenon which is present in and in the fear of contagion schooling and is engaged in the all countries and all cultures, as (69.6%) (see Graph 7). promotion of correct informa-

% Discrimination of parents towards children 33,9 Discrimination towards family members 64,3 Discrimination towards the marriage partner 35,7 Graph 7: Discrimination Towards Individuals within the Family Environment

Discrimination of parents towards children

Discrimination towards family members Frequency %

Discrimination towards the marriage partner

Subjects tion not only in relation to stu- b.1. Initiatives of the Ð the organisation of meet- dents but also as regards the Catholic schools ings between parents, students, teaching staff in matters con- Catholic schools, especially Catholic movements and exter- nected to the disease and its in such countries as Mexico, In- nal experts for the purposes of forms of transmission. dia, Colombia, and the Lebanon, education and information; In the sphere of schooling are very committed on this front Ð listening to the testimony the individuals who most often despite the objective difficulties of people who live with AIDS- display a discriminatory atti- which exist which are largely HIV; tude towards people with HIV- due to the lack of financial, and Ð educational conversations AIDS (69.9% of cases) but are even more human, resources. with debates, theatre, videos, also to be found in the first po- The activity of Catholic schools forums, and the testimony of sition in the decreasing order of in these countries is principally those afflicted with the disease capacity for discrimination are directed towards the provision and voluntary workers; the parents of children (% of of information and the raising of Ð the publication of con- the modal category: 39.3%). the awareness of students so as sciousness-raising material: This is particularly marked in to achieve a more careful and pamphlets, leaflets, posters, the countries of the Western detailed knowledge of this dis- multimedial packages for area (see Graph 8). ease and the ways in which it is schools, brochures on prevention etc.; Individuals % Ð education in self-promo- Teaching staff 58,9 tion, in the search for and posi- School companions 62,5 tive view of individual capaci- Parents of pupils 69,6 ties and skills; Ð the organisation of teach- Graph 8: Individuals by Whom Discrimination is Expressed ing staff for education in the in the School Environment prevention of HIV-AIDS and the training of young people Teaching staff belonging to anti-AIDS clubs and peer support groups; Ð education in emotional ties School within the couple, in responsi- companions ble procreation, the promotion Frequency % of changed sexual behaviour, Parents of pupils and education in life and love (the EVA Programme of the Subjects Cameroons); Ð health care education, meetings with workers in the The teaching staff consti- transmitted. This is accompa- health care field, with represen- tute the category which is nied by an intense educational tatives of the medical and sci- most open to understanding and formative initiative with re- entific world, and with repre- and to the welcoming of gard to respect for life, loyalty sentatives of the political seropositive pupils. However, to marital love, the emotional world. the activity of information and ties of the couple, responsible training in the state schools in parenthood, and all this to c. Health care structures relation to AIDS is only occa- achieve a lifestyle marked by sional in 51.8% of cases, a Christian moral values. In the health care structures percentage which decreases in Health care education consti- and in particular in the hospital the countries of the Western tutes a large part of preventive field forms of discrimination area and in Latin America. action in the Catholic schools towards people afflicted by These initiatives are principal- and this is entrusted to well and HIV-AIDS can be encountered. ly directed towards the diffu- suitably trained teachers capa- However, these are less fre- sion of health care education ble of transmitting these impor- quent than in the sphere which of a preventive character tant ideas to young pupils. (42.9%) and the training of Naturally enough, there are teaching staff with regard to certainly countries where the forms of prevention (33.9%). Catholic Church suffers unjust This fact could explain the forms of exclusion from social particularly welcoming atti- life. In Cuba, for example, tude of the teaching staff of Catholic schools do not exist; schools, to whose training es- and in Lesotho the AIDS units pecial attention is given. The of the Catholic Church are not elements which are the pro- accepted in 75% of schools. moters of these initiatives in Teachers and the parents of the the state schools are many in pupils need suitable education number: from government and training in this area but agencies to voluntary associa- there is a lack of funds. tions, the teachers themselves The initiatives which were and the Church organisations most commonly recorded are Ð where this is allowed. the following: has just been referred to, being ish in the presence of contin- drawn attention to in 64.3% of gent factors. A space is left for those interviewed. the assessment of the person In particular it can be ob- who has to deal with each case served that in Western coun- as it arises. tries where professionalism in To tackle such situations, work is accompanied by an in- which raise problems of no mi- creasing culture of the safety of nor ethical and moral impor- work the phenomenon is felt tance, initiatives to protect the much more keenly than in the marital partner or partner have so-called developing countries been engaged in. The most where even minimum safety widespread of these Ð in 76.8% conditions at work do not exist. of cases Ð is counselling Thus it is that in areas such as flanked by psychological sup- the Asian area where hitherto port which is provided to the low average levels in the pres- marriage partner or partner ence of this phenomenon have who is unaware of the seropos- been recorded there is a marked itivity of the other member of and significant increase . the couple. In public structures, Church is still not very present. The recurrence of rejection in 51.8% of cases, priority em- However, where the Church by health care workers in the phasis is placed upon the use of does work attention is primari- hospital structures and in condoms as a preventive mea- ly paid to the well-being of the social-health care services of sure. child (46.4%) followed by the people with HIV-AIDS is only To the sensitive question of mother (42.9%), naturally 19 observed ‘at times’ (on average knowing about the experimen- enough with the aim of accom- 41.1% of cases) and this datum tal and non-controlled use of panying the pregnancy until its is supported by the fact that in new drugs and medicines, natural end. 50% of cases there takes place 76.8% of the local Churches within health care structures which were interviewed replied regular activities of training negatively and 23.2% replied Pastoral Action and/or information provision in positively. This 23.2% princi- relation to the health care per- pally concerned the use of chil- Some descriptive statistics sonnel in order to achieve a dren (14.7%) and the terminal- policy of prevention. In 80.4% ly ill (8.8%) in such experi- The health care ministry of of cases seropositive health ments. These were followed by the local Churches which were care workers are known about women, prisoners, and the interviewed began to concern and in the majority of cases the mentally ill. itself with the question and dif- health care structures, although Both public services and ser- ficulties of HIV-AIDS in they consider this fact a prob- vices rooted in the Catholic 42.9% of cases many years lem, face up to it together with Faith were involved in support- ago, albeit not always in a sys- the health care worker and keep ing and sustaining pregnant tematic and planned way. The him or her in his or her job seropositive women: graph illustrates the distribu- (64.3%). However, these indi- tion by great geographical ar- viduals become the objects of a eas of when the Church began subterranean ostracism by the Public Services to be concerned with the pas- working group or team around Ð information and psycho- toral care of accompanying them despite the attempts made logical support for such women those suffering from HIV- to curb this practice by the ad- are reasonably present and are AIDS. Naturally enough, the ministrative structure. chiefly directed towards the Churches which first began The duty to respect secrecy well-being of the mother such pastoral care were those in is always observed in 37.5% of (55.4%) and the child (35.7%). the countries which first expe- cases and often in 30.4%. For However, the public service rienced the outbreak of this this reason there are good seems orientated towards ac- virus Ð the United States of grounds for believing that re- companying the mother until America and Western Europe. spect for this important right of the end of her pregnancy Moving to more recent years the individual is rather wide- (26.8%) rather than encourag- we can find Africa first, where spread. With regard to the ef- ing its interruption (19.6%). the spread of the virus has fective upholding of that right This fact is confirmed by the reached such high levels that it comes as no surprise that in information provided by many the Churches have been led to the United States of America local Churches which in recent take immediate responsibility where an individualistic culture years have observed an inver- for the problem and activate a prevails this duty is rigidly ob- sion of the trend Ð even though series of initiatives Ð above all served, irrespective of any con- small Ð on the part of many na- of an educational and cultural comitant event. In other coun- tional governments which dis- character Ð in order to spread tries, on the other hand, which play a greater sensitivity to- the idea that AIDS is a disease have a predominant religious wards, and respect for, life. and not a punishment. We then dimension Ð such as for exam- find a number of countries of ple in Latin America and East- Services rooted the Middle East and North ern Europe Ð the rigid applica- in the Catholic faith Africa where full awareness of tion of this principle can dimin- Ð in this field the Catholic the problem encounters difficulties in taking off but where they are increasingly great in people and adults in responsi- the Church also comes up number Ð from current esti- ble love and respect for the hu- against many problems of mates their numbers are on an man body; co-existence with Islamic gov- upward curve. This is a ques- Ð official documents, ernments (see Graph 9). tion which we will hear talked brochures about sexuality and the family, information book- Great geographical lets for schools; Graf. 9 - Pastoral Care in the field of AIDS areas Ð information for male and 100 Oceania female religious; 90 Eastern Europe Ð national and international 80 Western Europe symposiums with the participa- 70 Latin America tion of representatives of insti- 60 and the Caribbean tutions of the state, of non-gov- Central and 50 Northern America ernmental organisations, and of

Frequency % 40 East Asia and the Pacific the population as a whole; 30 South Asia Ð education in family life, in 20 Middle East marital faithfulness, and in re- 10 and North sponsible motherhood and fa- Africa Central and 0 Sub-Saharan Africa therhood; fo many for a few recently not yet no years years practised answer Ð seminars for health care workers; Ð the development of aware- About 80% of the Churches about for a very long time to ness. 20 which were interviewed did not come and which requires the refer to an official body in their drawing up of suitable pro- C. Health care and assistance local Church responsible for grammes of action. pastoral work in the field of Ð the involvement of chap- AIDS. 50% of options were A. Training lains and voluntary workers, placed under the heading of and of Catholic medical per- ‘health commission’ to which Ð the training of health care sonnel; specific pastoral care for the workers (medical doctors, Ð counselling services pre field of AIDS was referred. paramedics etc.) and voluntary and post test and basic home 66.1% of the Churches workers; support; which were interviewed de- Ð information/training and Ð the identification and diag- clared that they had established male and female religious and nosis of seropositivity; a programme for action to deal pastoral agents (religious and Ð participation in projects with the AIDS emergency. In lay); with other co-operation agen- some cases (for example in the Ð the training of educators cies; Ivory Coast) the local Church for natural family planning, an- Ð support for national pro- acts as the national co-ordina- imators; jects in the fight against tor for all the services and ini- Ð the training of young peo- AIDS-MST-TUB; tiatives in the field of HIV- ple leading to the creation of Ð support for charitable asso- AIDS, acting as a point of con- groups of educators amongst ciations (Caritas); tact between the dioceses, the peers. Ð promotion and support for parishes, the health care struc- mutual aid groups; tures, and the movements and B. Prevention Ð the establishment of rest the associations of the territory. homes for those suffering from This commitment seems to be Ð education in prevention AIDS; concentrated, naturally enough, and the raising of the aware- Ð rehabilitation centres; in the areas where the epidemic ness of the members of society; Ð projects of assistance for is tending to spread with great- Ð preventive health care edu- AIDS victims and their family est speed (Sub-Saharan Africa cation; relatives from a health care, hu- 17.9%, Asia 16%). The essen- Ð the education of young man, psychological and spiritu- tial points of the action of the al point of view (the Good local Churches can be sum- Samaritan Project in Mexico). marised in the following way: A. Training D.Caring and pastoral B. Prevention accompanying C. Health care and assistance D. Taking care of and the Ð psycho-social and health pastoral accompanying of care assistance for people suf- those afflicted by HIV-AIDS, fering from AIDS; even though the taking care Ð caring for orphans, widows of, and spiritual accompanying and widowers; of, these sick people and their Ð the accompanying of peo- families is of especial impor- ple with AIDS in institutions of tance. Taking care of people forced detention; goes beyond those with the dis- Ð support for activities direct- ease to those who have been ed towards the social reintegra- orphaned because of it, and tion of HIV positive people; Ð homes for children and trative and explanatory ses- their HIV positive mothers (Ar- sions about MST and HIV- gentina); AIDS, by conferences, and by Ð homes for HIV positive direct experience in the provi- men and women who are in a sion of social pastoral care. condition of destitution; There is then an attempt to Ð community homes. develop a capacity to engage in In order to carry out such counselling, to encourage con- programmed initiatives eco- tact with patients, and to stimu- nomic contributions have been late contacts and links between requested in 48.2% of cases seminarists and health care from bodies such as: workers in this sector. Ð MISEREOR Ð CRS (Catholic Relief Ser- vice) Socio-Health Care Ð MEMISA Services and Initiatives Ð CARITAS INTERNA- TIONALIS (CAFOD) It should be made clear that it Ð FOREIGN CHURCHES and supported by the local is not possible to offer reliable Ð WHO Churches which are producing and significant data on the num- Ð THE WORLD BANK reassuring results Ð the Provi- ber of Catholic hospitals which Ð UNICEF dence Outpatient Clinic of Rio have sections specially dedicat- Ð UNESCO de Janiero, the EVA Pro- ed to AIDS and the number of Ð UNDP (United Nations gramme in the Cameroons, the non-hospital Catholic centres 21 Development Programme) pastoral programme of the which care for and treat AIDS Ð FOREIGN DONOR Good Samaritan in Mexico, victims. This is because of the AGENCIES and the Open Hearth House in small number of countries Ð NATIONAL BODIES Ireland. All these initiatives where it is possible to carry out Ð GOVERNMENTS AND cover the whole of the so- such an inquiry. HEALTH MINISTRIES cial-health care context and It is, however, possible to ob- These requests has been adopt multidimensional strate- serve that there is a rather ho- made with prevalently positive gies towards the problems of mogenous distribution of the results (42.9%). people who live with HIV- different kinds of non-hospital At a diocesan level planned AIDS. Catholic centres, with the med- and systematic pastoral action The objective which the dio- ical health care centres, so- is underway according to ceses currently hold to be of cial-aid, socio-educational and 57.1% of the respondents to the primary importance in relation social support centres hovering questionnaire. However, this to the question of AIDS is edu- around 35%. However, it is the figure is only slightly higher cation in love and in chastity social-aid centres which are than the number of Churches amongst young people most frequently encountered who declared that such action (67.9%), help for sick people (42.9%), something which con- had not yet been set in motion. and their families (66.1%), and firms the prevalent concern of The essential points of such sexual education (58.9%). the Church in relation to the planned action are as follows: question and reality of AIDS. A. Prevention Such aid is, however, accompa- B. Training The Training of Candidates nied by an intense educational C. Assistance for the Priesthood and training action directed to- Pastoral action at a diocesan and Pastoral Care of wards the person in an overall level follows the model defined Sick People with HIV-AIDS sense. Education and aid are by the local Churches, even the two pillars of the response though with greater attention The teaching of this particu- of the Church to AIDS at the being paid to the practical lar pastoral approach is slowly level of action and practical ini- needs of the local territory and being inserted into courses for tiative. population. special morality or courses for Both the Catholic hospital Different initiatives exist education in life, or into the centres and the Catholic with regard to health care and units for pastoral counselling non-hospital centres are con- psycho-social care for people during pastoral theology stud- centrated in the urban areas, with HIV-AIDS and orphans, ies, or into courses for pastoral even though they are also pre- a category which is becoming medicine, courses for pastoral sent in many rural areas or hin- increasingly numerous. How- education, courses for the train- terlands Ð areas which are of- ever, notwithstanding the fact ing of chaplains, or into the ten very dangerous and where that the progressive increase in training of young candidates the Church is the only refer- the number of orphans is an for the priesthood. ence point or possible support urgent problem there are as yet Such forms of teaching and for a population abandoned to very few initiatives in this di- training utilise audio-video cas- itself. rection. Attention is prevalent- settes which, after being seen, With regard to the assess- ly paid to caring for people are followed by individual ment of the ability to meet the with AIDS/HIV and to pre- commentaries, by testimonies needs of the patients, either the vention. There are important from people who have experi- respondents were not able to forms of activity promoted ence of this approach, by illus- reply (32.1%) or they defined it as being reasonable, and indeed countries of Latin America and of America but something the access of patients and the the Caribbean is still not yet which is even more impossible terminally ill to such hospital sufficiently planned and organ- and unobtainable for develop- centres or non-hospital centres ised (see Graph 11). ing countries. is rather easy (39.3%-37.5%). However, the access of the ter- Graf. 11 - Access to Pastoral Care for the Sick minally ill to structures for ad- 100 mission and specific forms of Great geographical care is clearly much more diffi- 90 areas cult. Central and With regard to services of a 80 Sub-Saharan Africa Middle East medical-health care character, 70 and North Africa an attempt was made to register South Asia the level of accessibility to 60 East Asia and some of the tests which are 50 most present in the systems of the Pacific Frequency % Central and health service available in the 40 Northern America countries of the people who Latin America were asked to fill in this ques- 30 and the Caribbean tionnaire. It should be pointed 20 Western Europe out that many ‘no answers’ were recorded under these 10 Eastern Europe headings, probably because of 0 Oceania 22 the special nature of the question being discussed. However, easy difficult no answer an examination of the distribution by great geographical ar- When it comes to immuno- This picture demonstrates eas of the opinions expressed logical tests there is a certain that the level of services in on levels of accessibility to the difficulty at the level of access, 55.4% of cases is still inade- anti-HIV test reveals that by above all else in developing quate, in particular in Sub-Saha- now access to this kind of test countries in Asia and Africa. ran Africa and Asia, and this de- for the identification of With regard to protease in- spite the employment of profes- seropositivity is rather wide- hibitors, side by side with a gen- sional figures such as medical spread and available even in eral access in the richer coun- doctors, nurses, social workers, the poorer countries, such as tries, such as the United States spiritual assistants, voluntary those in Asia. However, in of America, there is an inability workers, and the members of Africa, where it could prove to to obtain access to such forms religious orders. Professional be an effective means for the of treatment in the poorest figures such as psychologists, monitoring of this phenome- countries which do not have the laboratory technicians and legal non, access is still rather diffi- economic resources to meet the advisers are less numerous and cult (see Graph 10). costs of buying this pharmaco- less present on the ground. In 64.3% of cases it is to be Graf. 10 - Access to the anti HIV test observed that the up-dating of health care workers takes place 100 at least every twelve months. This is something which ensures an average level of profes- Great geographical sional skill and competence 80 areas Central and which in 50% of cases is de- Sub-Saharan Africa fined as being ‘good’. Middle East 60 and North Africa

South Asia Projects and

Frequency % Experimental Initiatives 40 East Asia and the Pacific Central and Northern America In order to improve the re- Latin America and the Caribbean sponse to the needs of people 20 Western Europe suffering from HIV-AIDS, there are presently underway in the Eastern Europe sectors of intervention identi- 0 Oceania fied by this research in 76% of easy difficult impossible no answer countries projects and experiments of a largely national character (64.3%), which are in- As regards pastoral care, the logical package. creasingly supported by interna- opinions expressed seem to Lastly, with regard to phar- tional forces and agencies converge in full agreement macological prevention at the (32.1%). concerning the high level of ac- level of the maternal foetus it is The following are the most cessibility to this kind of sup- to be observed that this is wide- important: port which, however, in the ly adopted in the United States Ð the creation of institutes of social hygiene and contagious in the struggle against AIDS; ceived our questionnaire. It is diseases, medical-social centres, support for family life; and the connected with serious forms of and programmes to strengthen production of information mate- marginalisation of people in re- diagnostic capacities; rials for priests. lation not only to social life but Ð in Germany, Belgium, the Ð in Brazil: projects for the the health care system as well. United States of America: phar- fight against poverty and desti- Poverty is also connected macological studies, studies on tution; projects in favour of with unemployment because mutations in the virus with a children, adolescents and young there is a lack of work and view to creating a vaccine; people at risk; projects for ho- where work is available the Ð ecumenical programmes to mosexuals; projects dedicated wages are very low. As a result promote the fight against AIDS; to the improvement of the quali- there is a veritable exodus of units for reflection about AIDS; ty of life of people suffering young people from the rural to the training of voluntary work- from HIV-AIDS; and the Provi- the urban areas and the aban- ers to provide home-based care dence Clinic of Rio de Janiero. donment of elderly people in for those people suffering from At the present time there is in- the villages. We should also AIDS/HIV; creasing co-operation between take into account the low levels Ð in Argentina: the opening of public/state bodies and Catholic of education which are to be en- homes for seropositive mothers non-governmental organisations countered, especially in certain and their babies; (71.4%), even though this is not countries. Ð in Peru: the ‘Casa Hogar’ always of a sufficient level (only These problems, which are project for the children of in 30.4% of cases). Some of the rooted in the social fabric, result sieropositive parents; most important forms of such in the exposure of large seg- Ð in Burundi: the ‘New Expe- co-operation are directed to- ments of the population to riences’ project of Brijumbura, wards the financing by govern- forms of behaviour at risk in re- 23 the establishment of the Nya- ment/state bodies of training lation to the transmission of the mugari Centre in Citega, the projects for voluntary workers HIV virus: ‘Families for the Defeat of providing a grounding in coun- Ð prostitution: women, often AIDS’ national project, the cre- selling, the acquisition of drugs very young women, engage in ation of the Association of and medicines for opportunistic prostitution, enter the world of Seropositive People and AIDS infections, food aid, the moni- sexual tourism and have homes Victims, and the national pro- toring of the HIV infection in where such encounters are or- gramme of aid for orphans. pregnant women, the establish- ganised; Ð in Uganda: CRS-CAFOD- ment of ethical and scientific Ð drug-addiction: the use of CARITAS for a project of med- committees, and seminars for drugs of various kinds, the ex- ical-health care assistance and the study of AIDS and the change of syringes. support for orphans; UNAIDS launching of ecumenical action for the prevention of transmis- against this disease. b. Ethical-moral aspects sion through the maternal Co-operation between gov- womb; and funds supplied by ernment/state bodies and Today the way in which HIV the World Bank; non-Catholic non-governmen- is most transmitted is through Ð in Guinea: the project for tal organisations is even more heterosexual contact. This fact the creation of three med- intense (78.6%), but in this raises serious ethical and moral ical-health care and social sup- case as well it is not always sat- problems, amongst which: port centres in the dioceses of isfactory (33.9%). The most Ð the protection of the non-in- the country: the project for the important experiences in this fected spouse/partner; creation of a unit for the thought area regard the creation of mi- Ð social discrimination to- and action of the Catholic cro-projects, the organisation wards seropositive people (in- Church in its fight against of information seminars and cluding children) or those suf- AIDS; debates, food aid and other fering from AIDS at work, in Ð the Ivory Coast: the nation- forms of aid, aid at the level of the services, and in the family al AIDS plan of the Catholic drugs and medicines against environment; Church for the years 1995-1997 opportunistic infections, the Ð the recovery of moral and and the three year AIDS plan of free distribution of condoms, spiritual values; the Catholic Church for the programmes for the adminis- years 1998-2001; tration of methadone and Ð in India: conferences and against the exchange of sy- workshops on the subjects; ringes, programmes against so- co-operation with Catholic in- cial marginalisation and exclu- stitutes, non-governmental or- sion; and the diffusion of mate- ganisations, and dioceses; the rial for the defence of sexuality. publication of three books on the subject; text books for schools on AIDS, and a book on The Emerging Questions pastoral assistance; and Difficulties Ð in Poland: projects of co-operation with the Ministry a. The social fabric of Health and large NGOs, the establishment of a free tele- Poverty is without doubt the phone line on AIDS run by the problem which most afflicts the voluntary associations engaged countries whose Churches re- Ð greater respect for cultural countries offer a suitable re- traditions; sponse to AIDS. Ð greater solidarity towards The areas which can be im- various groups which have dif- proved are: ferent lifestyles; Ð the strengthening of the Ð the promotion of human right to health and to suitable life; care and treatment for every- Ð education in love and sexu- body; ality. Ð the protection of the rights of people who suffer from c. Initiatives in the field HIV-AIDS; of the health care ministry Ð the reduction of the costs of care and treatment and mak- The answers to the question- ing access easier; naire brought out a recurrent Ð the obligation to engage in request for greater support for counselling both before and af- the action of parishes and ter the test; priests from the local Churches of funds and financial resources Ð blood tests; and an urgent request for in order to create projects which Ð the drawing up and imple- guidelines for pastoral care in involve making access to mentation of norms against so- this field directed towards es- anti-retroviral and anti-oppor- cial discrimination; tablishing certain directives tunistic drugs and medicines Ð the study of effective sys- about the prevention and con- easier; initiatives directed to- tems of prevention; 24 trol of HIV-AIDS in line with wards the promotion of Ð making sure that seroposi- the ethical and moral parame- socio-economic development; tive people and those suffering ters of the Church of Rome. the creation of a ‘credible’ net- from AIDS can keep their jobs; There is also an evident need work of partnerships between Ð support for groups at risk. for a specific training of the non-governmental bodies and Contemporary legislation male and female members of associations involved in the meets the questions and diffi- religious orders in this area of fight against MST and HIV- culties generated by this dis- action, for greater co-ordina- AIDS which could support ac- ease only in part (58.8%) and tion of the various experiences tivities already underway and often the major problem is the in relation to this subject, and reproduce those which have had actual implementation of such for a more rigorous planned most success elsewhere; support legislation. The public sector and organised approach to pas- for the action of individual na- very often does not permit the toral action. tional governments; and support provision to Catholic centres of for the initiatives of Catholic public funds and this is yet an- d. Social-health care and non-Catholic NGOs. other problem brought out by services and intervention The local Churches should this inquiry. be able to influence national I believe that through this The answers to this question- health care policies, first and broadly-based inquiry the Pon- naire bring out the need for foremost by establishing closer tifical Council for Health Pas- greater financial, (professional- ties and forms of co-operation toral Care has become the ly trained) human, and material with public authorities, thereby spokesman of the courage and resources in order to respond in becoming an indispensable commitment with which the an effective way to the needs of partner of the state. There is a Church continues to face up to AIDS patients. need for a more significant the question and difficulties of There also emerges a need presence of male and female AIDS at a moment when little is for: religious within health care said about it Ð a demonstration Ð psycho-social and med- structures; a joint struggle of how the Church never forgets ical-health care assistance against poverty and illiteracy; about the least of our brethren which is more capillary in na- and the creation of a clear ori- and the most alone. This work ture; entation with regard to the seeks to be only a modest point Ð the use of modern medical health care ministry and AIDS. of departure, a launching pad for equipment; We need to find substantial suggestions and observations Ð easier access to anti-retro- economic and financial means from which this prestigious as- viral drugs and medicines and with which to promote the ac- sembly can draw information in specific forms of health care; tivity of Church organisations order to set in motion a work Ð the prevention of oppor- involved in advancing policies which helps to establish the tunistic pathologies; in favour of the protection of bases for those guidelines which Ð a greater number of hospi- life and which challenge con- most of the local Churches are tal and social centres belonging temporary preventive policies calling for in order to achieve to the Catholic tradition. based Ð often solely Ð on the greater uniformity and incisive- widespread use of the condom. ness at the level of action and in We need to learn how to use terms of the message which is Proposals and Suggestions the press and the mass media in conveyed. a mature and suitable way. Dr. FIORENZA DERIU The international community 58% of the Churches which BAGNATO should intervene in the field of were interviewed asserted that Social Researcher, AIDS by fostering the allocation the national legislation of their Italy Section I PREVENTION

Life as a Founding Value

One of the greatest Italian po- the works of thy hands; thou Following the exhortation of ets, Giacomo Leopardi, asks the hast put all things under his section 34 of Evangelium Vitae, moon about the meaning of hu- feet”(Psalm 8). I will seek to demonstrate with- man life in a tender poem that Who is right and who is in a merely human horizon he wrote: “Tell me, moon: what wrong? “Why is life a good?” – that is to say of “instinctive is the value to the shepherd of (Ev. Vit., 34). John Paul II an- perception” and “experience” – his life, of your life to him? Tell swers that the good of life is an that life is a value. Then I will me, where do my brief wander- “instinctive perception and a try to go beyond this and to fol- ing and your immortal course fact of experience, and man is low the title of this conversation 25 lead?” In a dramatic crescendo called to grasp the profound by demonstrating that this value Leopardi observes that after so meaning why this is so” (Ev. is at the base of every other val- much suffered running man has Vit., 34). This definitive reason ue and of the essential struc- before him a “horrid, immense could be expressed by employ- tures of society itself. Finally, I abyss Ð where everything falls ing the words of St Ireneus: will ask myself if the horizon into complete oblivion”. And “Living man is the glory of which I have termed “merely that “man is born with difficul- God”. The roots of the value of human” is sufficient or whether, ty, his birth runs the risk of human life are in the Trinitarian instead, human experience and death; trial, pain and torment to heart of God. We can say this intuition do not touch upon the begin with; and in his very be- with the simple words of Moth- threshold of religiosity and the ginning, his mother and parent er Teresa of Calcutta uttered Faith and do not constitute a consoles herself at being creat- when she was contemplating very human and very rational ed”. The conclusion is without the beginning of human life: appeal. hope: “perhaps in that form, “that still unborn child was cre- For many years I have trans- whatever state it may be, in his ated for a great thing: to love formed myself into a biologist lair O moon, it is fatal to be and be loved”. I know this deep in order to proclaim the value of born on that day of birth”. In an- reason but because for almost a life: the life of the embryo, of other verse the poet refers to quarter of a century I have been the foetus, of the newly-born himself when he concludes with called upon to explain it to child, of the person with a hand- the statement: “life for me is those who, like Leopardi, do not icap, and of the elderly person evil”. The contrast with Evan- want to ask God but want to has great value because the gelium Vitae of John Paul II limit themselves to talking to qualification of being noble could not be more radical. In matter (the moon), I will try to which lies in existence depends section 34 the Holy Father relate my experiences as the ex- exclusively upon membership writes: “Life is always a good”. periences of one who is com- of the human species. This is Because I have allowed the pelled for the most part to ex- something which unfailingly re- contrary to be said by a poet, to plain the reasons for life with- quires a scientific demonstra- confirm the positive view of life out reference to the Faith. This tion Ð that is to say that which there come to mind the verses is a hard task, especially when can be supplied by the disci- of another poet. Full of amaze- human life encounters suffer- ment Ð and like Leopardi looking, and it is even harder when Ð ing at the sky Ð this poet wrote as has been observed in this psalms 138 and 8: “I praise thee seminar Ð suffering and death for thou art fearful and wonder- come forth during the flower of ful. Wonderful are thy works” years and often, although not al- (Psalm 138). “When I look at ways, are the consequence of a thy heavens, the work of thy desperate search for joy, for en- fingers, the moon and the stars counter, for meaning, for es- which thou hast established; cape, and for the future, as takes what is man that thou art mind- place in the practice of sexuali- ful of him, and the son of man ty, that is to say of our humani- that thou dost care for him? Yet ty, which in the distinction be- thou has made him little less tween masculinity and feminin- than God and dost crown him ity is the image of the inner self with glory and honour. Thou of God and a condition of the hast given him dominion over very meaning of the creation. plines of biology and genetics. deed every individual man Ð is ture matter where there mysteri- For some time, however, my the most complex and perfect ously burst forth awareness, attention has been directed in part of the entire universe. And thought, moral experience, ex- large measure towards the ques- there is more: the modern theo- pressions of contemplative and tion of meaning. Present-day ries of relativity proposed by creative spirituality, nostalgia experts in bioethics, such as Einstein and the ideas of Dar- and dedication and tragedies in Singer and Engleharth, do not win all demonstrate in scientific love, all things which make hu- deny the human identity of terms that the entire energy of man life the largest part of the weak individuals, such as the the universe is directed towards entire biological and physical foetus or handicapped people or the appearance of man. Indeed, universe which contains it, an the dying, but they judge them it is known that according to effect that can transcend the im- as being of less value than a evolutionism life appeared on mense cause in which it has its badly trained dog or a computer the earth first in elementary origins...the ontological majesty because of their alleged inabili- forms which later became more of man as living body and spirit ty to be useful. complex: from the single-cell renders valueless distinctions of In Practical Ethics (pp. 100 living creatures to the fish, to social rank and roles; it makes and 126) Singer writes that the reptiles, to the birds, to the every individual humanity a cos- “there are many non-human mammals, to homo faber and on mic and indeed more than cos- animals whose rationality, to homo sapiens...and all this mic greatness...”. self-awareness, knowledge, over very long periods of time. And thus it is that we come to ability to see and so forth are A great amount of time was the fourth instinctive percep- superior to those of a week-old needed, therefore, to obtain tion. The “big bang”, which ac- or even a year-old human man. But according to the theo- cording to many contemporary 26 child”. For this reason, “it ry of relativity time and space scholars gave rise to the uni- seems that the life of a new- are intrinsically linked. Vast verse ten or twenty thousand ly-born child has less value space is needed for vast time. million years ago, was not the than that of a pig, of a dog, or a And if a vast amount of time real creative big bang. The be- chimpanzee”. “Whatever the was needed to obtain man, then ginning of the life of every hu- case may be, the principal the whole universe, with its in- man being is the real creative point is clear: the killing of a numerable stars, galaxies, and act, in the full sense of purpose; newly-born child who has mal- its extraordinary distances, is it is the real step from non-be- formations is not morally directed in the nature of its pur- ing to being. Something which equivalent to killing a person. pose to man. previously did not exist sudden- And very often it is not in the Here the second instinctive ly begins to exist and it is some- least wrong”. perception is to be found and lo- thing which is extraordinarily Faced with such ideas the de- cated. Every human being be- different and superior to every- fence of the weakest individuals fore being a son of a man and of thing which exists merely to cannot be limited merely to a woman is a son of the Im- prepare its origins. demonstrating their human bio- mense. Thus his life is marked This series of instinctive per- logical identity but must tackle by something which is incom- ceptions and demonstrations the question of the specific mensurable, extraordinary, and does not yet tell us if the im- meaning of being human. which deserves and requires press of positivity is to be found The complexity of the argu- contemplation and amazement. in human life, as the psalmist ment and the nature of this pa- It must have a wonderful mean- sang in his psalm, or instead per only allow me to outline the ing if in order to bring it about a whether we encounter the im- subject, which, indeed, deserves building site of enormous pro- press of negativity, as expressed far greater analysis. portions was prepared and all in the lament of Leopardi. Does The first instinctive percep- the resources of an unimagin- the “horrid immense abyss” tion is that if there is a meaning able intelligence were devoted which seems to finish that life in the whole universe this is to to it. Human life is really a mar- prevail, or are we faced, rather, be found in the life of man. Ac- vel. Such could have been the with the grandiose immensity of cording to what we know and moon’s answer to the poet a building site which prepares we can experience, man Ð in- Leopardi. for life and then gives rise to the The third instinctive percep- real creative big bang in the tention is that of a gap between man derness of an encounter be- and the rest of the creation, of a tween a man and a woman who mysterious transcendence which should together express a wish places him within an absolute di- for love, an unusual self-giving, versity in relation to the matter and voice an unheard cry to- of which he is composed. It is wards the eternal? However the not only his power over things majesty of human life seems to which is not equalled. What be so great that it cannot be re- gives rise to amazement is his ferred to a collective entity capacity for thought. In truth, the whatever that might be Ð class, entire immensity of space and race, nation or species Ð but ap- time would be non-existent if pears, instead, as the quality of man were not capable of think- every human being as such and ing about it. As Lombardi Val- as something which does not al- lauri has written on this point: low of gradations: it is always “human life is that place of ma- the maximum. This idea is expressed in very secular modern Second World War has recently thought Ð whether philosophi- finished and shortly after the cal, legal or political Ð with the supreme risk of an atomic con- phrase “human dignity”. This flict capable of making the phrase is found in many consti- whole of human history fall into tutions of the second part of this the absurd has arisen. A few century and especially in the years previously the German Universal Declaration of Hu- constitutional court, the highest man Rights of 10 December court of the state which had 1948. In the preamble to this caused the holocaust, had writ- document we can read that “the ten: “faced with the omnipo- basis of freedom, justice and tence of the totalitarian state peace in the world is the recog- which sought dominion in all nition of the dignity of every the areas of social life and for being who belongs to the hu- which respect for the life of the man family and his equal and individual meant nothing, the inalienable rights”. The phrases constitution has built a system “human dignity” and “value of of values which places the indi- dignity is the foundation of free- human existence” are the same vidual man at the centre of all dom, of justice and of peace. In in meaning. For this reason, the its norms. At the basis of this the encyclical Evangelium link established between dignity approach is the idea that man, in Vitae, in a most apt neologism, and equality should be under- the order of the creation, has an the value of life is termed lined. The long historical autonomous and specific value “fontal”, that is to say a source, process which led to the rejec- which requires constant uncon- a generator of every other value. 27 tion, at least at a conceptual lev- ditional respect for the life of The demonstration, further- el, of the past divisions between every individual, including the more, is very detailed. One can- men into slaves and freemen, life of those who may seem so- not but cite the “pressing ap- foreigners and citizens, blacks cially valueless”. peal” addressed to “each and and whites, women and men, In this way the apparently every person”: “respect, protect, reached its point of arrival in valueless person becomes the love and serve life, every human the upholding of equal human parameter of dignity, which in life! Only in this direction will dignity. This dignity is so great turn is the guarantee of hope. you find justice, development, that it does not allow of a dis- Human thought arrives to this true freedom, peace and happi- tinction between lives which are point. And such thought is cer- ness!” “Upon the recognition of more valuable and lives which tainly not without contradic- the right to life”, John Paul II are less valuable, and at the tions. The confrontation be- writes a little earlier in the en- same time if such a discrimina- tween utilitarianism and person- cyclical, “every human commu- tion in relation to dignity was alism is at its sharpest when nity and the political community allowed this would be a denial judgement concerns the most itself are founded” (n.2) The of the principle of equality marginal stages of human life Ð theory of the rights of man which has been achieved in unborn life and life near to its (n.18), solidarity (n.18), democ- such a difficult way. end. In this area utilitarianism, racy itself (nn.19, 70, 90), the But the word “dignity” is en- which values only what is use- rule of law (n.20), and the moral veloped in mystery. It has a reli- ful and is the decadent son of sense which knows how to dis- gious connotation. Some people materialism, seems still to have tinguish between good and evil have spoken about the declara- the better of personalism which (nn.4, 20) become endangered if tion of human rights as a secular instinctively perceives the mys- the value of every human life is prophecy. In this word is to be tery within and outside man, not recognised and respected. found the amazement of man in and which places its bet on such Here it is of course not possi- the perception of his grandeur, a mystery of existence. ble to examine all the aspects of but there is no demonstration of And yet personalism has al- the question. I will make a sim- why this should be. However ready won when it manages to ple reference to the subject the history of amazement adds place the same question which which concerns me particularly an indirect proof: the painful was formulated by the Pope in because of my profession as a experience of mankind demon- Evangelium Vitae: “can there be judge, that is to say the whole strates that each time that the a human individual who is not a area of man and the law. The equal human dignity of every- person?”(n.58), that is to say a question posed by St. Augustine body and of each individual is bearer of a ministry which has always perturbed me a great denied, humanity is invaded by makes him different from every deal: “what distinguishes the anxiety and pain. Because of other part of the creation Ð al- state from a well-organised this historical experience, as a ways a subject and never an ob- criminal organisation?” And I postulate of hope, the charter of ject, always an end and never a have also always been disturbed 1948 affirms the faith of the means, and never to be reduced by another question which from peoples of the earth in the rights to thing? Socrates onwards until the of man. One should observe the A word should be added Nuremberg trials of the Nazi entrance of the word “faith” in a about the fundamental character war criminals marked the histo- civil juridical act and remember of the value of life. ry of human thought: “what dis- the symbolic meaning of the This affirmation can already tinguishes law from the rule of year 1948: it is in the middle of be found in the Universal Decla- the strongest?” A secular answer our formidable century, after the ration of Human Rights: human to what Christian thought had always seen came in the middle man life itself. The sexual ac- being lived. I added that the eu- of our formidable century from tion cannot be banal if by its thanasia argument has an ex- the Universal Declaration of very nature it is the way in panding force and can endanger Human Rights: the distinction which the grandiose mystery of the lives of all suffering people, lies in human dignity, that is to the creation comes to be imple- the least capable, the least use- say in the equal value of the life mented. The family cannot be ful, the social burdens. But of each person. The reason why listed amongst the structures of when faced with suffering life, we live together in an organised repression and alienation but in order to be victorious, needs society is because there is a kind rather should begin its existence God. And furthermore it needs of implicit pact according to by promoting the gospel (= Christ. And again: it needs the which we are ready to pay a good news) of love. crucified Christ. And thus it is high price to ensure that our in- It is clear that this reflection that I have often thought of dividual lives are defended. The has on more than one occasion what St. Paul wrote, even rule of law is required by ethical touched upon the religious di- though I have never given voice reasons even when its dictates mension of things. The culture to these words during parlia- are mistaken because the legal of death and the culture of life mentary debates: “Nihil aliud system as a whole, because it is confront each other exactly on inter vos cupivi scire, nisi a guarantee of order, is an in- the religious terrain in the sense Christum et hunc crifixum”. strument “for life”. But if, and in that the first sees nothing be- The full value of human life the extent to which, law goes yond death (because man, seen finds its compete truth in the against life, it ceases to be law. only as an especially well or- mystery of the measureless There are other aspects ganised part of matter and as Love of God. What makes through which the value of life something which remains mat- every human life “mysteriously 28 displays its fundamental or ter, is reduced to a thing and as high” is the origin of love and “fontal” character, and these are such is destined to finish), while the destination of love. For this aspects to which we should ded- the second (perceiving instinc- reason, the Holy Father in icate special attention given the tively that man is “mysteriously Evangelium Vitae sees in the concerns of this seminar. I am high” in relation to matter and “eclipse of the sense of God” referring here to the degradation that as such cannot have the the loss of “the sense of man” of sexuality and of the family, same destiny as things) hopes, (Ev. Vit., 21). In the end in order something which reduces the bets, hypothesises, and believes to believe in human life you capacity to see and respect hu- in a human mystery beyond the need to believe in Love. “Cre- man life. Yet from the conceptu- tomb. didimus Charitati”. al point of view it is precisely But there is something which It seems to me a source of the contemplation of the wonder reason is not able to understand great hope that the second mil- of human life which can recon- on its own, and which leads it to lennium of the Christian era is struct the meaning of sexuality fall into natural “amazement” closing not only with the and the family. In a materialistic when considering human life: tragedy of the twentieth century vision of things the search for this is suffering, the pain of the but also with the entrusting to meaning of life comes close to innocent. the new millennium by all the the banality of pleasure, of I have often discussed abor- peoples of the earth of words which sexual pleasure is a spe- tion and euthanasia with other which place their hope (for free- cially intense expression, and to people. Even when I have not dom, for justice and for peace) the anxiety of loneliness in an introduced God into the argu- in an unarmed word: human absurd universe where individ- ment I have always perceived dignity. ual self-assertion is the only the objectively victorious supe- I am convinced that for this thing that matters, that is to say riority of my arguments in de- word the dominant word of the power of the individual. The fence of the unborn child. But I modernity Ð to think and to act life of another person is thus confess that I have never had “etsi Deus non esset”, as if God seen as a limit which is not be the same sensation when I have did not exist Ð will sooner or crossed solely when to do so debated the issue of euthanasia. later be abandoned. “If God would provoke pain or a In the European Parliament I does not exist, everything is diminution of pleasure. When was able to impede the approval possible”. Even the idea that hu- this is possible Ð as indeed takes of documents in favour of the man life has no meaning. But place when the life of the other killing of human beings in pain then it would simply become person is especially weak Ð the who were near to death by em- impossible to live. For this rea- other person is even censured or ploying human arguments. I son I believe I can conclude mentally cancelled out. Thus said that the freedom to end life with the observation that the pan-sexualism becomes almost does not exist because without value of human life during the the meaning itself of a life life freedom, too, ceases to be. I third millennium will no longer which is banal because it is demonstrated that nobody ac- be a wall or a dividing ditch but without greatness and mystery, cuses a person who impedes the a bridge and a territory of rec- and the family, which is the suicide of a healthy young per- onciliation between the re- structure of gift and victory son of violence since the subject sources of reason and the re- over transience, becomes an un- of euthanasia is not one which sources of the Faith. acceptable bond. Thus to restore concerns freedom but rather a meaning to sexuality and the negative judgement on quality CARLO CASINI, family these two realities must of life which, indeed, distin- President of the Italian be pervaded to the utmost by guishes between lives which are Pro-Life Movement, the mystery that envelops hu- more worthy and less worthy of Italy. Education in Values?

In technical civilisation, of the economy, of politics, of education à rebours. They treat which today permeates the sex, of marriage, of the family, man as though he were a com- thought and wishes of man, it is of sciences, of philanthropy and puter to be programmed. Com- not easy to speak about educa- so forth. The former produce puters function better than men tion. In this civilisation people “bread” which is used for their do in terms of the efficiency are trained to produce objects greater or lesser pleasurable and the speed of their opera- of every kind and for everyone, survival, whilst the latter pro- tions, but so far nobody has and thus man is encouraged to duce “entertainments” (Pascal) spoken about the education of forget about his own being and which work towards forgetting these machines. Indeed, the that of others. Blocked in this the real. In surviving in a com- brainwashing which precedes way in this “produttura” (pro- fortable way in forgetting the the “programming” of men production) Ð if one could use a ne- real, they free themselves from vokes in men mental distur- ologism in Italian which is nei- the moral obligation to live in a bance and insanity. ther linguistically nor phoneti- decent way. Not even the Church is im- cally elegant Ð which is quite The cogito-fungor of both mune to the risk of Sophistic wrongly today called “culture”, categories, in drawing them education. This education frag- 29 the perception of man becomes away from being, leads them to ments the unity of the spiritual debilitated to such an extent that surrogate for wished-for life of believers and corrupts that he comes to mistake the salvation which is one or an- their faith because many of surrogates of the real, things other form of u-topian Func- them, rather than struggling for which are the productively tion, that is to say a function the salvific meaning of life, dreamed objects of his own erected into an ideal. For the dress themselves up as func- cogito, for what is actually real. cogitor-fungor it is of no im- tionaries and fight for those In the world of surrogates, portance whether the ideal is things which allow them to feel which function as though they real or not Ð it is sufficient for it at ease in the world of func- were reality itself, man is not so to function as though it were. tions. For salvific faith they much educated as drilled to The cogit-fungor does not even substitute today tomorrow’s set know how to function in order think about the devastating of elements which place them to make him able to survive in consequences of its own ac- at the mercy of the cogitor-fun- an increasingly comfortable tions which, deprived of the gor. People who are thus edu- and pleasant way. The educa- wish to know the truth and to cated in a Sophistic way enter tion of man gives way to the love good, leads man to u-topi- into dialogue with no one at all. training of the functionary who an non-being and, as a result, to Indeed, objects do not engage is efficient and effective from a non-suitability to living with in dialogue Ð they struggle to the point of view of doing this flower, with this wood, and have a higher price. something. The utility of the with this man. The otherness of The spiritual life of man is function, which is itself pro- every being frightens him and carried out and realised in dia- duced by man, takes the place disturbs him. logue. In engaging in dialogue within man of the very meaning The functionaries of the he unites with the sacred identi- of life. He does not change utopias, by way of example, ty of the other which is sacred himself but changes, rather, his mention only the Communist because it does not depend upon functions and those of other utopia or the utopia of prosperi- any man. The identity of every people. ty, and condemn everybody to being is a gift which is continu- Modern Sophists, who fol- compelled behaviour which is ally made by the creative low after their predecessors the thought of God. The gift is to be Athenian Sophists, realise that worshipped. In worshipping “in the cogitor ergo sum is translat- spirit and truth” (cf Jn 4:23-24) ed into fungor ergo vivere pos- man worships the origin of sum and sell to their fellow citi- every gift, that it to say God. He zens various forms of knowl- worships it when in the light of edge connected with producing God he contemplates a moun- things which help them not on- tain, a flower, a lake, but he ly to survive but also to domi- worships it above all else when nate each other. Indeed, the he contemplates another man working of the surrogates of the who, in turn, in giving of him- real immerses society in the self also enters into dialogue “slave-master” dialectic. In the with him and in contemplating final analysis rather than having him worships God. before us society we encounter The person who worships his the need to address ourselves to own cogita is compelled to con- those collectivities which are struct so-called consensus. Oth- composed of the functionaries erwise his worship loses its significance. The functionary who person who saves himself and neglecting this “single thing” does not manage to construct becomes what he should be, if without which all other things consensus does not function, you say that he is saved by a di- pass and disappear into noth- and this is something which for vine favour you can be certain ing. When amongst Christians him means that he does not live. that you are not telling a lie”.2 and their pastors there is no In the final analysis the “spiritu- The situation becomes even shining forth of the Word which al” life of functionaries, which more dangerous when the mere “leads out” men from the dark- lies specifically in the construc- exteriority of the state, which is ness and from the non-under- tion of consensus, is only a made up of administrative func- standing of their immanence struggle to reach ever higher tions, in a totalitarian way and leads them to freedom-love functions because it is these strives to make the citizens ad- which renders them under- functions which decrease or in- ministrable. The exteriority of standing and saved, the Church crease the value-price of life. the state cannot tolerate the gives the impression of being Never be pushed to one side, in- “person being” of men because an association established to deed never be overtaken by oth- ecstasy Ð that is to say the per- carry out some or other kind of ers! This is the basis and the son Ð transcends all functions social activity. Vocations are ideal of the morality and the ed- and their ability to be adminis- obstructed or stopped because ucation of functionaries, and tered. The functionaries who young people perceive a contra- such morality and education, in are chained to the exteriority of diction between evangelisation essential terms, can be reduced administration devastate within and the administration of func- to a low quality form of politics. this being of man the ecstatic tionaries. The mechanism of For those functionaries who love of truth and good which the pure exteriority of adminis- no longer feel important in the are greater than utility and ef- tration sooner or later is substi- 30 world they live in, freedom, fectiveness and close the door tuted by the computer. Howev- which is revealed in the selfless in the face of freedom. Lost in er, the fact remains that man union of man with good Ð time and detached from each does not feel called to become a something which does not work other because there is no ele- computer. to increase their having and ment which can unite them, The pastor leads out and their power Ð is a source of freedom becomes reduced to guides his flock. He is an edu- scandal. They ridicule it and so-called free choices, that is to cator. And this is a difficult un- marginalise it and depict those say to reactions to contempo- dertaking. What, then, is educa- who aspire to such freedom as rary and visible forms of stimu- tion? anachronistic. For functionar- lus. In etymological terms the ies, the person who loves use- The functionaries of the visi- word “education” refers to a less things which do not in- ble are not directed towards the particular action Ð that of lead- crease having and power are invisible Transcendence from ing out (“edurre”) a man from a touched by madness because which the freedom of man state of ignorance in order to they impede technical progress. takes its origins and thus do not lead him to a state in which he Directed towards realities know how to govern free men. encounters new evidence. The which are found beyond such In not understanding their being educator awakes. The person progress, that person is con- love for things which are who is awakened, who is so to cerned with the direction of greater than the visible world, speak “led out” of sleep, enters progress itself and in this way they fall into an inability to en- into the real world where he disturbs the peace of the func- gage in communion with other sees how things really are. In tionaries who bring it about. people. They are with others this state he feels free from the For functionaries, such a person only when they need them for things which are dreamed and is irritating because in not con- something. When the product to which he surrendered his rea- cealing the fact that he has has been manufactured they son and his will, immersed as obligations because of, and to- separate from others. In their they were in sleep. wards, invisible realities, he world betrayal and loyalty are A man is educated in propor- forces them to think. Socrates unknown categories. Indeed, tion to the extent to which he was killed by men who were loyalty and betrayal take place allows the truth of beings to de- “very talented in educating both only in a world built in a fend him from the chaos of the the young and old, men and knowledge and love of being, unreal world. The real world re- women, and turning them into and never in the world of func- sists the feelings and calcula- what they wanted”.1 For this tions. Indeed, only the man who tions of man. It wants him to thinker, however, freedom in- knows and loves the being of adapt himself to other people, volved choosing not what one other people and identifies with and this is something which wanted but what one should it to the point of becoming it re- means the abandonment of the want. Today, when so many ally knows what it means to be- comforts he previously enjoyed forces act together against man tray or to be loyal. in his dream world. The truth of in order to force him to accept In the Church the mentality beings calls man to convert his own condition as a “useful of functionaries corrupts love himself to them, and this is slave” and to produce visible and thus corrupts the work of something which is the very things from the beginning to the evangelisation. This is a corrup- essence of education. Indeed, end of his life, the words of tion of love, of knowledge, and the person who converts him- Socrates still have a prophetic of work. This corruption is ex- self is led out of dreaming opin- ring: “it should be recognised pressed by Christians and their ions and led to live together that in a political constitution pastors in being actively con- with others. This is a paschal along contemporary lines the cerned with many things and in journey which is never easy. The liberation of man which meaning of life, a meaning takes place in conversion be- whose otherness begins to shine gins in his becoming a ques- forth in the otherness of the oth- tion: “where do I come from er person. If the otherness of the and where am I going?”. This meaning of life begins to ex- question, which seeks the Invis- press itself in sexual difference ible whose imperative presence this meaning obliges man not to in all the realities of life means halt in that difference which is that every ending is nothing but something which only opens up a beginning, frees man from the the path. The meaning itself, visible things, which, indeed, shining forth in the visible, re- are transient. The man who is mains invisible and calls us to led out and guided by this ques- go further. It is the Invisible tion to the Other touches upon which obliges man in the deep- the meaning of life. est sense of the word, not the In the question “where do I visible. Thus it is the Invisible come from and where am I go- and not the visible which edu- ing?”, which is brought about mosexual tautologies, never cates man. by the experience of time which have an educational character. We can, I think, leave to one man is from his birth to his They do not “lead out” man side the explanations as to why death, to a certain extent there from himself. the world made up of functions is expressed the Memory of the The education of man begins does not know loyalty or be- Other which is eternity. In this with his body. It is his body trayal. Only the Invisible, question there vibrates the hope which is the first reality to which does not identify with 31 that the end of life does not de- point out to man the exit door any function, requires man, and ny its beginning but confirms it from himself. In the presence calls on man, to engage in un- and gives it significance and of a person who is sexually dif- conditional loyalty. And pre- meaning. The question “where ferent man begins to see the di- cisely in calling him to this it do I come from and where am I rection in which he must direct “leads him out”, it educates going?” is the beginning of ed- his ecstatic being in search of him. However, man cannot be ucation in the deepest sense of the Beginning and the End. loyal to the Invisible only be- the term. The educator is a per- Life lived beyond sexual differ- cause It shines forth in the visi- son who helps man to become ence by-passes the question: ble. For this reason, the loyalty this question. In order to do this “where do I come from and of man to the Invisible is ful- he himself must know how to where am I going?” and means filled in loyalty to the visible in unite the beginning and the end that man behaves in a mistaken which the Invisible reveals it- of life in asking with his whole way. He is “badly led out”, that self to him and gives itself to being: “where do I come from is to say badly educated. him, and this because the man and where am I going?”. The Sexual difference “leads who abandons the visible be- person who knows how to unite out” the person from himself trays both. To love the Invisible them knows how to live be- and leads him to another per- as though one abandoned the cause only he knows how to die son. It frees both of them from visible and love the visible as and to be born again. He dies the loneliness within which though one abandoned the In- and is born again asking the neither of them manages to un- visible Ð here is the secret! question: “where do I come derstand themselves. Indeed, Christ revealed this secret and from and where am I going?” the man-male cannot under- only he amongst men knew He dies and is born again look- stand his being without the how to realise it in a divinely ing for “one thing only”, which light of the man-female, and perfect way. is something he does not have the converse is also true. The At the same time, loyalty to (cf Mk 10:21). He searches, truth of the being of each of the Invisible, brought about that is to say, for that Other who them is revealed only when through loyalty to the visible, is the beginning, from which he they reveal themselves to each requires that man abandons the comes, and the End, to which other. Where sexual difference visible itself and increasingly the “new pilgrim of love...di- is forgotten the education of moves upwards. Otherwise he rects his face”.3 Any other form man has already failed. It has will never be able to be loyal to of education stops man in failed because of the impossi- the Invisible. Lacking loyalty things which are detached from bility of walking towards the to the Invisible, his loyalty to the unity of the end and the be- truth and the good of man. I the visible has already failed ginning of life because of the would venture to say that in because he does not seek to non-presence of the question: not accepting this difference save it. “where do I come from and man closes the path which Loyalty and betrayal refer, of where am I going?”, and which leads him to understand the course evidently enough in dif- reflect only his being closed up Otherness of God even at the ferent ways, to the meaning of within the human. In seeing very point of asking: “where the life of man. As a conse- himself in others and things as do I come from and where am I quence, the man who is loyal to though they were mirrors, man going?” the Invisible which shines forth sees only this or that hic et nunc In other words, man, in pro- in the visible is loyal to himself. to which he is reduced and portion to how he neglects or When he betrays this dual total- whose last word is pleasure. forgets sexual difference does ity, he betrays his own being Tautologies, and not only ho- not direct himself towards the which is directed towards it. The meaning of life, which is directed to what, although it himself to be led out from him- in some way present in the takes place in the time which self and guided towards the in- question “where do I come passes, it is not identified with. visible Other. The first are from and where am I going?” is The man who is trusted is trust- Abraham, Isaac and Jacob be- expressed as the unity of the worthy. In not allowing himself cause in yearning for He who Beginning and the End. Man to be devoured by the saeculum only is they have no price. They comes from the Beginning and which, as Tacitus declared, cor- are not saleable and they are not goes towards the End in which rumpit et corrumpitur, he does buyable. They can only offer he hopes to be able to find it not allow himself to be corrupt- themselves. Each one of them again. Does this mean that he ed and does not corrupt other is dignity and represents an ide- loses it? And if so, when? The people. Only the person who is al in itself. Each one of them answer to this question can only not corrupted by the things lives in the world of visible be the following: in illo tem- which pass, only the person things but does not belong to pore. For this reason, he lives who is not that is to say secu- that world. They measure them- this Beginning in the same way larised, is able to educate oth- selves in relation to the Other- as he continues to lose it in ers. The transparency of his ness of the Divine which they every hic et nunc. In the light of visible being allows them to wish for and which they search what happens in illo tempore he perceive the Invisible from for. They measure themselves understands the things which which like a sun everything not in relation to their time but pass and how he should behave and everybody is illuminated. in terms of the the eternity that in order to do justice to them. This is exactly what being edu- He is. The understanding of His education should be direct- cated really means. Abraham, Isaac and Jacob ed towards what happens in illo Man educates another man in comes from the fire with which 32 tempore and from which comes relation to the extent that he re- they burn and which enables the truth of everything that ex- veals himself. The educator them to present themselves ists hic et nunc. Only the man gives himself to the person who with the words: “I am”. In com- directed towards the realities is being educated. In other ing from and going to the Reali- which constantly take place and words, the educator dies of his ty which takes place in illo tem- never pass away knows how to own accord. He dies in his own pore, the time of their earthly behave in every situation. He is entrusting of himself to the oth- existence is lived out by them prepared for new things and er person. For this reason he is as a time of becoming and not nothing takes him by surprise born again in him because the as a time of corruption. or in a condition where he is other person in his turn entrusts Dignity requires the heroism unprepared. himself to him. Both of them, in of agere, that is to say the hero- This was how Abraham and educating each other, are edu- ism of knowing truth and lov- his son Isaac were educated in cated. The uneducated do not ing good. Dignity is not some- the area of the mountain in the rise again because they do not thing to be purchased. It fit. It country of Moria. Both of them know how to die. takes place in dying of one’s search for the meaning of life The uneducated fall into own accord and rising again in which is provided by God (cf loneliness in which the non-ed- the loved and known person. Gen 22:7-8). The father search- ucation of man in relation to the The person who does not de- es for it in the otherness of the reciprocity of giving and re- cide to think and exist in a hero- son and the son in the otherness ceiving expresses itself in sur- ic way is someone who is un- of the father. They entrust render to the dialectic of able to say to another person: “I themselves to the truth that “slave-master” where the “mas- am you and you are me”, and they believe has a divine origin ter” teaches the “slave” and the he will never be dignity. In his and hope that they will not be “slave” teaches the “master” inability to engage in heroism disappointed by it. For Abra- according to their respective he expresses his non-education. ham this truth shines forth in needs. Loneliness always has a Only he who says to the other Isaac; for Isaac it shines forth polemical character which at person “I am you and you are in Abraham. One auget, enrich- times is even aggressive. Use- me” behaves in a worthy way. es, the trust of the other, plac- fulness and comfort, indeed, He is the dignity which edu- ing in him his own trust. Each lead the “slave” and the “mas- cates the other person, calling for the other becomes auctori- ter” far away from the Invisible him to be dignity as well, that is tas, that is to say a reality in which is “lost” in illo tempore, to say to reply: “I, too, am you”. which the “lost” Invisible thereby giving them up as prey The non-education of man is shines forth and is wished and to things of any price. expressed in his inability to searched for by both together. The person who halts in use- say: “I am you and you are me” Uniting themselves to each oth- ful and comfortable things to in marriage, in the family, and er they place themselves on the the point of identifying with in friendship. It expresses itself road of return. From where? them will always be secondary, in his inability to engage in From “exile”. They go up, in the same way that the instru- ponti-fical mediation between reaching the summit... In the ments which serve to some end men and God, and in an espe- entrusting of man to man the are always secondary. He will cially painful way in the media- question “where do I come always be saleable and buyable. tion of priesthood in the from and where am I going?” His price will increase or di- strictest sense of the term. does not cease to be a question minish in line with the rules and Tragedies in marriages, in fam- but grows deeper, one could workings of the market. ilies, in friendships and the say, in the direction of the In- The person who comes first Church herself arise from the visible. It becomes increasingly is only that person who allows fact that many marriage partners, many friends, and many They lose their educating force entrusting himself to the person priests are more “mere work- because in the technical activi- who calls him with “you”. In ers” (homines fabri) than ty of loving, knowing and order to then become himself, “pontiffs”. They do not build working the truth about man is that is to say “I am”, it is neces- bridges which unite men and not revealed, that truth which sary for him to die of his own unite men with the Other. In makes man free. Indeed, the accord. Only in this way can other words, those who are not truth about man is never given man rise again as “I am”. Every suitable to heroism do not con- to “idiots” because “idiots” do person is the “I am” of the oth- vert themselves to others. As a not give themselves to each er. But this is not true of “id- result, they do not perceive the other. iots” because they do not reach meaning and the greatness of The light of the Invisible, the such a stage of experience. In- life. This is the real tragedy it- Memory of which (anamnesis) deed, in being secularised, “id- self of the non-education of the educator awakens within iots” allow themselves to be man. The man who does not the innermost self of man, illu- corrupted by time. think and exist in a heroic way minates everything and every- “I am” has a divine sound. It does not have before him that body around it. It is precisely burns with the “I am He who Future which is greater than this light which frees man from is”. To his “I am” man ascends time. And in not knowing “idiocy” and leads him to the in ascending to “I am He who where to go in saeculo he be- wisdom of love, knowledge and is”. He abandons himself in or- comes easily corrupted. Secu- work. One force alone is the ed- der to be really himself. It is larised man does everything on ucator of man Ð the Invisible. precisely for this reason that his own because in not being “Do not have yourselves be man is sacred, in the same way led out from himself he does called masters because one as the burning bush is sacred. not reach others. Closed up in alone is your master, and you Faced with his own “I am” he 33 his own private world he be- are all brothers” (Mt 23:8). feels called to “take the sandals comes, as the Greeks would The educator educates to the off his feet” (Gen 3:5). The have said, “idiotes”. The “id- extent that he opens himself Light which is the “I am He iot” does not unite himself with and invites the other to enter who is”, in illuminating him, others, he does not even look and live therein with him. frees him from “idiocy” and for them, and it is precisely for “Master, where are you stay- leads him to that freedom which this reason that he is an “idiot”. ing?” Andrew and Peter asked takes only one form, namely di- In reducing everything and Christ. “Come and see” He an- vine freedom. It is not easy to everybody, including himself, swered them. “They came and be educated, which means to be to an object with some price or saw where he was staying and free, because it is not easy to be- other, he breaks the organic they stayed with him that day” come similar to God. unity of love, of knowledge (Jn 1:38-39). The person who The home in which each per- and of work. He transforms has nothing to reveal, indeed son is “I am” is based upon the them into techniques by which has many things to hide, will relationship between the father to do and make things. He never be an educator. The home and the son. Abraham and Isaac makes love but does not love should be revealed; the hovel build this home on the slope of because he does not reach the should be concealed. the mountain of the area of Mo- other person; he acquires It is only at home that man ria. The father who runs to the knowledge but he does not feels the “you” directed to- prodigal son and the prodigal know because he does not wards him by the person who son who returns to the father reach the other person; and he has invited him to enter. This build this home. The friends engages in work but he does “you” awakens him because he who are “journeying” towards not work because in not reach- enters a real world made up of some Emmaus or another (cf Lk ing the other person he merely his “I am” and the situation 24:13) build it. All those who produces objects to be sold in which he is given to exist and search for the truth and good which he does not offer himself live in. In the real world, which entrusted to their knowledge, to others. His love, his knowl- is different from the dreamed their love and their work all edge and his work fall sick. world of his cogito, the “I am” build this home. In the relation- of man is before him like a pri- ship between father and son mordial gift and at the same there reawakens in men that time as a primordial task. The self-awareness in which they re- “I am” does not arise from the member that Other which the cogito of anybody and as a re- Gospel tells them to call “Fa- sult is not to be identified with ther”. In and thanks to this rela- any cogitatum. It shines forth in tionship men discover and “re- man and evokes him. It is as member” that they are loved though his “I am” were not his and known “before the creation own property even though in of the world” (cf Eph 1:4). reality it is his. In remembering “And call no man your father on it man enters into the work that earth, for you have one Father, the Other carries out in illo tem- who is in heaven. Neither be pore. As a result, in ascending called masters, for you have one to his “I am” man transcends master, the Christ”(Mt 23:9-10). time. He does not allow himself If things are of this character, to be secularised. He resists. education takes place in the Man ascends to his “I am” by adaequatio filii cum Patre, per- sonae cum Persona, and it is in moving the whole of his being him, the value emerges as a re- this adaequatio that there is reso that he identifies himself ality which is still to be realised vealed the truth pointed out by, with them without becoming in knowledge and love in the and aimed for in, the question their master. These values are profound meaning of these which man becomes, that is to the objects of the compassion terms. In uniting himself to this say: “where do I come from of man. Com-passion makes value man unites himself with and where am I going?”. In oth- him a “neighbour” of the being the being himself. After carry- er words, it is the question that has touched and moved ing out such a con-summatum about the meaning of life which him in this way. The Good est he can do anything that he begins the spiritual generation Samaritan passed opposite a wants. His facere will be trans- of man. man who had been attacked by figured by agere (to know and When the uncontrolled ac- evil: “he saw him and felt com- to love). And in his free choices tivism of “idiots” destroys man, passion for him” (Lk 10:33). he will express the freedom of and as a result society and na- There can be no doubt that the love and the love of freedom. ture as well, the Sophist-physi- man attacked by evil was in These values, therefore, de- cians sell various remedies, himself a good, a truth, but for pend both upon the beings which they call values, in order the priest and for the Levite he themselves which are “good” to salve the painful parts of man represented no value at all. and “true”, that is to say loved and nature. If they are theolo- They were probably concerned and known “before the creation gians they speak about God as and moved by other goods of the world”, and on man who though He were one of these which took primary place in the in his compassion feels called to values Ð the greatest of them all calculations of their reason. re-love them and to re-know it would appear. It is no accident that immedi- them. In re-loving them and 34 I do not oppose values Ð ately after narrating the parable re-knowing them, that is to say quite the contrary! I am op- of the Good Samaritan St. Luke by thinking and knowing in the posed only to the Sophists who refers to the visit made by metaphysical dimension, man make them objects to be sold. Christ to Martha and Mary. grows together with such be- The Sophists killed Socrates Mary “sat at the Lord’s feet and ings. Indeed, he ascends beyond because his questions about listened to his teaching. But the “good” and “truth” of the values (what is justice, what is Martha was distracted with being because he ascends to peace? etc.) which they said much serving; and she went to their Beginning and their End, they knew and practised, had him and said, ‘Lord, do you not that is to say to God. God is He placed them in difficulty. care that my sister has left me who in addressing himself to The home in which we dwell alone? Tell her then to help me’. man with “you” through the is without doubt built upon var- But the Lord answered her, “truth”, the “good” and the ious values. We will find there ‘Martha, Martha, you are anx- “beautiful” of every being, life, economic, political, aes- ious and troubled about many leads man to Himself, that is to thetic and moral values. Some things; one thing is needful. say to Holiness. of them we possess; others, on Mary has chosen the good por- If education is not towards the other hand, call upon us to tion, which shall not be taken holiness it is reduced to teach- become them rather than to away from her.’”(Lk 10:39-42). ing man to do this or that, possess them. Those values To perceive that the being is whose value depends on the which are possessed serve for “true” (verum) and “good” one side on the situations in our survival and for our com- (bonum) still does not mean to hand, and on the other on the fort; without the others, howev- live it as a value so as to be- wish or the capacity to calcu- er, we could not be dignity. The come it. This being lights up in late. Education is connected, as difference between values man from such a value when he has already been pointed out, which are to be possessed, and allows himself to be touched by with the home. Education values to be, emerges from the truth, by good, by the beautiful which is not directed towards world in which we know them of the being that calls him to the holiness of man, the holi- and realise them. defend such things, if they are ness which transcends all val- Things appear to man as val- threatened, or to realise them if ues, throws man into hovels. ues to be possessed and he sees they are not carried out. The All values, even those of their calculable utility in rela- person who answers “no!” to having, disappear the moment tion to what he can have and this call commits an injustice, man ceases to carry them out. do. His reason (ratio, from destroys peace, and the person They exist until man realises reor, ratum, to calculate) calcu- who says “yes! effects justice, them, calculating them (values lates their value, or rather to put creates peace...Com-passion of having) or having com-pas- it more precisely their price, does not allow him to treat the sion for the other person (val- and his reason “knows” its own being who calls him as an ob- ues of being). In both cases calculation, that is to say its ject which is useful in relation man identifies with what is own construction. This is with- to what he does and to what he valuable for him. In identifying out taking into account that be- possesses. Compassion requires with the values of having he beings are true, good and beauti- him to treat this being as a sub- comes today the tomorrow of ful (ens, bonum, verum et pul- ject which can give himself (the the calculated object, some- chrum convertuntur).4 person) or, mutatis mutandis, thing which some people call The values which man which has already been given to “self-creation”. This, in fact, is should become do not depend him (the thing). Between the none other than a maltreatment upon man. They offer them- man and the being which calls of man, a maltreatment made selves to him, touching and him to defend him or to help possible by his forgetting about himself. In carrying out the val- All this means that the values platur, i.e. he himself does not ues of being, on the other hand, of being, whose realisation is become a templum. It is pre- man exists as a sovereign sub- decided upon by man, reach cisely this that I am talking ject, that is to say he is pos- him as gifts. Only on his deci- about when I speak about sessed by nothing and by no- sion to receive them diligently growing in the growing togeth- body. Indeed, who can become or otherwise depends whether er of the being of man. In not the master of the man in whom he will exist as a subject or as con-templating, in not, that is to there takes place the event of an object. His ability to receive say, becoming a templum, man love, of faith, of hope, the event them diminishes when man himself should not be con-tem- of truth, justice, peace and of worships his reason and his will plated. He does not say to the many other values which can- and as a result when he reduces other and the other does not say not be grasped by possessive his freedom to so-called free to him: I am you and you are hands? choices. Free choices which do me. He walks along gropingly, The subject being, realising not emanate from freedom wasting his “inherited goods” in his actions the values whose shipwreck man in the chaos in (verum, bonum, pulchrum) in validity derives from the holi- which he, in the best of cases, the same way as they are wast- ness to which man is directed, searches for salvation in moral- ed by the prodigal son in the will never be something which ism or in aestheticism, that is to “far away country” through for- is purchased once and for ever. say in the possession of moral getting about his own being and Man becomes a subject by values or values which are that of his father, his brother, working continually. It is in his purely aesthetic in character. and the other inhabitants.5 work that he is led out “of the Idiots can increases their pos- Contemplation is absent and dust of the earth” (cf Gen 2:7) sessions, including their moral knowledge, love and work de- and guided to the Freedom of (the possession of virtues) and cay. Activism, even moral ac- 35 God the creator who semper aesthetic ones, but they cannot tivism, corrupts man because it laborat (cf Jn 5:17). increase their being. In order secularises him. Maria, seated The subject being of man de- for man to grow he himself at the feet of Christ, “chose the rives, on the one hand, from his should know how to reach the best portion, which will not be constant filial work, and on the other. Despite the appearances, taken away from her”, and that other hand from the constant idiots Ð who do not reach as far portion was: to say with all one- work of the Father. The Father as, and do not unite themselves self to the other Ð I am you and always generates and creates. with the other Ð do not know you are me. When He says to man “you are the real and do not really work. When the identity of man is my son, today I created you” he This is because they only love forgotten about, man has no gives him Himself, and thus their own constructions. To be a dwelling place. Home is a God makes a gift and does this holder of the Nobel prize does dwelling in which everything is in a divine way. He does not not mean to say that such a per- oriented towards the “centre”, keep anything back. Not even son is not an idiot Ð an idiot is from which the identity of what Himself. The Father is ab- somebody who does not reach is found in the boundaries set solutely poor. He alone is the the real different of his cogito. out by this centre springs. Man Father, that is to say Love: “I The being of man grows only bows in worship in front of the am He who is” (Ex 3:14). “God when he grows together with “centre”. If the “centre” is not is love, and he who abides in another being; he grows togeth- God but something else which love abides in God, and God er with him con-templating his apes him, worship degenerates abides in him” (1 Jn 4:16). This identity. The identity of every into an idolatrous prostration is the truth of the divine Subject being represents a templum, a along the lines of what hap- being and of the human subject temple, and a temple is no pened with the “golden calf”, being who becomes Him. To longer a temple for the person whose possession depends upon the paternal poverty of God, who does everything he can to reason and will. We should not, man must reply with the filial gain possession of it. Posses- therefore, be amazed if those poverty which he has still to sion is divisible because what is who worship the “golden calf” achieve. possessed is itself divisible. The worship the so-called free divided templum is no longer a choices of their own reason and temple. If the verum, bonum, their own will. In the men who pulchrum were each divided, are prostrated in front of such the Other to which they refer choices the values of being are would also be divided. Our no longer ignited. The prostrat- knowledge of truth and our love ed people see only the ground, for good, that is to say our per- indeed they see only that piece son being, would also be divid- of ground which is near their ed. To be divided means to be hands and under their feet. They calculable. But neither man nor calculate it in the spontaneity God is calculable. with which their free choices In not ascending, therefore, “respond” to the determined beyond having, or even beyond stimuli of situations. They are the possession of virtues, in not not able to go further, to the ho- building that is to say his home liness of freedom which when it with that Other who is absolute- is not divine is not freedom. The ly poor and whom we call Fa- idolatry of free choices repre- ther, man does not contem- sents the highest possible level of non-education, that is to say only the abyss of the Invisible sent and is thus treated as such. of allowing oneself to be in which to throw oneself like a The rich are absent. Their ab- blocked by one thing or another. question-challenge shaped only sence makes them clumsy. Idolatry is the beginning of the by hope: “where do I come They forgive everything, even destruction of the home, that is from and where am I going? though they gain the “whole to say the beginning of the de- Please tell me!”. Up there on world” (Mk 8:6). struction of the filial being of the summit Abraham and Isaac, If the things of man are of man and the beginning of the illuminated by the Invisible, this character, the only “text- negation of the paternal being carry out such a great act of book” for education to divine of God. trust in the Holiness of Divine poverty of the “I am” is the In a society which is prostrat- Freedom that from that moment speech made by Christ on the ed in this way the “honest” per- onwards, although they exist on mountain (cf Mt 5 and 6). It is son is he who knows how to the earth, they no longer belong there that the Memory of man achieve social balances out of to it. They love the earth and relights the question: “where do individual interests which are they abandon it.6 They live as I come from and where am I treated in an idolatrous way. though they were flying. Up going?”. His wings spread out The person, instead, who has there, on the summit, the man and explain themselves in the not thrown honestas amongst who does not open his wings wish to fly beyond every hav- used objects, who in classical and does not throw himself into ing, in the Divine Poverty of philosophy speaks about the the abyss in the hope of being Love “which moves the sun union of man with truth and able to fly beyond himself in and the other stars”.7 good which transcend useful- the Freedom of the invisible ness and pleasure, is listed as Other, collapses spiritually and Prof. STANISLAW GRYGIEL, 36 being one of the mad. hands himself over to the Professor of Philosophical The man who in the deepest dreams of the functionaries. Anthropology at the sense of the term is “non-edu- The young rich man was too John Paul II Institute for the Study cated”, that is to say who is rich to be able to fly. “At that of Marriage and the Family dominated by doing and hav- saying his countenance fell, and of the Pontifical Lateran University. ing, believes that he can be the he went away sorrowful; for he “Lost One”. At times he thinks had great possessions” (Mk he can do this with the help of 10:22). Having many virtues, ethics which are mixed up with he thought that as a result he science in which moral virtues could also have the kingdom of are the instruments by which to heaven. He was not able to sell Notes construct and have the “celes- everything and take that deci- 1 PLATO, The Republic, VI, 492b. tial kingdom”. sive step. Virtues can close man 2 Ibidem, 492e and 493a. 3 DANTE ALIGHIERI, La Divina Com- The young rich man asked up in ethical idiocy and deform media. Purgatorio, VIII, 1 and 4. Christ the question: what do I his spiritual life so that the man 4 I am referring here to the so-called have to do to gain the kingdom with wings, given to him to fly, transcendentals of classical metaphysics, namely: ens, verum bonum et pulchrum of heaven? The answer given as C.K.Norwid would say, ends convertuntur. by Christ is suitable to this ethi- up by sweeping the streets. 5 Obedience understood as this as- cal question – “observe the “Blessed are the poor because cending in the contemplation of other people and in the worship of God does commandments”. The young the kingdom of heaven is not alienate man because to obey anoth- man went on: I have obeyed theirs” (Mt 5:3). “Be perfect as er man by contemplating him and in the them ever since I was a child. your Father in heaven is per- final analysis to obey God by worshipping Him, means to follow the truth of Then Christ looked at him with fect” (Mt 5:48). his own identity, whose realisation in love and said: “only one thing In those axiologies which are God is reflected in the sacred identity of you do not have: go and sell detached from the metaphysics other people. With the alienation of everything that you have and of the father-son relationship, man, instead, we are face to face with man obeying functions, by “con-tem- give it to the poor...and follow values go mad and man, in try- plating them”, and obeying functionar- me”(Mk 10:17-21). ing to live them, becomes in- ies, by “worshipping them”. The man who is made unedu- sane. Values which have gone 6 In the context of this throwing of oneself into the abyss of the Holiness of catable by possession does not mad do not help him to fly. the Freedom of God I would like to cite receive with all of himself the They contradict themselves. the words of Christ: “He who loves fa- call of Christ to exit from hav- Stopped in the present they ther or mother more than me is not worthy of me; as he who loves son or daugh- ing, and even from having cease to be an event of holiness. ter more than me is not worthy of me; virtues. He does not understand As a result, they are easily used and he who does not take up his cross that only men who are free in political struggles. What do and follow me is not worthy of me. He who finds his life will lose it, and he from having manage to reach the words “peace”, “brother- who loses his life for my sake will find being and are joined by verum, hood”, “love” and “hope” real- it.”(Mt 10:37-9). That love which does bonum, pulchrum. ly say in the mouths of politi- not abandon the loved one so that its One ascends to being. At the cians and the crowds which are bearer can climb to the summit devas- tates not only the loved one, halting him summit of being, to which manipulated by them? The by himself far from the mountain (cf Abraham and Isaac climbed to- “kingdom of heaven”, seen as Gen 22:4) but also the person who loves. gether, there is no longer hav- an ideal object to make and to This, then, is not love. If Abraham had not abandoned his son Isaac, both men ing to which to connect oneself. possess, is transformed into would have remained at the foot of the Up there man can only decide u-topia, to which the education mountain together with their slaves, as to carry out a decisive step in of man is directed. Educated to their “masters” and at the same time as “slaves”. favour of his liberation. Up u-topia man falls ill because of 7 DANTE ALGHIERI, La Divina Com- there in front of man there is an unreal ascension. He is ab- media. Paradiso, XXXIII, 145. ROUND TABLE “The Places of Education in Values”

I: The Family

Introduction: the death of parents, and makes context of mental weakness in The Link between children into orphans. the individual concerned. He is the Epidemic of AIDS-HIV 3) The family is the best immature and rather irresponsi- and the Crisis of the Family place to take care of the person ble towards himself and others. 37 afflicted with AIDS, to help This leads to an approach In the years immediately af- and accompany him day after which is full of risks. ter the discovery of this illness day, and to help him in his jour- In this weakness of character little attention was paid to the ney towards death. of the child, which exposes him role of the family in the strug- 4) Lastly, the family should to contamination by HIV, is to gle against AIDS. Attention be the strong point in the strug- be found, according to the was paid above all else to the gle against AIDS, the place phrase employed by Pope John medical and epidemiological where the counter-attack should Paul II, a ‘sort of immunodefi- aspects of the illness and thus commence, and this in line with ciency of existential values to its prevention in narrowly its ability to become once again which cannot but be recognised technical terms. Today this can an entity with an educational as a real pathology of the spir- no longer be the case. The role and the place where it com- it’.1 This ‘worrying crisis of alarm has been given by social municates its values to its chil- values’2, which is ‘characteris- workers and those who look dren and opens them up to true tic of the emergence and spread after these sick people outside love. of AIDS’, continues the Holy hospitals, that is to say by This paper will confine itself Father, finds one of its princi- those who are the first to be in to this last point Ð that of the pal roots in the crisis of the contact with the human reality values of the family which en- family. When the family is de- of AIDS. In the front line we able it to prevent children from ficient, destroyed or not loyal find the international humani- being contaminated by AIDS. to its own vocation it loses its tarian organisations, such as These are the values which ‘warmth’ and the ‘psychologi- the World Health Organisation, must be cared for, supported cal and spiritual immunology’ which are drawing the atten- and promoted within the frame- of its own children begins to tion of people to this polymor- work of the struggle against disappear, to employ the figu- phous link between AIDS and HIV-AIDS. rative phrase of John Paul II.3 the family, something which does not fit into the usual rules and schemata but which is in- 1. Infection by HIV: 2. The Family as a Place of creasingly central to the prob- a Sign of the Crisis Training of the Character lem of this illness and its reper- of Human Values of the Human Person cussions. This is the case at four differ- Despite the evident diversity If this is a fact which has ent levels: to be encountered in the con- been empirically demonstrated, 1) there is first and foremost texts and epidemiology of it is also true that the climate it- a relationship of cause and ef- AIDS, the same observation is self of the family means that fect between the degradation of valid in relation to HIV-AIDS young people find in it the nec- family structures and values transmitted sexually as for essary defences by which to and the appearance and spread HIV-AIDS transmitted within overcome the challenge which of AIDS. the sphere of drug-addiction. In brings with it attraction both to- 2) There is in addition the se- both cases Ð that of contami- wards a premature, immature rious problem which AIDS nation because of a heterosexu- and not very responsible form raises for the family Ð it deal or homosexual relationship of sexual activity which is re- stroys families and family or that of contamination by duced to mere individual plea- bonds, corrodes solidarity and means of an infected needle or sure, and towards the use of, the family spirit, brings about syringe Ð we find the same and attachment to, drugs. This is because the family becomes tablish a value which has previ- flesh. The children express at the fulcrum and key element in ously been lived out, and which least in a physical sense the re- the training of the character of thereby becomes a conscious ality of this one flesh, which the person and is thereby a de- value. unfortunately would be poor in cisive guide in forming atti- Recognising and wishing for character if it were not an ex- tudes towards other people and this value helps to incorporate pression of the communion of towards society as a whole. it into one’s life, but this is not their spirits. It is this profound something which is automatic communion of the persons of a. The family, the first and or which can be taken for the parents which must inform fundamental school of life granted. The school and other and support the daily life of the media of information can help family as a communication and If one can speak of human a person to look deeper into the participation of all its mem- ecology, the first and fundamen- values which already exist in bers. Precisely because it is a tal school and structure in that person at the level of dis- communion based upon the favour of such an ecology is the position, but only with difficul- mutual self-giving of the mar- family itself. Indeed, in the ty can they develop them if riage partners, all the relation- heart of the family ‘man re- they are not already gained in ships between the members of ceives his first and determining the primary structure of train- the family community are in- ideas about truth and good, ing received within the context spired and guided by welcom- learns what to love and to be of the family. ing, encounter and dialogue, loved means, and thus what in disinterested willingness to practical terms being a person b. Giving of oneself help, generous service, and involves. Of course here one is as a generating nucleus profound solidarity (cf FC, 43). 38 referring to the ‘family based within family education Indeed, the love of the par- upon marriage, in which mutu- ents as a spring must further al giving of oneself by a man ‘One cannot forget that the become a ‘soul and thus a rule and a woman creates a life envi- most radical element in educa- which inspires and guides all ronment in which the child can tion, which defines the educa- practical educational action and be born and develop his poten- tional task of parents, is pater- activity, enriching it with those tialities, become aware of his nal and maternal love’. This is values of sweetness, constancy, dignity and prepare himself to the love that brings to perfec- service, disinterestedness, and tackle his unique and never to tion the work of the child spirit of sacrifice which are the be repeated destiny’ (CA, 39). which was begun with procre- most valuable fruits of love’ And it is here that we touch ation. (FC, 36). upon the central feature of the On the one hand there is the family, both as a place of the relationship of love between education of men and women the married parents and the 3. The Family, who are masters of themselves, children which is the best a Place of Education and, in contrary fashion, as a school for their training and ed- in Personal Values lost opportunity for the acquisi- ucation. But on the other hand tion of the above mentioned there is the child who like In a well constituted family fundamental human values. every man needs love and ‘can- the children are seen as unique Education within the family is not live without love’. He ‘re- and never to be repeated per- above all else life, lived out val- mains for himself an incompre- sons, with their gifts and their ues, and only in second place hensible being...if love is not own specific vocation. As a and later is it something of a revealed to him, if he does not consequence, they also are led conceptual character. Experi- experience it and makes it his in parallel fashion to self-es- enced life can then become a own’ (RH, 10). There is there- teem, to the discovery of their concept, an intellectual expres- fore on the one hand the need own capacities to discern sion achieved through retro- for love, and on the other hand moral values. For this reason, spective thought in order to es- the structure which is suited to the family must be the principal provide for such a need in a full source for the transmission of way. And thus in the family moral values. which works, people matter, The parents in this way train are loved and are treated as the children in the essential people. values of human life. Some of The generating heart and these values, when they are not nucleus of the ability of the acquired within the sphere of family to educate its children is the family, can only be ac- the giving of oneself which quired subsequently with great takes place between the mar- difficulty. Thus it is in the fami- riage partners. A self-giving ly that the right freedom in re- that in addition to involving the lation to material goods is as- marriage partners unites the similated, with a simple and persons of their children. In- austere lifestyle. In the family deed, at the basis of their exis- as well the children can be en- tence there is a concrete reali- riched by the meaning of real sation of that initial self-giving justice, by respect for the per- which made them become one sonal dignity of others, and by real love as sincere concern and oneself for conjugal love so as disinterested service in relation to give oneself to one’s real to other people. partner. It is precisely in the family Prevention within the family that one learns the real mean- environment of sexually trans- ing of sexuality and where each mitted HIV-AIDS is to be child is prepared for self-giv- achieved through education in ing, as a beginning to a life of the essential, personal and so- love as well. Sexual education cial values of chastity, respon- here is based upon integrating sibility, and solidarity. sexuality into the richness of Today there is a great deal of the whole of the person Ð body, talk about informing young feelings and soul Ð and mani- people about HIV-AIDS and its fests its meaning in the giving transmission. But it is forgotten that the person engages in that information on its own is through love. not sufficient, as indeed was pointed out by the Holy Father in his speech of 15 November 4. The Family, such as respect for the person, 1989 to the fourth congress of Place of Education commutive and social justice, the Pontifical Council for Pas- in Social Values solidarity, hard work, and so toral Assistance to Health Care forth. The family cannot be- Workers held in Rome: ‘as a The giving of oneself, which come itself without serving the consequence it is necessary in inspires the love of the mar- life of its children: that is to say the first place to repeat with 39 riage partners, presents itself as by generating and educating force that the work of preven- a model and guideline for that children in the virtues, and thus tion, in order to be worthy of self-giving which must take without serving the good of so- the human person and really place between brothers and sis- ciety. From the family, indeed, effective, must set itself two ters and between the various are born good citizens who objectives: to inform adequate- generations which live together have understood and try to live ly and to educate to responsible within the family (cf FC, 27). for those near to them and far maturity’ (n.5). Daily communion and partici- from them through a giving of To inform young people pation, in moments of joy and self. They have found the best about infection by HIV, about familial difficulties, represent school for human and social its forms of transmission, and the most practical and effective virtues in the sphere of the about its development, is obvi- form of teaching for the active, family. This is the reason why ously important. But this infor- responsible and fecund inser- the family is seen as the soul of mation is not sufficient in itself tion of children into the broader society (cf FC, 42). And thus to stop these young people horizon of society (ibid.). ‘the family is the native place from falling into an irresponsi- In the family ‘the various and the most effective instru- ble attitude which provides generations encounter each ment for the humanisation and HIV-AIDS with its opportunity. other and help each other to the personalisation of society’ In order to bear fruit this infor- achieve a more complete hu- (FC, 43). mation about HIV-AIDS must man wisdom and to match the encounter a rooted sense of re- rights of individuals with the sponsibility from early child- other needs of social life (GS, 5. The Family in the hood in these young people. 52). ‘Faced with a society Struggle Against Sexually The education in values given which runs the risk of being in- Transmitted HIV-AIDS by the family is thus a funda- creasingly depersonalised and mental element in the preven- modelled along mass lines, Because the family is not on- tion of HIV-AIDS. The Holy with negative results of so ly a transmitter of personal and Father clearly indicated the many forms of escape Ð such social values but also an educa- condition for effective educa- as, for example, alcoholism, tor in these values, it has an es- tion in relation to the preven- drug-taking and terrorism itself sential role in the prevention of tion of AIDS. John Paul II Ð the family still possesses and the infection of its children by talked about helping young releases formidable energies HIV. people to discover ‘the funda- which can tear man away from When one asks the question mental meaning of existence, anonymity, ensure that he is about the education to be given love which is self-giving’ aware of his personal dignity, to young people in order to pre- (speech of 15 November 1989, enrich him with deep humani- vent sexually transmitted HIV- n.5). ‘Only’ with this kind of ty, and actively integrate him AIDS, that question is often education ‘is it possible for with his uniqueness and never posed in a negative way: what adolescents and young people to be repeated nature into the must one do not to contract to have the strength to over- tissue of society’ (FC, 43). The AIDS? To this question there is come forms of behaviour at family becomes, in relation to no real possible answer which risk’ (ibid.). This education, human relationships which go does not deceive and which is therefore, must be ‘preparation beyond its circle as well, a nec- positive other than the follow- for responsible and loyal love’ essary and irreplaceable school ing: adopt a chaste form of be- (ibid.). The encyclical Evan- for personal and social values haviour, that is to say prepare gelium Vitae (25.3.1995) con- by shaping them in the image with anxiety. This can be a con- and likeness of these empty de- sequence of the break-up or formations. fracturing of the family, or be- Today these are on a worry- cause of the weakness of the ing increase in society and give lack of an authority which must rise to crises of marriages and also be supported by example. families: separations, divorces, Young people are forced to and co-habitations which ex- bear the heavy burden of an in- press the immaturity of many terminable adolescence in a of those who, having to give of permanent state of the immatu- themselves in marriage, do not rity of their personalities. know how to live the needs of When the family is loyal to such a self-giving. The conse- its vocation, when self-giving, quences for the marriage part- generosity, solidarity and re- ners are the difficulties in their spect for the person and his relationships in the family and freedom is lived out daily in the an inability to fulfil themselves family, then such a family is an tinues on from Familiaris Con- consistently with that self-giv- ideal environment for preven- sortio in insisting on the impor- ing. In the children who have tion, for recovery, and for inte- tance of this sexual education lived in these distressing cir- gration into society. provided by the family. It must cumstances there appears a be a ‘training in chastity as a void and a disorientation in virtue which fosters personal their spirits in relation to the Conclusion 40 maturity makes one capable of meaning of life and the values respecting the “spousal” mean- which structure their relation- Today the question of pre- ing of the body’ (Evangelium ships with other people. vention dominates the ethical Vitae, n. 97). In the realm of drugs those debate about HIV infection. who are the parents, friends or The message which the Church those accompanying drug-ad- addresses to all men of good 6. The Family in the dicts recognise the incon- will with regard to AIDS is Prevention of HIV-AIDS testable fact that the principal much broader than the discus- Connected with factor which encourages the use sion about the use of a condom Drug-Addiction of drugs is the absolute or rela- or the kind of information tive absence of family life. The which should be given to young The problem of the preven- lack of family, indeed, makes people: it is a ‘yes’ to life, a tion of transmission through the person lacking in human ‘yes’ to a life lived out nobly drug-addiction seems distant values, with scarce resources and humanly with respect for from that discussed immediate- by which to defend himself one’s own body and the bodies ly above. Here one is no longer against dangerous forms of de- of other people. To the ques- acting through education in re- pendency on drugs. This is one tion: ‘a condom yes or no?’, the sponsible love but in terms of of the causes, perhaps indeed Church answers ‘chastity’, the struggle against drug-addic- the most important cause, but self-control, education in real tion. In this field we encounter certainly it is not the only one. love, loyalty, and individual the same importance of the val- Drug-addiction is above all and social responsibility. This is ues transmitted by the family. else a symptom which mani- not an anachronistic message; it Where the family performs its fests an interior situation of is not an impossible message. educational role well there is profound emptiness. An empti- But this message assumes that no space for drugs. It is unfor- ness in relation to those moral the family is strong, loyal to its tunately true that the transmis- values which help to direct and vocation as an educator of man, sion of values is not easy today guide existence. This empti- because faithful to its vocation in many homes. The use of ness of values tries to find com- of love and self-giving, the drugs takes place in many very pensation artificially in escape spring of life and of authentic good families. But it is useless or flight into the unreal imagi- freedom. to remember that the drug-ad- nary worlds which drugs pro- dict often comes from a weak duce. The idea that ‘drugs can- H.E. Mons. F. GIL HELLIN, family which is weak or unsta- not be banished with drugs’ is Secretary of the Pontifical Council ble because of a variety of mo- very true, or in other words that for the Family, tives, a family which cannot or the problem is not medical or the Holy See. does not know how to react by psychiatric in nature, at least to offering an overall education in begin with, but existential, hu- order to deal with the common man, and to do with values. problems of life. Investigations into the phe- Notes Drug-addicts are the person- nomenon of drugs agree in al victims of their own deci- demonstrating that there is a re- 1 JOHN PAUL II, ‘Discorso ai Partici- panti alla Conferenza Internazionale sions, but in large part they are lationship between the family Promossa dal Pontificio Consiglio per la previously the victims of a soci- and drugs. When in the home Pastorale degli Operatori Sanitari ety without a soul which pro- deep values have not been in- (1989’, in Insegnamenti di Giovanni Paolo II, XII, 2, p. 1270. duces its life models and makes culcated in the children, these 2 Ibid. its citizens become its admirers latter experience emptiness 3 Ibid., p. 1273. II: Schools

Introduction tion to an illness, such as AIDS, has rightly been declared to be which bears upon forms of be- the ‘central question’ of this Luc Montaigner, who togeth- haviour, values, the meaning of change in epochs. The civil er with Robert Gallo discov- life, sexuality, and so forth. My community is convinced of this ered the virus responsible for paper is organised around three fact; and the Church even more AIDS, made clear that in order principal points: the education- so. Civil society, indeed, is re- to counter the spread of this al challenge today, education in discovering the great value of disease ‘medical instruments values, and sexual and emo- education and sees it as one of are not enough: it is much more tional education. the absolute priorities if we important that there should be want to guarantee the future not campaigns which operate at a only of individuals but also of deep level, and in which the The Educational humanity as a whole. In partic- various actors of society partic- Challenge Today ular, schools have become a ipate, against sexual practices sensitive cross-roads of these 41 which are against the biological It has often been said that the changes and are called to meet nature of man. And in particu- historical period in which we the challenges raised by them lar we need to educate young are living is not only an epoch and to overcome these chal- people against the risk of sexu- of changes but a real change in lenges. Today two approaches al promiscuity and sexual epochs. Light and shadows, ad- prevail. On the one hand refer- vagabondage’. These words of vances in civilisation and new ence is made to the right to edu- the French scientist well intro- challenges, poverty and wealth, cation for all, on the other hand duce the theme which has been and marginalisation and devel- there is an attempt to ensure entrusted to me. Amongst the opment, represent the bright- that schools and education are actors of society called to carry ness and darkness of the dawn of quality and adequate, and out these campaigns there of the new millennium. Para- teach ‘reading and arithmetic’ should certainly be listed insti- doxically, we find ourselves in today’s society. tutions dedicated to schooling. faced with a reality where the From many sides there is a call mutations which are underway for schools to act as a place of have increased the opportunities Education and Values prevention. Programmes are for each individual to gain ac- drawn up to explain what AIDS cess to information, to knowl- I believe, however, that the is, the ways in which the virus edge and to places, such as in educational challenge is princi- is transmitted, and to provide certain areas of Africa and Asia pally another. There are, in fact, information about relationships but also in many city outskirts very many perplexities raised at risk. Much more rarely does of Europe and North America by the educational situation. I one hear people speak about where access to instruction is am referring in particular to values, about emotional matu- denied, where the school ‘mor- values, to the person, to the ration, and about the meaning tality’ rate is very high, and concept of education and of of life. This should not surprise where millions of people are il- schooling. I ask myself, indeed, us in that it brings out to the full literate. A developed and tech- if it is enough to educate young a difficult and complex reality nological world and a world people to use techniques and which bears upon the identity that suffers illiteracy and exclu- of schools themselves and their sion: unfortunately when it educational role. For good rea- comes to education as well the son, this paper of mine is given world is divided into two. At the at a round table discussion same time, in the so-called first whose subject is ‘the places of world, the factors of scientific, education in values’, but the technological and economic question which is at the basis of change require modifications in everything is whether schools, skills and notable adaptations, at least in certain parts of the thereby giving rise in an in- world, are really educational. creasingly large part of the pop- This is not, unfortunately, a ulation to a feeling of insecurity merely rhetorical question. On and situations of new marginali- the ability of schools to be edu- sation. We are immersed in an cational depends the possibility event that is not only partial but of drawing young people near which has the characteristics of to values and of developing being world-wide and total. ‘authentic’ prevention in rela- In such a context education manage complex systems. Or central core of the question is to say choose in a positive sense. whether we should place the be found elsewhere. Beyond At a practical level schools student in a condition to acquire the various forms of ‘training’, must be able to train people for new work skills. Or whether the educational proprium is an- an essential thing, through that education has achieved its ob- other. It consists, that is to say, which is specific to them: the jectives when it makes a stu- in enabling the student to be courage of real freedom. AIDS, dent a manager or an estab- able to make free choices on the unfortunately, is often the ex- lished professional. The prob- basis of freely taken on values. treme symptom of freedom lem of AIDS is an eloquent an- From a pedagogic and educa- spent badly, of an existential swer to the inadequacy of such tional point of view, the essen- emptiness which is filled with a methodological approach. tial thing is to teach the person, artificial paradises produced by These questions bring to mind to use a term dear to Aristotle, drugs, by wandering about an essay by Postmann, a United the ‘trade of being a man’. All without a meaning and without States pedagogist who spoke this brings us to the fundamen- a goal. about the ‘end of education’. In tal discussion about education order for schools and education in values, the central concern of to retain a meaning we have to this round table debate. Emotional and overcome the error of their re- During our century pedagog- Sexual Education duction to mere instruction or a ics has influenced in a deter- place of instruction. One is not mining way the way in which I spoke at the beginning of dealing, in fact, with merely schools exist: they are more this paper about the totality of providing knowledge but with ‘functional’ in relation to the in- man, and his emotional life and bringing the man out of the boy, dividual, his tastes, motivations sexuality form by no means a 42 of allowing the boy to become a and needs, than directed to- small part of this totality. An man in the full maturity of all wards goals and values. We overall reflection on emotional his being. must recognise that still today maturation cannot neglect the Man, the person, has a spiri- the composition of these two existential personal and rela- tual, ethical, emotional, reli- poles has not been arrived at, tional conditions of being, as gious and social dimension even though the problem is be- well as the social and economic which cannot be forgotten in ginning to be felt in many quar- insecurity, the difficulties of so- the educational process without ters, including authors and cial integration faced by young running the risk of ‘the end of scholars from different cultural people, and the crisis of the val- education’. In a document pub- and ideological backgrounds ues which characterise our soci- lished by the Congregation for who welcome a return to values ety. Catholic Education over twen- in the various educational con- Emotional education, seen in ty years ago, dedicated to texts and in particular in the context of the unitary schooling, one reads the fol- schools. It is right for a person process of the maturation per- lowing: ‘if one listens to the to go to schools, to come into son, for which schools cannot deepest needs of a society char- contact with learning, to be but be responsible, is also a acterised by scientific and tech- helped to overcome the various matter of a progressive opening nological development which forms of conditioning (of a bio- up to moral values, the acquisi- could lead to depersonalisation logical, psychological or social tion of the ability by the indi- and a mass scale of existence, character) inherited from the vidual to live out his emotional, and if one wants to give suit- past or present in the context in sentimental, psycho-sexual and able answers to these, there which he lives, but such ‘free- friendship dimension in an au- emerges the need for schools to dom from’ is not enough if it tonomy of judgement and in the be really educational and able does not become ‘freedom to’. light of values which are fully to train strong and responsible We are dealing here, therefore, taken on by his rationality as a personalities which are capable with giving young people the man. The student brings to of making free and right deci- possibility to ask themselves school the whole of his self. sions. This is a characteristic about which values they wish to The complex dynamics and the which can be even more de- spend their lives with, which duced from thinking about ideals they wish to invest their schools as institutions in which own human capital in. We need young people are capable of to reach the other shore of free- progressively opening them- dom - that of responsibility - selves to reality and of training without wandering in a state of themselves in a certain concept emptiness, in non-commitment. of life’ (Congregation for That freedom which chooses Catholic Education, La Scuola something or someone without Cattolica, n.31). We need, in a employing values becomes word, to recover the total transformed into ballast, bur- meaning of man in the educa- den, ‘hell’. Existence without tional and schooling process. essence and thus without values Who is the complete man to becomes a tragic and insoluble whom the educational effort drama from the educational and should be directed? Today great pedagogic point of view as insistence is placed upon vari- well. One must, therefore, be ous aspects of training but the able to choose ‘for’; that is to ways by which schools help in which is removed from the atti- does not react almost mechani- the training of young people tudes of the educators, nor by its cally to natural or external stim- and adolescents are the subject nature is it neutral, but it is uli but as someone who is able of study by experts, but the ac- strongly linked to the anthropo- to accept self-discipline and the tual power of their influence is logical vision which underlies sublimation of his own impuls- not something which is under it. Within the framework of a es without compromising his discussion. permissive anthropology, for self-actualisation. In this con- Relationships between peo- example, the growing individ- text education in values finds ple are bound up with variable ual feels that he has a right to its space and its meaning, and values and elements over which sexual pleasure over and be- becomes ‘prevention’ in rela- the creators of school pro- yond any moral and cultural in- tion to diseases such as AIDS. grammes (officials, headmaster dication. The age of youth, in Schools are certainly a place etc.) have little or no control. this approach, must lead onto for training in values but they The relationship between the the adult age in an atmosphere are also part of a wider context. teacher and the student takes free of any constraint. Within There are many environments place, in fact, in a personal psy- the framework of a naturalistic in which values or anti-values chology of values which only anthropology man is seen as an are acquired. These contexts are with difficulty can be referred object of nature and studied in sub-divided by scholars into to clear objective methods. This relation to the external world. two categories: those which are is because each person is a The consequences of these ap- functional and those which are ‘world unto himself’. The emo- proaches are easy to predict. In intentional. People of the same tional relationship between our case they become translated age, and society in terms of its people certainly follows strate- into pseudo-educational and instrumental aspects and the gies but the ways by which it partial remedies such as the dis- mass media, are functional. 43 unfolds are almost unknown. tribution of condoms and the They place the individual face Childhood and early youth are use of sterile syringes. Very of- to face with sexual issues and stages when personality forms ten in schools the line is drawn questions, and not only these its basic affective structure, and at minimal education which is (for example they place him these are stages which coincide limited to information which as- face to face with violence, with the school period. The re- pires to be ‘scientific’. We need, drugs etc.), working for the sponsibility of the school insti- however, to strive to ‘fly high’, most part in a traumatic way, tution is great, therefore, called, above all in schools, by basing and they are not concerned with as it is, to be a ‘home’ where the the educational journey on the the young person or his possi- students can mature. Even concrete and real person. The ble reactions. Here we need on- greater is the responsibility of person should be seen for what ly refer to certain television the educators, upon whom de- he is: a rational being endowed programmes, or films, or think pends in essential terms the with freedom and thus with ra- about the contexts in which success of the school educa- tionality, directed towards the young people pass their free tional project. transcendent and open to other time. The area of sexual education, people, not because of social The intentional spheres, on to adopt a judgement of the contingencies but because of in- the other hand, are made up of philosopher Abbagnano, is the ner needs which are specific to the family, schools, and youth most difficult and unstable sec- the human being. Affective and groups. In these an attempt is tor of the training of young peo- sexual maturation is possible if made to enlighten young people in which nobody feels at within the individual there are ple who are engaged in a ease even though he may have motivations which justify it and search, to respond to their inter- behind him a long experience match the individual in his to- ests and their needs, to bring as a teacher and a consolidated tality. In this sense sexuality about positive attitudes towards iter of reflection. should never be seen as an ab- life, to entertainment, to sexu- Sexual education, in fact, solute because it must be con- ality, and to promote their mat- given that it aims for the matu- tinually vivified by the spirit uration. Given the data pro- ration of the female and male and find its fullness in the digni- duced by the research which personality, cannot merely be ty of the spousal state. Human has been carried out, the func- seen as an initiation into hy- love, in an educational and tional environments by a large giene and the physiological as- school context which is both measure prevail over the inten- pects of sexuality. Nor can it be healthy and meaningful, must tional. Only a percentage of carried out outside the total be placed within the perspective about 20-25% of young people training of man. of responsible commitment so draw upon information gained The young people who pre- that life is lived out under the from competent adults in mat- pare themselves for life need banner of seriousness and of be- ters relating to sexual educa- precise and scientifically ing a project. tion. Most young people learn drawn-up knowledge, but above As can be seen, such an ‘an- facts and news from unquali- all else they need to be directed thropology’ centres educational fied sources which make their with regard to the overall mean- attention not on instruction but personal equilibrium unstable ing of sexuality and affectivity upon education and the goal of and rather than solving their in- and their objective ends. This growth. It also reaffirms the dividual situations actually reminds us that in the educa- value of the ideal in the struc- make them worse. This should tional relationship educational turing of the person because he make educators reflect a great transmission is never something is seen as an individual who deal, make them ever more aware, and prepare them for This is aggravated by the dan- cept: schools must be educa- their vital tasks. gers into which teachers can tional and not merely the Schools as an educational in- fall: thinking that everything providers of information if they stitution cannot, therefore, ig- can be resolved by biological want to become ‘places of edu- nore the problems of the emo- information, wanting to do cation in values’. The recovery tional development of their stu- without the family, and incul- of this educational dimension dents and allow them to under- cating certain ideas about life, requires deep synergy between go the damaging impact of al- affectivity and sexuality. The schools, the family, and society; ternative models. Even in the contents of sexual, affective in a word the creation of an au- ideal hypothesis that parents do and human education are multi- thentic educating community. their duty to the full, schools faceted. Indeed, they involve In this sense the Church offers should broaden and deepen information about the descrip- her contribution and her ‘expe- their activity. When this is to- tive aspects of sexuality and rience in humanity’, as Paul VI tally absent, as unfortunately questions about the meaning of loved to say. In particular, seems to occur in the majority life which worry young people, Catholic school institutions, of cases, the responsibilities of in addition to authentic and real with their educational project the schools increase out of all education designed to make which has in Christ and the proportion, and this is some- them understand their motiva- Gospel its inspiration, can offer thing which complicates what tions in order to control their their valuable contribution to an they have to do. For this task, sexual instincts so as to subject ‘across the board’ education schools need a trained teaching these to reason and their will, in where values and responsibility staff with suitable equipment order to integrate the sexuality have full ‘citizenship’. It is cer- and the presence of specialists. of the person in a harmonious tainly the case that the problem 44 Most concerns revolve around way, into his affections, and of AIDS is not only of an edu- the involvement of the families, within a life project. The first cational nature, indeed in some the definition of the contents aspect, which is of a scientific areas of the world, such as, for which are most suitable to each nature, does not imply a moral example, Africa, its presence is age group, the methods to be purpose; the second, which is so high as to even compromise used at a group level and with of a moral character, pre-sup- the future of peoples and na- each individual, and the phys- poses a basis of a scientific nations, but without doubt schools iognomy of the class which has ture, and in this sense becomes and education can do a great to be addressed. Despite these education in values. deal by training men and obstacles, schools must main- women who are able to turn tain a critical position, of re- their lives responsible self-giv- search, and of experimentation, Conclusions ing. in order to carry out their func- H.Em. Cardinal PIO LAGHI, tion as a guide in the develop- It seems to me that what I Prefect Emeritus of the Congregation ment of young people. The task have tried to say can be sum- for Catholic Education, is arduous and full of problems. marised in a fundamental con- the Holy See.

III: The Communications Media

How can the communica- be said to be infallibly effec- the spread of tragic disease. tions media help to prevent the tive in preventing desease. What I mean is this: sexual ac- spread of AIDS? Also, instead of treating tivity is viewed as a mere I know that some would re- sexual intercourse as an act of means of personal pleasure spond that the media should self-giving and unselfish love and the sexual partner is promote the notion of so in the context of a permanent viewed as the object through called “safe-sex” – that is, the and exclusive loving union of which such pleasure is ob- use of condoms in sexual ac- a man and a woman in mar- tained; the antidote to unwant- tivity. riage, it would seem that the ed consequences from such It will come as no surprise use of condoms is designed to activity has become the sale of that I do not share this view. avoid both responsibility and objects, and there is money to First, let me indicate why consequences in sexual activi- be made from the sale of ob- not. ty, an activity which comes to jects. Nobody makes money For me, the promotion of be viewed as primarily recre- from self-control and absti- condom use is an invitation to ational rather than as procre- nence. Nobody makes money immature and irresponsible ational. from respect for others, and sexual activity and to sexual I also think that such objec- respect for the sacredness of promiscuity. The promotion of tification or instrumentaliza- sexual activity is not promoted the use of condoms is, in my tion of sexual activity and of and this is why the sale of con- view, also deceptive, because sexual partners leads to the doms is promoted. the method can certainly not objectification of antidotes to When I was preparing these remarks, I asked the members morality in sexual activity is from sexual activity before of our discussion group during also a norm for health in sexu- marriage Ð to be able to offer the Special Assembly for Eu- al activity. It can be indicated oneself in marriage pure and rope of the Synod of Bishops in the media that sexual absti- unblemished to one’s beloved? if they had any suggestion, nence outside of marriage is I am sure that most women do and the Bishop of Gibraltar physically healthy, and is not not want to marry a gigolo and gave me a pen on which were merely a spiritual ideal of the that most men would prefer to printed the words: “Fight Judaeo-Christian tradition. marry a virgin; why are we AIDS with a new lifestyle”. Dramatic programs on tele- afraid to say it Ð and to advo- In an age in which preven- vision could and should pre- cate it? tive medicine is encouraged in sent a positive image of family While the question of AIDS order to avoid contracting dis- life. Without neglecting the has now gone far beyond the ease which are both difficult various temptations which question of homosexual activ- and expensive to cure or to came at all ages, dramatic pro- ity, it remains nevertheless contain, it is amazing that few grams could well illustrate the true that the highest incidence have the courage to say: possibility of victoy over such of AIDS, at least in the United “Fight AIDS with a new temptations, the great psycho- States, is traceable to promis- lifestyle”. logical and even physical cost cuous sexual activity and the So, let me address the ques- of surrender to temptation and second highest incidence, at tion of what I think the media the need for forgiveness, rec- least until recently, has been can do to prevent the transmis- onciliation and unselfish sup- traceable to shared needles sion of AIDS. port in difficulty. Thus, dra- among drug users. First, let the media help matic programs can not only If such activities are clearly make known the dangers of promote the virtue of absti- a public health hazard, then 45 promiscuous sexual activity nence, but also compassion why not have the courage to and let the media help make with those who suffer either say so? The surest way to elim- sexual abstinence outside of from disease or from a strug- inate ot at least to control AIDS marriage the accepted norm. gle with strong temptation. is to eliminate those activities The media have done much in Advertising campaigns which have been proven to some societies to remind the could carry the message the lead to AIDS: promiscuous public of the dangers of smok- Bishop of Gibraltar had print- sexual activity, especially ho- ing and have made abstinence ed on the pen: “Fight AIDS mosexual activity, and shared from tobacco the accepted with a new lifestyle”. If adver- use of needles among drug norm. While the sexual urge is tising campaigns have been users? much stronger and more fun- able to say, “Smoking is dan- If smoking has been so ac- damental than the desire to gerous to your health”, why tively and successfully dis- smoke, the Judaeo-Christian can’t they say the same thing couraged, why cannot the me- norm has always been that about promiscuous and extra- dia use the same norms in sexual activity is to be expect- marital sexual activity? treating the question of drugs ed and indeed encouraged There have been advertising and sexual activity Ð to have within marriage and that sexu- campaigns against drunken sympathetic and appealing al abstinence is to be expected driving Ð why not such cam- characters who themselves outside of marriage. For cen- paigns against promiscuous lead moral sexual lives who turies, the Judaeo-Christian sexual activity? obviously abstain from sexual norm was also the norm for If it is a fact that the best activity outside of marriage. It society itself. Then came what way to avoid lung cancer is is a tragedy of many modern has been called the sexual rev- not to smoke, and if it is a fact situation comedies that persons olution, but it should be con- that the best way to avoid be- who abstain from sexual activ- soling for those in the media coming addicted to drugs is to ity are viewed as anaemic; they to know that the norm for abstain from them completely, should be viewed as coura- and if the media are encour- geous Ð or at least as having aged not only to report such profound respect for others as facts but to construct public well for themselves. service advertising campaigns Perhaps the media can dis- around them, why are the me- cover and even have the dia not encouraged to conduct courage to make known that campaigns encouraging absti- health, happiness and indeed nence from promiscuous sexu- holiness can go together Ð that al activity and extra-marital rightly ordered moral activity sexial activity – “Say ‘no’ un- can contribute not only to a til marriage”. healthier personal lifestyle but It is now fashionable not to also to a healthier society. smoke; it is now fashionable not to take drugs; it is now H.E. Archbishop fashionable not to drink before JOHN P. FOLEY driving and, in fact to have a President Pontifical Council designated driver. Why can it for Social Communications not be fashionable to abstain the Holy See ROUND TABLE “Experiences and Future Prospects for Action and Programmes of a Preventive Nature Based upon Education in Values”

I: Italy - The CUAMM 46 Introduction At the present time the Uganda and AIDS health care projects of the The CUAMM (University CUAMM are concentrated in Calculations carried out by College for Missionary Doctors Africa, and more specifically: UNIADS indicate that 930.000 and Medical Students) was in Angola, Ethiopia, Kenya, people are infected by HIV or born from an idea of a Catholic Ruanda, Uganda, Tanzania and suffering from AIDS, that 1.8 medical doctor, Prof. Francesco Mozambique. The CUAMM million have died because of Canova. That idea was to train largely works and operates, the disease, and that 1.7 mil- Italian and foreign doctors, both though not exclusively, in rural lion orphans have lost one or men and women, who in the areas. both of their parents because of practice of their profession bear This paper is based upon the this scourge. witness to evangelical charity. experience of actions and ini- A containment of the epi- Its motto, which comes from tiatives taken by the CUAMM demic of AIDS is a tendency the Gospel according to St. to combat AIDS in certain rur- which has been registered in Luke, is ‘Euntes curate infir- al hospitals in North Uganda. Uganda. The data on seroposi- mos’. This paper is based more up- tivity in pregnant women indi- The CUAMM officially on the methods of dialogue cate the occurrence of a grad- came into being on 3 Decem- and the identification of future ual decrease in infection by ber 1950 and is an integral part prospects than on the defence HIV in the urban context since of the Religious Foundation of of personal positions and con- the middle of the 1990s (UN- St. Francesco Saverio of the centration on the contingent AIDS, 1998). diocese of Padua. It has its own situation. Firstly, the situation This decrease seems to be legal, canonical, and civil sta- of AIDS in Uganda and our particularly marked in young tus. experiences with regard to pre- women in the 15-19 age band. Since 1954 the CUAMM vention will be examined. At- Two surveys carried out six has worked in various conti- tention will then be turned to a years from each other seem to nents of the world through the number of reflections on three indicate a real change in sexu- sending out of medical doc- key elements: taking care of al behaviour above all else tors, nurses and technicians – the cut in half couple, helping amongst young people in the more than a thousand in num- young people to escape from same urban areas where inves- ber – to be involved in hospi- loneliness, and linking person- tigations into seropositivity tal health care projects; al responsibility with social re- were carried out. through primary health care; sponsibility. The changes in sexual be- and through training (in med- haviour in young people re- ical schools as well). In so do- Uganda: a Statistical Profile volve around: ing it has worked with Total population 20.4 million Catholic dioceses, various re- Urban population 2.2. million ligious missionary congrega- Rate of annual population growth 2.5% tions, and non-governmental Rate of HIV infection amongst adults 9.5% organisations at a local level. Rate of infant mortality 97/1000 It has also secured the estab- Life expectancy 41 years School attendance levels: Males 68% lishment of relationships in- Females 45% volving co-operation, not least Average pro capita income $240 with the governments of the Source: UNAIDS, 1998. local countries. – a raising of the age of the communities in order to help which we must recognise and first sexual experiences; people afflicted by AIDS. defend, however I believe that – a raising of the age of mar- we must not fall into the trap of riage; facile optimism. It is our duty – a decrease in sexual rela- The Future Prospects: to be discerning, to be realistic: tions with non-regular part- Tackling Certain Central the epidemic of AIDS will be ners; Questions with Courage with us for quite some time and – an increase in the use of even the positive results the condom. Over recent years a great deal achieved in Uganda run the has been done in Uganda in the risk of evaporating if we do not struggle against AIDS. The in- tackle certain key aspects with Experiences in Prevention formation and awareness-rais- courage – questions which are ing campaigns have reached in- at the base of the widespread A large number of associa- creasingly vast areas of the presence of forms of behaviour tions are active in the field of population. New and vigorous at risk and the cultural, social, prevention. Two non-govern- initiatives have been developed and economic causes which mental organisations in Kam- in the field of education, pre- foster the diffusion of the virus. pala – the TASO and the AIC – vention, and counselling. The If the problem, as everybody have launched a project called health care services for the di- recognises, is that the sexual the ‘Philly Lutaya Initiative’ agnosis and treatment of sexual behaviour of the population whose goal is to change sexual diseases and the adoption of must change, then a great deal behaviour through the co-oper- correct methods in the transfu- remains to be done in order to ation of young seropositive sion of blood have been im- spread the message of sexual people. These are ready and proved both in terms of accessi- responsibility, and the value of 47 willing to describe their per- bility and in terms of effective- faithfulness and chastity, in an sonal experiences and their sit- ness. And lastly, communities effective way. uation, in particular to students. have been directly involved in At the heart of the prevention The ‘Alive Youth Club’ also the provision of services of help of AIDS are the problems of directs its attention to young and support to the victims of sexual ethics. people. It was founded in 1992 AIDS. In order to advance in this by Sister Myriam Duggan, a The results are undeniable, area I believe that we must face member of the Missionary demonstrable and encouraging. up to certain forms of resis- Francescans of Maria and a They are the fruit of a set of tance which are surrounded by doctor at the Nsambya hospital factors such as the openness silence and embarrassment, in in Kampala. Beginning with and transparency of the govern- much the same way as this dis- the Gospel, young people are ment of Uganda in recognising ease provokes fear. asked to understand the mean- the seriousness of the problem In this sense I believe that ing of sexuality in the life of of AIDS and its determination the future prospects with regard man and thus to take consistent to fight the epidemic through to the prevention of AIDS must decisions with the help of indi- the implementation of a nation- take into account the plurality vidual and community prayer. al programme. To this should of prospects which we have be- In all the hospitals of the be associated the decisive ac- fore us. Catholic dioceses, including tion of the Churches, which those in which the CUAMM is have been involved in cam- active, and in many parishes, paigns of awareness-raising, in Taking Care of there are sections which are in- educational work, and in help- Halved Marriages volved: in providing informa- ing the sick. Finally, the mas- tion to local communities, in sive involvement of non-gov- I would like to begin with education and prevention, in ernmental organisations and certain constant realities in the the diagnosis and treatment of the support which has been personal experience of the sexual illnesses, in counselling, provided by international aid medical doctor. It is well and in the mobilisation of the should not be understated. known that most people infect- These results should also be ed with, and ill from, AIDS, are ascribed to the contribution women. It is also the fact that which has been made by those the clinics for sexual diseases, afflicted with AIDS, who have and the meetings for the re- borne witness with moving sponsible regulations of births, courage and touching humility are attended for the large part to their personal journeys made by women. In contrary fashion, up of suffering and of accep- choices in matters concerning tance of their illness. These sexual relations, family plan- sick people are known to us by ning, certain traditional prac- name. To them we must pay tices such as the mutilation of great homage for having in- the genitals, polygamy, and the spired people, and ourselves, to fact that a widow has to be- reflect upon, and to struggle come the wife of a brother of against, this terrible affliction. her deceased husband, all be- It is certainly the case that long to the sphere of influence, this is a valuable inheritance if not of dominion, of men. Halved marriages are not ing dialogue. Not enough is which young people, and espe- based only upon a system of known, and not enough is done, cially adolescents, bring with unilateral decisions about the as yet, in this field. them. These questions, indeed, marriage but also on a substan- are destined to remain unan- tial absence of dialogue and swered. spousal communication with Helping Young People Even pastoral realities often respect to delicate and intimate to Escape from Loneliness leave a great deal to be desired matters such as those which are when it comes to the proposals under consideration here. This Sexual violence, unwanted and initiatives made to young is also reflected in behaviour pregnancies and abortions, and people. Unease and difficulties directed towards avoiding the sexual diseases, are phenomena are felt by young people and accurate communication of a which are present, at times in a married couples in drawing condition of sexual disease, or very widespread way, in the near with feelings of trust to the of a condition of seropositivity, world of young people. Church. I have the impression to one’s own marriage partner. We become aware of this in a that for historical and cultural To this should be added the limited and rather late way in reasons, rather than for evan- persistent tendency to attribute our hospital clinics where only gelical reasons, the Church the social stigma which arises a small proportion of young continues to give the impres- to the woman when she be- people present themselves, shy sion that there are moral reser- comes infected by sexual dis- and ashamed as they are, with vations about speaking openly eases, or becomes seropositive, this baggage of problems about the positive value of sex- or becomes afflicted by AIDS, which have to be solved. In this uality, about dealing with sexu- when it is known that often it is case, too, the medical and al problems openly, and about 48 the sexual behaviour of many health care response is in gen- involving oneself with determi- men which renders the couple eral only partial and insuffi- nation in education about the vulnerable to venereal diseases cient. ethics of love. or to infection by HIV. In Africa there are very large The absence of adults within There is an urgent need to numbers of young people but the family and the community help to foster the spread of the in many contexts such as that is counterposed by a wide- spousal virtues through the of sexuality they are alone or spread polytheism of values in equal, mutual and corresponsi- abandoned. This is a loneliness society. Tea rooms, discos, ho- ble involvement of the marriage which continues for some time tels and magazines are wide- partners in their life choices and and which has many causes. spread in the urban and rural choices regarding sexuality. Firstly, the family has not contexts and involve models of To educate people in the taken the place of the social behaviour in which there pre- Christian values of being a re- rites of initiation into sexuality. vails a ‘dominant, masculine sponsible marriage partner, Indeed, the silence which is sexual culture where excite- faithfulness, and charity could present within the couple is ac- ment, transgression, pleasure, then mean having the courage companied by an absence of di- violence and danger are part of to read the taboos, the supersti- alogue between the parents and the same semantics’. tions and the negativities which their children. And when dia- Furthermore, there are by no are present within, and prac- logue actually takes place it means a small number of male tised in, all cultures, at all times seems to be dominated by the and female students in sec- and in all places, in the light of rebukes and remonstrances of ondary schools who, not satis- the Gospel. I am thinking here the parents and the possible fied with the standard of living of those which provoke oppres- failures, errors or dishonouring which is offered to them by sion and immiseration in the effects on the part of the chil- their families, or out of sheer couple, and that of the woman dren in matters connected with necessity, prostitute themselves in the couple in particular. sexual behaviour. Only rarely in order to obtain a monetary in- It could also mean recovering does dialogue become for the come. At the root of these forms in a Christian sense those reli- parents an opportunity for the of behaviour we find profound gious and social values which transmission to their children of problems such as sexual abuse, every culture manifests in rela- knowledge, ideas and experi- low self-esteem, relationships tion to the meaning of sexual re- ence about why sexuality, one’s lacking in affection, and a lack lations, and in addition promot- own sexuality, is a human and of ‘vision and goals’. ing those exemplary, concrete Christian factor of identity and The results which have been forms of witness which demon- growth in which the child can – achieved in Uganda with re- strate that the Christian value of if he so wishes – measure him- spect to changes in the sexual the integral couple is not only a self, recognise himself, and en- behaviour of young people precept, in the sense that it is to gage in imitation. should be greeted in a positive be placed amongst the declara- The absence of adults ex- spirit. However, the challenge tions of principle, but is also tends to schools as well where which we have to meet is even something which can be trans- sexual education is a rare event greater. I believe that in order formed into a criterion for ac- which is often translated into to meet and defeat this chal- tion, into a moral principle ac- embarrassed and furtive expla- lenge the learning of mere cording to which the married nations about physiology and techniques – perhaps learnt couple directs and guides its the reproduction of humans through occasional educators – choices and sustains them with a few or ineffective an- by which to avoid the infection through an intense and enrich- swers to the many questions is merely a minimal and insuf- Uganda where, despite the mediating between people and strong recent increase in pro public institutions. capita income, that income on- The very action of the ly reached its 1970 levels this Church would be more effec- year. But poverty is not only a tive if her social teaching was question of economic growth. disseminated amongst priests The status of inferiority of and the laity, if she promoted women, widespread unemploy- innovative forms of political ment, armed civil conflict, dis- and economic pastoral care, as ordered urbanisation, the in- well as experimental models of creasing privatisation of public intra- and inter-ecclesial soli- services, the difficult – and at darity. times denied – access of young The mass media of the North people and women to educa- and the South could increase tion and to health care services their role as vital channels of – these are all factors which health care education by giving help the spread of the disease. more space to news about med- ficient solution if it is not ac- Faced with this reality we ical advance, problems and companied by a wider ap- must doubt whether prevention cases connected to questions proach to the deep relational on its own can stop the AIDS and issues of health and securi- meaning of human sexuality epidemic, unless, that is, it is ty, and health care policies which is made up of self-disci- accompanied by other mea- rather than selling objectivity pline, harmony of growth, sures which help to build a and independence for reasons self-respect and self-esteem, favourable social and econom- of commercial gain. 49 respect and esteem for others, ic context which is able to sup- Researchers and men of sci- and life projects. In order to report and broaden programmes ence could help in the analysis spond to the complexity of the which promote prevention. It is of the economic, demographic, hopes of love in young people the question of growth and de- socio-cultural and organisa- and in adolescents we need velopment, the process of so- tional factors which influence well-directed programmes cial change, which liberates people’s behaviour in terms of which are administered by people and the community the perception of diseases, and adults and young people who from the bonds of poverty, of sexual diseases in particular. have been suitably trained as which widens the possibilities They could also help in the educators. We also need cen- of choice in relation to different search for forms of treatment tres where young people can options, which strengthens the and care. meet, where dialogue can take ability of people to be self-suf- Given the prohibitive costs place, where young people and ficient, which promotes partici- of the drugs and medicines in- families can meet each other pation, and which, finally, im- volved, a responsibility of pri- and exchange ideas, and cen- proves the quality of life. mary importance for the West- tres which can offer protection This approach ‘matches the ern scientific world is that of and security to young people very nature of HIV and the developing an effective vaccine who have no rights. form it takes as an invisible which is safe and reasonably (asymtomatic), visible (symp- cheap. The present-day empha- tomatic) and fatal disease’. As sis on combined anti-viral Linking Personal a result, all the programmes in- pharmacological forms of treat- Responsibility with volved should be based not on- ment runs the risk of concen- Social Responsibility ly on access to prevention, to trating efforts on benefiting a the HIV test, to care and sup- few rather on the potential ben- At the roots of the spread of port provided by the communi- efits which could be guaranteed AIDS there is not only the ty, but more in general on a to many. problem of human behaviour continuum between prevention Local governments and the and the ethical responsibility of and development. international community should the person but also certain so- The path to take could be be asked to act responsibly in cial an economic causes locat- that of the construction of terms of fairness in the distribu- ed in inequality and injustice. so-called ‘social capital’. This tion of resources and in provid- There is also, therefore, a prob- is a long path, but one which is ing sustainable help for devel- lem of social ethical responsi- open to everybody. opment. bility. The non-governmental or- I am convinced that dialogue It has been said that AIDS is ganisations could play an im- and relations between the North a problem for all people and for portant role if they stopped and the South with reference to each individual, but in reality it competing between each other AIDS presents many affinities is a question primarily, and and instead worked with the and similarities with the discus- once again, which afflicts the variegated social tissue by sions about the global economy, poor. It is an incontestable fact favouring the participation of world trade, the role of the Unit- that the greatest burden of the people in formal and informal ed Nations, and other similar disease of AIDS weighs in networks, by encouraging posi- questions. large part upon the shoulders of tive social norms, by building Dr. G. PUTOTO the poor countries and of poor up high levels of trust, by pro- CUAMM – Padua, people. This is also true in moting social cohesion, and by Italy II: India

Introduction who may not even be aware crease in the number of new that they are carriers. In fact cases in the country. Much of HIV did not arrive in Asia, we live in a world “where this increase is attributed to home to half the world’s pop- there are 16,000 new HIV in- better case finding and report- ulation, until the late 1980s fections a day, and where 9 ing which have resulted from and early 1990s. Today, the out of 10 seropositive people various NACO activities. region accounts for 20 per do not know they are infected The nationwide sentinel sur- cent of all infections world (UNAIDS: I999). veillance data collected (NA- wide. Experts worry about the CO: 1998) clearly indicate potential for epidemic expan- that HIV infection is prevalent sion in India, where more than Situation of HIV-AIDS in all parts of the country. In 4 million people have already in India recent years it has spread from 50 been infected – the largest the urban to the rural areas and number of infected individu- The HIV-AIDS population from individuals practising als in any single country in the in India is not uniformly dis- high risk behaviour to the gen- world (UNAIDS: 1999). tributed, nor is it rising at a eral population. Studies show In India (NACO: 1998) the uniform rate. The determining that more and more women at- HIV-AIDS epidemic is now a factors are (Thomas & tending ante-natal clinics are decade old. Within this short Pereira: 1999): testing HIV positive which in- period it has emerged as one a) The time and place where dicates the increase in risk of of the most serious public the infection first appeared perinatal transmission. health problems in the coun- b) The effectiveness of pre- The 97-98 NACO report try. The initial cases of HIV- vention campaigns shows that about 75 per cent AIDS were reported among c) The effectiveness of test- of infections occur by sexual commercial sex workers in ing system route (both heterosexual and Mumbai & Chennai and in- d) The socio-cultural and homosexual,) about 8 per cent jecting drug users in the religious background of the through blood transfusion, north-eastern state of Ma- people and another 8 per cent through nipur. Even though the offi- e) The routes of transmis- drug use. Over 90 per cent of cially reported cases of HIV sion the reported cases are occur- infections and full blown f) The presence of other ring in the sexually active and AIDS cases are in thousands STDs and communicable dis- economically productive age only, it is realised that there is eases group of 15-49 years. One in wide gap between the report- g) The type of health deliv- every 4 cases reported is a ed and estimated figures be- ery and reporting system woman. cause of the absence of epi- available in the country, Some of the attributable demiological data in most and factors for the rapid spread of parts of the country. g) Other factors (Panos the epidemic across the coun- Making an accurate assess- Dossier: 1990), such as an un- try today are: labour migra- ment of the situation is not an der funded and understaffed tion and mobility in search of easy task. The UNAIDS and health surveillance system, employment from economi- National AIDS Control Orga- suggest that it is not always cally backward to more ad- nization (NACO – India) possible to estimate the extent vanced regions, promiscuity, maintain statistics on the of infection in a country accu- low literacy levels leading to number of persons with HIV- rately. low awareness among the po- AIDS, and does its best to The first few seropositives tential high risk groups, to- keep them up to date. Yet the reported in the country were gether with gender disparity, disease progresses faster than from Chennai in 1986 (Shiv sexually transmitted infec- statistics (Lebel: 1988), which Lal & Sengupta: 1995). Since tions and reproductive tract are very approximate (and then over 8,000 cases of AIDS infection among men and sometimes totally lacking for and over 85,000 cases of HIV women. a number of countries. While have been reported to NACO, There have been cases of the there is much we do not know Ministry of Health and Family refusal of admission of AIDS about persons with HIV, we Welfare from 32 States and patients in hospitals and nurs- know even less about people Union Territories till August ing homes both in government living with HIV who have not 1999 (NACO: 1999). There is and private sectors. This has developed the disease and certainly a substantial in- compounded the misery of the AIDS patients. More often it is HIV-AIDS Prevention court of India has banned pro- taken to be a contagious dis- Programmes: fessional blood donation with ease and patients are isolated Government Initiatives effect from 1st January, 1998. in the ward creating a scare e) Surveillance by the estab- among general patients. In the Soon after the reporting of lishment of voluntary blood workplace there are instances the first few HIV-AIDS cases testing centres in all govern- of discrimination leading, in in the country in 1986, a Na- ment medical colleges. some occasions, to loss of em- tional AIDS committee was f) Control of sexually trans- ployment. HIV infected peo- constituted in the same year mitted diseases by the strength- ple have been thrown out of by the Government of India ening of 504 existing STD village communities, women and a National AIDS Control clinics. have been tonsured, children Programme was launched in g) Clinical management by of HIV infected people have 1987. The components of Na- the training of physicians in been thrown out of schools, tional AIDS Control Pro- government hospitals with institutions providing shelter gramme (NACP) are given be- more than 200 beds, and to the AIDS patients have low: g) Reduction of impact by been stoned or attacked, and a) Programme management the implementation of a pilot refusal to dig graves for those by establishing various nation- continuum care programme in who have died of HIV infec- al and state level organisations the state of Manipur and the de- tion, are some of the ways in b) Information, education, velopment of a national train- which people have reacted to communication and social ing programme for counselling. this deadly disease and its vic- mobilisation (IEG) by devel- tims. Table 1.1 show the cu- oping IEG multimedia pack- Critique mulative occurrence of HIV- ages, training programmes, 51 AIDS cases and the number of and awareness campaigns. The efforts of the govern- blood samples screened across c) Condom promotion and ment have been largely sup- the country as on 31st March its social marketing. ported by several Non-Govern- 1999 (NACO: 1999). d) Blood safety: the supreme mental Organizations (NGOs) spread across the country. Table 1 – State-wise distribution o the reported cases of AIDS However, these programmes on 31st March 1999 and the efforts made so far have not yielded the desired re- S. State/Union Blood HIV + AIDS sults primarily because of the No Territory samples adoption of programmes and screened policies followed in developed 1 2 3 4 5 countries which are not in tune with the social, cultural and re- 1. Andhra Pradesh 74.566 704 48 ligious values of Indian soci- 2. Assam 12.717 173 22 3. Arunachal Pradesh 495 0 0 ety. For example a message 4. Andaman & Nicobar Islands 14.447 115 0 like “use condoms to have safe 5. Bihar 10.194 41 3 sex” is not generally welcomed 6. Chandigarh 56.687 260 by parents and teachers al- 7. Punjab 1.488 65 100 though promiscuous activities 8. Delhi 317.457 1.282 219 are no less widespread among 9. Daman and Diu (UT) 250 8 1 the Indians. 10. Dadra & Nagar Haveli (UTa 160 1 0 Most of the printed materi- 11. Goa 69.395 2.104 15 als are duplications of materi- 12. Gujarat 451.464 1.675 137 als from other countries or 13. Haryana 160.330 494 1 publication of UN bodies and 14. Himachal Pradesh 3.851 92 9 bilateral donor agencies which 15. Jammu & Kashmir 8.981 40 2 have been developed without 16. Karnataka 402.142 4.845 172 17. Kerala 44.547 215 106 taking into account the socio- 18. Lakshadweep (UT) 1.194 8 0 cultural background of Indian 19. Madhya Pradesh 96.083 587 210 society. 20. Maharashtra 429.045 47.408 3.354 21. Orissa 83.127 217 2 22. Nagaland 8.548 429 10 The Existing AIDS 23. Manipur 38.362 5.644 310 Education Programme 24. Mizoram 37.251 122 7 in India 25. Meghalaya 14.250 60 8 26. Pondicherry (UT) 84.579 2.971 141 The AIDS education pro- 27. Rajasthan 22.446 465 79 gramme in India is still in its 28. Sikkim 510 6 2 infancy. There are many areas 29. Tamilnadu 741.774 13.375 1.881 in which the concerns about 30. Tripura 5.613 4 0 the AIDS pandemic interact 31. Uttar Pradesh 106.936 1.253 125 32. West Bengal 163.991 649 57 with the fabric of society. Such Totale 3.457.080 85.312 7.012 interaction becomes particularly intense and conflictual around the issues of AIDS, Critique al promiscuity and the need to family life and sex education – educate people about AIDS”. subjects that appear erratically The above contradictions in The main policy and strategy in the curricula of our medical purpose and strategies exacer- outlines are (CBCI: 1992): sciences, let alone all other dis- bate the crisis in a land such ciplines (Thomas & Ranga: as India with its vast popula- Policy: 1995). This is true for the tion (980 million) and linguis- Our institutions will give schools, conventional universi- tic, communal and geographi- loving and compassionate care ties and open learning institu- cal differences (with 18 offi- to all patients with AIDS. Pre- tions. To date there is no en- cially recognized languages vention is the only force richment programme or a cer- and 1652 dialectics and 23.5 against AIDS at present. It tificate, diploma or degree proper cent of her population calls for the correction of per- gramme on AIDS, sex or fami- comprising tribal groups). missive habits and sexual ly life education anywhere in There are 32 states and union promiscuity and the preven- the country (Thomas: 1998). territories and the literacy rate tion of infection through blood This anomaly in scholarship according to the 1991 census and needles, and attention to with regard to the provision of is 52.1 per cent (Manorama: high risk groups. authentic and adequate knowl- 1994). It is quite reasonable to edge for creating awareness on argue that the tide of crisis Strategy: AIDS, sex and family life edu- could be stemmed only if 1. Creates an awareness of cation through appropriate ed- AIDS, sex and family life ed- the problem and educates peo- ucational programmes cannot ucation programmes are ple about AIDS. be explained by rational con- launched quickly and effi- 2. Welcomes patients with 52 siderations because there are ciently by the various educa- AIDS; at the same time pre- few areas of life that touch tional establishments in the cautions will be taken so that everyone so profoundly. Al- country. the disease does not spread in- though research on substance A review of the materials advertently among other pa- abuse, AIDS, sex and sexuality prepared for schools, colleges, tients or public or health per- related topics is hardly lacking universities, medical and nurs- sonnel. and intellectuals are well aware ing institutes clearly show that 3. Orients people towards of the AIDS threat and the con- hardly any change in content, orderly sexual behaviour. sequences of its unchecked style and presentation exists. It 4. Promotes voluntary blood spread, no legitimate avenues looks as if ‘the same soup is donation by health donors, af- are made available for the pre- served’ in different plates. ter testing for the human im- vention and control of the dis- Similarly experiences at vari- muno-deficiency virus and disease in an intelligent manner ous seminars, workshops and courages professional donors. (Thomas: 1998). conferences are the same 5. Uses sterile needles and The University Grants Com- where the same things are dis- syringes and disposable ones mission (Gangurde: 1994) pro- cussed by and large by the to the extent necessary and posed the introduction of a same participants and resource possible. compulsory course on AIDS at persons with one or two ex- 6. Keeps close check on all the undergraduate level. Some ceptions. In short, one may blood products for statutory of the social work training in- conclude by saying that hardly HIV test certificates. stitutes, medical and nursing any concerted effort is made to 7. Collaborates in the nation- schools have introduced AIDS widen the scope of such ef- al programme against AIDS. as a unit into their curricula. In forts made in conventions, and 1991, a programme called Uni- national and of international versities Talk AIDS (UTA) was meetings. CBCI Response started by the National Service to HIV-AIDS: 1996 Scheme, Department of Youth Affairs and Sports in collabo- Intervention Strategies In 1996 the CBCI brought ration with the WHO and the and Programmes out its second policy statement Ministry of Health in 59 uni- of the Church in Indian on HIV-AIDS which was giv- versities in the country (Shiv Health Policy: 1992 en wide circulation. The state- Lal: 1993). Later this was ex- ment entitled “The Response tended to most of the universi- The Catholic Bishops’ Con- of the Catholic Bishops’ Con- ties in the country. Apart from ference of India (CBCI) initi- ference of India to HIV-AIDS” these, several NGOs are in- ated timely action to address called on the Catholic educa- volved in creating awareness the issues pertaining to HIV- tional institutions to embark about HIV-AIDS among their AIDS. The CBCI’s policy and on a mission to launch a com- beneficiaries through commu- strategy is clearly spelt out in prehensive family life educa- nity organization and develop- the Health Policy of the tion programme with accurate ment programmes. However, it Church in India which has and complete information on may be noted that those re- been circulated among all HIV-AIDS. It further states: sponsible have decided not to bishops and Catholic health “The time has come for teach- incorporate sex education into care institutions across the ers in Catholic educational in- the school curriculum (Inderjit: country. It calls for “correction stitutions and parents to be- 1994). of permissive habits and sexu- come increasingly aware of the fast changing social per- – CHAI commits itself to a perspective, particularly the spectives of young people. It is programme of prevention of New Testament. The book was important and apt that our chil- spread of HIV infection authored by a priest and a lay dren receive prompt, accurate through a process of education man, edited by a moral theolo- and truthful answers to their and training at all levels and to gian and has a foreword from questions on sex, sexuality and the unconditional care of those the President of CBCI, namely HIV-AIDS. The CBCI calls affected by the infection. Most. Rev. Alan de Lastic, upon all Catholic brethren to – CHAI policy will focus at- Archbishop of Delhi. recognize the great values en- tention on ethical social and b) The Prevention of HIV- shrined in the Bible and in the spiritual values apart from AIDS. A test book for schools teachings of the Church re- physical and caring needs, as comprising 12 chapters with garding male-female relation- well as on the justice dimen- five exercises in each chapter ships, God’s plan for procre- sions without being judge- in the form of role play, de- ation and for the realisation of mental. bates, group discussion and His love from the total and – CHAI and the mernber in- other content-based classroom unconditional sharing of one’s stitutions will promote com- activities. It has a number of self with the life partner” prehensive education on hu- illustrations and has been pre- (CBCI: 1996). man sexuality and values for a pared keeping in view moral, meaningful life with responsi- social cultural spiritual and ble sexual behaviour. family values. This book is Policy for the Management available in two languages, of HIV-AIDS patients: Critique namely, English and Hindi. 1997 c) A curriculum on HIV- A analysis of the above AIDS, sex and family life edu- 53 The St. John’s Medical Col- mentioned policy statements cation was prepared in consul- lege, Bangalore (the only of various Church bodies in tation with experts from vari- Catholic medical college in India show that the Catholic ous fields like physicians, psy- the country), has evolved its Church has been responding chologists, social workers, policy for the management of to the problems associated counseliors and other special- HIV-AIDS patients which was with HIV-AIDS ever since the ists on the subject. This vol- approved by the CBCI in Sep- emergence of this disease in ume is meant for educational tember 1997. The policy the Indian Sub-Continent. The institutions to help them in de- states: “Continuing education Church and its educational veloping value based pro- should be organized for all and health care institutions are grammes of study in the above categories of employees with very much concerned about mentioned areas to suit local special emphasis on those at the onslaught of HIV-AIDS needs. greater risk. The objectives of and are committed to provid- d) A brochure on: “AIDS: these sessions should be to ing value education to the gen- CBCI call for prevention and raise awareness that treating eral masses and employees, control of HIV-AIDS” was pre- HIV infected person is safe and providing treatment, care pared for free distribution provided recommended pre- and spiritual support to those among the masses during cautions are taken” (St. John’s infected with HIV and their meetings, conventions, train- Medical College: 1997). families within its limited re- ing programmes etc. Due to sources – that is to say both fi- public demand this brochure nance and personnel expertise. has been reprinted with certain CHAI Policy on AIDS modifications under the title “A call for the prevention and The Catholic Hospital Asso- Other Value Based control of HIV-AIDS”. Moral ciation of India (CHAI) in its Educational Interventions and spiritual values are en- policy statement issued in shrined in this brochure. 1994 states (CHAI: 1994): Publications Collaboration with the The CBCI Commission for National Open University Health has developed and published printed materials on The CBCI has entered into HIV-AIDS which provide a an agreement with the Indira policy framework and guide- Gandhi National Open Univer- lines to the clergy, religious, sity (IGNOU) to develop and school teachers and other laity. launch programmes of study Some of these are: on HIV-AIDS, family life edu- a) HIV and pastoral care cation and social service in the comprising 14 chapters, glos- larger interest of teachers, sary, a bibliography and de- paramedicals, parents, NGO tails pertaining to HIV surveil- functionaries etc. spread across lance centres and zonal blood the country. testing centres in the country. To begin with the university This book has been written initiated processes to develop a keeping in view the biblical certificate programme of study on “HIV and Family Educa- nars, rehabilitation, treatment do not express any misgivings tion” to be offered through a facilities, care, support, coun- about handling HIV patients “distance learning mode”. This selling and HIV testing facili- although many of the surgeons is the first ever endeavour by a ties etc. has been developed are afraid. During the last university in India (India has for the purpose. This ques- three years, there were reports about 250 universities) to de- tionnaire has been dispatched of five needle prick injuries to velop and launch a programme to all the bishops and respons- doctors and all these occurred on this subject. The beneficia- es have started pouring in. It due to carelessness and fa- ries could number thousands. is expected that within six tigue. The pathologists are still It gives us great satisfaction months time this study will be unwilling to do autopsies on to report that the university completed. On the basis of patients who have died of has endorsed the stand of the the data being collected, I HIV-AIDS. Church as far as the approach would like to present a couple The social work department and strategies for the preven- of case studies which high- provide all types of assistance tion of HIV-AIDS in the coun- light the experiences of some to the patients as well as their try are concerned. of our institutions involved in families which include finding The expert committee mem- HIV-AIDS work. a job, housing, emotional sup- bers appointed by the univer- port and at times financial sity comprise several Chris- help to meet urgent needs. tians (priests, moral theolo- Case studies Continuous education of the gians and other eminent acad- staff on HIV-AIDS is an im- emics). The curriculum de- St. John’s Medical College portant aspect in St. John’s. signed by them which has the Bangalore Regular courses are being 54 approval of the university is in conducted for physicians and tune with the stand of the The St. John’s Medical Col- para medicals, not only for the Church as far as moral issues lege is situated in Bangalore hospital’s employees but also and values are concerned. which is the capital of the for the staff of other medical I am also pleased to state South Indian state of Karnata- and health care institutions. that IGNOU has accepted a ka. It is in the Archdiocese of To coordinate and give di- folder entitled “HIV-AIDS Bangalore. rection to the HIV-AIDS pro- prevention guide for students” When the Indian Council of gramme, St. John’s has estab- prepared by the lone Catholic Medical Research (ICMR) be- lished an AIDS cell which faculty in that university. This gan to establish nodal testing consists of a physicist, a mi- folder which also upholds centres all over the country crobiologist, a dermatologist moral, social and family val- during the late 1980s, St. and a psychiatrist. It also has ues has the approval of NACO John’s refused to become a an advisory council which as well as WHO. In fact, NA- nodal centre. Only in 1990 did consists of the members of the CO and WHO have agreed to the hospital introduce ELISA administration and the heads print this folder which will be lab tests for HIV-AIDS as test- of major departments. They sent by the university to its cu- ing blood for HIV became meet periodically to review mulative strength of 800,000 mandatory in the country. and plan for the future. students (0.8 million). Pre-test counselling is pro- In short we may say that the vided to clients before a blood Shalom – a Rehabilitation approach followed by the test is conducted and confi- Church in India in sensitive dentiality is protected. Even Shalom is a centre for the subject areas like HIV-AIDS when a patient is discharged, rehabilitation of substance and family education is gain- the discharge summary only abusers (mostly HIV infect- ing momentum in academic mentions that the patient is ed), and for creating aware- institutions in the country. suffering from human retrovi- ness on HIV-AIDS. It is situat- Much more can be done pro- ral infection. ed in Dimapur which comes vided there are adequate funds The first AIDS case was di- under the Kohima Catholic for any similar initiatives. agnosed in 1989 and a single diocese in the North-Eastern bed was allotted in the isola- state of Nagaland. Nagaland A Study on Diocesan tion ward to take care of the and its neighbouring state of Level Initiatives AIDS patient. In 1992 the hos- Manipur accounts, compara- pital started handling more tively speaking, for the largest The CBCI Health Commis- and more cases and now the number of drug addicts and sion has undertaken a coun- patients are treated without HIV positive cases in the try-wide study to find out the any discrimination and are not country. initiatives taken by the 144 separated or isolated. In early Easy availability of the dioceses with regard to the 1992, a separate labour room drugs at relatively cheap prevention and control of was allotted for handling HIV prices is the major cause be- HIV-AIDS. A questionnaire infected mothers. Now there is hind this deadly habit among to find out various aspects of no separate labour room and the youth of this region. This the programme such as HIV- adequate precautions are taken region borders the gateway to AIDS education, family life to prevent HIV transmission the Golden Triangle, the tradi- education, AIDS awareness, during labour. tional global drug trafficking training programmes, semi- The nursing staff and aides route. Roughly 2.5 per cent of the tance learning package com- community offers 24 hour care total population of Nagaland prising eight lessons on drug for PWAs and treats any kind are reported to be drug ad- abuse and HIV-AIDS. More of illness that is HIV related. dicts, excluding those using than one thousand students are Snehadaan also offers support alcohol and other mild types participating in this pro- when the person’s home envi- of drugs. Most of these addicts gramme. Shalom also provides ronment may not be sufficient, are also I.V. users. regular training workshops on may put him or her at risk, or Shalom has the capacity to HIV and drug addiction to where it does not exist at all. admit 20 patients at a time. priests, religious, school and Snehadaan is a respite They are given treatment and college teachers, medical pro- home for those who need a follow up programme for fessionals and other youth shelter and convalescence about 6 months. Shalom also workers. Shalom is also plan- while they are being treated. provides counselling services ning to introduce a vocational It also acts as a half-way to the drug addicts lodged in training programme for the home after an individual has the central jail of Dimapur. drug addicts who have re- been admitted to hospital and Professional medical help is ceived treatment as well as cannot return to his or her provided by the resident doc- those under vanous stages of home environment. Both as- tors and staff located at a near- rehabilitation process. pects of care provide timely by health centre. The efforts of Shalom in interventions for minor or During the last seven years this part of the country seem major ailments that may oc- of its existence, Shalom’s pri- to be reasonably successful as cur in the course of disease. It ority has been to provide treat- far as their intervention in the ensures safety as well as secu- ment and rehabilitation to the area of prevention and control rity to the residents. Special economically backward HIV of HIV-AIDS and drug addic- attention is given to those in 55 positive and drug addiction tion is concerned. need of physical rehabilita- cases who could not afford for tion. Snehadaan also provides costly treatment. Snehadaan: palliative (or ‘hospice’) care The unique characteristic of The St. Camillus for those in the last stages of Shalom is that three former Home of Charity their life. The latter is seen as addicts are employed as ani- a priority. Snehadaan has a vi- mators and counsellors in Snehadaan belongs to the sion of a dignified existence Shalom. Apart from this, sev- Society of the Order of St. of those living with HIV. It eral other addicts who re- Camillus. Camillians have a seeks to help them to accept ceived treatment from Shalom presence in three states in In- with dignity their bereave- are serving in other de-addic- dia and have been present in ments – be they physical, fa- tion centres as counsellors. this country since 1980. The milial, psychological, finan- Experience has proved that organisation has a preferential cial or emotional. these animators are very effec- option to take care of people In line with its core values, tive in providing rehabilitation with HIV-AIDS (PWAs) and Snehadaan promotes a holistic services and counselling to as a result of this Snehadaan vision of care and strives to- other patients. was formally started on 14 Ju- wards maximized rehabilita- During the short span of its ly 1997 in Bangalore. tion. PWAs living in Sne- operation shalom has extend- Snehadaan has a prophetic hadaan are empowered to ed its education and awareness vision of care for PWAs. They grow morally, spiritually and programmes to scores of say that they have seen that socially as far as they are ca- schools, colleges and youth there is hope even after the di- pable. Each person is treated groups in the North-East by agnosis of an individual being as a unique individual with organizing film shows on HIV+ve – the individuals’ power to change and control drugs and HIV and conducting prognosis depends significant- his or her own lives. At the workshops. ly on how they are treated by end of the person’s stay at Shalom also offers a dis- the health services. Those who Snehadaan, social readmission are admitted to Snehadaan are as well as family reconcilia- encouraged to become part of tion is sought and warmly en- a family in which each indi- couraged. vidual can love and be loved Snehadaan feels that the by the other members of the most urgent need is to train community. Therefore, each families and communities in resident is accepted on the ba- how to care for PWAs. In ad- sis of his or her own character dition, there are constant calls and becomes a part of the for training programmes tai- whole community. lored to the needs of particular Snehadaan accepts PWAs as NGOs or government bodies – a priority for care at whatever from nursing schools, radiog- stage of the disease process raphers, students at the insti- that they are in. Preference is, tute of management, pastoral however, given to the sickest – care workers, hospice teams those whom the disease has al- etc. The Camillians are doing ready devastated. Snehadaan’s a wonderful service for PWA. Other Similar programme in Theni also inte- b) Non-availability of drugs Endeavours grates reproductive health at affordable prices. care programme as well as the c) Indifference on the part Several religious communi- T.B. control programme in of hospitals and staff. ties and dioceses are involved collaboration with the govern- d) Difficulty in monitoring in large and small ways in ment. The sisters from them family members and care HIV-AIDS work. A brief note also work among nomadic givers. on some of their experiments groups, auto-drivers, con- e) Rehabilitation and dis- are given below. struction workers, as well as charge to the community. commercial sex workers. f) Lack of community par- St. Catherine Home: ticipation and acceptance. Snehalia g) Staff stress etc. Experience, Achievements, Snehalia in Bombay is in- and Limitations Suggestions volved in the care and rehabilitation of children born to The analysis of some of the The Church in India has HIV-AIDS mothers. Snehalia initial responses gathered initiated a number of pro- has 24 children. Almost all of from various parts of the grammes across the country them came totally shattered, country show that our health for the prevention and control physically and mentally. Three care providers, teachers, social of HIV-AIDS, particularly in of them tested negative. Some workers, priests and religious areas where the problem has of those tested HIV negative have gained rich and varying come to light. However the are being adopted or will go experiences during their work vast geographical area, the 56 back to either their home or to with HIV-AIDS and related is- huge population, limited re- some relative. Home care and sues. The methodologies and sources, under funded and un- acceptance are the main strate- intervention strategies adopted derstaffed health care sys- gies involved in the care and include: counselling services, tems, the large number of rehabilitation work of the nuns occupational therapy, yoga HIV infected, the increasing in this home. and exercise, awareness, edu- number of AIDS cases, and cation, vocational training, the multifaceted needs of Sneha Bhawan recreational programmes, spir- those affected, have all posed itual care and emotional sup- an almost insurmountable Sneha Bhawan is situated in port. task to the Church in terms of Imphal, the capital of Manipur Many of our institutions are immediate response. Some of in the North-East of India. At also involved in networking the aspects to which the Sneha Bhawan, female drug by organizing support group Church needs to respond im- addicts and those infected for HIV positive people, care mediately are: with HIV are provided with and support group meetings in a) There is a need to evolve care and support. Most of the hospitals, home based care a strong, comprehensive, fea- residents are in the age group teams, decentralized institu- sible and “one common poli- of 15 to 25. Sneha Bhawan tional care, the sharing of in- cy” to confront the HIV-AIDS provides counselling, home formation and the dissemina- problem in the country. At pre- care and other rehabilitation tion of knowledge to people sent various Church bodies services to female clients. Al- from every walk of life. have brought out their own most all the residents were policies. These need to be inte- found to be HIV positive in Some of the limitations grated with a holistic approach this home. or areas that require to include various actors such improvement are: as socially disadvantaged The Holy Redeemer Hospital: groups, women, children, Theni a) Difficulty in finding long- youth, parish community etc. term funding. b) There is a need to evolve The Holy Redeemer Hospi- tal is situated in the South In- dian state of Tamil Nadu. The sisters here are involved in a unique way to spreading HIV- AIDS awareness. Their entry point is through the barber community. Over 200 barbers are associated with the project for spreading HIV-AIDS awareness. Men folk from every home visit barber shops at least once every two months. Therefore it is a sure way of reaching every home through this medium. The HIV-AIDS intervention workable strategies which will References have adequate room for: the CBCI (1992), Health Policy of the sharing of experiences at the Church in India: Guidelines, CBCI, New national, regional, diocesan Delhi, p. 24. and parish level. There is also CBCI (1996), The Response of the Catholic Bishop’s Conference of India to an urgent need to mobilize re- HIV-AIDS, CBCI Centre, New Delhi. sources (for short term and CHAI (1994), Policy on AIDS, The long term projects) in terms of Catholic Hospital Association of India, Secunderabad, p. 2. funds, expertise and infra- CHAI (1999), Proceedings of the Con- structure facilities. sultation of Church Bodies in India on HIV-AIDS, CHAI, Secunderabad. c) For proper implementa- Gangurde, R.P. (1994), Action plan for tion of the policies and strate- Preventing and Controlling AIDS with the gies the Church has to train a Help of University and College Communi- ty (letter D.O. No. F.29-1/93 – NFE-I dat- large contingent of personnel ed March 1994), U.G.C., New Delhi. from among the health care INDERJIT, SABINA (1994), “No to Sex providers, teachers, social Education in School”, T01, New Delhi, 22 September. workers, counsellors etc. LEBEL (Most Rev. Robert Lebel 1988), d) The Church in India needs Summary AIDS: Is there a Catholic Response? (ex- to discuss and make draft plans tracts from the text of an address given by Reports released and pub- His Grace, Bishop of Valleyfield and Vice to meet any eventuality be- President of the Canadian Conference of cause more and more children lished at various national and Catholic Bishops, at the 1988 CHAC An- are becoming orphans, more international conventions indi- nual Convention) Chac Review, Summer cate that among all the nations 1988. HIV positive children are born, MANORAMA (1994), India and the more and more house-wives India has the largest number of States: The Principal Languages (The 57 HIV infected individuals. It is Manorama Year Book), Malayala are getting infected and more Manorama, Kottayam. and more people are reported alleged that India has the dubi- NACO (1998), Country Scenario to be dying of HIV-AIDS. ous distinction of becoming 1997-98, National AIDS Control Orga- the AIDS capital of the 21st nization, Ministry of Health & Family e) It is not enough for the Welfare, Government of India, New Church to project its strong century. The relentless spread Delhi, p. 1. opposition to ‘condom culture of HIV-AIDS in India in re- NACO (1999), AIDS Update (reported cent years has had grave con- to NACO by the 32 States and Union Ter- and safer sex campaigns’ only. ritories every month), NACO, New Delhi, It has to publicise its own sequences for the health and September. strategies, policies, achieve- behaviour pattern of people OUSEPARAMBIL, SEBASTIAN (1999), St. from every walk of life. John’s Experience with AIDS: Achieve- ments and experiences in ments, Failures and Aspirations. (paper working successfully with In the absence of a drug presented at the counsultation of Church which cures and a vaccine for Bodies in India on HIV-AIDS organized HIV infected people across by Catholic Hospital Association of India the country without adopting prevention, education for pre- in New Delhi on 28-29 April 1999). immoral practices. vention is the only effective PANOS DOSSIER (1990), The 3rd Epi- option available to contain the demic-Repercussion of the Fear of AIDS, f) The Church in India and The Panos Institute, London, pp. 5-6. the international Church must further spread of HIV. The SHIV LAL (1993), Preventing AIDS: educate its people not to be Church in India and the CBCI Educating Youth to Protect Themselves Health Commission in particu- from Infections, Swasth Hind (Nov-Dec), carried away by suggestions, Central Health Education Bureau, New arguments and teachings lar have embarked on a mis- Delhi, p. 270. which are opposed to human sion to address the issue SHIV, LAL and DR. SENGUPTA (1995), through the launching of value HIV-AIDS Pandemic: The Indian Context, values, ethics, social justice in AIDS in India, NACO, New Delhi. and which are challenging the based education in spite of its St. John’s Medical College (1997), very fabric of our Catholic limitations, and especially fi- Policy for Management of HIV-AIDS pa- nancial constraints. It is hoped tients, Bangalore, p. 9. community. THOMAS, GRACIOUS & V. RANGA The recently released UN- that the Church in India will (1995), Prevention and Control of AIDS continue its efforts to contain Through Distance Education. In: ‘One AIDS Report of June 1999 World, Many Voices’ (Conference pa- states in page 35-36: the further spread of the AIDS per): 17th World Conference for Distance “Opponents of safe sex virus through value based edu- Education, Birmingham, 26-30 June cation and awareness cam- 1995. campaigns have disseminated THOMAS, GRACIOUS (1996), Concept misinformation about con- paigns. The Church also has to paper on establishment of a ‘Teaching, doms – one of the most effec- engage in introspection with Research and Extension Centre for AIDS regard to its policies, strate- Programme’ at Utkal University (Unpub- tive tools in stopping HIV lished), Bhubaneswar. transmission – alleging that gies, and methodologies adopt- THOMAS, GRACIOUS (1998), “Need for they do not work or actually ed for the implementation of Programme of Study on AIDS and Family various programmes so that Education” in Contemporary Social contribute to the spread of Work, Lucknow University, vol XV HIV. Persistent advocacy is adequate measures can be tak- April, pp. 37-44. en on time to meet any future THOMAS, GRACIOUS (1998), Situation needed to counter unscientific of AIDS in India: Strategies for Preven- arguments and to support eventuality. tion (Thesis for Doctor of Letters), Utkal those governments and institu- University, Bhubaneswar, p. 212. Dr. GRACIOUS THOMAS THOMAS, GRACIOUS and PEREIRA tions who implement best GEORGE (1999), HIV and Pastoral Care, practice”. Has the Church a Programme Coordinator-HIV CBCI Commission for Health, New Del- response to this statement? Is & Family Education hi, p. 76. Indira Gandhi National UNAIDS (1999), The UNAIDS Report it right for us to ignore such Open University – A Joint Response to AIDS, UNAIDS, arguments? New Delhi, India Geneva, Switzerland, p. 16. III. Spain: the Foundation ‘Dimensiò Sida’

1. Introduction establish interaction and real- tal organisations which offer istic policies of co-operation service in the field of AIDS. It The Foundation ‘Dimensiò and aid between countries, has a simple structure and is Sida’ of Barcelona thanks the and in particular with those present in the five continents Spanish Episcopal Confer- which find themselves in es- of the world. ence for having entrusted it pecial difficulty, is more than with the task of representing evident. The International Conference it at this conference on AIDS of the AIDS/NGOs organised by the Pontifical Spain is the European (Paris, 1-4 November 1990) Council for Health Pastoral Country with the Highest Care (the Vatican City, 9-11 Number of Cases From 1-4 December 1990 December 1999). of ‘Full-Blown’AIDS the ‘Second International In order to avoid possible Conference of the Non-Gov- 58 confusions we would like to The situation of cases of ernmental Organisations Of- observe that the Foundation ‘full-blown’ AIDS in Europe fering Service in the Field of ‘Dimensiò Sida’ does not in shows that Spain is the Euro- AIDS’ (AIDS/NGOs) was the least depend upon the pean country with the highest held and its subject was ‘Poli- Spanish Episcopal Confer- number of such cases, indeed cies of Solidarity’. 1,200 peo- ence or upon any other body it has double those of the ple from 80 countries of the of the Catholic Church or up- most hard-hit countries such world took part, of whom a on any other institution. We as Italy and Switzerland and significant number were are a private and civil (non- three times those of France. seropositive or afflicted by ecclesiatical) foundation root- AIDS. ed in Christianity inspiration The work group ‘Religion which is of an inter-denomi- 2. AIDS: a Challenge and AIDS’ drew up a resolu- national character and legally for the Churches tion which was presented to constituted in Spain and Cat- the final assembly and fully alonia. We are simply a non- The Pastoral Care approved by the participants. governmental organisation of the Church in Spain This resolution wanted to be a which provides service in the cry of alarm on the part of the field of AIDS (AIDS/NGO) The Pastoral care of the various religions and reli- with the advantages and the Catholic Church in Spain in gious denominations of the disadvantages that this in- the field of AIDS is principal- world: volves. ly carried out and organised ‘The participants at the in the following way: Second International Confer- AIDS: Three Epidemics 1) Diocesan delegations of ence of Non-Governmental the health care ministry Organisations Offering Ser- We must begin with the fact 2) Diocesan Caritas organi- vice in the Field of AIDS that AIDS covers three dis- sations (AIDS/NGO) on the Subject tinct, albeit interdependent, 3) Religious congregations of ‘Policies of Solidarity’ – epidemics: 4) Religious assistance and believers, Christians of vari- 1) The epidemic of HIV care in hospitals ous Churches, and atheists – (infection) 5) Christians in AIDS- inform the members of these 2) The epidemic of AIDS NGOs Churches and their authori- (opportunistic illnesses) ties: 3) The epidemic of the psy- ICASO 1. That the people who live chological impact and social with the AIDS virus increas- rejection which afflicts those Thanks to the support pro- ingly hope that believers will people who have been struck vided by the World Health help them in their search to by this disease. Organisation (WHO) and the give meaning to their lives It would be a good idea to UNAIDS programme there is and in spiritual accompany- bring to mind the epidemio- in existence an international ing. logical data on HIV-AIDS in body bearing the name of 2. That although they re- the world and to note the seri- ICASO (International Coun- ceive this help they often ous imbalance which exists cil of AIDS Service Organisa- meet with incomprehension, between the so-called devel- tions) which promotes at an distrust and rejection on the oped countries and the devel- international level the volun- part of these Churches. oping countries. The need to tary work of non-governmen- We maintain that AIDS is neither a punishment nor a Barcelona on 7 March 1995. mental importance. We will gift of God, but an illness This is a private and civil outline here the values which which involves: (non-ecclesiastical) founda- guide us and the principal – the possibility of living tion rooted in Christian prin- forms of activity by which we positively in a world struck ciples which works within an seek to foster them and de- by the AIDS virus; inter-denominational frame- fend them. – the possibility of sharing work. resources in a society which Value 1: is fundamentally unequal; Objectives Courage – a challenge for the truth and the spirit; The objectives of the Foun- The pandemic of HIV-AIDS – a challenge for the dation ‘Dimensiò Sida’ are as calls on everybody – and also Churches’. follows: the Catholic Church and other 1. To stimulate the inner religious denominations – to ICAN: The International and spiritual dimension of have the COURAGE to see Christian AIDS Network people who live with the the reality before us in all its AIDS virus, with full respect various aspects and features. The ICAM (the Internation- for their own special path in al Christian AIDS Network) life. Speaking about AIDS is at the present time based in 2. To foster the sensitivity in our Churches Amsterdam and works within and work of the different The wording on a mani- a Christian and ecumenical Churches and religious de- festo on ‘Christians and framework. Non-governmen- nominations with regard to: AIDS’ from France declares tal organisations of different – welcoming people who as follows: ‘AIDS, we can al- 59 countries of the world which are afflicted; so speak about it in our work in the field of AIDS and – the spiritual accompany- churches’ No aspects or fea- have the Gospel message as ing of people afflicted by the ture of this whole question their point of reference be- virus and their relatives and must be extraneous to the long to it. dear ones, if they ask for such Church. accompanying or need it; – solidarity and living to- Value Activities 1 3. The Nature gether between people who The Foundation ‘Dimensiò and Objectives have made different life Sida’ wants to deal with the of the Foundation choices; three faces of the HIV-AIDS ‘Dimensiò Sida’ – the prevention of the in- epidemic with different forms fection. of activity. Some of these re- Having the approach and 3. The gathering together quire great COURAGE on the freedom of an AIDS/NGO and publication of informa- our part. We here outline the and a member of ICAN, the tion and documentation, in two most important forms of Foundation ‘Dimensiò Sida’ particular on the subject of such activity in terms of their of Barcelona will now present spirituality and AIDS, which impact on the public: to this conference held in the can help individuals, groups, 1) The Publication of ‘The Vatican its paper on ‘experi- Churches, and religious de- Church in Catalonia and ences and prospects in the nominations. AIDS’(1997) prevention of HIV/AIDS: ed- 4. The promotion of other The drawing up and publi- ucation in values’. useful activities, above all cation in Catalan of the book with young people, and co- ‘L’Església de Catalunya i la Nature operation with public authori- Sida: Esperiènces, Reflexions ties and non-governmental or- i Propostes’ (‘The Church of The Foundation ‘Dimensiò ganisations (NGOs). Catalonia and AIDS: Experi- Sida’ was established in ences, Reflections, and Pro- posals’). The book is divided 4. The Values into three major parts: and Activities – A REALITY of our time of the Foundation – Some PEOPLE who dis- ‘Dimensiò Sida’ cuss, act and live – Some SERVICES of care, Some of the present-day accompanying and conscious- members of the Foundation ness raising ‘Dimensiò Sida’ have worked 2) The Report which was within various organisations Presented and Discussed in and initiatives connected with the Vatican (1998) HIV-AIDS ever since 1985. The drawing up and the The Foundation ‘Dimensiò publication of the report pre- Sida’ was created in 1995 to sented at the meeting of the bring together the efforts to AIDS Group of the Vatican uphold certain values which (18-19 December 1998) on we believe to be of funda- behalf of the Spanish Episco- pal Conference. This report HIV virus at the Luis Pasteur which are run by members of bears the title: ‘the pastoral Institute of Paris, published male or female religious or- action of the Catholic Church under the title ‘AIDS: the ders, priests, and members of in Spain and HIV-AIDS’. Facts, the Hope’. the lay faithful exist every- The report deals with: This work is divided into where. – Epidemiological and three parts: health care questions – the AIDS virus and its Value 4: – Psychological and social tranmission DRAWING NEAR to those questions – Infection by HIV and its who Live with HIV-AIDS – Pastoral questions and the treatment pastoral action of the Church – Prevention. In the gospels Jesus gives – The Foundation ‘Dimen- 2) The Publication and Dis- us the parable of the Good siò Sida’ tribution of Millions of Copies Samaritan (Lk 10:25-37), a – And has enclosed and ap- The ‘Caixa’ Bank which model and example for the at- pended documents. has a very large number of titude and behaviour to be The Secretary of the Span- branches in Catalonia and adopted towards every mar- ish Episcopal Conference, throughout Spain – and in- ginalised and in-need person. Mons. Asenjo, sent a copy of deed abroad as a well – ac- The first thing which must be this report to all the bishops cepted our work and printed a done is to DRAW NEAR of Spain. Subseqently, the million copies (500,000 in these people wherever they same episcopal conference Catalan and 500,000 in Span- are to be found: ‘But a certain asked us to send a copy of the ish). The publication was dis- Samaritan, who was on his report to the delegates for the tributed free to the customers travels, saw him and took pity 60 health care ministry in every of the bank, to schools, and to at the sight; he went up to him diocese of the country. The youth organisations. The and bound up his wounds, Foundation ‘Dimensiò Sida’ Foundation ‘Dimensiò Sida’, pouring oil and wine into did this with great pleasure like many other NGOs/AIDS, them, and so mounted him and employed notable eco- uses this work in the confer- upon his own beast and nomic means to do so. ences it holds for the purposes brought him to an innn, where of instruction. he took care of him. And next Value 2: day he took out two silver LISTENING to Scientists Listen! pieces, which he gave to the and Professionals Scientists and those who inn-keeper, and said, Take work in the field of research care of him, and on my way Another value which we into, and the treatment and home I will give thee whatev- constantly encourage is that prevention of, HIV-AIDS er else is owing to thee for thy of LISTENING to those who have uttered a cry of alarm: pains’. are expert in matters connect- ‘Listen!’. This is directed to- ed with HIV-AIDS in the wards citizens, associations, John Paul II and those fields of epidemiology, medi- civil and religious institu- Afflicted by HIV-AIDS cine, psychology, sociology, tions, and even the Church, The Holy Father has sup- human rights and so forth. We on the basis of the facts pro- plied us with numerous exam- strive to be aware of the con- vided by science and experi- ples of DRAWING NEAR to stant contributions made by ence which call for a change people who live with this ill- scientists and professionals to in attitudes and forms of be- ness. We remember his pas- the various aspects of this haviour at risk. It is wise to toral visit to the United States pandemic. pay attention to the new sci- of America when he took a We are in permanent con- entific results which are pro- child who was ill with HIV- tact with the World Health duced in this field without AIDS in his arms. Various Organisation (WHO) and locking oneself away in be- male and female religious, with UNAIDS, as well as liefs and attitudes which are priests, and members of the with national and internation- now obsolete. laity dedicate great energy to al organisations. caring for and accompanying Value 3: those who live with HIV- The Activities of Value 2 Scientifically ‘Healthy’ AIDS, and in particular those We would like to draw at- Forms of BEHAVIOUR within society who are most tention to two principal forms (Interdisciplinary Dialogue) in need. They are the authen- of activity connected with this tic personification of the value: In many parts of the world Good Samaritan. 1) ‘AIDS: the Facts, the many citizens and also many In this drawing near the first Hope’ members of the Catholic thing to do is to bind up the Some members of our Church and other Churches wounds, the pain, the feelings Foundation were the promot- have borne, and are still bear- and the wishes of the person ers in 1993 of the translation, ing, great witness through the we draw near to. We need publication, and distribution expression of solidarity and above all else to see and to lis- in Catalan and Spanish of the fraternity towards people who ten. The following words, work of Prof. Luc Montag- live with HIV-AIDS. spoken by a patient to his doc- nier, the discoverer of the Centres for such sufferers tor, are valid for us as well: In order to describe our work eth anniversary of the Univer- The real words of a patient of accompanying we would sal Declaration of Human to his own doctor: like to mention two publica- Rights (Geneva, 10 December tions on people who have died 1948) the Foundation ‘Dimen- Doctor, please, listen to me without judging me, of AIDS. We contributed to the siò Sida’ published its work without evaluating me, production of both publica- book n. 4 (157 pages) which without labelling me. tions because we had accom- bore the title ‘Human Rights Doctor, please, be good with me, panied the people in question and HIV-AIDS’. and be serene. during their personal journey: The organisation of the doc- Doctor, please, in listening to me – Joseph M. Mercader, Se- uments for this publication do not allow my silence to frighten you cret Search was the work of David Xan- and be patient with me: – Joan Ferrer i Sisquella, cho, the co-ordinator of our I will find the moment for my real words AIDS, a Stimulus to Life? Foundation. The publication is when you speak about this body which I do 3) The ‘Proyectos de los made up of three parts and has not know well, Nombres’Memorial accompanying enclosures. whose pains We also work with the asso- The three parts are: often conceal great suffering. ciation ‘Proyecto de los Nom- – General documents on hu- Doctor, please, teach me to experience bres’ which wants to keep man rights and to take my steps in this fruitful journey where you walk at my side, alive the memory of those – Specific documents on where you teach me to accept myself. who have died because of this HIV-AIDS and human rights I want to cure myself, or at least illness. – The resolution of the Cat- to go beyond myself. 4) Guide for the Pastoral alonian Parliament on the pro- Accompanying of People who tection of personal privacy (Dr. Françoise Roday, Live with HIV-AIDS and secrecy with regard to the 61 Docteur s’il vous plait, Ecoutez-moi! Pour une Médicine Rélationnelle, The World Council of results of diagnostic tests for Editions Jouvence, Geneva, 1992). Churches (Geneva) has pub- AIDS. lished in French and English a The accompanying enclo- ‘Guide for the Pastoral Ac- sures are: Activity Value 4 companying of People who – Documents by the United We describe here the four Live with HIV-AIDS’. Our Nations on the history of the principal forms of activity of Foundation has translated this defence of human rights in the the Foundation ‘Dimensiò Si- work into Spanish and Cata- field of HIV-AIDS (New York da’ connected with its drawing lan under the following two and Geneva, 1998). near to people who live with titles: – The message of John Paul HIV-AIDS. – Guia per l’Accompanya- II to commemorate the fiftieth 1) Personal Care and Ac- ment Pastoral de Persones gue anniversary of the Universal companying Viuen amb VIH/Sida (Editorial Declaration of Human Rights The Foundation ‘Dimensiò Claret, Barcelona, 1996). by the United Nations Organi- Sida’ looks after and accompa- – Guia para el Acom- sation (L’Osservatore Ro- nies various people afflicted panamiento Pastoral de Per- mano, n. 51, 18 December by HIV-AIDS, as well as their sonas que Viven con el 1998). family relatives and friends VIH/Sida (Gayata Ediciones, – The Foundation ‘Dimen- when these ask for such an ap- Rubì, Barcelona, 1997). siò Sida’. proach. Some of these sick people are still alive, but other Value 5: Value 6: have since died. Their psycho- Human Rights Religious Reflection: logical needs and their spiritu- (Justice and Solidarity) ‘HIV-AIDS - al and religious worries are the a Sign of the Times’ objects of special attention. We often observe a lack and 2) Publications on People even a violation of human Our Foundation stresses the who have Died from AIDS rights in the treatment of peo- need for greater religious re- ple who live with HIV-AIDS. flection on the question of We should be very careful and HIV-AIDS by all those who concerned about the forms of make up the Church, in terms discrimination which these of its being the ‘people of people have to endure and we God’. The pandemic of HIV- should seek to defend their AIDS is an authentic ‘sign of rights. the contemporary times’. God is speaking to us through this Activities Value 5 harsh and universal reality. He We would like to draw at- invites us to engage in solidar- tention to our publication on ity towards those who are af- ‘Human Rights and HIV- flicted by it and in the preven- AIDS’. tion of the infection so as to The Publication ‘Human prevent its diffusion. For this Rights and HIV-AIDS’ reason we collect documents To mark the celebration on produced by the ecclesiatical 10 December 1998 of the fifti- hierarchy, and at times the thoughts and criticism pro- terises the approach and the ac- Because of AIDS many peo- duced by those who live with tivity of the Foundation ‘Di- ple end up on their own, but this affliction. mensiò Sida’, which is ‘private this malady unites together An- and civil’ in character. glicans, Buddhists, Catholics, Activities Value 6 The document which Jews, Muslims, members of We would like to record achieved the greatest reso- the Orthodox Churches, three publications produced nance at the level of the inter- Protestants, and people of by our Foundation: national press was that issued every creed and persuasion. 1) John Paul II and AIDS by the French bishops (cf Le In 1999 we celebrated the (1987-1997) Monde, 13 February 1996). fourth of these prayer meet- This contains seventeen ings and over a thousand peo- speeches and writings by John Value 7: ple took part. Paul II on AIDS from 1987 to Inter-religious Prayer 1997: two in the United States Value 8: of America, seven in the Vati- The Foundation ‘Dimensiò Spiritual COMMUNICATION can, and eight in Africa (Bu- Sida’ believes deeply in the and AIDS (Web Page) rundi, Madagascar, Malawi, value of both shared and indi- Rwanda, Tanzania and Ugan- vidual prayer. Jesus told us: The Foundation ‘Dimensiò da). The introduction to the ‘Ask, and the gift will come; Sida’ has become specialised dossier is the work of a person seek, and you shall find; in the inner and spiritual ac- who contracted the disease in knock and the door shall be companying of people who 1989 and bears the dedication: opened to you’ (Mt 7:7-8). live with HIV-AIDS and in the ‘to my brother John Paul II ‘And moreover I tell you, that raising of the awareness and 62 from the experience of HIV- if two of you are agree over sensitivity of the spiritual and AIDS’. any request that you make on religious forces with regard to 2) Declaration of the World earth, it will be granted them this pandemic. For this reason, Council of Churches (Geneva, by my Father who is in heav- the Foundation has sought to 1998) en. When two or three are make known, and make avail- Our Foundation translated gathered together in my name, able to all those who ask for it, into Spanish and published the I am there in the midst of the existing material on ‘spiri- ‘Declaration of the World them’ (Mt 18:19-20). tuality and AIDS’. This mater- Council of Churches’, based ial requires communication in Geneva, of 1998. Activities Value 7 and interaction. 3) Bishops and Episcopal We would like to point out Conferences in the World and two forms of activity involv- Activities Value 8 AIDS (1986-1999) ing shared prayer in out Foun- We would like to point out We have also collected and dation: two principal forms of activity published forty-nine docu- 1) Monthly Prayer Meetings in this area: ments on AIDS produced by Every second Thursday of 1) The ‘Spirituality and bishops and episcopal confer- the month we hold a prayer AIDS’ Centre for Documenta- ences of twenty countries meeting for people who live tion and Publications from the five continents of the with HIV-AIDS, for those In appendix 1 we include world. Some documents have who are dead and their friends the publications of our Foun- been published in only one and family relatives. We also dation, which belong to the language and others in two or pray that all members of soci- following five areas: three. The total number of ety will demonstrate a greater 1) Books. documents which have been capacity for non-discrimina- 2) The document ‘The collected, including those pub- tion, respect for human rights, Church and AIDS’. lished in different languages, and fraternal solidarity. 3) Work books. amounts to seventy-six. These monthly encounters 4) The ‘Spirituality and It should be observed that take place in the crypt of the AIDS’ series. we have transcribed all the Basilica of Santa Maria del Pi 5) Memorials of the Foun- documents that we have been in Barcelona at 20.30 and last dation and Projects of Primary able to find in journals, li- for half an hour. From No- Importance. braries and elsewhere. We have vember 1995 until today (De- 2) The ‘Spirituality and not selected or rejected any cember 1999) we have organ- AIDS’Web Page documents bearing on AIDS ised forty-five such meetings. Our Foundation seeks to which have been issued by Usually from thirty to forty help the users of our web page bishops or episcopal confer- people take part. and electronic mail in the fol- ences of the world that have 2) Annual Inter-religious lowing ways: come into our possession. Our Prayer Meeting on AIDS – by gaining access to the work has needed honesty and On every World Day of documents and publications of respect for ‘episcopal colle- AIDS (1 December) since 1996 the Foundation; giality’ and all its various man- we have organised an inter-reli- – by knowing about the ifestations. We have worked gious prayer meeting on AIDS Foundation: with the freedom which is re- at which representatives of var- – by reflecting on the mater- quired in the search for exist- ious Churches and religious de- ial which exists and is avail- ing material and which charac- nominations have taken part. able; – by communicating with the Value 5: HUMAN RIGHTS 5) The documentation cen- Foundation and other users; (justice and solidarity) tre (web page ‘spirituality and – by getting into contact with Value 6: RELIGIOUS RE- AIDS’). other institutions and web FLECTION ‘HIV-AIDS – a pages concerned with the sub- sign of the times’ Conclusion ject of ‘spirituality and AIDS’. Value 7: INTER-RELI- GIOUS PRAYER We would like to finish this Value 8: COMMUNICA- paper by quoting the German 4. Summary TION ‘spirituality and AIDS’ manifesto of the congress on and Conclusion (web page) AIDS which took place in Hamburg in 1992: ‘if we do To summarise this paper we not communicate, AIDS will would like to express the val- Areas of Practical Action win’. This means that if we ues and the areas of practical of the Foundation close our senses and our minds action of the Foundation ‘Di- ‘Dimensiò Sida’ to the complex reality of AIDS mensiò Sida’. and its various aspects and fea- Summary of Values: The chief fields of practical tures, if we do not communi- Value 1: COURAGE in the action of the Foundation ‘Di- cate with people afflicted by face of the HIV-AIDS pan- mensiò Sida’ are: HIV-AIDS and with their envi- demic 1) Pastoral care for, and the ronments, if we do not dia- Value 2: LISTENING to accompanying of, people who logue with scientists and pro- scientists and professionals live with HIV-AIDS. fessionals about the various Value 3: BEHAVIOUR 2) The raising of the aware- forms of prevention and care, which is scientifically ‘healthy’ ness and sensitivity of Church- then AIDS will defeat us. 63 (interdisciplinary dialogue) es and religious denominations. Dr. ANTONI MIRABET Value 4: DRAWING NEAR 3) Shared and inter-reli- President of the Foundation to those who live with HIV- gious prayer. ‘Dimensiò Sida’ AIDS 4) Publications. Spain

IV: Aids and Caritatis Internationalis

HIV has been a reality in all die from treatable conditions tries of the South. our lives for well over a like malaria. Last year the Reduction in life expectan- decade. Now the arrival of WHO estimated that 2 million cies for adults is becoming a combination therapy, despite people lost their lives to stark feature in a number of its limitations, has fundamen- malaria. Death from AIDS last African countries, reversing tally changed our perception year amounted to million 2.5 the health and economic gains of the impact of the virus. Bio- million. So for the first time, of recent decades. This is just medical technology is moving AIDS-related deaths have sur- one more indicator of the dev- at such a pace that HIV is in- passed those from malaria. astating effect of the pandem- creasingly being managed as a A glance at a map of the ic, especially on countries of chronic infection in the North. worldwide picture of HIV as it the South. We have reason to hope where was in December 1997, shows With every passing hour the once we had little reason for the stark reality that the pan- majority of people living with hope. demic is concentrated in coun- the virus, who are to be found However, the widespread in the South, receive propor- provision of combination ther- tionally less and less of the apy in the North highlights in worlds resources spent on a very vivid way the vast HIV-AIDS. UNAIDS esti- chasm between what is avail- mates that less than 10% of able here and what is available expenditure on HIV-AIDS is in the South. The most recent spent on the 95% of the global statistics available from UN- population of people living AIDS (Dec. 1998) show that with HIV in the South. over 47.3 million people have In places like Zambia, been infected with HIV since Malawi, Tanzani and Zimbab- the start of the epidemic and we, the national governments 14 million adults have died are not able to ensure that peo- from HIV related disease. ple living with HIV and AIDS Many people question why get even the most basic drugs there is such a focus on HIV- such as anti-bacterials, anti- AIDS when so many people fungals, anti-diarrhoeals and pain killers. TB incidence has more likely it is that the head risen exponentially in areas of the household is HIV-1 pos- where HIV prevalence is high itive (0.02

Per capita spending Potential per capital on HIV prevention saving from bilateral and care in 1996 debt relief (as of 1997) Zambia $ 0.73 $ 10.73 Kenya $ 0.76 $ 5.24 Nigeria $ 0.03 $ 1.69 Uganda $ 1.81 $ 3.66

Source: Paper by Jonathan Simon Harvard Institute for International Development, presented at 11th ICASA Conference, Lusaka, September 1999. Uganda, whose national Catholic Church-sponsored sist the Confederation in ful- campaign against AIDS has humanitarian assistance and filling the 1999-2003 Confed- succeeded in reducing the HIV development organisations eration Work Plan, which once prevalence rate among first included HIV-AIDS ac- again identifled HIV-AIDS as teenagers from nearly 28% in tivities among its programme a priority theme for reflection 1992 to just 10% in 1996, has priorities at its 1987 General and action. The Task Force is not invested more in control- Assembly. Since that time, the closely linked to the CI Liai- ling the epidemic than could be Confederation has mobilised a son Agency for HIV-AIDS, released to most other Sub-Sa- response to HIV-AIDS in CAFOD, and has been haran countries through bilater- keeping with its overall mis- charged by the CI Secretary al debt relief. sion of Animation, Co-ordina- General to co-ordinate the As we add our voices to the tion, and Representation and Confederation’s activities in Jubilee 2000 Campaign calling has engaged in such activities this field. CAFOD, which is for debt relief for the poorest as the following: the Caritas member organisa- countries (among which can be – Sponsored regional, nation for England and Wales, counted some of those hardest tional, and local consultations has served as the Caritas Liai- hit by the AIDS pandemic) we on HIV-AIDS to assist Church son Agency for HIV-AIDS ac- also dare to hope. leaders as well as those en- tivities since 1987. Thus the As Christians we are fre- gaged in the Church’s educa- Task Force provides to the Li- quently confronted with the tional, socio-pastoral, health aison Agency a reference point question where is God in all of care and spiritual services to and forum in which to discuss this? I am reminded of a story attend to those affected by and report on its coordination that Rev. Enda McDonagh, the HIV-AIDS within their own activities. The Director of the 70 Irish moral theologian and con- respective apostolates; Liaison Agency CAFOD, Mr sultant to the Caritas lnterna- – Raised funds to support Julian Filochowski, and Rev. tionalis AIDS Task Force, tells national and local educational Robert Vitillo were re-appoint- when reflecting on this. Enda and service efforts; ed co-chairpersons of the Task recalls an account of how, in a – Organised theological Force following the CI general concentration camp in Nazi consultations on HIV-AIDS in assembly in June this year. Germany three Jewish prison- Africa, Asia, Europe, and The current Task Force has ers, two men and a boy, were to North America; been given the following man- be executed by public hanging – Served in a representation date: for some minor misdemeanour. role at the United Nations and To assist the Caritas Interna- All the other prisoners were in other international fora; tionalis (CI) Confederation in marched out to watch the hang- – Formed an international maintaining priority attention ing. The two men died quickly Working Group on HIV-AIDS to the HIV-AIDS pandemic but the boy, being lighter, had a (between 1988-1995) and a within the activities of its slow and painful death and Task Force on HIV-AIDS member organisations and hung still struggling and chok- (1995-2003) to monitor the within other relevant organisa- ing as the prisoners were made spread of the pandemic; to mo- tions and structures of the to parade past him and return to tivate the most comprehensive Catholic Church. their barracks. One of the pris- response possible by Caritas oners angrily shouted out Internationalis member organi- Objectives “where is your God now?” to sations and other Church-relat- 1) To share information which another solemnly replied ed organisations; and to share within the Task Force and the “Our God is there, hanging on experience across the conti- Caritas Confederation on the the gallows”. nents. status of the pandemic in rela- In this time of AIDS we must The present, and fourth, CI tion to the medical, pastoral, denounce those who claim the AIDS Task Force was recon- spiritual, social and develop- pandemic is the punishment of stituted in July 1999 by the mental issues raised. an angry God. They do not Secretary General of Cl to as- 2) To support theological re- know the Jesus of the Gospels. flection on the issues and Only in as much as we align problems raised as a result of ourselves with the God “hang- the HIV-AIDS pandemic. ing on the gallows”, only in as 3) To encourage the Caritas much as we embrace and pro- Confederation to deepen or claim God present in those in- initiate action in response to fected and affected by HIV, can people affected by HIV-AIDS we be bold enough to dare to in the local context. hope. 4) To network on behalf or Caritas Internationalis with Catholic and other organisa- Background information tions, including UNAIDS, in order to ensure an adequate re- Introduction sponse to those affected by HIV-AIDS. Caritas Internationalis (CI), 5) To build on the momen- the global confederation of tum of the CI/CISDE Confer- ence on HIV and TB so as to with Caritas, CIDSE, and other ensure that the lessons learnt international Catholic organi- are disseminated and incorpo- sations to sponsor a Seminar rated into the activities of the on Sustainable Health Care in Confederation. the Netherlands in October Since 1987 the CI Confeder- 1995. ation has dedicated much energy and expertise to conscious- 3. Conference on Tubercolosis ness-raising among Church (TB) and HIV-AIDS leaders and other Church Tuberculosis has been de- workers. Some of the publica- clared a global health emer- tions produced under the aus- gency by the World Health Or- pices of the Task Force are: ganisation (WHO). In re- The Caritas Training Manual sponse to this dire situation, on the Pandemic of HIV-AIDS the CI Task Force on HIV- (1994); Proceedings of the AIDS joined with other CI/CISDE Workshop on Sus- Church-related health and so- tainable Health Care (1995); These workshops included: cial service organisations to The Church Responds to HIV- sponsor a Conference on Tu- AIDS (1996); AIDS, Emergen- 1. Follow-up Consultation berculosis and HIV-AIDS in za Planetaria (AIDS: A Plane- in the Asia/Pacific Region Würzburg, Germany, from 8- tary Emergency) (1997). In ad- With the help of the Caritas 12 March 1999. The aim of dition CAFOD has undertaken Internationalis Task Force on the Conference was to bring several participatory evalua- HIV-AIDS and CAFOD, rep- about an improved response 71 tions of Home-Base Care Pro- resentatives of 12 Asia/Pacific from CI/CIDSE organisations grammes in Kenya, Uganda countries, as well as col- in relation to HIV and TB, to and Brazil. More recently leagues from Europe and strengthen appropriate struc- CAFOD conducted a study on North America, gathered to tures, to ensure that operations Behaviour Change entitled: share experiences of Catholic are more cost-effective, ethi- Safety Through the Night Church-sponsored HIV-AIDS cally appropriate, and atten- (1998) in collaboration with services from 2-6 February, tive to scientific evidence. partners in Malawi, Tanzania, 1998, in Manila, Philippines. Zimbabwe and Zambia and The local host organisation 4. Theological Consultations produced a report on access to was Caritas Manila. on HIV-AIDS treatment and care entitled: In an effort to encourage ad- Valuing Life (1999) which is 2. Workshop on ditional theological reflection based on partners’ experiences Sustainable Health Care on the social justice implica- in Zambia. As a result of their engage- tions of the HIV-AIDS pan- CI has reached out to ment in HIV-AIDS education demic, Caritas Internationalis Church leaders and pastoral and services, the member or- joined with other Church-re- workers by means of sponsor- ganisations of Caritas Interna- lated organisations in inviting ing or participating in HIV- tionalis have witnessed the sig- theologians to learn more AIDS training workshops in nificant impact of HIV-AIDS about this global phenomenon. many part of the world. In the on Church-sponsored health In addition theologians were workshops, members of care services in countries of the invited to share theological in- CAFOD staff and of the CI South. It was noted that the sights on the most appropriate Task Force on HIV-AIDS lack of health care infrastruc- response both by the Church have served as presenters and ture in such countries was one and by the global family of hu- facilitators. During the years of the root causes of the rapid mankind. During 1995-1999 1995-1999, such programmes spread of HIV-AIDS among these consultations were held were made available in many the most poor and vulnerable in France (for Francophone parts of the world, including populations. Thus the CI Task Europe and Africa) and in the following: Force on HIV-AIDS joined Southern Africa.

AFRICA Benin¸ Burkina Faso, Burundi, CI and UNAIDS Cameroon, Congo, Congo-Brazzaville, Côte d’Ivoire, Ethiopia, Ghana, Lesotho, Madagascar, Malawi, Mali, Since 1987, Caritas Interna- Niger, South Africa, Sudan, Swaziland, tionalis has undertaken advo- Tanzania, Togo, Uganda, Zambia, cacy at the global and national Zimbabwe levels, with both national governments and inter-govern- ASIA Burma/Myanmar, India, Korea, mental organisations, on is- The Philippines, Thailand sues of concern to those affected by HIV-AIDS. On 7 EUROPE Lithania, Poland January 1999, Caritas Interna- tionalis signed a Memoran- LATIN AMERICA - CARIBBEAN Dominican Republic, Peru dum of Understanding with the Joint United Nations Pro- by other organisations with the world agenda, to ensure gramme on HIV-AIDS (UN- Caritas Internationalis. that the human rights of peo- AIDS). CI’s then Secretary – Policy development: in ple living with the virus are General, Mr Luc Trouillard, order to reduce the discrimi- respected and to inform poli- and the Executive Director of nation and stigma associated cy-makes. Caritas Interna- UNAIDS, Dr Peter Piot, joint- with HIV and to strengthen tionalis and UNAIDS will re- ly signed the Memorandum to community approaches to inforce public information ac- foster co-operation on a re- care, Caritas Internationalis tivities on HIV-AIDS as ap- sponse to HIV-AIDS at the lo- and UNAIDS will share expe- propriate and will strive to cal national, and international riences on the development of maintain the highest ethical levels. HIV-related policies on hu- standards. The agreement specified the man rights, gender issues, cul- following areas of coopera- ture, ethics and law, and their H.E. Mons. FOUAD T. EL-HAGE tion: dissemination in the private Maronite Archbishop of Tripoli – Access to care: in order to and public sector, including President of address the needs of people Church networks, the work- “Caritas Internationalis” living with HIV-AIDS, UN- place, among professional as- AIDS will work with Caritas sociations, youth organisa- Internationalis to document its tions and government agen- experience in the area of care cies, taking into account their Note as an example of best practice differing perspectives. 1 (1998) Safety Through the Night: A which could be used by other – Public information: HIV- Report of the Thematic Review carried organisations in creating and AIDS prevention needs accu- out by CAFOD and Four Partner Or- 72 strengthening their own pro- rate and timely information to ganisations between October 1997 and October 1998 on Behaviour Change in grammes. UNAIDS will also motivate responsible behav- the Context of HIV and AIDS (CAFOD, share best practice developed iour, to keep HIV-AIDS on London).

V: AIDS in Africa

Introduction The treatment of this dis- How can we strengthen this ease requires the professional system? For two decades a terrible skills and expertise of various The experience which we and fearful epidemic has af- categories of professionals: have gained in Africa and oth- flicted millions of people in medical doctors, biologists, er continents, thanks to the ex- the world regardless of race, researchers, socio-anthropolo- change of experiences, allows ethnic group, socio-profes- gists, psychologists, members us to focus this paper on the sional condition, sex or age. of religious orders, communi- African continent. No infection has ever be- ties, and so forth. fore mobilised so many re- During this paper I will dis- searchers of every kind, and cuss: Objectives so many financial resources. – the present-day situation In Sub-Saharan Africa, with reference to specific 1. To guide the questions where there already existed groups; and issues connected with serious difficulties with regard – the current existing sys- AIDS according to the papal to securing the health of the tem to deal with this epidemic Magisterium. population, AIDS then arrived and the relationship between 2. To co-ordinate the move- to make this bad situation this system and the response ments and groups of the even worse. of the Catholic Church at the Catholic Church which work Poverty worsens the life level of: in the field of HIV-AIDS. conditions of the populations – national countries; 3. To promote help to of this continent: – the international commu- seropositive people and those – the inability on the part of nity. who have AIDS. most of the population to gain access even to essential medi- Some Epidemiological Data on AIDS in the World cines; and in Africa in Particular – the inability to achieve Average Incidence Incidence good nutrition; amongst Adults – bad conditions of hy- Southern Africa 17% 22.7%-27.0% giene; Eastern Africa 9.6% 3.2%-14.5% Central Africa 4.3% 0.1%-11.1% – a lack of health care edu- Western Africa 2.4% 0.5%-10.1% cation. Strategies of Prevention – young people (boys and men and women. Today of girls); every twenty Africans infected Transmission by blood – women; by the virus, twelve to thirteen – couples; of them are women. – To ensure that systems of – men. At the end of 1999 12.2 blood transfusion are safe ac- Young people are the catego- women and 10.1 men between cording to established stan- ry which is most afflicted by the ages of nineteen and dards in all countries through- HIV and the incidence of the forty-nine were seropositive in out the world (both in industri- virus in this category is 27%. Sub-Saharan Africa. alised countries as well as in We should strengthen the edu- – A high level of illiteracy; developing countries). cation of young people with re- – the socio-cultural factors – To combat traditional prac- spect to the following specific prevent women from advanc- tices which use cutting instru- subjects: ing and engaging in deci- ments (excision, scarring, tat- – the reproductive health of sion-making. toos). young people; Women are subordinated to – To ensure the sterilisation – those who suffer from this men, economically weak (de- of medical materials. disease (MST-AIDS); pendence, the need to give of – To promote the use of – pregnancies at an early age; themselves in order to meet throw-away material. – sexual abuse at an early their needs), divorce, separa- – To ensure the provision of age; tion. equipment or other material – sexual relations at an early which is needed to prevent age. What Exists in these transmission through profes- The education of young Structures to Help Women? sional error. people must be carried out in Education and development 73 primary schools, secondary projects should be engaged in Sexual Transmission schools (menstruation, sexual- to give women greater opportu- ity), universities, and the fami- nities because they play a very – To encourage voluntary ly (the strengthening of moral important role in the family identification of the disease be- and family values through unit: fore engaging in any relation- communication). – they educate children; ship (marriage, living together) – they take care of their chil- with a view to procreation. dren and husbands; – Faithfulness. What Structures Presently – they look after the house – Abstinence. Exist within the Catholic and the hygiene of the home. – Sexual education within a Church to Strengthen these How can the Catholic religious context. Strategies of Prevention? Church help them through its – The teaching of the moral existing structures? Are there values of respect for the human – Scout movements; centres for listening and sup- body and of the meaning of – the CVAV (courageous port for women who have no fi- love. souls, courageous hearts); nancial support or are abused? – To include an AIDS unit in – charismatic renewal; How can the religious move- the programme for the teaching – youth organisations ments take up present-day of the catechesis. (Catholic students); questions and integrate them in- – the Legion of Mary; to their activities? Transmission through – the Rosary Group; At a national level there are the Maternal Womb – all congregations; groups of young people en- – the lay faithful and the cat- gaged in co-operatives for – To propose the voluntary echists; women, and these could be tak- identification of HIV prior to – the Association of Christ- en as a model for action. marriage. ian Families; – To propose the voluntary – the Association of Catholic Men identification of HIV in prena- Leaders; tal counselling. – the Justice and Peace Com- Sexually transmitted diseases – To ensure the treatment of mission. manifest themselves clinically sieropositive pregnant women Discussion and debates on very early on in men. Hence the in order to reduce the incidence specific subjects could also be need for awareness-raising to of transmission of the virus held: achieve an early interest in from mother to child. – during holy mass; treatment. Education amongst – after holy mass; men should try to change forms – during the catechesis of behaviour: What Can be the Role lessons for young people; – to abstain from extra-mari- of the Catholic Church – etc. tal sexual relations; in the Strategies – to provide education on for the Prevention of AIDS? Women sexual abuse; – to promote communication The initiatives must be di- At the beginning of the epi- within the couple (the involve- rected towards certain specific demic the people infected bal- ment of men in women’s groups such as: anced roughly equally between movements); – the strengthening of moral Accompanying the Sick – some patients ask to be and family values; Person who has AIDS baptised; – the use of the system of the – preparation for, and ac- confession to engage in coun- What does the international ceptance of, death. selling and psycho-social sup- community do to look after What exists at the level of port. people with HIV-AIDS? the Catholic Church which we Organisations such as the can strengthen? Catholic The Couple WHO, the PNUD, UNICEF, health care structures must: FNUAP, the World Bank, and – ensure the early identifica- – Awareness-raising and ed- the European Union have cre- tion of symptoms: ucation to ensure respect and ated a programme – UNAIDS – supply treatment at an ear- faithfulness within the couple; – to think about questions and ly stage, if possible; – dealing with these various issues connected with the field – send those infected to the questions during preparation of AIDS. most specialised structures; for marriage; However, the World Health – ensure the training and ed- – some Christian movements Organisation continues to be ucation of professionals; must seize the opportunity of- the organisation which acts to – involve the family in the fered by AIDS to organise dis- provide technical support in the care and treatment of the pa- cussions on this pandemic in implementation of initiatives tient; order to encourage the avoid- directed towards seropositive – ensure the education of ance of extra-marital sexual re- people or people afflicted by the community with regard to lations and other forms of be- AIDS. health care questions (What haviour which can damage the Policy towards these sick should be done? Where should 74 institution of marriage. people is very delicate be- we go? Notices? Posters?); cause the psycho-social prob- – open up a VCT service; lems involved are of distinct – help patients at the termi- The Socio-Economic Impact relevance and importance. nal stage of their lives to make In order to deal with the a will; – A diminution in life ex- psycho-social question an ap- – allow the partners of those pectancy. proach has been developed suffering from AIDS to take – Absenteeism: through counselling, and there the test and provide them with - the employee afflicted by should be support groups in post-test counselling and psy- HIV-AIDS is forced to often schools, companies and com- cho-social support. absent himself from work for munities in order to ensure so- repeated periods of rest after cial integration. clinical manifestations of the With regard to forms of Conclusion disease. treatment, there are treatment – A diminution in productivi- services for patients with The pandemic of AIDS in- ty and performance. HIV-AIDS within the existing volves all of us. The involve- – A diminution in the human structures. ment of the members of reli- index: In order to avoid long stays gious orders through the influ- - The employee who is ill in hospital by these sick peo- ence of the teaching of moral with AIDS at a certain point be- ple, in some African countries values to the young is very im- comes unable to make his own home-based treatment pro- portant in achieving changes contribution: grammes have been developed in forms of behaviour. - dismissal or early retire- which involve special kits. Indeed, the age band which ment: The patients turn to the health is most afflicted by this - following repeated ab- care structures whose profes- scourge is that of young peo- sences the employer often has sionals have been trained to ple and adults between the to engage in the dismissal or this end. ages of fifteen and forty-nine. early retirement of his em- To ensure the comfort of the This age band is exposed to ployee; patient: forms of behaviour at risk - the consequences of the – single and pleasant single such as sexual activity at an payments made to employees; rooms; early age, different partners, - the cost of treatment is very – clean clothes and sheets, the use of drugs involving the high, the health care budget. good hygiene; exchange of syringes, and all – Consequences for the fami- – assistance. the rest. ly: To fight against pain: Education and teaching with - the inability to meet the – the administration of respect to attitudes which are needs of the family; a decrease strong pain-killers against the damaging to life must be the in monthly income; pain. central weapons used by - falling into poverty (pau- To ensure psychological members of religious orders in perisation); support: order to ensure that young - psychological problems: – listening to the sick per- people remain healthy. • abandonment; son; Dr. J. AGNESS-SOUMAHORO • dependence; – affection; Regional Chief for HIV-AIDS Care • depression; – readiness to help. Regional Office for Africa • AIDS orphans. To provide spiritual support: Ivory Coast SECTION II ACCOMPANYING Papers in the Programme “Assistance and people with HIV-AIDS”

I: Health Care Aspects

75 Of the many health care as- always at the moment of birth childbirth), much lower costs, pects which have characterised and for this reason it is possible and an effectiveness in terms of the AIDS epidemic over recent to reduce the incidence of the prevention similar or superior to years it seems to me important infection of new born babies that provided by AZT. A large to draw attention to some of thanks to anti-viral therapies number of international agen- those which, because of their during the last months of preg- cies, governments and NGOs impact on public health or the nancy and at the time of child- are organising themselves to health of individuals, are of es- birth. For some years, in fact, promote pilot projects or active pecial relevance. treatment protocols during measures to extend the use of pregnancy for women who are this new and promising system HIV positive and for the baby of treatment as much as possi- 1. The Prevention of have been established which re- ble. Transmission through duce the transmission of the in- the Maternal Foetus fection through the maternal foetus. These forms of treat- 2. The HIV-Tuberculosis This subject is one of the ment, which so far have been Co-Infection most topical for a whole variety based upon the use of AZT (the of reasons but above all else be- first widely used anti-retroviral The epidemic of HIV has ag- cause of the scale of the prob- drug), have allowed a very sub- gravated the problem of tuber- lem and because of recent en- stantial reduction in the number culosis over recent years. This couraging prospects which have of babies who are infected dur- disease was already serious in been opened up in the field of ing pregnancy and at the time of all countries of the world but it prevention. As regards the scale birth. A reduction of the rate of was (once again) especially se- of the problem, it has been cal- infection from 20-30% to less rious in the south of the planet culated that last year 600,000 than 10% has been estimated in and in particular in Africa. It is children were born who had the various studies. However, these calculated that in 1999 there infection because their mothers brilliant results have only been were about 2.5 million deaths were infected. The great majori- achieved in industrialised coun- from AIDS of which at least ty of these children were born in tries because of the high costs 30% were caused directly by Africa where the problems con- and the organisational difficul- tuberculosis. It has now been nected with poverty, malnutri- ties involved in such treatment. scientifically demonstrated that tion, very bad conditions of hy- Where, in contrary fashion, the the HIV infection encourages giene, and socio-political disor- need for action is greatest – in the acquisition of a tubercular der make any preventive ap- the African countries – the eco- infection or the clinical advance proach vastly more complicated nomic constraints and the lack of a latent tubercular infection. than in industrialised countries. of effective health care net- In addition, the presence of tu- It should be remembered that works have obstructed the berculosis accelerates the ad- every child who is born infected widespread use of this measure vance of the HIV infection is also destined to become an of prevention. Recently some which means that a relationship orphan within a very short peri- signs of hope have come from of negative reinforcement is es- od of time. Indeed, the problem studies carried out with another tablished by the two infections. of AIDS orphans has taken on anti-retroviral – nevirapine. In patients with AIDS, tubercu- dramatic proportions in Africa. This involves a much more sim- losis can develop clinically and A great deal of research has ple system of treatment (a sin- radiologically in atypical forms, demonstrated that a child be- gle dose administered to the something which means that comes infected with HIV nearly mother and the baby during there are greater difficulties in diagnosis and possible delays in was the creation of new and cessible in terms of costs and beginning treatment. This fact more potent anti-retroviral thus this is one of the fields has important repercussions drugs, and in particular the pro- where we should concentrate with regard to public health. It tease inhibitors (saquinavir, ri- our efforts in terms of future is known that the most impor- tonavir, indinavir, nelfinavir) planning. Furthermore, it has tant factor in the epidemiologi- and the non-nucleosidic in- been demonstrated that the pre- cal control of tuberculosis is the hibitors of the reverse transcrip- vention of opportunistic infec- rapid recognition and treatment tase (nevirapine, efavirenz). tions, even in the absence of an- of people who have it – a delay These drugs, when used in conti-retroviral therapy, can im- in diagnosis leads to an increase junction with the more classic prove the possibilities of sur- in the period of possible conta- nucleosidic inhibitors of the re- vival and quality of life, and region and as a result a more ef- verse transcriptase (zidovudine, duce the number of people ad- fective diffusion of the infec- didanosine, zalcitabine, stavu- mitted to hospital. tion. Another important phe- dine, lamivudine) have given nomenon linked to the increase rise to spectacular improve- in cases of tuberculosis is that ments in patients in an advanced 5. Treatment of the resistance of the my- state of the illness and the im- with Pain-Killers cobacterium tuberculosis (the munological and clinical stabili- bacillus responsible for the ill- sation of patients in the interme- Those who take care of peo- ness) to the most powerful diate stages of the infection. Of ple with AIDS have before them anti-tubercular drugs. It is esti- course this is not a definitive so- individuals with a terminal mated that about 2% of the lution, primarily because a real prognosis who will die in a strains are resistant but this per- elimination of the infection has rather short time. For this rea- 76 centage figure is bound to in- not been encountered in any pa- son it is important for the prin- crease. This resistance to drugs tient so far. It should also be ob- ciples of palliative medicine to is influenced by various factors, served that the systems of treat- be applied on a broad front. the most important of which is ment are complicated and are This is a branch of medicine the accuracy with which the applied without a time limit, are which is concerned more with long and complex systems of administered in a specialised en- removing the consequences of treatment are administered. An vironment, and are not without an illness than its causes. In par- effective anti-tubercular thera- side-effects which at times are ticular, much attention should py is effected with various very serious. The principal diffi- be paid to the treatment of pain drugs administered together for culty of these new diagnostic and the other symptoms which at least six months. It is clear and therapeutic approaches is inevitably accompany the pa- that where the health care struc- that of the costs involved – they tient suffering from AIDS who tures are not efficient or the are already very high in the in- is in an advanced stage of the costs cannot be met the risks of dustrialised countries which illness. We must increase our incongruous or overly brief have a high pro capita income efforts to accompany the patient forms of treatment are very and so for poor countries they on his path to a dignified death high, and for this reason the are absolutely prohibitive. Un- and avoid isolation from the probability that resistant strains fortunately, there is no real pos- family and the health care become selected increases. sibility of these new diagnostic workers. We must improve the methods and forms of treatment quality of the life which is left being applied on a vast scale. and avoid forms of treatment 3. The Development This must make us reflect fur- which are useless and heavy for of Diagnostic Techniques ther on the crucial importance of the patient in a context where and the Appearance programmes of prevention in re- there are no reasonable of Powerful New lation to the HIV infection. prospects for improvement. Anti-Retroviral Drugs Dr. MASSIMO FANTONI, In the mid-1990s two impor- 4. The Diagnosis and The University of the Sacred Heart, tant advances were made in Treatment of the Principal Rome. treating patients infected with Opportunistic Infections HIV. The first was the possibility, through sophisticated tech- In recent years there have niques of molecular biology, of been decisive steps forward in measuring the quantity of viral the treatment of the principal genome in the blood and there- opportunistic infections. The fore indirectly the self-reproduc- drugs which have been used ing power of the virus in the in- since the emergence of the epi- dividual patient. This is an demic remain substantially ef- analysis which, when carried fective, such as, for example, out in conjunction with the more cotrimoxazol for pneumonia classical dosage of the CD4+ caused by pneumocystis carinii, lymphocytes, enables us to as- pirimetamine and sulfadiazine sess and monitor the ‘activity’ of for cerebral toxoplasmosis, or the infection, its development, the azoles for fungine infec- and even to produce possible re- tions. The prevention and treat- sponses in terms of treatment. ment of the principal oppor- The other important advance tunistic infections is often ac- II: The Transmission of AIDS through the Maternal Foetus: New Possibilities in the Field of Prevention

The epidemic of HIV – the United States of America, but To summarise, the scientific virus that brings about AIDS – little has been done for Sub-Sa- proof that just one pill given has not halted. Indeed, it contin- haran Africa where at the pre- just once can reduce the fright- ues to spread throughout the sent time over 70% of the peo- ening number of six hundred world. The recent calculations ple in the world infected by thousand new cases of infection of the World Health Organisa- HIV live. each year by almost a half ur- tion refer to 33.6 million people A very important research ar- gently requires the creation of infected by HIV in the world, ticle was published at the end of new strategies of prevention in and estimate that five million 1999 in the most important Eu- all developing countries. adults and 600,000 children ropean medical review The A very practical considera- were infected last year. Last Lancet (L.Guay, The Lancet, tion leads us to recognise that if year, also, 2.6 million people 1999, 354, pp. 795-802). It ob- it were possible to apply this died from the disease bringing served that even very brief treatment to the roughly two the total number of deaths treatment of mothers at the mo- million children who are born caused by AIDS to 16.3 million ment of birth and of babies in every year in the world to individuals. the first hours of life is more ef- women infected with HIV, the There are in substantial terms fective than those more lengthy total cost of this drug would be 77 three ways by which the disease and more expensive forms of about 8 million American dol- can be transmitted: by haematic treatment which have hitherto lars, a truly irrelevant figure if sexual means, through infected been available in the richest one thinks of the social and hu- blood, and through the maternal countries of the world. In practi- man cost of this disease which foetus, that is to say from an in- cal terms, a single pill of the could probably be prevented in fected mother to her child. strong anti-retroviral nevirapine at least 300,000 children. The In recent years a great deal of (whose commercial name is Vi- capillary organisation of the dis- research has brought out the ramune) given at the moment of tribution of this drug and the fact that a child becomes infect- birth to the mother and to the training of health care workers ed by HIV nearly always at the child is sufficient to reduce the is a much more difficult ques- moment of birth. For this reason chances of the HIV virus being tion. Experience shows us, in it is possible to reduce the prob- transmitted by a figure of 47%. fact, that even the easiest and ability that the newly-born child The advantages of this treat- least expensive to treat maladies will be infected through the use ment are manifold and they are (such as diarrhoea or measles) of anti-viral drugs during the fi- rooted in the simplicity of the are not treated because of fail- nal months of the pregnancy. treatment: one single dose being ings at the level of organisation In recent years the proof that given to the mother and the and disinformation. treatment with AZT (whose child (at the very low cost of An initiative involving the commercial name is Retrovir) is about $4 in all) and at a time Holy See and the United Na- able to reduce the number of in- (birth) when most women are in tions (UNAIDS) as the promot- fections in babies has led in the hospital or are being cared for ers of activity designed to plan West to the extensive treatment by health care or semi-health really incisive forms of action of mothers infected with HIV, care personnel. in relation to the health of ba- and this in turn has led to a sig- Studies on the ‘cost-benefit’ bies has great possibilities of nificant reduction in new cases ratio of this treatment confirm bearing fruit as a result of the in babies. In the United States its very high advantages (E. union of the great organisational of America between 1992 and Marseille, The Lancet, 1999, abilities of UNAIDS and the 1997 there was a reduction of 354, pp. 803-809). capillary and motivated pres- up to 80% in the infection by At an international scientific ence of the Catholic Church at HIV of babies. The same took level there is a very great the level of institutions and on place in those European nations awareness of the social and the ground. which employed the same pre- public health possibilities of this A meeting to define the re- ventive forms of treatment. research and the United Nations spective spheres of interest and The caesarean operation also (UNAIDS) has displayed great action, and the human, organi- involves a reduction in the risks interest in the promotion of, and sational and financial resources run by new born children of be- support for, projects involving available, is something which is coming infected by HIV. Euro- prevention at the level of mater- much to be welcomed. pean studies on populations nal foetus transmission. which use such precautions in- There are still a great many Dr. MASSIMO FANTONI The Catholic University dicate that the risk run by new- problems to solve, such as that of the Sacred Heart, ly-born children is reduced to a of breast feeding which is also a Rome, few percentage points. source of contagion, or the ill- Dr. GUIDO CASTELLI These systems of treatment ness of the mother and the fate GATTINARA, and prevention have significant- of the orphans who, however, if The Paediatric Hospital ly reduced the number of infect- they are not infected, have bet- of the Baby Jesus, ed babies in Europe and the ter life possibilities. Rome III: Psychological Aspects

Introduction liefs which can develop into a thing which stigmatises them delirious framework, even both in terms of their life choic- AIDS is characterised in the though clinical symptomolo- es and their membership of a collective imagination as being gies are absent. transgressive and amoral group a ‘social catastrophe’, a ‘blame- Although recent investiga- which is seen as being poten- worthy disease’ which is full of tions have observed a marked tially infected and infectious.10 unconscious symbolisms: it is increase in infection amongst An important element to be contagious, involves preju- heterosexuals,7 which is caused, considered is the psychological dices, and leads to discrimina- at least in Western countries, by problems which arise in their tion. It is incurable and fatal, models of life-identity which relationship with their seroposi- and is associated with deviant, are increasingly proposed and tive partners. These are even transgressive and amoral forms spread by the mass media and more relevant and upsetting in of lifestyle.1 which are directed towards the the case of people who have For this reason it unleashes a liberalisation of habits and been infected accidentally and pathophobic, emotional, social practices marked by a tendency who live out their lives with reaction,2 of a psychologically towards the exaltation of trans- ‘responsibility’.11 78 defensive, ambivalent and con- gression, it nonetheless should This leads to situations of tradictory character. This tends not be forgotten that infection anxiety and fear about a possi- to distance the moral anti-value by HIV particularly hits people ble past or future infection, of the illness and to justify and with lifestyles and life histories something that gives rise to legitimise the ‘ghettoisation’ of which bear a high risk of infec- profound changes in the nature people suffering from it, for tion, such as drug-addicts and of the couple’s relationship. It is whom actions of solidarity, homosexuals.8 deprived of its day to day di- support and care – having to The causes which bring mension. This relationship can take into account both the right about the difficulties they have be subjected to ‘fracture’ or to to individual freedom and pro- to encounter are well-known: the maintenance of the bond, grammes of protection and pre- suffice to say here that the os- with an awareness of the risks vention of society as a whole3 – cillation in the personality of involved and the sharing of are actions which are still very these people goes from a seri- markedly depressive responsi- far from being fair, co-ordinat- ous psychological dysfunction bilities as if nothing in life mated, effective and ethical. to a more suitable psycho-so- tered any more. Or a choice is cial maturity.9 made in favour of abstinence The personalities of drug-ad- from sexual relations in the A Moment of Diagnosis dicts, because of their psycho- form of a withdrawal of the li- and a Person’s Life Changes logical vulnerability, the imma- bido from an objective invest- turity of their characters, their ment which runs high risks. However much the role of low capacity to tolerate frustra- However, this leads to the ex- information-giving on the part tions, and their spiritual alien- haustion of the relationship in a of health care workers to out- ation, tend to deny the serious- very short space of time. line the different stages of the ness of the illness and the risk Given what has been said so illness is extensive, becoming of infection and to place trust in far in this paper, it is very evi- aware of his own state of infec- the ability of their bodies to re- dent how important and neces- tion involves the patient in a act and respond to it. For these sary it is to invest in action in- state of anxiety which is so reasons, they are difficult med- volving the promotion of pre- great that it becomes a sort of ical subjects who are not very vention. This involves both pro- paralysing stress. This under- receptive to programmes of viding suitable information and mines the plans a person has prevention, to health-care edu- educating people to adopt re- for his life, provokes fantasies cation, or to counselling. sponsible maturity. Such a ma- full of death, and all this with In the case of homosexual turity within the context of the inevitable destructive repercus- patients, the diagnosis that they couple leads to a rediscovery of sions on affective, interperson- are seropositive and have AIDS the spiritual value of love al, social and work relation- brings about serious feelings of which is given as the funda- ships.4 It should, indeed, also guilt with regard to their own mental meaning of existence. be emphasised that the pan- sexual choices. They feel that This is a concept, as I will ex- demic spread of AIDS and the they are responsible for the ill- plain in greater detail later on, publicity that is provided about ness but at the same time they which should be diffused it by the mass media,5 induce in are more considerate and care- amongst adolescents so that those who are psychologically ful about the dangers of spread- they acquire the strength of disturbed and who are aware of ing the infection. Their greatest character to avoid and rise forms of behaviour at risk that worry is that their condition above forms of behaviour at so-called ‘worried well’ of the will be discovered and they risk – opposition to which the Anglo-Saxon commentators.6 wish more or less to conceal the Church holds up as a positive These are hypochondiachal be- fact of being infected, some- ideal – and which involves and applies moral rules of behav- which gradually changes until The sensitive task of coun- iour which can prepare them for the person is driven towards a selling the person with HIV responsible and faithful love – closing of interpersonal rela- should promote the acceptance the main guarantee by which to tionships. of his own state and the recon- defend their and other people’s Anger because the person is struction of a positive self-im- health. the victim of the infection. age which will allow him to es- At the basis of this idea, as Most of the time this reaction tablish future and realistic ob- the Holy Father observes, is involves expressions of desire jectives, in which process the ‘the proposing of forms of pre- for revenge which even end up, hope that such objectives can vention of the illness of AIDS in extreme cases, in a wish to be realised should be main- based upon recourse to means infect other people and to tained.15 and remedies which violate the spread the disease out of an im- In relation to this pathology authentically human meaning pulse towards revenge. recent therapeutic systems have of sexuality and are a palliative Depression brought about by brought about significant re- for those deep disturbances, feelings of desperation and very ductions in the viral assault and where the responsibility of indi- strong feelings of guilt in rela- have also created new hopes viduals and society is called in- tion to an experience pregnant about possible quality of life. to play... and a pretext for a with death which strengthens Equally, they have given rise to yielding of ground which opens and broadens the mythical and unrealistic hopes of a cure up the path to moral degrada- symbolic approach to AIDS. which, when they come against tion, are deeply harmful to the the tragic character of the ill- dignity of the person and ness, see the patient lose control morally illegitimate’.12 The Various Stages of his surrounding reality in a of the Illness state of desperation and psy- 79 chological decline which in ex- People’s Psychological In the period which goes treme case even ends in sui- Reactions to Being Told from the infection and the cide.16 that they are Seropositive anti-body positivity – defined As Nichols has observed,17 as the ‘window stage’ – an indi- the psychological iter of the The possible psychological vidual is seronegative even person suffering from AIDS is reactions to a positive diagnosis though he has been infected and characterised by three separate for AIDS, which international can transmit the disease. Here stages: the state of the initial scientific research has shown to one can evaluate which poten- crisis, the state of transition, interfere with the immunity pa- tial serious dangers of transmit- and finally the state of adapta- rameters and the acceptance of ting and contracting the illness tion leading to preparation for treatment,13 depend on a num- can be run by society as a death. ber of variables: on the charac- whole because of forms of be- The moral pain caused by so- teristics of a person’s personali- haviour at risk, especially in the cial prejudice, in addition to the ty and his capacity to respond sphere of sexuality. frightening loss of hope, the by adapting; on the lifestyle When the diagnosis of distress caused by isolation and which is followed, which ex- seropositivity is confirmed by by being abandoned by other poses individuals to a high risk clinical analyses, as has already people, and not least the identi- of infection; and finally, on the been observed the patient has a fication with the death of a dear physical complications brought number of psychological reac- friend with whom the same life about by the infection itself. tions which place him in a state choices have been shared, are These reactions can be summed of continuous oscillation bein conflict-ridden counterposi- up in the following words: de- tween thoughts of life and tion with the need for emotion- nial, anger, and depression. death, which involve him in al, psychological and social Denial as an immediate reac- frequent cognitive and behav- support, compensated at the tion designed to exorcise the ill- ioural alterations, and new ap- most by the maternal figure in a ness; an attitude which is at first proaches which should allow symbiotic relationship charac- one of incredulity, hypotrophic him to experience new forms of terised by regressive-infantile and later introspective, and psychological balance.14 traits. And this side by side with a renewed and rediscovered interest in the search for a skilled spiritual adviser who can be the new departure for many processes of moral rehabilitation and an important interac- tive element in the treatment which is received. It is at this existential stage that the person suffering from AIDS rediscovers and reaffirms the fundamental values of life, side by side with a com- bative approach to the illness which, unfortunately and in- eluctably, finishes the cycle of life.18 The Family The Health Care Workers ed. The precautions which are of the HIV-AIDS Patient: taken, which at times are above Reactions The psychological implica- what is really necessary, are a tions of AIDS and HIV virus further psychological barrier In general terms, people with infections should be analysed in placed in the relationship with HIV during the stage when they the relationship with the health the sick person, whilst the use of do not display any symptoms care workers.22 In addition to af- imprecise, equivocal and contra- try to keep the situation under fecting the balance of the per- dictory forms of communication control and minimise to them- son himself, they frequently tend to involve avoiding the as- selves as well the painful conse- bear relevantly upon the func- sumption of responsibilities. quences of the illness. When the tioning of the health care struc- This is something which can pathology is no longer contain- ture and the quality of care. The lead to the well-known phenom- able because of complications sick person develops a condi- enon of ‘burn-out’.24 which develop at the level of tion of psycho-physical depen- It is very rare to encounter symptoms and the forms of dence in relation to the health cases where people afflicted health-care treatment, the diag- care workers, while his family, with HIV-AIDS are refused nosis of AIDS often finds the family unprepared for the illness’s revelation when it learns through this discovery about the drug-addiction problems or un- faithful or transgressive forms of behaviour of their relative.19 80 A change in the family environment takes place which changes, in an overall reorgani- sation, all the relational variables which are involved: in extreme cases the family dynamics are made more complex and come to disintegrate because of fears about moral condemnation and the stigmatisation carried out by public opinion in relation to a ‘shameful’ diagnosis. in recognising the authority of treatment. This would be some- The family tends to dissimu- their knowledge, place them- thing which would in dramatic late and to close itself up in its selves in a position of subordi- form contravene articles 5 and own suffering from which there nation to such workers. Both 7 of law 135 of 18/9/1990 of re-emerge very serious internal patients and families project on- the current Italian Deontologi- conflicts with accusations and to the health care workers wish- cal Code. It would also be a re- the attribution of blame being es for survival through a mecha- fusal indicative of deep person- levelled at the sick person to the nism which I would define with ological and indeed profession- point of his expulsion in order the phrase ‘anchoring on life’. al disturbance.25 It is very clear to achieve defence against feel- The health care personnel, that it is necessary to offer the ing associated with the de- for their part, can engage in whole of the staff involved in viance, the lifestyle and the two opposing defensive atti- looking after patients with HIV- anti-values which have brought tudes of a more or less uncon- AIDS psychological advice about the sick person’s different scious kind which are used to which helps in controlling anx- approaches.20 All this takes distance worries about death iety and reducing stress in the place with deep internal lacera- and feelings of therapeutic work place and thus improves tions which impede both sides powerlessness. They are: either both their understanding of pro- from constructive decisions an emotional distancing from fessional tasks and responsibili- which can achieve reconcilia- the sick person who comes to ties and their ability to provide tion with life. This is a dynamic be seen as a ‘clinical case’, the a dialogic relationship, in addi- which was emphasised by His bearer of symptoms emptied of tion to present, capable and ef- Holiness in his speech of 1990 his humanity on the one hand, fective human help and assis- given to the international con- or, on the other, an affective hy- tance. ference on AIDS organised by per-involvement through a the Pontifical Council for Pas- process of identification with toral Assistance to Health Care the sick person which damages Reflections Workers: ‘the loss of family their professional image, some- warmth provokes in those sick thing, however, which requires All the subjects and issues with AIDS the diminution and empathy, solidarity, and charity which have been discussed here even the extinction of that psy- in the highest meaning of these are of dramatic topical rele- chological and spiritual im- words.23 vance, and they are made even munology which at times re- The problem which is most more crucial because of the cul- veals itself to be no less impor- felt by health care workers is tural divergences evident in the tant that that of a physical char- certainly that of being infected answers to the solution of the acter in supporting the reactive themselves or of the family rela- problem of the prevention of capabilities of the individual’.21 tives of the patient being infect- AIDS. These questions see on the one hand the great guiding her Magisterium, of the Faith, ed in the most difficult contexts and teaching role of the Church, and of Ethics. with pragmatic methods which and on the other a cultural vi- However, as is confirmed by respect and are suited to the dif- sion of modern society which the facts which emerge from the fering political-economic, an- because of the principle of sci- questionnaire carried out by the thropological and cultural reali- entific rationality – something Pontifical Council for Pastoral ties of the planet, and which can not unconnected with involve- Assistance to Health Care counter the impoverishment and ments with political and/or eco- Workers, historical acceleration moral degradation which unfor- nomic power – is increasingly today requires new strategies of tunately often find freely con- rooted in technology and the evangelisation and hope which querable spaces amongst the control of the real. These are the Church, beyond any ad- problems of ignorance, illitera- differentiated approaches which mirable local initiative, must, cy, unemployment and prostitu- give rise to opposing emotional and will know how to, organise tion in social contexts which are currents which find ordinary for those suffering from AIDS undeveloped, or technologically man in a condition of dismay and their families; that is to say advanced but often depersonal- and of a worrying crisis of val- practical, solidarity-inspired, ising. ues. These, in turn, can lead to charitable and spiritual help To this end the work of diplo- the covert entrance of an ethical which will give them relief, tak- matic mediation by the Church subjectivity which tends to look ing over, for example, old con- with governmental authorities for a model of the Church vents which could be trans- must be pressing and urgent, di- which is more responsive to formed into nursing homes or rected towards reducing the gap personal needs, thereby produc- by entrusting female religious which exists between the poor ing an unreal, comfortable dual- orders with caring for orphans and the rich countries through ism between secular ethics and of AIDS in a natural environ- the defence of health in general 81 Christian ethics, between sci- ment. This help, through the es- and the struggle against AIDS ence and religion, and between tablishment of a central obser- in particular-scandalous and in- the state and the Church. vatory having the task of co-or- human inequalities for which As the Holy Father empha- dinating human, social and sci- we must bear our full responsi- sised in the above mentioned entific resources in relation to bility. speech to the international con- AIDS, could be a nucleus of in- Only in total co-operation ference on AIDS: ‘we are not formation which could be will it be possible, with a hu- far from the truth if we affirm spread amongst, and act to stim- manitarian impulse, to with- that in parallel with the spread ulate, all the complex local ec- draw these suffering people and of AIDS there has manifested it- clesial realities, in addition to their families, afflicted in both self a sort of immunodeficiency being a just recognition of their body and soul, from the dramat- at the level of existential values pastoral work. ic loneliness and the despera- which cannot but be seen as a Help provided by the Church, tion that the illness of AIDS in- real pathology of the Spirit’.26 therefore, which must take prac- volves through a valid and fair HIV-AIDS and its connected tical form, in addition to the ac- health care and psychological problems and issues, indeed, tive exaltation of the great val- assistance (in order to then pro- constitute, albeit in all the dra- ues at the basis of life, through ceed to a cathartic approach to matic nature of the illness, programmes of information, ed- the illness which recodifies it merely the tip of an iceberg, the ucation, formation and preven- internally), flanked by spiritual tip of a more complex psy- tion implemented in capillary comfort as sensitive as always cho-physical and spiritual reali- fashion in all social sectors and but specifically trained in the ty to which we must react and made more productive by deter- knowledge of the techniques of respond. mined, involving and highly counselling (crisis counselling, Here we encounter the real publicised actions in synergy problem-solving counselling, ‘challenge’: to avoid running with other government or pri- decision-making counselling),28 the risk of the extinction of the vate initiatives. in order to help sick people to conscience, of the negation of The Church herself must be a open their hearts to hope the dignity of the human per- trait-d’union between the state through the rediscovery of their son, in order to promote a cul- and the scientific community in own dignity as men and as chil- ture of life of utility in the build- order to encourage society in dren of God. ing of a more just and human her ideals – ‘authentic values’ Through an action of feed- society. This challenge is ac- through which can be overcome back early educational initia- cepted by the Church which in sterile positions of demagogic tives can be made more incisive this sense, mother and teacher,27 politics and scientific determin- if directed towards personolog- has always worked in this direc- ism in favour of more mature ical factors (lack of self-esteem, tion, responding with her heart, and responsible attitudes, begin- the search for a role, anxiety knowing how to speak to men, ning with the very young, as an provoked by the crisis that one aware of their fragility, and unaware choice of life, the found- will be abandoned or die, pro- derstanding their upsets and dif- ing value of that human project found conflicts, insecurity, the ficulties. The Church untiringly which is based upon moral and search for gratification, etc.); promotes new readings of hu- spiritual incisiveness and mean- social factors (marginalisation, man behaviour with the courage ingfulness. changes in social structures of a person who searches for the All this will be possible with a marked process of his- truth, the truth of values, of the through the use of actions de- torical acceleration, immigra- sacredness of life, with respect signed to uphold universal prin- tion, urbanisation, unemploy- for the inescapable principles of ciples proposed and implement- ment, etc.); health care factors (access to treatment, costs, etc.) Abuse Aspects of AIDS (Raven Press, New York, 1988), pp. 187-197. and by taking into account two 14 G. G. BELLOTI AND M. L. BELLANI, fundamental objectives which Il Counselling nell’Infezione da HIV and are as important and as noble as nell’AIDS (McGraw-Hill, Milan, 1997), ever in relation to contempo- pp. 97-120. M. L. BELLANI AND G. G. BELLOTTI, ‘Aspetti Psicologici dell’In- rary society, which, indeed, of- fezione da HIV e Linee Guida per il ten seems to have lost its own Counselling’ in F. DIANZANI, G. IPPOLI- points of reference. These are TO AND M. MORANO (eds.), AIDS 1988: Il Contributo Italiano (Piccin Editore, on the one hand the re-evalua- Padua, 1998), pp. 135-142. tion of the role of women in 15 E. TROTTI AND M. L. BELLANI, ‘Il their essence as mothers, wives Counselling nella Fase di HIV Sieropos- itività Asintomatica’, in G. G. BELLOTTI and daughters, the spiritual del- AND M. L. BELLANI, Il Counselling nel- egates of love which gives of it- l’Infezione da HIV e nell’AIDS (Mc- Graw-Hill, Milan, 1997), pp. 159-169. self and a special witness in the 16 29 P. M. MARZUK, H. TIERNEY, K. journey of every human being, TARDIFF ET AL., ‘Increased Risk of Sui- and on the other the recovery of cide in Persons with AIDS’, JAMA, the importance of the family, n.259 (1988), pp. 1333-1337. 17 S. E. NICHOLS, ‘Psychiatric Aspects which is today far too often be- ond edition, London, McMillan Press, of AIDS’, Psychosomatics, n.24 (1984), low standard because of forms 1989). pp. 1083-1089. of disharmony, crises, conflict 3 S. E. NICHOLS: ‘An Overview of the 18 R. MILLER AND R. BOR, AIDS: a Psychological and Social Reactions to Guide to Clinical Counselling (Science between parents, or which para- AIDS’, in J. C. GLUCKMAN AND E. Press Ltd, Philadelphia, 1991). doxically does not exist in VILMER (eds.), Acquired Immunodefi- 19 R. BOR AND C. LEASK, ‘Il Coun- terms of its institutional ciency Syndrome, international confer- selling nell’HIV/AIDS e la Famiglia’, in essence, when instead, as Car- ence on AIDS held in Paris 23-25 June G. G. BELLOTTI AND M. L. BELLANI, Il 82 1986 (Paris, Elsevier, 1987), p. 261. Counselling nell’Infezione da HIV e nel- dinal Trujillo observes, it is in 4 A. DENMAN, ‘Immunity and Depres- l’AIDS (McGraw-Hill, Milan, 1997), pp. fact ‘witness to loyalty to the sion’, British Medical Journal, n.293 459-470. R. MILLER, E. GOLDMAN, AND plan of God and the heart of the (1985), pp. 464-465. R. BOR, ‘Application of a Family Sys- 5 J. E. DILLEY, H. N. OCHTILL, M. tem Approach to Working with People civilisation of love, gift and PERL, AND P. A. VOLBERDING, ‘Findings Affected by HIV Disease. Two Case commitment for the future of in Psychiatric Consultations with Pa- Studies’, Journal of Family Therapy, n. mankind’.30 tients with Acquired Immune Deficien- 16 (1994), pp. 295-312. cy Syndrome’ American Journal of Psy- 20 P. SCHWARTZ ET AL. ‘Projective Re- The commitment of the chiatry, n. 142 (1985), pp. 82-86. J. port about Self, Family, Environment Church, with the mission of her GREEN, ‘Dealing with Anxiety and De- and Discomfort Associated with Symp- ‘heralds of the Gospel’,31 as the pression’, in J. GREEN AND A. MCCRE- tomatic HIV Infection in Children’, Ab- ANER (eds.), Counselling in HIV Infec- stract Books of the V International Con- Pope has defined the female and tion and AIDS, (Blackwell Scientific ference on AIDS (Montreal, 1989), p. male religious and priests, as Pubblication, Oxford, 1989), pp. 272. C. LEVINE, ‘AIDS and Changing well as all the Catholic workers 174-177. Concepts of the Family’, The Milbank 6 B. HEDGE, T. ACTION, AND D. Quarterly n. 68 (1990), pp. 35-58. who look to her ideals, can facil- 21 MILLER, ‘The Worried Well: Identifica- JOHN PAUL II, ‘Discorso Tenuto alla itate, through the recovery of a tion by Simple Checklist’, in Abstract Conferenza Intemazionale sull’AIDS’. moral conscience, the achieve- Books of the V International Conference 22 G. G. BELL, M. L. BELLANI, B. DEI on AIDS (Montreal, 1989), p. 701. MEI, AND D. GRECO (eds.), Il Coun- ments of objectives placed to 7 N. MUSICCO, A. LAZZARIN AND M. selling nell’Infezione e nella Malattia da combat and defeat aberrations GASPARINI, ‘Trasmissione Eterosessuale HIV (Istituto Superiore di Sanità, ISTI- and negations of the values of HIV: Conoscere per Prevenire’ (‘Atti SAN 95/28, Rome, 1995). the person, in order to allow della Prima Giornata Italiana di Studio 23 M. DI GIANNANTONIO, T. MAT- sulla Trasmissione Eterosessuale del- TIONI, S. FAVETTA, AND E. TEMPESTA, them to reach that dignity and l’HIV’, Milan, 1983). ‘Burn-out: Helping Professions and fullness of life which must re- 8 C. L. CAZZULLO, C. GALA ET AL., AIDS. The Stressing Care of AIDS Pa- cover its true essence, its spiritu- ‘Psychopatolpgic Features among Drug tients’ Italian Journal of Psychiatric and Addicts and Homosexuals with HIV In- Behavioural Sciences vol.I, n.1 (Idelson, ality, and its transcendence. fection’ International Journal of Psychi- Napoli, 1991), pp. 85-93. atric Medicine (1989). 24 C. CHERNISS, La Sindrome del 9 DSM IV, Manuale Diagnostico e Burn-out. Lo Stress Lavorativo degli Dr. ROSA MEROLA, Statistico dei Disturbi Mentali (Masson, Operatori dei Servizi Socio-sanitari Psychologist, 1995). (Centro Scientifico Torinese, Turin, Rome, Italy. 10 S. MARTINI, M. ROSSINI, AND R. 1983). RUSSO, ‘AIDS: Problernatmche e Aspet- 25 Commissione Nazionale AlDS – ti Psicosociali’ Psichiatria & Medicina, Ministero della Sanità, ‘Aggiornamento II n.2 (Edimedica, Milan, 1988), pp. dell’Epidemiologia dell’AIDS e dell’In- 34-38. fezione da HIV in Italia’, Giornale Ital- 11 Società Italiana Medicina Generale, iano dell’AIDS, vol. III n. 3 (1992). Manuale Pratico sull’Infezione da HIV 26 JOHN PAUL II, ‘Discorso Tenuto alla per i Medici di Medicina Generale ( Conferenza Internazionale sull’AIDS’ Supplemento a SIMG- Medicina Gen- 27 JOHN XXIII, the Encyclical “Mater Notes erale, X n.6, UTET Periodici Scientifici, et Magistra”, III, in AAS 53, (1961). Turin, 1993). 28 World Health Organisation, Global 12 1 S. E. NICHOLS: ‘The Social Climate JOHN PAUL II: ‘Discorso Tenuto al- Programme on AIDS (WHO/GPA). when AIDS Develop’, in S. E. NICHOLS la Conferenza Internazionale sul- Progress Report 1992-1993 (Geneva, AND D. G. OSTROW (eds.), Psychiatric l’AIDS’, Dolentium Hominum (the 1995). Implications of AIDS (Am. Psyc. Press journal of the Pontifical Council for Pas- 29 JOHN PAUL II, Lettera alle Donne Inc., Washington, 1984), pp. 86-92. toral Assistance to Health Care Work- (Vaticane, Vatican City, 29.6.1995). 2 D. G. OSTROW, ‘Models for Under- ers, Vatican City, n.13, 1990). 30 L.A. TRUJILLO, Famiglia: Vita e standing the Psychiatric Consequences 13 G. F. SOLOMON, L. TEMOSHOK, A. Nuova Evangelizzazione (San Paolo, of AIDS’ in T. P. BRIDGE (ed.), Psycho- O’LEARY, J. ZICH, ‘An Intensive Psy- Cinisello Balsamo, 1997). C. CAFFARA, logical, Neuropsychiatric and Substance choimmunologic Study of Longsurviv- ‘AIDS: Aspetti Etici Generali’, Dolen- Abuse Aspects of AIDS (Raven Press, ing Persons with AIDS’, Annual of the tium Hominum (the journal of the Pon- New York, 1988), pp. 85-94. D. MILLER New York Academy of Science, n.496 tifical Council for Pastoral Assistance to ‘Psychosocial Problems Associated with (1987), pp. 647-655. 1987. L. Health Care Workers, Vatican City, n. HIV Infection and Disease’, in D. TEMOSHOK ‘Psycoimmunology and 13, 1990). MILLER, J. GREEN AND J. WEBER (eds.), AIDS’, in T.P.Bridge (ed.), Psychologi- 32 JOHN PAUL II, ‘Discorso Tenuto alla The Management of AIDS Patients (sec- cal, Neuropsychiatric and Substance Conferenza Internazionale sull’AIDS’. IV: Ethical and Moral Aspects

The Conflict between Values by the illness the infection for example wanting to continue gives rise to. From this conflict with disordered and dangerous The ethical-moral approach spring all the questions which, forms of behaviour. Indeed, dur- from which to examine people already faced up to in other ing the first years of the appear- infected by HIV or AIDS is fields of bioethics, become par- ance of the HIV infection the something which I have had to ticularly critical in the case of ethical debate often emphasised deal with since the first appear- infection by HIV because of the the meaning of the individual ance of this epidemic and its special nature of the disease, autonomy of infected individu- strikingly large number of prob- which still does not have defini- als and AIDS was strongly ide- lems. One could say, indeed, tive forms of treatment, and be- ologised by social pressure that the HIV infection has acted cause of the ways in which it is groups involved in forms of be- to catalyse the many ethical transmitted. haviour at risk. These groups conflicts which have emerged, In particular, this conflict made the infection into a banner as it were, from a Pandora’s box emerges when one has to define by which to legitimise their 83 of the twentieth century. It has the ethical principles to be reforms of behaviour and to claim raised questions for the conferred to, and even more when a series of ‘privileges’(special sciences of individual workers one has to place them together laws, funds from the state for both at a personal level and in and harmonise them. The ethical their associations, for their pro- terms of health care policies. literature on the subject, indeed, jects to distribute condoms At the beginning of the centu- brings out a plurality of values freely and on a very wide scale, ry the famous clinical doctor, and consequent ethical-moral absolute respect for their priva- Sir William Osler, in discussing duties which are brought into cy, and so forth). Concern for syphilis – a disease which is of- play in caring for and treating the protection of the infected inten compared to AIDS when people who are infected by the dividual, in substance, often this latter is discussed – wrote HIV virus. took pride of place over concern the following words in the pref- First and foremost there is the for society, as a common good ace to his famous tract on inter- principle of respect for the dig- and as a good of healthy indi- nal medicine in which he em- nity and autonomy of the individuals who run the risk of be- phasised the complexity of the viduals concerned, and in par- coming infected. clinical ways in which it could ticular the seropositive or sick An article which appeared at express itself: ‘study syphilis in person who cannot be made to the beginning of the 1990s in all its manifestations and clini- disappear as a person because The New England Journal of cal correlations and every other of his condition, however he Medicine with the title ‘An End pathology will be learnt about may have contracted the illness. to HIV Exceptionalism?’ de- even more’. In the same way to- He must, instead, be helped to scribed the policy which had day one could say that to know face up to the consequences of been adopted until then in rela- AIDS in all its ethical-moral his condition through personal tion to the appearance of AIDS correlations means to address and responsible choices which in the following way: ‘During oneself to all the questions and go from thinking about his own the first decade of the epidemic issues of biomedical ethics, or forms of behaviour to decisions a community of interests made at least to most of them given about telling other people about up of the spokesmen of homo- that HIV infection has a whole his condition, about getting sexuals, defenders of the free- series of aspects and manifesta- married, about procreation, and doms of the citizen, medical tions. about refusing or accepting ex- doctors and administrators of If one examines the various perimental treatment, etc. One health services, came to develop ethical-moral questions and is- is dealing here, therefore, with a policy of behaviour towards sues which caring for and treat- promoting the responsible free- the disease which was based up- ing people infected by HIV has dom of individuals so that such on the concept of ‘special treat- raised, one sees that one is deal- responsibility can encounter the ment’. Not only in the United ing with problems which are responsibility of society and States of America but also in very different from each other avoid the occurrence of mo- many Western industrialised but which, in substance, re- ments or acts of discrimination countries health policy was de- volve around the conflict be- or the violation of the privacy of termined by an alliance which tween: a) the right and duty to patients. placed individual freedom prevent infection in healthy in- In truth we should also under- above responsibility towards dividuals, to protect that is to line that often in the name of the one’s neighbour and towards say society, and b) the right and principle of autonomy freedoms society. In this way the aim was duty to assist and protect the in- have been claimed which are achieved of bestowing upon fected individual who is only not always associated with the HIV infection a special status seropositive or is also afflicted practice of full responsibility, amongst the infectious diseases and sexually transmitted dis- such as drug-addiction and the eases, and thus providing for the eases in particular.’ disordered use of sexuality. application of the measures de- Today the disease is so wide- In the name of the principle of signed to combat such diseases, spread that those infected with benefit, for example, it is the du- but acting, rather, through the it live – and can infect – for a ty of the medical doctor to care creation of ad hoc legislation. longer period of time; the utili- for and treat those who are in- This direction is only partly jus- sation of health care services fected. He cannot refuse to pro- tifiable taking into considera- cannot necessarily be correlated vide the required assistance tion the special characteristics with the infection; and amongst merely because he is afraid of of AIDS as compared with other health care workers themselves becoming infected himself. It is infectious diseases. The reasons there are many individuals who the duty of researchers to dedi- which brought about this are infected. Indeed, mutual cate themselves to advancing re- choice, however, have emerged fear between doctors and pa- search in order to find remedies with much clarity. These rea- tients now seems to be chang- for this pathology. And society sons are not external to those ing the debate. There is a ten- must act with suitable preven- forms of behaviour and those dency, that is to say, to sideline tion campaigns in order to con- social groups (drug-addicts and the autonomy of the individual tain the spread of the infection homosexuals) which from the and his right to absolute privacy and protect healthy individuals. onset have been connected with and to give space to the need Reference is also made, last- the systems of infection. The infor the greater right of the com- ly, to the principle of justice, fection, in other words, was an munity and institutions to know which is applied not only in the opportunity, as has already been about the condition of being in- sense of social fairness in the observed, to reaffirm at an ideo- fected in order to protect shared distribution and allocation of logical level that one could not 84 interests within a context of re- burdens but also in the sense of call into question certain forms sponsibility. In other words, actions to meet the needs of of behaviour and that all that there are no medical reasons, or each individual (needs which had to be done was to continue reasons of another kind, to re- are not equal for all people) and to defend them, albeit with quire AIDS to have a special of the ability of each individual greater safety when it came to status, or for this disease to be to meet these needs himself. the transmission of the infec- treated on the basis of criteria This principle, therefore, in- tion. which have already been ac- vokes solidarity and subsidiari- And in this regard there was quired for infectious diseases, ty and does not mean mere egal- no lack of condemnation on the and especially those transmitted itarianism. part of eminent clinical doctors sexually. These criteria are: the Upon the principle of justice, to the effect that this ‘special’ protection of those who are not in addition to the principle of treatment of AIDS – special yet infected; the identification benefit which has already been laws, the allocation of funds for of those people who have been referred to, is also based the du- research and care and treatment infected; the strengthening of a ty to inform and to be informed – seemed to be unfair when sense of responsibility and of about the condition of seroposi- compared to the health care the intention not to propagate tivity of an individual in order policies applied to other the disease; coercive measures to implement all those actions pathologies which are equally in a minority of cases where a and initiatives which are neces- serious and which involve a sense of responsibility is ab- sary to prevent infection. Only certainly not inferior number of sent; and care for the sick per- if one knows about the risk is it patients, such as neo-plastic son in order to reduce his suf- possible to implement preven- pathologies. In Italy, for exam- fering. tive actions and initiatives, and ple, despite the high incidence This need – which in truth for this reason it would be of these maladies, there have has foundations which go well wrong to keep quiet about infor- never been special laws for beyond the contingent sociolog- mation which would be decisive them; nor were there, at least ical modifications encountered in bringing about a change in for a long time, public funds by the HIV infection – confirm behaviour. This argument is, for specifically dedicated to sup- the fact that the principle of au- example, supported with refer- porting research and treatment tonomy is insufficient when it ence to the question of profes- into them. does not refer to personal and sional secrecy. Such secrecy, Apart from these considera- social responsibility. specifically in the case of AIDS, tions, however, the principle of Another principle at stake is has been profoundly called into justice also emphasises that the the principle of benefit, a princi- question with regard to the cri- social dimension of AIDS is ple which is invoked both in re- teria which should be applied to closely bound up with the ethi- lation to the infected person – it, not only for legal reasons but cal dimension, and that it has a who must be cared for and treat- also for socially relevant rea- particular relevance in the case ed in the best way possible – sons, such as, for example, the of this disease because it in- and in relation to healthy indi- imminent danger of an individ- volves the person not only as an viduals and society as a whole ual who is unaware of the risk individual but also in his rela- (and the family in particular) of becoming infected. tionships with others. Every- whose health has to be defended In the light of the principle of body, therefore, must feel them- against infection through effec- justice as well one cannot but be selves committed to a series of tive and suitable programmes of surprised by the direction taken forms of social responsibility prevention which also envisage by much legislation in not in- and professional duties which the control of immediate, re- serting HIV infection within the refer to values and indicate mote and concomitant causes list of existing infectious dis- moral obligations. The principles which have the good or the objective and fore, that health care workers been outlined above came into transcendent good of the cos- cannot refuse to provide care being in particular in the North mos itself. and treatment. This is primarily America literature on bioethics because the obligation to care and have meaning and signifi- and treat patients without en- cance only within an ethical Special Ethical Problems gaging in forms of discrimina- model which places them in in Caring for and Treating tion is a part of the professional agreement and harmonises People with HIV/AIDS code of ethics. Secondly, it is them. From the methodological because there are effective and point of view of ethical thought, We will now briefly examine sufficient precautions by which indeed, it is important to be some of the ethical questions a person can avoid becoming clear about the framework of and issues which are raised, and infected when he is in a health values which one wishes to fol- which spring precisely from care environment. These mea- low so as to be able to achieve that conflict which has already sures, as is well known, are no their harmonisation. The har- been referred to between the greater or more difficult than mony which should be achieved duty to protect society and the those required in the case of is not a mere compromise ob- duty to protect the rights of in- other virus infections, such as, tained through a pragmatic fected people. I have chosen for example, hepatitis B. ‘weighing of values’. It in- some of the most significant of Obviously enough, on the volves the search – by no means these questions and issues and part of the patient who knows always easy at a practical level the reader can consult the vast that he is seropositive there is a – for a hierarchy of the values in literature which has grown up moral obligation to inform the question because man is unitary, on them for a more detailed medical doctor and the person- grows upwards, and maintains analysis. nel and staff who are looking 85 himself in personal and ethical after him so that they can en- rectitude only if he constantly A) One of the first questions gage in precautions to defend strives for that convergent unity which has been raised is that of themselves and the other pa- which is made up of a harmo- the refusal of health care per- tients, always knowing that a ny-hierarchy of values. sonnel and staff to care for and risk exists, and indeed is more The central and primary val- treat AIDS victims. Section 2 of dangerous, when too much ue involved in the problem of the Charter for Health Care weight is given to the negative AIDS, as in every health care Workers (Pontifical Council for result of a test, and this given problem, is the human person: it Pastoral Assistance to Health that the so-called ‘window peri- is within the human person, and Care Workers, 1995) declares od’ which follows the event of to the advantage of the human that such activity is ‘a meeting contagion can conceal the pres- person, that there converge the between trust and conscience. ence of the infection. action of the medical doctor and The trust of one who is ill and However, the various obliga- the scientists, the action of pas- suffering and hence in need, tions of the medical doctor to tors of souls, the action of soci- who entrusts himself to the con- engage in care and treatment ety, and the action of culture. science of another who can help must be interpreted in the light The human person, because of a him in his need and who comes of their balance and their real vision which arises from a suc- to his assistance to care for him operational effects. At the same cessful philosophical anthropol- and cure him.’ time they must be shaped by the ogy, is not only the central point Unfortunately, today there is needs of the safety of the med- of the ecosystem – which is se- a wish to eliminate this meaning ical and nursing staff from riously disturbed by the appear- of the profession by emphasis- whom professional, diligent ance of the phenomenon of ing the aspects of the contract and non-discriminatory service AIDS in the same way as it has between the medical doctor and must be asked. These last, how- been seriously disturbed by oth- the patient rather than providing ever, must not be called upon to er serious epidemics at other benefit in trust. For this reason engage in forms of useless times in history – but also the it becomes more difficult to up- heroism. point of reference, and the very hold the obligation to care for spring, of society. He is, finally, and treat sick people: I as a B) The special area of the ter- health care worker am obliged minal stage of the illness is also after I have accepted the con- to be placed within the sphere of tract but I am not obliged to ac- the duty to care for and treat. cept the contract! Assistance to the AIDS patient The refusal to receive and during the terminal stage of the treat infected patients, indeed, illness involves a concrete per- is, however, contrary to the very spective – of a more or less meaning of the profession, a short duration – which involves meaning which today needs to health care workers and the be rediscovered by health care whole of society being placed in workers – people who are front of a disease which still strongly tempted by the idea of cannot be definitively cured. the contract. From the moment of the diagno- In agreement with what was sis of the illness, indeed, AIDS said by the Episcopal Confer- enters a stage when it seems that ence of the United States of nothing can be done to block the America, it must be said, there- illness, although much can and must be done at the level of as- soon came into conflict with the who is benefiting from the se- sistance. In this assistance the difficulties to be found in the cret is an unjust aggressor. It is medical doctor who is responsi- interpretation of ethical princi- evident that the priority which ble for the patient must take into ples, above all else in the practi- is established must not go be- account the real emotional qual- cal application of the theoretical yond what is strictly necessary ities of the patient, the flexibility approach; 3) the problem of or be the source of certain forms of the role that he can adopt dur- whether to keep quiet about the of discrimination. ing the advance of the illness, disease or whether to reveal its the possibilities of treatment – presence gave rise to renewed D) Lastly, the subject of sci- both technical and non-technical interest in the relationship be- entific research and the experi- in character – which are intend- tween the medical doctor and mentation of new medicines and ed solely to help the patient and the patient, a relationship which drugs, which belongs to the full do not have a clear therapeutic is certainly the primary point of to the sphere of the duties to objective in mind because of the reference for the clarification of help infected people. It is cer- absence of good motives. Rejec- certain ‘grey areas’ which can tainly the case that we are face tion of euthanasia and therapeu- emerge in the case of ethical de- to face with a disease whose tic overkill must be supported cisions and which are not al- origins and epidemiology are by the use of pain-killing drugs, ways interpreted in a unani- known but whose cure is not yet in which treating pain, all the mous way when it comes to the available to us. Our first task, normal forms of treatment due duty of the medical doctor to therefore, is to plan effective to the patient, the communica- engage in benefit towards soci- and valid prevention. However, tion of truth, and human and re- ety as a whole as well as the in- we also need to encourage sci- ligious assistance, play their dividual patient. For this reason, entists in their search for new 86 part. although the maintenance of drugs and vaccines which will Today there are people who professional secrecy in medical be able to defeat the virus. theorise a sort of ‘rationality’ in activity remains of absolute im- AIDS is different from other the decision to commit suicide portance and is recognised in major serious diseases for on the part of patients who are fundamental terms, there also which clinical trials are organ- diagnosed as having AIDS. It is emerged with great force the ised because it is an epidemic argued that there is even a need to pay (if not greater at illness of an infectious nature ‘moral obligation on the part of least equal) attention to those which gives rise to great hopes people to protect and indeed to individuals who, as a result of a about the possibilities of finding favour to the greatest extent rigorous respect for such secre- effective measures of control possible – where this is allowed cy, would run very great risks to along the lines of what has been by the law – the rationality of their lives. done for other infectious dis- this choice’. In discussing this The social health interest, in- eases during the course of this kind of ‘assistance’, Evangeli- deed, can at times require the century. As a result, there is a um Vitae strongly declares that: breaking of the secret (and such very striking development of ‘to concur with the intention of is the case with the situation of new drugs and medicines which another person to commit sui- infection by HIV as long as this are proposed in the form of sin- cide and help in carrying it out disease continues to be incur- gle treatments or as combined through so-called “assisted sui- able and fatal) which, together treatment – often publicised cide” means to cooperate in, with the classic principles of without any good reasons and and at times to be the actual per- medical ethics with their re- thereby giving rise to false petrator of, an injustice which course to the principle of the hopes – which must be assessed can never be excused, even if it necessary respect due to the hu- and evaluated clinically. is requested... Moreover, the act man person, converge in indi- Today, great hopes surround of euthanasia appears all the cating the nature of the relativi- experimentations with vaccines more perverse if it is carried out ty of professional secrecy and against HIV. Recently in Italy by those, like relatives, who are the conditions which must exist such measures have been an- supposed to treat a family mem- when one can consider the pronounced. The ethical questions ber with patience and love, or vision of secret information to and issues which arise with the by those, such as doctors, who third parties as something experimentation of these vac- by virtue of their specific pro- which is legitimate. fession are supposed to care for From an ethical point of the sick person even in the most view, awareness that the princi- painful terminal stages’. ple of autonomy, as has already been pointed out, cannot play C) The duty to engage in se- an absolute part in the sphere of crecy requires ethical-moral dis- the relationship between the cussion given that the question medical doctor and his patient of secrecy has become a critical leads to a certain breach being issue for a series of reasons: 1) opened in the wall of secrecy. before the appearance of AIDS The foundation of the breaking professional secrecy had never of such secrecy is to be found in before been so called into ques- the principle of justice, that is to tion to the point of bringing say in the need to avoid an un- about profound conflicts be- fair wrong being done to a third tween law, deontology and party who is innocent, or to one- ethics; 2) the ethical approach self. This is because the person cines are manifold, and they are forms of behaviour at risk in or- As has been seen, ethical subjects which ethical commit- der to act as a control measure- thought appears with ever tees are called upon to assess ment for those to whom the vac- greater force in all the spheres and evaluate. cine is given? It is certainly the in which the effects and conse- In particular, I would like to case that the absence of stan- quences of infection by HIV are briefly examine the ethical dard preventive therapy makes present. In addition to technical problems which are raised to- the use of the placebo and other and professional skills, there are day during the third phase of the methods which reduce forms of the ethical responsibilities of development of vaccines, a interference (randoming and health care workers and for this phase when their effectiveness double blinding) acceptable in reason there presents itself the within the population at high this case, but it is also clear that need to include in their pro- risk is assessed and evaluated. for the control group as well it grammes of training and of pro- From an ethical point of view it is ethically necessary to provide fessional up-dating the contents seems to me that we cannot for suitable counselling which of biomedical ethics as well, ‘limit ourselves’ to administer- corrects their forms of behav- and this should be an integral ing the vaccine to individuals at iour at risk. part of their training and a risk and waiting to see its possi- These are some of the ethical pre-requisite of full service to ble effectiveness, leaving the in- questions and issues which can life which is such only when dividual to continue in his arise in the experimentation of there is loyalty to moral law. forms of behaviour. It is appro- new drugs and medicines to It was, indeed, directly to priate, and morally imperative, combat HIV, but they are suffi- health care workers that John that during this phase there is cient to enable us to express the Paul II directed his speech to adequate counselling which can belief that the solution to such the participants at the fourth in- remove, where this is possible, questions and issues cannot ternational conference on AIDS 87 the causes of the risk even at the come about by laying stress organised by this Pontifical cost of sacrificing the possibili- solely, or in a reductive way, on Council ten years ago: ‘up-date ties of assessing and evaluating the freedom of scientific re- your training, make yourselves the effectiveness of the vaccine search or solely on the autono- promoters of action directed to- when the counselling in itself is my of the individual to subject wards raising the awareness of sufficient to remove or limit the himself or otherwise to experi- the social community, be causes of the infection. mentation or solely on social spokesmen for the worries, the The problem becomes more utility in terms of costs and ben- needs, and the hopes of those complicated when the experi- efits. Above these individual you care for and treat’(n.13). mental plan envisages the use of values, and as a point of con- a control group, that is to say a tact, we must consider the value group of individuals who will of the human person in his Dr. ANTONIO G. SPAGNOLO, MD, not receive the vaccine but wholeness and concreteness, a The Institute of Bioethics, merely a placebo: will it ever be value which harmonises auton- The Catholic University possible to accept the fact that omy, therapy, prevention, and of the Sacred Heart, this group continues with its social intervention. Rome, Italy

V: Spiritual Aspects of Accompanying People with AIDS-HIV

The history of every person is fought or recovered and who al language which places us in a mosaic made up of relation- feel the need for prayer, recon- contact with the values and the ships and failures, loves and be- ciliation with God and with the hearts of people. trayals, opportunities taken and Church, and the wish to face up c) The human horizon. This is realities lost, actions of loyalty to religious questions. represented by those who do not and examples of inconsistency. b) The spiritual horizon. This believe in God or in the Church, In this framework is also to be is represented by those sick peo- who reject the presence and the placed and located the history of ple who cultivate their own spir- approach of religion, who dis- people with HIV-AIDS, individ- ituality whose elements include dain those who try to give a uals whose spiritual needs are to the search for the meaning of ill- meaning to suffering and death, be read through the filter of their ness and death, the balance of who ridicule the idea of a life specific autobiographies. their own lives, the meaning of beyond this one, and who adopt From the point of view of the limits to, and the acceptance aggressive attitudes and atti- their inner needs there are three of, themselves, the positive ap- tudes made up of escape. We al- horizons in which we can place preciation of the transcendent, so need to offer these people the the experience of these sick peo- the affirmation of values such as gift of humanity without blam- ple: peace and altruism, the joy of ing them or trying to convert a) The religious horizon. This profound relationships, and the them. We should, rather, bear is represented by those who for need to say goodbye. witness, through the practice of good or for evil have an experi- Today, there is an urgent need respectful communication, to ence of faith which is received, to build bridges with this spiritu- their human dignity and also help them to move out of the tion from society, abandonment gia for health and for salvation. tunnel of protest and build up of the Church, marginalisation At a spiritual level the pain their identity as humans. in relation to work, the betrayal caused by the gradual succes- In the various paths which are of friends, and the depersonali- sion of these losses becomes re- taken and followed the spiritual sation of relationships with duced when we are witnesses of search does not so much involve health care personnel. listening and comprehension, entering the fragility of the sick At the heart of Christianity something that is represented by person in order to direct him to- we encounter the injunction ut- the icon of Emmaus where Jesus wards God, but a policy of tered by Jesus: “when you did accompanies the pilgrims on the adapting his language of keep- this to the least of my brethren road and guides them from dis- ing vigil next to his mystery as a here you did it to me” (Mt may into hope. suffering man in order to dis- 25:40). St. Paul reminds us of the trial cover the mystery of God which At a spiritual level the pain of of existence: “But we have this works within him. God is not isolation and loneliness can be treasure in earthen vessels... we the slave of our schemata – He reduced when we become wit- are afflicted in every way, but knows, rather, how to shape the ness of nearness as exemplified not crushed; perplexed, but not human clay in His hands. by the icon of Jesus with the driven to despair; persecuted, Placing ourselves in a way so leper where our Lord, through but not forsaken; struck down, that we can to listen to these human contact, restores him to but not destroyed; always carry- people who suffer helps us to the human community. ing in the body of the death of understand three wounds which Isolation can be cured Jesus, so that the life of Jesus often afflict those who suffer through the promotion of pro- may also be manifested in our from HIV-AIDS: jects of hope and solidarity mortal flesh” (2 Cor 4:7-10). 88 which dissipate the false fears 1) The Wound of contagion which are blown of Condemnation up by ignorance, and which in- The Journey of Illness: AIDS is often brought about volve actions of tenderness and An Inner Journey by sexually promiscuous or warmth which help the sick per- transgressive forms of behav- son to recover a sense of be- The person with HIV-AIDS is iour. Its victims are often homo- longing and security and to feel cured when the journey of the sexuals or drug-addicts, even that he or she is loved. illness is transformed into an in- though today the number of ner journey and when he en- those who contract the illness 3. The Wound of Grief and Death counters on this journey Good through heterosexual relations is The advance of the illness in- Samaritans who help him to re- on the increase. As a conse- volves an increasing number of deem his personal history, to re- quence these sick people feel losses which have to be dealt cover his own dignity, to give a that they are judged, in particu- with: the loss of health and se- new meaning to a changed life, lar by the Church, and they tend curity, the loss of self-image, the to discover positive images of to have negative images of God, loss of work or of productivity, God who is seen as being near at seeing Him as a severe, sadistic the loss of independence, and hand, compassionate, a good and vindictive judge. This inten- the loss of the future and of life shepherd, a healer, and a helper. sifies their feelings of guilt, projects, and this until the ulti- These witnesses of the good- alienation and resentment. mate loss represented by death. ness of God respect the beliefs At a spiritual level the pain of Every loss has its price which of the sick person, welcome his this wound becomes less when is in line with the various sepa- states of mind and his silences, we become witnesses of wel- rations which it involves. help him to die in peace, and come, in the fashion of the icon When faced with the presence where the conditions are of the prodigal son who is em- of the break-up of the different favourable accompany him with braced and joyfully welcomed pieces of the personal mosaic, prayer, the sacraments, or the by his father without him re- spiritual care involves listening comfort of the promises of the ceiving questions about the na- to the various feelings of anger faith. ture of his past behaviour. and dismay, guilt and sadness, I would like to conclude with and anxiety and turbulence the words of a drug-addict who 2) The Wound of Isolation which accompany these various was dying of AIDS, words In the relational context, peo- separations. which were spoken to the pastor ple with HIV/AIDS often expe- Separation is not only a psy- who was visiting him: rience a feeling of marginalisa- chological experience but also a “I used to think that God had tion and of segregation in rela- spiritual experience... it is the punished me with this illness. tion to society. Holy Friday of what people Now I have begun to think that It is their families which re- have to undergo. He really loves me if he has sent ject them above all else. They In the background of these me a friend like you”. do not accept what their son or feelings are to be found memo- May these words also inspire daughter has done or they feel ries and disappointments, and an our way of being present next to stigmatised by his or her illness. awareness of lost opportunities these sick people! At times this rejection ex- and unrealised dreams. presses itself in the prohibition In the unfolding of grief the Rev. ARNALDO PANGRAZZI M.I., of a return to the family home; troubled spirituality of the crea- Professor of the “Camillianum” on other occasions contact is ture who experiences his fragili- International Institute of Health Care broken off for ever. ty and mortality comes to the Pastoral Theology, Secondly, there is also isola- fore. It also expresses his nostal- Rome, Italy. Papers in the Programme “Access to Care and Treatment, Assistance in the Field, the Pastoral Experiences of Certain Local Churches”

I: The Catholic Church in the Kingdom of Thailand

Thailand, known as Siam be- 29. Here are some facts on Pastoral Experience fore 1939, is located in the HIV/AIDS in the country. 89 Southeast Asian region. The – Cumulatively, there are ap- The Catholic Church in Thai- country now has a population proximately 900,000 people land started HIV/AIDS ser- of 61 millions. Buddhism is the living with HIV in the country. vices, responding to the call of main religion (95%), followed Although all of the epidemics His Holiness Pope John Paul II, by Islam (4%) and Catholicism peaked during 1993-1994 there in 1990. From our last survey in accounts for only 250,000 of are still 40,000 or new cases October 1999, there are at least the total (0.4%). The Church in each year. Most of the new in- 28 organizations dedicated to Thailand has 10 dioceses. There fections are caused by sex re- some kind of HIV/AIDS ser- are 400 native fathers, 225 con- lated activities. vice or activity. However, these secrational fathers, 1445 sisters – Annual cross-sectional sur- services are available only in 5 and 120 brothers. Although the veys by the government agency out of the 10 dioceses in Thai- number of Catholics is quite found at least 80,000 women land. The type of services and small, the Church in Thailand involved in commercial sex at activities can be classified as plays a very important role for any particular time. The most shown here. in the development of the King- recent surveillance data of June dom, especially in the area of this year found a prevalence of Table 1. Type of services modern education and commu- HIV among direct sex workers or activities to prevent nity development. The Church in brothels of 17% and 6.5% and alleviate the problem runs approximately 300 schools among indirect sex workers of HIV-AIDS organized distributed in every dioceses who work in other sex estab- by the Catholic Church and also one university in the lishments. in Thailand, 1999. capital city. There are 4 hospi- – No less than 100,000 peo- Type of services/activities Number tals for services and care for all ple are drug addicted. The Community rehabilitation for drug addicts 2 diseases. number of IDUs is around Social center for commercial sex workers 2 60,000 persons. The latest Orphanage home and related activities 8 prevalence of HIV is still as Caring for AIDS in different stages 3 HIV-AIDS Situation high as 50%. Counseling and sheltering in Thailand – Each year there are 1 mil- for people living with HIV 11 lion pregnant women and the Hospital for HIV/AIDS treatment 3 The first case of AIDS was lastest prevalence revealed a Family and youth activities 2 reported in 1984. During the HIV infection of 1.7% in this first five years there were few population which will result in To give some idea of the kind AIDS cases. Starting in 1988 17,000 HIV infected pregnant of services or activities related the country has faced four big women with approximately to HIV/AIDS, here are some waves of the HIV epidemic 3,000 HIV infected newborn examples of pastoral work: among target populations of in- children this year. The rebirth center is a thera- jecting drug users (IDU), com- – The number of new AIDS peutic community where men mercial sex workers (CSW), cases for 1999 which need and women afflicted with drug male clients of sex workers, medical treatment is estimated addiction live, learn and work and pregnant women. Principal at around 60,000 persons and together to help each other to HIV diffusion is by heterosexu- this figure will reach its peak in gain a drug-free life and be- al transmission through com- 2002. come productive members. It mercial sex and other types of – The cummulative number was started in 1979 and the pre- casual sex, especially among of orphans due to AIDS prob- sent location is in Rajchaburin young adults of the ages of 18- lem is as high as 200,000. province in the central region of Thailand. The center is operat- work comes from donations are addicted to drugs. This will ed by the Society of Our Lady from both domestic and over- be done without any loss of stu- of the Most Holy Trinity. Al- seas sources. Some organiza- dent educational opportunity. most 400 drug users are in this tions received seeding money 3. The building of more com- rehabilitation center. from the government AIDS munity rehabilitation centers The foundation of life center program. The Church in Thai- for drug users. is a place for nuturing friend- land has established a Catholic 4. The promotion of family ship and support for women, committee on AIDS to plan, co- life activities, premarital educa- young girls and children who ordinate and support HIV- tion and counselling programs are engaged in or vulnerable to AIDS work in each diocese. for premarital, spouses, and prostitution. It is located in Pat- However, the work is still youth. taya, a famous tourist seaside limited when compared to the 5. The establishment of com- resort which is well known for problem load. munity centers or programs many entertainment places. The In a recently review, it was providing care for orphanages, center has been operated by the found that the Catholic Church the elderly, sex workers and Good Shepherd Sisters since in Thailand needs to develop a people living with HIV-AIDS 1988 and provides different master plan and action plan for 6. The launching of a home- kinds of services such as skill the next decade, establish a based care program in all training, language proficiency, strong network for the sharing parishes for people living with adult education, ect. of resources and experiences in AIDS. The Ban Mettha Tham in all dioceses, and mobilize funds 7. Educating general public Payao, a norther province, pro- and human resources for a more about HIV-AIDS prevention vides pastoral care to persons effective response. and care. 90 living with HIV-AIDS (PLW HIV-AIDS) and their families. The project is run by the Sis- Policy Framework Conclusion ters of the Daughters of Chari- for the New Millennium ty. Because many people have AIDS causes a lot of suffer- died of AIDS in the area, the In October 1999 the Catholic ings and social problems for the project also has to take care of committee on AIDS organized Thai people. The Catholic almost 100 orphanage chil- a seminar in order to outline a Church in Thailand has started dren. policy framework on HIV- many activities to show the St Clare’s Hospice is a 16 bed AIDS in the first decade of the love of Christ for people who hospice for AIDS patients who next millenium (2000-2009). are vulnerable and affected by are in the last stages of AIDS. According to the recommenda- HIV-AIDS. However, the re- The Franciscan Friars saw a tions, each diocese will develop sponses of the Church are still great need to care for poor and its own action plan which will small when compared to the homeless persons with AIDS. give priority to the following current magnitude of the prob- The hospice received its first activities: lem. With the new policy patients in 1993 and up to now 1. The development and im- framework for the coming 400 patients have been taken plementation of appropriate ed- decade of the new millenium, it care of. Because of the advance ucational processes for family is hoped that the Church will be of antiviral therapy, late stage life and sex education in all able to mobilize more internal patients can live longer. This is Catholic schools. and external resources to carry a new problem for the hospice 2. The development action out its pastoral work. because some patients are get- plan in all Catholic schools to KUMNUAN UNGCHUSAK, ting better and can live for prevent and detect AIDS at an MD, MPH months or years. early stage, and refer for reha- Catholic Committee on AIDS The budget to support this bilitation those students who Bishops Conference of Thailand

II: Africa - The Congo

Introduction of control and prevention were 1. Some Medical-Health set in motion with short and Care Parameters in 1998 The Democratic Republic of medium term plans of resis- the Congo is in the centre of tance to the disease looking The Democratic Republic Africa, has a surface area of forward to 1987 and 1991. of the Congo is one of the 2,345 KM2, and a population These, however, did not African countries which is of 52,000,000 inhabitants of achieve their objectives be- most afflicted by AIDS. The whom 50.6% are women and cause of political instability. In statistics which follow have 46% minors under the age of July 1999 a national plan to to be up-dated and will cer- fifteen. combat AIDS was drawn up tainly be more alarming given The first cases of AIDS ap- and adopted with a strategic the widespread contact of the peared in this country in Octo- national programme involving population with people who ber 1983 and in 1984 systems three and ten year time spans. have come over the border from Uganda, Rwanda and 2. Care and Treatment intermediate level in 60% of Burundi (countries which are the health care zones; heavily infected by the epi- Our understanding of access b. to reduce the risks of sexu- demic), a process which be- to care and treatment is gained al contamination and of trans- gan in 1984. from the organisation of the mission of the virus through Of the 22,600,000 seroposi- Congolese medical-health care blood throughout the health tive people in the world, service. In 1978 the Congo care zones; 14,400,000 (63%) are to be signed the Alma Ata Charter c. To improve the access of found in Africa and 2,000,000 and in 1998 adhered to the people who live with HIV to in the Congo (8.8%). Of the Health Development Charter of structures of treatment, medical 1,600,188 full-blown cases of Africa. The provision of basic follow-up, psycho-social ac- AIDS, 578.172 are in Africa health care has been the strate- companying, and the develop- (35%) and 38.426 in the Con- gy which has been adopted, and ment of such access to levels go (2.3%). The distribution this is essentially based upon where it provides a broad re- by province of observed cases scientifically valid methods and sponse. in the Congo is as follows: practices which are socially ac- The fields of action are as Kinshasha 45.9%, Eastern ceptable and accessible to all follows: Kasai 11.2%, Bandundu the members of the community – social mobilisation and 6.8%, Western Kasai 6.5%, who belong to that community community participation; Lower Congo 6.2%, Katanga in a spirit of self-determination. – the prevention of the trans- 4.7%, Equator 4.3%, North Because of economic, popula- mission of the disease within Kivu 2%, South Kivu 1.5%, tion, geographical and cultural certain specific groups; and Maniema 0.2%. The dis- factors the Republic of the Con- – the prevention and treat- ease prevalently afflicts peo- go is divided into 305 health ment of sexually transmitted 91 ple between the ages of 20 care zones of which 30% are so diseases; and 49, with a statistical peak far operational at various levels. – the creation of an effective between 20 and 29. This reali- The forms of health care which national network to guarantee ty lowers the number of young are provided are curative, pre- infection-free blood; people in the ages of repro- ventive, promotional, and reha- – assistance and pyscho-so- duction and procreation. bilitative in character. cial accompanying for people There are 410,000 young Three kinds of care are to be who suffer from, and have to orphans under fifteen years of encountered, and they are as live with, HIV; age and 310,000 of these have follows: – the establishment of an eth- lost both their parents. – outlying: in the health care ical and legal committee to cre- The incidence of this dis- zones where preparation and ate a favourable environment ease is on average 4.35% in implementation are carried out for people who have to live the 15-49 age band, a figure as a basic operational element; with HIV; which is higher in the urban – intermediate: at a provin- – the strengthening of the na- areas than the rural areas. cial level where the health care tional system for the epidemio- This higher incidence is also zones are organised and co-or- logical surveillance of AIDS to be seen amongst habitual dinated in a general sense; and other sexually transmitted blood donors and the family – central: at the level of the diseases; relatives of AIDS victims, Ministry of Health where pro- – a general policy involving workers in companies (5.3%), gramming, co-ordination and the actors in the fight against pregnant women (6%), prosti- general organisation are carried AIDS and sexually transmitted tutes (30%), and people suf- out. Here we encounter the vari- diseases; fering from tuberculosis who ous plans and specialised health – a strengthening of the ca- have been admitted to hospi- care programmes, amongst pacities of the institutions and tal (33%). which are those which deal with agents involved in the fight In addition to AIDS, the AIDS and other sexually trans- against AIDS. other following social facts mitted diseases. This national policy is not are equally worrying: The national policy against yet operational. We are still – the rate of infant mortali- AIDS was adopted in July waiting for a specialised pro- ty is 119 every 1000 live 1999 with the creation of a gramme of intervention to sup- births; three year plan for the years port the health care zones in – the rate of maternal mor- 1999-2001. Its aim is to stop matters relating to information, tality is 870 every 100,000 the spread of this epidemic and education and communication, live births; its impact on families and indi- condoms, the treatment of sex- – a weight deficiency in viduals. An effective approach ually transmitted diseases, the 34% of babies; is required which is decen- safety of blood, the treatment – life expectancy in 1996 tralised, multi-sectorial and in- of people who live with HIV, a was 48 whereas in 1993 it tegrated into the pre-existing monitoring of the spread and was 52; basic system of health care. behaviour of the epidemic, op- – GDP per capita is $117; The objectives of this policy erational and fundamental re- – accessibility to treatment are as follows: search, follow-up and supervi- for the urban population is at a. To strengthen the ability to sion, training, the provision of 40% whereas for the rural act of the agents and institu- drugs and medicines, and the population it is at 17%, mak- tions involved in the fight drawing up of directives, rules ing an overall average of 26%. against AIDS at a central and and regulations. Side by side with govern- (theatres, educational talks, 4. Comments ment action we find the initia- group encounters, video fo- and Conclusion tives of 170 non-governmental rums, micro-training, slides organisations united in a forum and films and other audiovisu- Access to treatment and care in the fight against AIDS which al material, conferences and by people suffering from goes under the name of ‘FOSI’. debates) and the accompany- AIDS, in terms of the popula- Some of these NGOs are large ing of those with the disease tion as a whole, can generally in size – such as the religious (diagnostic follow-up, visits, be reduced by 26% because of group ‘GOS’ – some are medi- and home-based care and the marginalisation of the sick um sized (AMO-CONGO), treatment). person, and as a result of this and some are small (PAES). The other Christian action condition, of his community as Their funding is provided by groups involved in the fight well. It will be even lower be- special backers, by the commu- against AIDS have few finan- cause of the war going on in the nity, and by measures of cial resources and thus can only country and all its pernicious self-funding which are organ- draw upon the resources of consequences. ised within these organisations. people of good will (medical Given that a national policy Because these bodies do not doctors, nurses, chaplains, and against AIDS has not yet been always have sufficient eco- the members of small church- implemented, assistance is es- nomic means, the action of es) who work within the con- sentially and symbolically pro- members of the community is text of their basic professional vided by the individual and his of primary importance in the responsibilities. Such people close family, and this despite field of AIDS in the Congo. are not necessarily benefactors. the great poverty which afflicts The costs here are essentially At this level the material diffi- this community. 92 born by individuals and the nu- culties which are encountered The appearance of AIDS in a clear family. often make the support which family is currently experienced is begun at the moment of ad- as a catastrophe. This will be mittance to hospital ineffective. the case for a long time to come 3. Pastoral Care The pastoral care which does because in addition to a good not take place within an organ- policy we need a suitable Pastoral care takes place ised framework sees AIDS as a health care budget and the po- within an organised framework divine punishment and is char- litical will which will really en- and a non-organised frame- acterised by the attribution of able us to fight against AIDS work. blame to the sick person who is and reduce its impact on indi- The first is characterised by thought to need purification viduals and communities. activities of consciousness- through dangerous practices Efforts must still be made to raising and accompanying which are held to lead to a promote organised pastoral based upon a neutral message miraculous cure (prolonged care and to curb the charlatans. of hope. The ecumenical group fasting in the case of sick peo- Overall, the Democratic Re- involved in the struggle ple who are already weak, be- public of the Congo is one of against AIDS (GOS) is the ing washed with poisonous liq- the countries which is most af- most important of the category uids and materials, collective flicted by AIDS and in which and promotes an overall ap- euphoria which increases the access to care and treatment is proach which includes all the practice of forms of behaviour scarce. Assistance in this field aspects of the AIDS phenome- at risk, etc.). The religious sects largely falls upon the individ- non. It has a multidisciplinary are the entities which most ual and his family. group of pastoral medical ac- work in this area. In this area tive members organised to- an attempt is being made to Dr. KAPEPELA gether into a special unit. The bring them under control so as KAKICHA MARIE, activities this group engages in to reduce the harm that they The Democratic Republic are the raising of awareness can do. of the Congo.

III: South America - Brazil

– As of February 1999, the main metropolitan areas of ment of the epidemic. there have been 162,865 cases the country; – The first case of AIDS in of AIDS registered by BMH. 2. Injection drug users, Brazil was diagnosed, retro- The BMH estimates that there mainly young subjects from spectively, in 1980, in São are over 500,000 HIV+ per- different social strata (mainly Paulo city. sons living in Brazil. disadvantaged) in the big and – Until 1987 there was no – The history of the AIDS middle-sized cities of the anti-retroviral treatment. epidemic in Brazil has quite country; – AZT was the first drug different phases: 3. Heterosexual dissemina- made available by the Min- 1. Homo and bisexual men tion toward women, with inte- istry of Health in 1991. from higher social classes in riorization and impoverish- – DDI was available in 1993. – In 1996 in a pioneering tients returning to their “nor- plex system, comprising 338 decision, the Brazilian govern- mal” life. The majority of general hospitals. ment made combined therapy them have returned to their Specialized care is available available to all Brazilians at no jobs. After the beginning of in most regions of the country, cost. HAART there was a decrease including 140 outpatient facili- – The amount of US$ of up to 81% of opportunistic ties, 60 day-care units and 46 500,000,000,00 was spent in infections amongst AIDS pa- home-care units. The latter fig- 1996 in medicines for AIDS. tients in Brazil. ures seem quite low vis-à-vis Currently, some 68,000 pa- The BMH estimates that the huge Brazilian demands tients receive this kind of some 47,300 patients were for medical assistance and the treatment. spared being in hospital wards scale of social problems. All patients under medical in 1997. That meant that some Another problem still to be supervision are entitled to re- US$ 10,000,000,00 were fully addressed is the referral ceive free of charge combined saved in that year. of patients from and to the dif- therapy (HAART). To monitor in a comprehen- ferent units of such a huge and There are specific rules to sive way Highly Active Anti- heterogeneous country. begin the treatment in sympto- Retroviral Therapy better lab- Our clinics and support matic and asymptomatic sub- oratorial resources (tests, houses care for homeless peo- jects. training, improved facilities) ple, male and female prosti- These rules are updated reg- were made available by the tutes, ex-convicts and street ularly by the Brazilian nation- Ministry of Health all around kids. We have tested for HIV al board (at least once a year). Brazil. some X patients and Y of them Currently there are 12 anti- All patients must know and were tested positive. retroviral drugs available for understand clearly that full ad- Our multidisciplinary team 93 treatment. hesion to treatment is funda- has physicians, odontologists, To receive the treatment the mental for a better quality of psychologists, social workers, patient has to be enlisted in a life and fundamental to avoid and nurses. National Databank. Using the the emergence of viral resis- Our population demands information of this databank it tance. very special care, as the major- is almost impossible to give Non-adherence, besides bad ity of them are homeless. So, the treatment twice to the consequences for individuals, we provide showers, clean same person, and BMH can has become one of the most clothes, meals and a day hospi- follow-up the patients under threatening challenges for pub- tal. This is a complex task, sel- HAART regimes in the differ- lic health in the post-HAART dom provided by other facili- ent regions of the country. era. ties, requiring the multidisci- The medicines are distrib- Some patients with a very plinary work of different spe- uted under regular medical su- low cultural background with cialists, besides social support. pervision and the amount of an undetectable viral load fre- Most patients are heavily af- medicines delivered is enough quently stop treatment and fected by alcohol and drug for at least a month-long treat- may transmit the virus, mainly consumption, with high attri- ment. All patients are entitled by sexual relationships. tion rates unless they receive to have free of charge CD4 Constant counselling is fun- care and continuous support. counts and viral load tests for damental for all patients on A unique role is reserved to re- up to three times per year. HAART. ligious assistance and support, There has been an impres- There is a high incidence of a core strategy to make their sive decrease in AIDS mortali- tuberculosis in Brazil, and lives better and meaningful ty in recent years. From 1995 some 20% of these patients and to improve adherence to to 1998 the mortality de- are HIV+ and cannot use dif- HAART and other medical creased around 49%. ferent regimes of combined and nursing protocols. The quality of life improved therapy while under treatment We deal with these patients substantially, with some pa- for tuberculosis, and ask for in the most comprehensive alternative strategies. and timely way possible, so Some citizens believe that that they can be assured that “a cure for AIDS” is already we do care for them!!! available and have not taken Due the lack of basic educa- any kind of prevention in relation, there are barriers to com- tion to HIV infection. munication with some of these Some patients with an unde- patients. We have trained our tectable viral load begin sexu- staff to sort this problem out. al relationships with partners One of the most important thinking that they have been aspects of our work is to res- cured. cue the self-esteem and digni- Highly resistant viruses can ty of these patients. be spread by some patients who have discontinued their MARIA INEZ LINHARES therapeutic regimes. DE CARVALHO, MD Assistance is provided to Archdiocese of Rio de Janeiro, AIDS patients through a com- Brazil IV: Central America - Haiti

The Republic of Haiti on the wards prostitution and drugs. The Catholic Church of western part of the island of For this reason, sexually trans- Haiti, whose mission is to Haiti has a population of mitted diseases (STD), and in serve man in his wholeness, 7,500,000 inhabitants. Over particular AIDS, are at the pre- makes an important contribu- 70% of them live at the present time in Haiti one of the tion to the reduction of the sent time under the absolute greatest problems for public level of illness and mortality poverty line with a pro capita health. caused by pathologies of of 500 gdes a year ($US 28 a Between 240,000 and every type. In fact, concern for year). Over 50% of children of 335,000 people are presently people with AIDS comes the school age do not go to infected with HIV - about 6% largely from the Catholic school and only 10% of chil- of the total population of the health care institutions amount dren who go to school then go country. However, these statis- to 190 in number - that is to on to secondary school (Re- tics are well below actual real- say 37.9% of the health care 94 port of the BID, 1997). ities. In this country there is no institutions of the country. The socio-economic condi- legislation which governs this Amongst these institutions we tions of the country continue disease. There is no law which should make a distinction be- to grow worse as a result of obliges medical doctors or the tween clinics, hospitals and political instability and in- health care personnel to report centres for the terminally ill. creasing insecurity. Serious diagnosed cases of HIV- The clinics of the Catholic health care problems afflict AIDS. For this reason, many Church are to be found in the the population, and the hardest cases escape the knowledge hinterland of the country, and hit are the poor. Hunger, acute and control of the health care access to them is often very hunger, illiteracy and unem- authorities of the country. difficult. Suspected cases are ployment drive people, in- Here are certain statistics identified by these clinics and cluding many adolescents, to- relative to 1998: referred to more advanced centres for diagnosis. Once Total Adults Women Children they have been diagnosed these sick people are sent back to their localities and care is People who live 236.65 223.71 100.35 12.94 provided to them by the per- with AIDS to 332.43 to 314.19 to 141.69 to 18.24 sonnel of the clinics. This care involves: – regular consultations in order to identify early on the New cases of 40.70 36.02 18.17 4.69 signs of opportunist illnesses; HIV infection to 56.01 to 49.43 to 24.96 to 6.57 – home visits in order to make the patient have an responsible approach towards the rest of the population; Number of new 28.26 24.45 10.43 3.82 – nutritional aid. cases of AIDS to 39.2 to 34.51 to 14.78 to 5.40 The hospitals are an intermediate structure between the clinics and the centres for the terminally ill: Total deaths 21.600 – they carry out diagnoses; since the outbreak to 30.000 – they treat the acute cases of the infection which are sent to them. After recovery these patients are sent to the local clinics or to Orphans 1.300 the centres for the terminally to 1.900 ill during the last stages of their life.

The centres for the termi- Tubercolosis 44.57 nally ill, four in number, re- + AIDS to 58.58 ceive patients when they are at the advanced stage of this illness. Their treatment involves: – physical help; and identify the causes of his prevention requires the con- – the treatment of oppor- failure. If he wants to he can certed action of all the sectors tunist infections; then renew his promise. of national life. The very – accompanying these pa- – education in favour of widespread use of the con- tients in order to help them faithfulness between marriage dom, which has hitherto been live out this new reality. partners. proposed as the measure of In addition to taking care of However, many obstacles prevention, has failed, as is people suffering from AIDS, make the action of the borne out by the statistics pub- the Catholic Church is also ac- Catholic Church difficult. We lished at a world-wide level tive in the sphere of preven- may cite some of them: - over the last ten years. It is tion. Action consists of: lack of material; thus imperative for the – encounters for informa- – a shortage of qualified Catholic Church to place em- tion and training; staff; phasis upon her doctrine in re- – education in favour of – certain taboos; lation to the dignity of the hu- chastity amongst young peo- – a lack of co-ordination be- man person and to stress her ple: after a period of prepara- tween the Catholic health care guidelines with regard to the tion the young person freely institutions (it should however family. Furthermore, she decides to engage in chastity be noted that for about two should seek to create spaces for a renewable period of six years an attempt has been un- by which to encourage and months. If he does not keep derway to create a network implement them. this promise the young person made up of these health care has the possibility to return to institutions). Dr. JEAN-MARIE CAIDOR, the training centre and with In conclusion, AIDS is an Episcopal Commission for Health, the help of the staff to detect illness of behaviour and its Haiti. 95

V: North-America - The United States of America

Please allow me to thank ty of those living with HIV. recent history. HIV infection His Excellency, Archbishop However, there is no sign that and the clinical complications Lozano, for the kind invitation new infections are following related to it are placing a which he extended to me to the same downward course; it heavy strain on medical and joint this meeting and to share is estimated that some 1.5 mil- social services. It should be some reflections on the expe- lion people in the above-men- noted that not all people living rience of the Church in the tioned areas were living with with HIV-AIDS in the United United States in response to HIV at the end of 1999. In a States can gain access to the this pandemic which has study of homosexual men in combination therapies. This wrought such profound effects San Francisco, for example, country does not have a na- on individual and family lives indication was given that high tional system of health care. as well as on social and eccle- risk sexual behaviors are be- Some private insurance plans sial structures despite the brief ing adopted once again. The will cover the cost of these period of time which it has fact that people living with medications for HIV-infected been in our consciousness. HIV are living longer also individuals who already were I will begin with a brief re- makes it possible that those enrolled in their plans. State view of the trends in the de- who engage in sexual inter- and federal funding is avail- velopment of the pandemic as course may infect others over able to provide such drugs to it presently has evolved in the a longer period of time. The residents whose annual in- United States. This country is positive effects of the anti- come is below established joined by others in Western retroviral therapy also seem to poverty guidelines. Others are Europe and North America, as be tapering off. In the United denied the possibility of bene- well as Australia and New States, for example, AIDS fitting from such treatments Zealand, in which their re- deaths decreased by 42% be- unless they qualify for particu- spective populations are par- tween 1996 and 1997, but by lar research protocols. ticularly vulnerable to the only half that proportion be- In December of 1998, the threats of denial and compla- tween 1997 and 1998. Centers for Disease Control, cency in the face of HIV- Let us look more carefully reported the following infor- AIDS. It is indeed true that the at the effects of this pandemic mation related to the extent of numbers of new cases of in the United States. In spite of HIV-AIDS in the USA.1 AIDS and of death due to the medical and technological – AIDS is the second lead- AIDS-related illnesses are resources available to many ing cause of death among both falling significantly in residents of this country, HIV- adults in the USA aged 25-44. countries where people have AIDS presents itself, never- – The total number of HIV- access to combination, anti- theless, as the most critical infected people in the USA is retroviral therapy for a majori- and devastating epidemic in estimated between 650,000 and 900,000, and approxi- ter issued by all the bishops of fornia, and in several other mately 40,000 are infected the United States, Catholics dioceses, young people are ed- each year, of which as many were reminded of the Gospel- ucating their peers about the as 50% of these cases may be based responsibility to affirm fact that the only “safe” way among young people under the dignity of those living with to avoid HIV-AIDS is to be age 25. HIV-AIDS and to care for abstinent before marriage and – Although racial and ethnic them without hesitation. faithful within marriage. minorities account for only Persons with AIDS are not 25% of the U.S. population, distant, unfamiliar people, the In the area of health they account for more than objects of our pity and aver- and social services: 50% of all AIDS cases. sion. We must keep them pre- In a 1995 survey, 120 hos- African-Americans and His- sent in our consciousness, as pitals, 209 outpatient health panics account for 58% of individuals and as a communi- services, and 177 social ser- adolescent males with AIDS ty, and embrace them with un- vice agencies identified them- and 83% of adolescent fe- conditional love. The Gospel selves as being Catholic- males with HIV. demands reverence for life in sponsored and responsive to – Many at greatest risk are all circumstances. Compas- the needs of people living still not aware of the behaviors sion – love – toward persons with HIV-AIDS.3 The health- than can result in HIV infec- infected with HIV is the only related services which they tion. It is estimated that some authentic Gospel response.2 sponsor include inpatient and 200,000 infected people in the In response to the strong en- outpatient medical care, nurs- USA have no idea of their in- couragement of the bishops ing home, hospice care, and fected status or of the threat and in following the excellent in-home care. The social ser- 96 which they can pose to others example of clergy, religious, vices which they sponsor in- through sexual contact or con- and committed laypersons clude emergency food sup- tact with infected blood. who heard the “cries” of those plies, transportation, home- – The proportion of all affected by this pandemic, ex- maker services, home visit- AIDS cases reported among cellent educational, medical, ing, emergency housing, tran- adult and adolescent women and social services in response sitional housing, permanent has nearly tripled – from 7% to the pandemic were devel- housing, counseling and men- in 1985 to 22% in 1997. oped under the auspices of the tal health services, support – The incidence of AIDS is Catholic Church in the United groups for HIV-infected per- 14 times highler in state and States. Here are some exam- sons as well as for the fami- federal prisons than in the ples of such resources and ser- lies and loved ones, support general population of the vices: groups for the bereaved, and United States. support groups for those pro- Let us now examine how In the area of education: viding care. Populations the Church in the United – The U.S. Catholic Bish- served include adults, chil- States has attempted to bring ops’ Conference developed a dren, the incarcerated, racial its ministry to those living videotape entitled Living with and ethnic minorities, and with HIV-AIDS. The bishops AIDS: An Occasion of Grace those who are disables. of this country were among (1990). It focuses especially the first to appeal to all the on the diocesan and parish re- In the area of faithful to respond to those af- sponses to HIV-AIDS. pastoral services: fected by the pandemic with – The National Catholic Ed- Perhaps the greates demand compassion and without fear ucation Associatin published a or challenge which the pan- or prejudice. In the document, teachers’ manual and curricu- demic places upon the Church issued in 1987 and entitled lum for primary and sec- is in the area of pastoral care. The Many Faces of AIDS: A ondary grade leverls; it is enti- Many of those infected with Gospel Response, the Admin- tled AIDS: A Catholic Educa- HIV, even those who formerly istrative Board of the U.S. tional Approach to HIV were alienated from the faith Catholic Bishops’ Conference (1992). community, urgently turn to mentioned the new services – Catholic Charities USA the Church for assistance in which should be considered developed a training manual searching out the deeper by parishes and institutions and educational program for meaning and value of their sponsored by the Catholich those engaged in the social lives despite, and often as a re- Church. apostolate (1995). sult of, the physical, psycho- Current programs and ser- – The National Federation logical, and social pain they vices needs to be expanded to of Priests’ Council published a experience. At times even the assist the families of those booklet on Clergy and Reli- Church’s vital sacramental with AIDS while they are gious and the AIDS Epidemic. ministry is not sufficient to alive and also to support them – Many dioceses have pro- satisfy the hunger and thirst in their bereavement. In addi- duced educational manual on for God posed by people liv- tion, new programs, services, HIV-AIDS and their own ing with AIDS as they face the and support systems need to plans for AIDS ministry with- “dark night of the soul” be developed to deal with un- in the respective diocese. through their suffering and dy- met and poorly met needs. – In the Diocese of Albany, ing. Despite the Church’s In a subsequent pastoral let- New York, and Oakland, Cali- unique capacity in this area of its mission, members of the us all with an unconditional willing to join an HIV-AIDS faith community have not al- and everlasting love”. apostolate in your parish. ways responded as fully as The following questions are – Plan and take action; keep possible and as necessary to posed to parishioners who are the other parishioners in- the call for pastoral ministry preparing to serve those af- formed about your activities by persons affected by the fected by the HIV pandemic: so that the apostolate keeps its pandemic. Some priests, reli- – How can our parish better roots within the parish. gious, and laypersons are fear- integrate the needs and con- – Evaluate and change your ful to approach those living cerns of such people into our activities as needed. with the virus because they existing apostolates? The pandemic of HIV-AIDS have the false impression that – What resources in our indeed has challenged and this disease could be transmit- parish can help us to provide shaped humanity – and contin- ted through casual contact. care and education related to ues to do so at the present The Catholic parish is the HIV, especially to members of time. It has tested it with phys- weekly gathering place for racial and ethnic minorities? ical pain and disfigurement, most of the sixty million – Is our parish a welcoming with exclusion and discrimi- Catholics in the United States. community? How can we help nation, with emotional conflict These 19;700 parishes are fo- it to become more welcom- and confusion, and with spiri- cal points for education, ser- ing? How can we expand our tual crisis and despair. This vices, social justice advocacy, apostolate of hospitality to in- same pandemic has demanded and pastoral care. Conscious clude and reach our to those that the Church transform it- of demands being placed on living with and affected by self in closer conformity with these parishes by those affect- HIV? its mission as teacher, servant, ed by HIV-AIDS, the leaders – How can we help fellow and convener of the worship- 97 of the National Catholic AIDS parishioners to overcome ing community. The members Network and Catholic Chari- judgment and stereotypes con- of the administrative board of ties USA prepared a training cerning HIV-AIDS? the U.S. Catholic Bishops’ manual and process to encour- This same training process Conference offered Catholics age the development of offers the following guidelines in the United States a “litmus parish-based HIV-AIDS min- to those who wish to provide test” of our ministry in re- istries. pastoral care to people affect- sponse to the pandemic of In the above-mentioned ed by the pandemic of HIV: HIV-AIDS, when they said: training process, parishioners – Move out of denial – un- Our response to the needs of are encouraged to prepare destand that AIDS is every- persons with AIDS will be themselves to respond to peo- one’s problem. Search for the judged to be truly effective ple affected by HIV-AIDS – path to compassion. when we discover God in not as “strangers” or “those – Get to know the life situa- them and when they, through others” but rather as brothers tions of people living with their encounter with us, are and sisters in the community HIV-AIDS by meeting them able to say, “In my pain, fear, of faith. They are asked to pay and inquiring how this disease and alienation, I have felt your particular attention to the affects their lives. presence, a God of strength, words of our Holy Father – Understand your own re- love, and solidarity”.4 when he visited San Francisco sponses to HIV-AIDS by ac- in 1989: knowledging and speaking Rev. ROBERT J. VITILLO “God loves you, without about your feelings and Executive Director Catholic distinction, without limit... He thoughts. Campaign for human development loves those of you who are – Seek your foundation in USA sick, those suffering from faith by reading and reflecting AIDS. He loves the friend and on statements of the Holy Fa- relatives of the sick and those ther and bishops about the who care for them. He loves pandemic, by meditating on Sacred Scripture, and by speaking with your spiritual Notes director. 1 AIDS – End the Silence, Resource – Make a personal commit- Booklet for World AIDS Day, Decem- ment to serve people affected ber 1, 1999, Washington, DC: American by HIV-AIDS. Association for World Health, 1999. 2 National Conference of Catholic – Make a community com- Bishops, Called to Compassion and Re- mitment to seek parish support sponsibility: A Response to the HIV- for action to bring AIDS in to AIDS Crisis, as appeared in Origins, No- vember 30, 1989, vol. 19, no. 26. the light and action of your 3 Resourche Directory of Catholic- faith. Sponsored HIV-AIDS Programs, pre- – Assess which needs re- pared by Catholic Health Association of the United States, Catholic Charities quire priority action within USA, and the National Catholic AIDS your parish. Network, 1996. – Assess the resources and 4 United States Catholic Conference Administrative Board, The Many Faces talents which are present of AIDS: A Gospel Response, in Origins, among parisioners who are XVII, 28 (December 24, 1987), p. 136. VI: Europe and Poland

1. Polish society realised that real diseases. A major increase tion Office for the Prevention of the HIV epidemic had also in venereal diseases has been AIDS and the Centre for the Di- reached Poland in 1985, the observed in Russia, the Ukraine agnosis and Treatment of AIDS. year in which a case of conta- and Bielorussia but this is also Patients can take advantage of gion with HIV was registered something which has been reg- the services offered in twelve for the first time in our country. istered in Moldavia and Kaza- specialist hospital institutes lo- Since that year diagnostic khstan. cated in the provincial capital analyses have been brought into The worrying epidemiologi- cities. Following a well estab- being in Poland for the identifi- cal situation of AIDS in Eastern lished practice, those suffering cation of HIV. The epidemio- Europe has special importance from AIDS are admitted to the logical data which have been for Poland, and is a source of infectious diseases wards and gathered by the National Health major preoccupation, because any form of isolation is ruled Service demonstrate that from we are the immediate neighbour out. All the patients who need the beginning of the analysis – of most of these countries. The anti-retroviral treatment receive that is to say from 1985 until development of so-called sex it as long as they meet the crite- 98 October 1999 – 6,050 Polish tourism and the phenomenon ria laid down by the National citizens were contaminated, of (which is becoming increasing- Strategy for Anti-retroviral whom at least 3,800 were in- ly widespread in Poland) of Treatment, which was drawn up fected because of drug use. prostitution practised by female by health care workers who There were 826 cases of AIDS immigrants from the East can were specialists in the treatment of whom 460 died. These are bring about an increase in levels of AIDS. Before beginning the official data. However, it of contagion in our country. The treatment the patients have to should be emphasised that giv- situation is certainly serious and undergo a series of tests and en epidemiological estimates, constitutes a challenge for the analyses which are subsequent- in reality from 15,000 to 20,000 authorities of the country and ly repeated three times a year people have been infected by the institutions established to and which permit an effective the virus. These data do not deal with the prevention of monitoring of the effects of the place Poland amongst the Euro- AIDS. Strict co-operation anti-retroviral treatment that pean nations which have a high should be engaged in, primarily these patients receive. percentage of infection, howev- in order to exchange experience As has already been ob- er this is not something which in relation to preventive action served, the anti-retroviral drugs should comfort us because the and legislative and structural – the most expensive part of the infection is demonstrating a remedies for carriers of HIV treatment – are bought from a gradual although slow rate of and those afflicted by AIDS. central body and paid for with increase. funds from the Ministry of The situation in Poland ap- 2. The carriers of the HIV Health. At the present time pears comforting in comparison virus and those suffering from anti-retroviral treatment is giv- with that which obtains in the AIDS receive guaranteed over- en to over a thousand patients other European countries, and all health care in Poland and and it is useful to make clear in particular with that to be they also have guaranteed ac- that this year seven million found in the Eastern European cess to therapies involving the American dollars have been al- countries. The expansion of the recent anti-retroviral drugs, located to such treatment. The epidemic in the countries of the something which is very impor- Minister of Health has also es- former Soviet Union is much tant for them. The responsibility tablished a special central fund more notable, and this is some- for the organisation of the sys- for preventive action which in thing which is worrying for us. tem is entrusted to the Minister 1999 amounted to four million In the Ukraine, Russia and of Health. The policy guide- dollars. Bielorussia, the last four years lines are defined by the Nation- An important goal in the sys- have demonstrated an extreme- al Plan for the Prevention of tem of anti-retroviral treatment ly high rate of increase in the AIDS, a plan lasting a number is the provision to pregnant levels of contagion. The princi- of years which outlines the gov- women infected by HIV of pal carriers of the virus in these ernment’s priorities in the treatment which has a high countries are drug-addicts who sphere of the struggle against probability of minimalising the inject themselves with drugs in- AIDS. Recently the government dangers of them having travenously. The same situation has established such a plan for sieropositive children. The ba- is to be found in Moscow, Min- the years 1999-2003. bies born to mothers who are sk and Kaliningrad. A clue re- In 1993 the Minister of carriers of HIV are from birth garding the possible propaga- Health created two government part of a specialised system of tion of HIV in Eastern Europe agencies specialised in preven- laboratory diagnosis which al- through sexual contacts is pro- tion and the drawing up of stan- lows the rapid identification of vided by the results of the in- dards in diagnosis and treat- possible infection. All sieropos- vestigations into cases of vene- ment: the National Co-ordina- itive minors (in Poland there are about fifty) are guaranteed tries of the former Soviet mentioned where AIDS victims treatment and care at the Clinic Union. It should be observed are treated the hospital chap- for Childhood Infectious Dis- that in general in the countries lains are fully occupied in pro- eases in Warsaw. It should be of the former Soviet Union it is viding spiritual care and assis- observed at this point that in rare to encounter patients with tance to these patients. I would Poland pregnant women with AIDS who are guaranteed like to stress the importance of the HIV virus receive strong health care of a good level. It is co-operation with the govern- psychological support and true that in the Ukraine and ment body the National Co-or- through specialist psychologists Russia the big cities have the dination Office for the Preven- are encouraged to remain preg- so-called ‘AIDS centres’. How- tion of AIDS which uses funds nant and to give birth to their ever, principally for financial from the Ministry of Health to child. reasons, they are not able to implement and finance the sys- The carriers of HIV and peo- provide patients with spe- tematic training of seminarists ple suffering from AIDS can cialised diagnoses or anti-retro- drawn from a large number of avail themselves of the services viral treatment. The govern- higher seminaries. This office of psychological consultors, of a ments of these countries have also organises the publication of special telephone service open established national AIDS pre- works for special groups of night and day, and of the system vention programmes and it is to readers, for example for the of support offered by a large be hoped that in the not too dis- clergy. It has produced books number of non-governmental tant future they will manage to such as ‘The Church and AIDS’ organisations. One of these is find funds so that these pro- and many others. All these pub- the voluntary association ‘Come grammes can be implemented. lications are given out freely to to Us’ in which people with It seems to me right to say at those who are interested in HIV, their friends and support- this point that our states are them. The Ministry of Health 99 ers, offer help. morally obliged to provide the also finances a conference on All in all the medical and so- HIV carriers and AIDS suffer- the questions and issues of cial care given to carriers of ers who live in the countries of drug-addiction and AIDS which HIV and those suffering from the former Soviet Union with takes place at the end of each AIDS in Poland is maintained at the best help possible. The year with the participation of the highest possible level and high-sounding slogans which numerous groups of female reli- certainly we should not in the marked the celebrations of the gious and secular students of least be ashamed about it. world AIDS day in many Euro- theology. To conclude: let us re- However, it should be ob- pean countries, such as ‘a world member that the Church in served that beyond the coherent of hope’, ‘common rights, com- Poland is responsible for vari- and efficient system which op- mon duties’, or ‘unite for equal- ous centres which operate with- erates, and the notable sums ity!’, seem to be mere common- in the spheres of action of heal- provided by the state, there is a places empty of meeting when ing communities and help need for an important initiative they are considered in relation drug-addicts. Most of these peo- of information in order to en- to the frightening situations to ple are young carriers of HIV. sure that society is increasingly be found in Africa and the These Catholic centres are com- informed about AIDS. This countries of Eastern Europe. In- pletely financed by the state as could provide for an even more deed, they are not even worth part of the collaboration with suitable shaping of social atti- repeating. the Ministry of Health. I can af- tudes towards AIDS. We are all firm with great satisfaction that convinced that discrimination in 3. In conclusion, I would like the presence of the Church in relation to those suffering from to stress the very important na- the field of helping people suf- AIDS, which unfortunately ture of the work of the Catholic fering from AIDS is noteworthy characterised the first years of Church in relation to the prob- and that the Church’s collabora- its appearance in Poland, is by lems and issues connected with tion with the government works now something which belongs AIDS. We are probably the only to the satisfaction of both par- to the past. country in which a Catholic ties. I would also like to discuss priest and member of the Order I would like to hope that the the health systems of the coun- of the Camilians is an adviser information that I have given to and delegate of the Minister of you in this paper has drawn you Health in matters connected nearer to the situation in Poland with AIDS and drug-addiction. and that it has been of help to This fact has a marked influ- the debate. I would like to ask ence on the shaping of a suit- you once again to forgive my able policy of the state and the absence and I would like to ex- bringing about of collaboration press to you my deep regret at between the government and not being able to be with you the Church in this important here today. area. One is dealing here in the main with educational activities Don ARKADIUSK NOWAK, and initiatives for young people, Adviser to the Minister of Health the construction of inter-human in matters relating to AIDS ties, and the encouragement of and drug-addiction, attitudes of solidarity towards the Ministry of Health people afflicted with this ill- and Social Insurance ness. In all the hospitals I have of the Republic of Poland. Conclusion

This conference led us to Co-ordinator of the Programme: recognise the urgent need to fol- H.E. Mons. José L. Redrado, O.H. low the question of HIV-AIDS very closely, both through the WORK GROUP standing study group and the Rev. Mons. Ryszard Selejdak continental study group, and (The Congregation for Catholic Education) with a programme organised around three key areas: Rev. Mons. Jacques Suaudeau – information; (The Pontifical Council for the Family) – archive material; Dr. Fiorenza Deriu Bagnato – education. (Social Researcher) Dr. Guido Castelli (The “Bambino Gesù” Hospital) 100 Work Programme for the Year 2000 Dr. Massimo Fantoni (The Catholic University of the Sacred Heart) 1. Information Dr. Pino Gulia (Caritas Italy) The insertion in the Pontifical Council’s Internet site of: Dr. Rosa Merola 1. The main papers given at (Psychologist) the conference held in Decem- Dr. Antonio Spagnolo ber 1999. (Centre for Bioethics of the Catholic University of the Sacred Heart) 2. An information statement Dr. Luca Tuninetti on the new possibilities con- (The Pontifical Council for the Laity) cerning prevention with regard to transmission from the mother CONTINENTAL STUDY GROUP to the foetus. 3. An information statement AFRICA on the initiative designed to Rev. P. Edward Phillips, M.M. help orphans. Tel. 02.441919 - Fax 02.447027 E-mail: [email protected] 2. Archive Material Kenya Dr. Benoit Ntari 1. The organisation of a spe- Tel. 242.830629 - Fax 242.837908 cial library on the question Republic of Congo based on material from many AMERICA sources. P. Robert J. Vitillo 2. The diffusion through In- Tel. 1.202.5413210 - Fax 1.202.5413329 ternet of the archive material of E-mail: [email protected] this special library. The United States of America 3. The publication of the acts Dr. Maria Inez Linhares de Carvalho of the conference of December E-mail: [email protected] 1999 on ‘The Catholic Church Brazil and the Challenge of HIV- ASIA AIDS’. Dr. Gracious Thomas Tel. 91.11.6969347 - Fax 91.11.6962313 3. Education E-mail: [email protected] and Training Initiatives India Dr. Kumnuan Ungchusak 1. The drawing up of a vade- E-mail: [email protected] mecum which will help the lo- Thailand cal Churches. EUROPE 2. The preparations for the Dr. Antoni Mirabet AIDS Day of 1 December Tel. 34.93.2117046 - Fax 34.93.2123518 2000. Spain 3. The meeting of the conti- P. Arkadiusz Nowak nental study group on AIDS Tel. 48.22.7884825 (30 November 2000-1 Decem- Poland ber 2000). Seminar

The Identity of the Catholic Chaplain in Pastoral Care in Health and Health Care on the Threshold of the Third Millennium

22-23 November 1999 Nova Domus Sanctae Marthae Vatican City On 22-23 November 1999 the Pontifical Council held a Study-Seminar at the Domus Nova St. Marthae on the subject of

102 ‘the identity of the Catholic chaplain in pastoral care in health and health care on the threshold of the third millennium’. This was the first initiative of the ‘programmes’ which the Ministry drew up during the celebration of the IV Plenary Session of 1998, and forms a part of the third section entitled ‘the ministry of communion’. Its specific objective is to ‘promote, direct and co-ordinate the union of the Catholic chaplains of health centres’, something required by the founding Apostolic Letter ‘Dolentium Hominum’. The participants were nominated by the respective bishops entrusted with this task by the episcopal conferences from the countries concerned, people different from those responsible for the ‘National Associations of Chaplains in Health Care’. The following are the four leading papers which constituted the platform upon which this seminar of study was based. The Ordained Ministerial Priest, Bishop and Presbyter in the Health Care Ministry in the Light of the Apostolic Exhortation “Pastores Dabo Vobis”

At the beginning of the third concealed and not dealt with from the others who reproduce millennium the health care other than at the level of statis- Christ. Christ has a personality ministry is experiencing a lack tical data or clinical cases. with many features. As a mod- of ministerial priests. This is in In this paper I will seek to el of the ordained priest, the part due to the lack of priestly present certain aspects of the four which have already been vocations and is in part perhaps significance of the ministerial mentioned emerge: Head, also due to the fact that this priest in the field of the health Shepherd, Servant, and Bride- priestly ministry is often not care ministry in the light of the groom. The ministerial priest understood. In some cases Apostolic Exhortation “Pas- has his own specific character- there is a limited vision of its tores Dabo Vobis” which of- istics which distinguish him range and it is thought that fers as an approach that of the from the other Christians who, there are other priorities to be step from Mystery to Ministry. in their turn, are shaped in dealt with which do not allow I will then try to begin with Christ, whose figure involves concentration to be placed up- certain fundamental aspects of being the Head, Shepherd, Ser- 103 on something which can be this area in order to understand vant and Bridegroom of the thought to be peripheral. the Mystery of the ministerial Church. This definition makes There is also the fact of hos- priest and then explore its im- him a being who is substantial- pital chaplaincies being en- pact on that Ministry. My pa- ly different from other Chris- trusted for a variety of reasons per, therefore, will be divided tians, as we will see later. Let to members of the laity. In into two parts. The first will us now examine each of these some quarters it has come to be deal with the Mystery of the features. thought that these members of ministerial priesthood and the the lay faithful are sufficient for second will examine the Min- a. Head this purpose and that the pres- istry which springs from it. In ence of an ordained priest is no the first part I will try to offer Curiously enough in the ‘ef- longer necessary, except per- a reflection on pastoral charity ficientistic’ approach of con- haps with regard to activity of beginning with Christ the temporary society we very of- his which is strictly sacramen- Head, the Shepherd, the Ser- ten forget the deep meaning of tal in character. This, however, vant and the Bridegroom of efficiency. I mean efficiency is something which some peo- the Church. In the second I in the mechanical sense of ple question given the new will propose some ideas about composition and recomposi- questions and issues which are the eucharistic ministry, the tion. The evolutive concept of raised by hospitals. ecclesial ministry, and there- technical-scientific apprecia- In this paper I will refer only fore about the healing ministry tion is common. Matter is not to hospitals and to the health of the ordained priest. the real mother of contempo- care ministry. As everybody rary progress but a source knows, the present-day ap- from which elements are taken proach has undergone a com- 1. The Mystery which are joined or separated plete transformation: at the and which are manipulated at centre of concern there are no As I have already said, I will whim. In deciding action we longer the illness and its treat- examine the Apostolic Exhor- allow ourselves to be guided ment as such, but health, forms tation “Pastores Dabo Vobis” by the agreements which are of treatment, and the ways in and in particular numbers generated by a psychological- which health is achieved and 21-23 of that publication where ly suitable repetition which maintained. Furthermore, to- the discussion falls specifically presents an interminable series day reference is made less to upon ‘pastoral charity’ as a of products of another kind on hospitals and more to health constituent element of the min- the globalised market of sup- care centres and institutions. isterial priesthood. ply and demand. It seems that In this approach everything In the light of this we have everything can be bought and us seen beginning with an im- before us a fundamental affir- sold, even agreement within manentist level which does not mation: the Holy Spirit, the context of a total subjec- deny the transcendental but through ministerial ordination, tivism which is welcomed by which in practical terms does shapes and moulds the priest to the mass media. not pay attention to it and Christ the Head, the Shepherd, The priest, shaped to Christ seems not to need it to provide the Servant and the Bride- the Head, is not only the person explanations. Everything is groom of the Church. who produces a series of reli- concentrated on health and the The previous way of existing gious agreements in presenting fundamental problems caused of the priest has changed and the product of the religious by the lack of health which his new form makes him a spe- word. He produces something necessarily lead to death are cial figure who is separate which is much more profound and which goes beyond what b. Shepherd Christ. The will of God, the could be called a quality leap – Holy Spirit, decrees that the he produces life. And this life is This ability to give life must priest leads the whole of his life the only life which in its deep- conform to those to whom this according to this conformation est expression exists; it is the life is given. This is the func- and definition to Christ the re- life of the Most Holy Trinity in tion of the Pastor. We could say deemer. In this way he is the which man takes part in a mys- that his essential function is in- highest servant of the Father terious historical coexistence culturalisation. And not only who sent the Son so that men of with the Word made Flesh in with respect to the presence of all times could have life and the historical experience of his the Gospel in the heart of every have it in abundance (Jn 10:10). life, passion, death, and resur- culture and its transformation This service is the whole of the rection. It places in a universal through its essential rooting in life of the priest and for this perspective, which is as the that culture (cf Redemptoris reason it is service to the point same time special, everything Missio, 52), but first and fore- of the total giving of self be- that is universal and special: most through its inculturalisa- cause the priest has no other life the Easter of our Lord. It brings tion in every person and people, than that of providing this real into being the so-called unique by which the priest realises his service. He is a servant of the ‘concrete universal’ of history action of giving life. This is the Father through conformation – full constitution of the life of how, the pastoral aspect of his and definition to the Son given humanity in Christ who mani- function. to him by the Holy Spirit, and fests himself through the Spirit This involves the need for in this way he is the full servant and projects himself into our every priest to identify himself of his brethren. For this reason history making it a history of with the people to whom he the priest shapes himself to 104 salvation which walks in pro- brings the life of God. He must Christ the Servant who came to gressive fashion towards its identify himself not in a super- serve and to give his own life consummation at the end of ficial way; he should reach the for everybody. This is his min- time. This efficiency of the centre of every person. But not istry, and for this reason his priest is the efficiency of merely to contemplate that per- priesthood is called a priest- Christ, who is not merely an son but to transform him hood of service or a ministerial example to follow but the sole through the priest. The divine priesthood. effective source of the whole of life remains the same but re- the life of the universe. This is ceives an infinitely distinct col- d. Bridegroom his meaning as Head of his oration by adapting itself to the Body which is the Church, as life of each person, thereby The priest is shaped to the beginning and the end of achieving the inner transforma- Christ, who is the Bridegroom what exists, as Alpha and tion of the cultures of peoples. of the Church. In this way his Omega, as he in whom every- Thus does Christ the Shep- ministry is ‘Amoris Officium’. thing has substance, in heaven herd realise himself according This is an absolute love which and on earth (cf Eph. 1:10; 1 to chapter 10 of the Gospel of is total and full towards the Col. 15:20; Ap 1:8). St. John: Christ knows his Church, and towards all men. When this is expressed it is sheep and these know his voice. His ministry, his service, has no expressed in a word which has His Voice is also the Word of other engine than the Holy real contents, which works God and to know it means to Spirit, who is the infinite Love what is expressed, and this is identify oneself thereby in a of God. One thus understands the Sacrament, the good news Christification. In this way he how his office can be nothing of this wonder, and such is the feeds his sheep and also gives else but full of love. Any moti- preaching of the Church, the his life for them (cf Jn 10:1-6). vation of another character preaching of the priest. The The being of the pastor is not would be inappropriate because Sacrament is the foundation of made up of a sort of religious his reason for being, his person- the Word and the Word is the referring of contemporary tech- ality, is a spiritual personality explanation of the Sacrament. nical know-how. It is the Trini- which loves the Spirit. And it is The Sacrament is the realisa- tarian divine life set in move- this spirituality of his, which tion situated within historical ment by the profoundest man of identifies him with Christ, that time of the above-mentioned all times. It also involves know- makes him transparency of the concrete universal of the Easter ing how to reach this man but Word which is the word of of Christ. All this expresses the only as a preface of pastoral ac- God, and which also places him reality of Christ as Head and of tion in the real sense of the in full communion with the Fa- the priest shaped and moulded term. The priest moulds his ther and the Son. This happens to Christ as Head. own personality in the being of is such a way as to generate an The ability to carry out the the pastor defined to Christ and understanding of why chastity mystery is conferred by the thus in the being of the effec- is total and exclusive union Holy Spirit because this shaped tive bearer of divine life. with Christ and thus total fertil- conformation comes about ity in order to reproduce the through the infinite Love of the c. Servant paschal Christ in his brethren. person of the Holy Spirit. This With the personality of the defines the character which the The Spirit shapes the priest to ordained priest made specific in Spirit has imprinted on the Christ. And in the final analysis these four lines, we can find in ministerial priest, and which the Holy Spirit is the will of them those words which are makes him essentially distinct God because He is the gift of suited to describing them, that from other Christians. this conforming and defining to is to say pastoral charity. This pastoral charity is the vital and Church in such a way as to car- source of the Church is the eu- inner maturation of the priest. ry out the memory of all the charist, and Christ summons us All his activity must be the fruit salvific work of Christ whose beginning with the eucharist. and the sign of this pastoral contemporary presence in this If the ministerial priest cele- charity; it is a gift, a duty, a way acquires its maximum ef- brates the eucharist, he there- grace and a responsibility. The fectiveness because Christ to- fore – because of his specific priest is asked to make his pas- day achieves redemption. It function – summons the toral activity real, credible and makes the Word made Flesh Church beginning with the eu- effective. It fosters his inner present, born of the Virgin charist, that is to say he consti- unity. It allows him to share the Mary, with his own history, his tutes it. Beginning with this history and the experience of own life, his own preaching, constitution one understands the Church. It reproduces the passion, death, resurrection, as- from another angle the meaning Trinitarian mystery and shapes cension into heaven, and con- of his conformation to Christ his unity around the successor temporary glorious presence. the Head, the Shepherd, the to Peter and the episcopal col- Given that through action one Servant and the Bridegroom of lege. arrives at being, from this ac- the Church. tion the being of the priest, con- This summons is the voca- formed to Christ, is constituted tion of humanity; through this 2. From Mystery to Ministry as an instrument of the Easter summons the whole of humani- of the Lord. ty exists, and this is its genuine a. The Eucharistic Ministry It is obvious that in this way existence. Christ models the whole of the In Holy Scripture every vo- In the second chapter of the people of God because he is the cation has three definite fea- Dogmatic Constitution of Vati- effective model in his historical tures: 1. Through the vocation 105 can Council II, Lumen Gentium concreteness which is realised the person is constituted in his (10), reference is made to the in the eucharist. It is also obvi- own existence. Thus, through priesthood of all the people of ous that in this way Christ leads the divine call, the world is God and it is made clear that the whole of humanity to the born from nothing and man, there is a distinction between Father, and also supports it. In too, is born to existence (Gen the ordained ministerial priest- the eucharist the Body is given 1-2). 2. Through the vocation hood and the baptismal real the opportunity to unite with one is led to a fulfilment of a priesthood of the whole of the the Head and offers itself to the mission for which one does not people of God. It is observed Father through the Spirit, con- have the strength on one’s own that there is an essential differ- stituting by this union the total – this strength is given to one ence between the two and not Christ. In this way, from the by God who makes man his merely one of degree. The celebration of the eucharist, partner in intimate company Council identifies this essential there follows the modelling of with him (Jer 1:8). 3. The voca- difference in the four features the people of God and the fact tion brings with it the realisa- present only in the ordained that this people is supported tion of a mission for the good of priesthood and which lie in the and offered in the sacrifice of the people of God and is not re- fact that the ordained minister: Christ. duced to an intimistic dimen- 1. Instructs the people of God; As a result we can say that sion closed up in its own indi- 2. Supports the people of God; the most profound difference viduality (cf the great vocations 3. Carries out the eucharistic between the ministerial priest for the benefit of the people of sacrifice; and 4. Offers the eu- and the real priest is rooted in God, judges, kings, and charist in the name of the peo- the celebration of the eucharist. prophets: Ez 3:10-22; Hebrews ple of God. It is here that the ministerial 3:9 et passim). All this is re- The principal feature is the priest in a historical and contin- alised in a special way in the celebration of the eucharist, fol- uous way identifies in practice call, for example, given to the lowed by the other three fea- with Christ the Head, the Shep- Apostles, who, especially in tures. In the celebration of the herd, the Servant and the Bride- Mk 3:13-19, are called to be eucharist the priests acts in the groom of the Church. The cul- with Christ, to cast out devils, person of Christ the Head of the minating point of pastoral char- and to proclaim the Gospel. ity is realised in this way in the The vocation of Mary in the eucharist and from this springs Annunciation is the paradigm the Church herself. in which these three features are realised in a perfect way b. The Ecclesial Ministry (Lk 1:26-38). As a consequence, the voca- From the summons which tion touches – to speak in a brings about the Church, the summarising way – three fun- Father send us His word which damental aspects of the whole is the Paschal Christ of whom of humanity: its being, its con- we speak in the eucharistic nection with God, and its con- ministry. Christ himself is the nection with other people. summons to humanity, he is the When, therefore, one says call from which the people of that the ministry summons hu- God is born, that is to say the manity through the eucharist, Church, that is to say the sum- its summoning is not merely an monsed. As a consequence, the exhortation to follow Christ but the foundation of the specific laid stress on in the spread of 2) Head being with the Lord for the this way of seeing things. But In some circles with refer- good of everybody. This is an- gradually the belief is spreading ence to the health care ministry other way of understanding the that the body is only one aspect there is a desire to reduce the presence of Christ in the eu- of man, who indeed should be action of the priest to that of be- charist. Through the eucharist seen in his entirety, and in this ing a ministry of the Word the priest acquires a conforma- way attention is also being paid which seeks through his com- tion to Christ the Head which to his social, mental, environ- pany, his words or his silences means being the foundation of mental, and even spiritual as- to be an effective consolation the existence of a renewed hu- pects. for sick people. When lay peo- manity in Christ, of the divine In this context the Pontifical ple who are trained (for exam- life which is given through an Council for Health Pastoral ple psychologically) for this identification with Christ, as his Care has produced a description task, meet each other, it easily mysterious body, and his uni- of what constitutes health: a dy- happens that the priest is dis- versal mission of service to all namic tension towards physi- tanced and it is not seen how men. cal, mental, social and spiritual his sacramental action can be This mission is put into prac- health and not only the absence integrated within a context of tice through Christ in the spe- of illness, which enables man to modernity which acts with the cific historicity which today is carry out the mission entrusted patient in line with the new mysteriously realised through to him by God according to the techniques of individual or the signs of this alive historici- stage of his life in which he group psychological therapy. ty, namely the seven sacra- finds himself. The action of the priest as ments, and which are manifest- This description centres upon someone conformed to Christ 106 ed in the communication of the the vocation of man. This is a the Head is not something Word, that is to say the pro- dynamic tension towards the which involves making purely claiming of the Gospel – some- structural harmony of man so religious suggestions, even thing which thereby unites in that he accomplishes the mis- when Christian in character, solid fashion the communion of sion which has been entrusted which can help or console in a believers and constitutes the to him by God. The mission psychological sense the patient Church. The eucharistic sum- changes in line with the differ- afflicted by a given illness. It mons is realised through the ent stages of life. This structural involves, rather, acting posi- three channels of the Church – harmony, that is to say physical, tively in favour of a health Sanctification, the Word, and mental, social and spiritual har- which is restored in reality ac- Communion. In this way the mony, is what constitutes the cording to the vocational divine vocation of humanity is de- vocational being of man, and in plan, as has already been ob- fined. the final analysis his fulfilment served. All the resources of The personality of the priest in his conformation to Christ modern therapeutic sciences, conformed and shaped to Christ who died and rose again. This is medicine, and psychological the Head, the Shepherd, the a conformation which is carried and sociological approaches are Servant and the Bridegroom of out by the Holy Spirit. In this not to be rejected but rather the Church, is thus the person- way temporal health is a part of they should be subordinated in ality of a person who, begin- overall health, something a health care ministry with a ning with the eucharist, pro- which means, in definitive sacramental face which is nounces as an instrument in terms, eternal health. Thus strongly curative and of deci- Christ the vocation of the whole health belongs to the full to the sive importance in the achieve- of humanity. eucharistic summons of the ment of an authentic health care Church. It cannot be outside the ministry. c. A Healing Ministry priestly action; it cannot be The sacramentality of other something which is peripheral times has been contested with 1) Health to his pastoral action – it is the assertion that it is not Hitherto there has taken rooted in its very nucleus. In enough for the hospital chap- place a transformation in the this meaning of health, pain and lain to go around with oil in his world of illness and health. Pre- illness are not rejected but tak- briefcase. It is certainly true viously the problem of its ill- en on in an acceptance of the ness and its treatment were of passion and death of Christ, as primary importance; today a good which produces the res- health and its maintenance, or urrection in an effective way. rather its recovery, take pride of We oppose pain and illness be- place. In this way it very often cause they obstruct the accom- happens that people do not plishment of the mission which want to refer to hospitals but God has entrusted to us, and rather to health care centres and like the Good Samaritan we institutions. The principal moti- strive to fight them with all our vation of contemporary culture strength. Although we know is health. It enters to the full in- that death is inevitable we do to the assumptions about the not see the end of life as a light meaning of the quality of life which goes out, but as a lamp and the quantification of the which is turned off because the well-being of a country. It often aurora of the great day has ar- happens that physical health is rived. that we need evangelisation be- obedience as an ‘ob audire’, as who died and rose again. The ginning with the sacrament so listening and paying attention priest with compassion must that this does not become a rite to the salvific meaning of min- conform himself to the sick per- which has no meaning for con- isterial action. This obedience son who suffers not only in or- temporary man but is some- is required of the receiver of der to pray with him but in or- thing which always has real ef- pastoral action and of the priest der to offer him the only solu- ficacy in line with the sacra- himself. It is an obedience tion possible, which is faith. As mental doctrine of all times. In which shapes pastoral charity in a pastor he must know how to the health care ministry the the form of loving obedience adapt to the times of the sick priest is the key because he is which listens carefully to that man by choosing the best way shaped according to the healing salvific and real Word – the to do so but he must not refrain Christ, the resurrected Christ, Easter of Christ. And which, in from providing this solution and he achieves his effective- this way, models the people of with the pretext that when faced ness by achieving in the sick God in the image and likeness with the greatness of human person the mystery of this form. of Christ who died and rose pain the only thing to be done is This means full faith in the again. to accompany unspeakable suf- priestly personality and full fering in silence and with mod- faith in what the priest realises. 4) Servant esty. To do this would mean His work in the health care The healing ministry is heal- demonstrating a lack of faith, ministry is not a compassionate ing service. As we well know, and cowardice, in relation to complement to the works of ministry is service. The service the definitive witness of giving mercy which others can carry must be that of the Servant of at the most important and cru- out but the source of these same the suffering Jehovah (Is 53) cial moment. This is not a mat- works of mercy. The Good who bears within Him all our ter of ‘consoling’ and of finding 107 Samaritan is Christ the Head of suffering and takes upon his only the psychological way of the Church who in this way shoulders the cross of all our consoling, but of giving the ef- cures through the priest. It is woes. In this way the priest fective contents of our faith therefore self-evident that it is gives a raison d’etre to pain. when it is most needed. This is mistaken for other people who Pain, which is in itself a bad the great service which is ex- are not ministerial priests to thing, through the pain of the pected of the priest and which take his place and to be in the Servant of Jehovah is trans- he renders in the eucharist of strict sense of the term chap- formed into a source of life and the viaticum which the priest lains of health care centres. resurrection and thus into a accompanies and makes doubly good thing. Together with the visible in the specific meaning 3) Shepherd meaning of health the priest al- applied to that sick person: the The priest as Christ the Shep- so gives meaning to pain, not as sacrament of the anointing of herd (or Pastor) must conform a mere theoretical explanation the sick. to contemporary man and in the but as a practical explanation: health care ministry to the man doing what he says. The anoint- 5) Bridegroom who is in a condition of illness ing of the sick is in particular a The authenticity of the priest- and health. This feature com- sacrament in which the sick ly ministry is demonstrated in plements the preceding one and person Christifies himself to absolute and total love, in dedi- gives all its force to the pro- take on his own pain, and his cation to Christ himself present found meaning of the Sacra- own death where this occurs, in the man in a state of illness ment. This last must be mean- conformed to Christ, and finds and health. The motivation to ingful for practical man and in it the source of resurrection. exercise this pastoral care is no thus in its administration it The sacrament of the anointing different from that of the minis- must be adapted to the practical of the sick redoubles in this terial priesthood, it is pastoral circumstances experienced by way the sacrament of the eu- charity understood as full and the sick person. Hence the im- charist and applies it in the ‘vir- total love. Hence one under- portance of the sciences of tuality’ of a death impregnated stands priestly chastity as dedi- communication, of psychology, with resurrection. The Holy cation if necessary to death, as a and above all else of the great Spirit ensures that the conform- total obligation to love, as the humanisation of medicine ing to the will of God in death so-called ‘Amoris Officium’ un- which pastoral action contains. is the placing in a generous and til the end, the termination of The Sacrament presents itself total way of his own spirit in life in death in order to reach as the authentic Good News of the hands of the Father so as to the fullness of the resurrection. salvation for man in a condition subsequently receive resurrec- Through this love the virtue of illness and health, and as tion. of hope has meaning and solidi- such it must be proposed to From the priest is required ty. The whole of the health care him. Hence the force of all the the virtue of humility in order ministry is rooted inescapably techniques created to bring to, to recognise that there is no hu- in the virtue of hope. Only with and make meaningful for, the man solution to the problem of immovable hope in the resur- sick person the health offered to death and that the only solution rection can one acquire the joy him by Christ, and to also bring is the resurrection of Christ, of service and love of awaiting it to the man in a condition of God and man. It is not the con- the bridegroom who arrives at health so as to point out to him soling words of the priest which the moment of death with all its meaning and real value. Be- will provide ‘acceptance’ in the the joy of the resurrection. The ing a pastor is to be understood face of death but the mysterious whole of the Church hurries to beginning with the virtue of and obscure reality of Christ this encounter with her Bride- groom and lives in fullness the alone but with his presbyter, their own bishop and to their Word revealed through her with those who exercise their fellow presbyters of their local which the Bride says to her ministerial priesthood which is church, all of whom are open Bridegroom at the end of time, the foundation of his local through the pontifical approach of her time: “Come Lord Jesus” church. This is carried out by to the unity of universal (Ap 22:20). the presbyter but he cannot do Catholicism. In this way, by We have sought to outline this unless he is in full union taking part in the same pontifi- certain ideas about the ministry with his bishop and with his fel- cal mission, it is also carried out of the ministerial priest and, below presbyters. Whether the by the Pontifical Council for ginning with this mystery and presbyter is religious or dioce- Health Pastoral Care. following the approach of the san makes no difference: both In order to accomplish a mis- Apostolic Exhortation “Pas- belong to the presbytery of the sion it is necessary to under- tores Dabo Vobis”, to come to bishop according to their differ- stand it at an ever deeper level. the healing ministry of the or- ent charisms in order to carry Perhaps these ideas will permit dained priest. This mysterious out their pastoral action. The an advance in comprehension mystery is a ministry which in Pope carries it out but as the of the mysterious priestly and reaching the concrete, and in visible foundation of the whole ecclesial eucharistic ministry of particular the priest, certainly Church, that is to say as the root the healing health care ministry. means his individual mission, and foundation of Catholic uni- but it cannot be achieved with- ty. He does this collegially with H.E.Mons. JAVIER LOZANO out a wider and collective ap- each and all of his fellow bish- BARRAGÁN, proach. The bishop accom- ops, as chiefs of their local President of the Pontifical Council plishes his mission in his local churches, and with each and all for Health Pastoral Care, 108 church but he does not do this of their presbyters, united to the Holy See.

The Identity of the Catholic Chaplain and the Health Care Ministry on the Threshold of the Third Millennium – a Theological Reflection

Introduction cancel out its specific nature. tions and issues which are now From the perspective of the ec- raised about the figure of the The question of the identity clesiology of communion one priest as a hospital chaplain of the Catholic chaplain in the cannot neglect the collaboration (III). But we should perhaps health care ministry is of great of the lay faithful in the carry- place this difficulty in delineat- contemporary relevance, espe- ing out of the unique mission of ing the identity of the chaplain cially in those Churches where Jesus Christ. The day-to-day within the general crisis which there is a strong fall in the num- context requires a definition of now characterises contempo- ber of priestly vocations and the bases of this relationship rary thinking about the priest- where the question is raised, on between these two ministries in hood (I). the basis of an ecclesiology of the light of the building of the In this way I will seek to pro- communion, whether it might ‘family of God’. vide basic theological elements not be a good idea to take into We may take the ecclesiolo- and criteria which today are of- consideration other models of gy of communion as the basis ten neglected in the debate the figure of the chaplain.1 The of this paper in order to outline which is conducted with regard present-day crisis of identity of certain key points of the subject to this subject. In this debate on the hospital chaplain must be which has been entrusted to me, the identity of the hospital placed within the vast frame- beginning with the historical el- work of the crisis of the identity ements which have helped to of the ministerial priesthood it- shape and mould the identity of self. A clarification of the na- the hospital chaplain, and this ture of the identity of the chap- so as to avoid projecting onto lain requires above all else a questions and issues of our time defining approach to the ques- an interpretation which is not tion of the identity of the minis- rooted in biblical or even his- terial priesthood and its rela- torical facts. An attempt will tionship with the ordinary then be made to outline the fun- priesthood of the faithful. It damental elements which have seems to me that this is the hub characterised the Catholic un- of the whole question. derstanding of the figure of the The ecclesiology of commu- hospital chaplain (II) and we nion places the ordained min- will then ask ourselves what istry within the life of the peo- light can thus be gained by ple of God, but this does not which to understand the ques- chaplain of the third millenni- tween the priesthood shared by ginning with fundamental theo- um we cannot construct within all the baptised and ministerial logical principles. We need an a vacuum. The basis was given priesthood.3 On the other hand overall and integral approach to to us in Jesus Christ once and it should be said that another the priesthood and only within for all. No other basis can be root is of an ideological nature such an approach can one un- supplied to us and everybody and is to be found in the cultur- derstand the figure of the hospi- should pay attention to this fact al revolution which took place tal chaplain in a more effective in the definition which is given at the end of the sixties and the way. The debate concerning to the identity of the chaplain (1 beginnings of the seventies. that figure can then become a Cor 3:10ss). This involved a transferring of kairos within which a new fig- democratic institutions to the ure of the hospital chaplain of Church4 and an ideological crit- the third millennium can arise. 1. Reflections on the icism of her institutions, or For this reason in addressing Present-day Condition rather distrust in the institutions contemporary questions and is- of the Hospital Chaplain which then characterised not sues the intention is not to work only the ecclesial world but al- in a merely apologistic way but The need to clarify the identi- so society in general. to engage in a constructive and ty of the hospital chaplain is In this context, therefore, one creative approach. something which makes itself can well understand that whilst felt today in a special way be- Vatican Council II offered us a 1.2. Figures of the Priesthood cause the ordained ministry fine theology of the Church as who have Marked during the second part of our the ‘people of God’, placing the the Second Half of century has entered into a state shared priesthood of the faithful the Twentieth Century of crisis in most of the Western in relation with the ministerial 109 Churches (Europe and North priesthood (LG, nn. 10-11; The ecclesiology of commu- America). 34-38 in particular), some theo- nion of Vatican Council II has A first fact can be found in logical interpretations subse- deep roots in the history of the fall of the number of candi- quently tried to counterpose the Christian theology. Its rediscov- dates for the priesthood. One two kinds of priesthood.5 Or ery, however, came about at the cannot but worry at the further there was an attempt to bring beginning of this century. This fact that a large number of out a certain contradiction be- rediscovery was accompanied priests are already well ad- tween chapter III of the LG by detailed research on the part vanced in years and that many which deals with the hierarchi- of theologians, above all else of them, as well as many of the cal constitution of the Church during the Second World War, young priests, feel that they and chapter II which describes which sought to capture the fig- work too much and work with- the charisms within the life of ure of the priest which would in a context marked by lack of the people of God and launches be nearer to the events of the success, by resignation and by an appeal to take the meaning Christian people.7 The shaping frustration in a highly secu- of the faith of believers serious- of this figure of the priest was larised and indifferent world. ly. Furthermore, although with- the work primarily of theolo- This fact may indeed have a in the ordained priesthood itself gians such as Yves Congar and certain impact. But it should be a relationship of collaboration Marie Dominique Chenu, but immediately observed that a between priests and the priest- support for such an approach large number of priests feel ful- hood of the bishop seems clear came first and foremost from filled in their ministry, and that enough, the relationship with Cardinal Suhard.8 Some radical the fall in the number of priests the deacon, to whom the Coun- interpretations of this perspec- should be placed within a cil refers in Lumen Gentium 29 tive led to a reduction of the framework of a general crisis of and Christus Dominus, 15 re- priestly ministry to mere pres- faith and within the context of mains rather unclear. ence in places where no sermon the fall in the number of mem- Very often one comes across was preached and where no bers of our communities. This the opinion that all these ques- sacrament was celebrated, and crisis has many causes and thus tions solve themselves in prac- the fine theology of the found- we need to avoid over-simplifi- tice (in pastoral care) through ing fathers was left only with cations and hurried generalisa- the delegation of tasks which what was called the salvific ditions. had previously been the respon- mension of the incarnation, that sibility of priests alone to the is to say that salvation is to be 1.1. The Reasons for the Crisis community and to members of found in the simple fact that the the lay faithful.6 It is certainly Saviour came in our flesh. Thus One of the fundamental caus- true that in practice one can it was enough for the priest to es which should be referred to solve many problems but it be present where men live who seems to be a lack of theologi- should also be said that solu- did not know Jesus Christ, in cal clarity. From this point of tions which seem to be merely the same way as he lived before view the roots of the crisis are of a practical pastoral character his public life in Nazareth. on the one hand to be found in a often have fundamental theo- This radicalisation was met unilateral and superficial accep- logical consequences and im- by the theology of Father tance of the ecclesiology of the plications. If we want to avoid Michel Laboudette O.P. who ‘people of God’ and commu- confusion and misunderstand- disputed exactly this reduction nion of Vatican Council II,2 ings we must think of the world of the ministry of the priest to a with a resulting unilateral inter- of practice in fundamental-the- mere presence: ‘It will not there- pretation of the relationship be- ological terms, that is to say before be through a mere presence or through contact that the crat’.13 It is in this sense that priest, as a priest, makes holy; it reference is made to Christ is precisely through his ministry, himself who communicates the preaching of the word and himself in the power of the the celebration of the salvific Holy Spirit. cult’.9 The question which was However, it should be imme- raised was that of the nature of diately made clear that this ele- the presbyterate: ‘because it is a ment of ‘representatio Christi’ power (the order) is ordained for can be said to a certain extent to those acts whose object is pre- belong to every Christian. cisely the sanctification of the Every baptised person has taken people of God, the expansion on Christ, lives in Christ, and and the diffusion of Christian Christ lives in him. It is there- grace within the Church’.10 But fore every Christian who must this response left unresolved the make Christ present for others question of whether the pastoral in words and deeds. As has al- mission of priests owes nothing ready been observed in this pa- to their consecration. And it was per with regard to Vatican thus in this context that the de- Council II, all baptised people tio Christi’ in a general sense cree on the ministry and life of take part in the triple ministry of but also ‘representatio Christi priests (Presbyterorum Ordinis) Christ and are a prophetic, capitis Ecclesiae’. In the full emerged on the eve of the clos- priestly and royal people (1 Pt meaning of the word such a ing of Vatican Council II on 7 2:5-10). It is this which is un- ministry belongs to the bishops 110 December 1965. derstood when we refer to the as the successors to the apos- In essential terms this docu- shared priesthood of all bap- tles (LG 21). The priests, ac- ment informs us that priests, tised people. It is certainly the cording to Vatican Council II, because they are the collabora- case that the Church as a whole are described as collaborators, tors of the bishops, must live is the body of Christ, the family helpers, limbs, but also sons, out the ‘apostolic life’ by prac- of God, and therefore ‘represen- brothers and friends of the tising ‘pastoral charity’, that is tatio Christi’ in the world, a bishops (LG 28, PO 2, CD 30). to say by acting ‘in persona sacrament, that is to say a sign They represent the bishop (SC Christi capitis’ (PO 2; LG 10). and instrument of God in the 42, LG 28). It appears that it is Their first task is to evangelise world and for the world. precisely this approach that and this task cannot be separat- This insistence upon the makes up the fundamental idea ed from their eucaristic min- shared responsibility of all of the Council’s decree Pres- istry. Furthermore, these two Christians has led, as has al- byterorum Ordinis.15 tasks are correlated to their ready been observed, to the Indeed, at PO 6 it is said that third task, which is the exercise questions: ‘so what remains in a in ‘exercising their function of of the ‘function of Christ the specific sense of the ministerial Christ Head and Shepherd at Head and Shepherd’ (‘Repre- priesthood?’ What is its propri- the level of authority due to sentatio Christi Capitis’), that um? Is the priest not thereby re- them, the presbyters, in the is to say to render present in a duced to a mere representative name of the bishop, gather to- sacramental way the salvific of the community or that is to gether the family of God as a action of Christ the Head of the say of the Church, and thus an brotherhood animated in unity, Church and to act so that this is expression of the majority and lead it to the Father visible in the world.11 The which is expressed within it?14 through Christ in the Holy theme of ‘Representatio Christi The paper given by His excel- Spirit’.15 With this ‘repraesen- capitis’ brings out the theologi- lency Mons. Javier Lozano tatio Christi capitis’the priestly cal and essential basis of the Barragán has brought out these ministry expresses at the same Catholic understanding of the issues very well by emphasis- time the fact that the Church ministry of the priest within the ing the specific character of the does not exist of itself but ex- Catholic Church. In 2 Cor 5 ordained priesthood. I would ists starting with Jesus Christ. 14-20 the Apostle Paul stresses like here only to draw attention This is a sign of the fact that the unity not only of the to the fact that from the theolo- nobody can of himself give preaching of the Gospel and gy of St. Paul one can derive a salvific grace. It is a gift from the ministers of reconciliation; clear answer to these questions. God alone and not a human indeed this unity is rooted in The shared responsibility of creation. Hitherto our approach the fact that in the ministry of everybody does not mean that has come from on high, that is the Apostolate it is Jesus within the Church everyone can to say from the mission of Christ, risen again and raised to do everything. Every charism Christ from the Father, and sees the right hand of the Father, has its specific task in the build- the priestly ministry as a part of who himself acts in the power ing up of the family of God the logic of this mission. But of the Spirit: ‘So we are ambas- (Rom 12; 1 Cor 12). this approach must be comple- sadors for Christ, God making From the Letter to the Eph- mented by that which comes his appeal through us’ (2 Cor esians (Eph 4:12) one under- from below, which sees the 5:20).12 St. Augustine expressed stands that the priestly ministry priestly ministry as part of the this fact in a more effective is a service for and to other ser- action of Jesus Christ who, way when he declared that vices. In this way one can af- through the vivifying Holy ‘Christus est qui paedicat’, firm that the ministerial priest- Spirit, sanctifies and guides the ‘qui baptizat’, ‘qui conse- hood is not only ‘repraesenta- Church towards the Father. In the eucharistic celebration deed which is rooted in Ro- Paul II has emphasised this fact these two dimensions are mans 15-16.22 The document of in insisting at one and the same brought out very well. On the the International Theological time on the Christological iden- one hand the minister acts ‘in Commission of 1971,23 in the tity and the ecclesial identity of persona Christi’ and can pro- preparation of which Hans Urs the priest,27 thereby outlining claim the same words as Christ: von Balthsasar played an im- the approach involving the per- ‘this is my body’, ‘this is my portant part, helped to over- manent facts by which to un- blood’. On the other hand he come this dichotomy between derstand the priestly identity. speaks and acts in the name of the ministry of the Word and This summarising descrip- the Church in bringing towards the ministry of the eucharist. tion of the questions raised by God the offerings of the com- This is possible if one sees the the theology of the priesthood munity.17 The Fathers were es- priestly ministry as the service during the contemporary period pecially emphatic on this point. of active power, which is invites us to ‘rediscover not on- Cyprian, for example, declared specifically eschatological, of ly the priest but also the figure that ‘the Bishop is in the the Word of God – Jesus Christ of the hospital chaplain in its Church and the Church is in the who died and rose again – originality, in its original spe- Bishop’.18 The same reality is whose discernible signs are the cific character’. How can a expressed by St. Augustine in preaching of the Gospel mes- glance at history help us to lo- other words: ‘For you I am a sage and the sacramental acts. calise such originality? We will bishop and with you I am a In response to the question of try to localise the fundamental Christian’.19 This way of seeing what the essential element of elements of the identity of the things does not place the bishop the ministerial priesthood real- chaplain first of all through the above the community or sepa- ly is, Padre Emile Pin S.J.24 history of the formation of the rate from it. This is why Cypri- would find an answer in the figure of the hospital chaplain 111 an would say that he did not distinction between the ‘func- and then through a presentation want to do anything without the tion of presiding (praeesse or of a series of key concepts. One advice of the clergy and the praesidere) over the Christian question will guide our inquiry: agreement of the people.20 The community’ and presiding over what vision does the tradition priestly ministry is therefore al- the eucharist. He did not, how- of the Church have of pastoral so to be placed in service to ever, make clear what kind of care for the sick? other charisms. In this sense relationship exists between Vatican Council II was able to these two kinds of presiding. go beyond a certain clericalism But it is precisely here that we 2. Looking after Sick People and tried to sow the seeds for a should take into account the and the Character trusting collaboration between observation of the ‘PO’ accord- of the Physiognomy pastors and members of the lay ing to which priests, because of the Hospital Chaplain: faithful in the unique ministry they take part in the unique the Creation of his of Christ and invited pastors to priesthood and the unique min- Identity as a Priest listen to the laity (LG 37; PO istry of Christ,25 are at the same 9). The Council also opened up time ministers of the Word of For the Christian communi- a way by which to think about God, ministers of the eucharist, ty, looking after sick people paths of responsible collabora- and heads of the people of God. has formed a part of its funda- tion between the various min- These three functions form one mental obligations since its be- istries. This was not a conces- single function. They cannot be ginnings.28 This task is rooted sion to the predominant democ- separated from each other, just in the words of Jesus who said ratic mentality but of a descrip- as the three Christological titles that the sick should be taken of tion and realisation of the of Christ – priest, prophet and (Mt 25:31-46) and this prac- Church as the family of God king – from which they are de- tice continues, in the same way and communion. But it should rived cannot themselves be as Jesus himself did in his be- be said that in addition to pro- separated from each other.26 haviour towards the sick, viding an impulse to the life of This rooting of the identity of through fighting against their many priests, the Council de- the priest in Christ seeks to re- marginalisation (Mt 1:40-45), cree was not able to close the mind the Church that her and through an overall en- debate about the theology of the salvific action does not spring counter with the person involv- priesthood.21 from herself nor from a greater ing the elimination of sin and Beginning with the fact that ‘consensus fidelium’ nor from illness as a sign of a state of Presbyterorum Ordinis gave a our ability to convince men of profound lack of salvation (as a certain priority to the preaching the truth of the Gospel, to gath- sign of great evil).29 It is certain- of the Gospel (whereas the er them together in the unity of ly the case that from this point Council of Trent made the sac- the faith and to lead them to of view the Jewish traditions, rifice of the Holy Mass the first salvation. Instead, it has its like the vision according to and most important task of the source only in Christ who re- which the priest exercises, as a ministry of the priest), some mains present amongst us in representative of God, the pow- people have since wanted to un- the power of the Holy Spirit er of Jehovah in relation to ill- dervalue the sacrificial charac- (LG 10-12, 20ss, 31-36). ness and healing,30 and the ter of the priestly ministry for- Once these fundamental thought of ‘caring’ from Greek getting that it was precisely the Christological and pneumato- therapeutics (to be concerned ‘PO’ which sees service to the logical data disappear the ques- with the suffering of the other Gospel as an integral part of the tion emerges of the crisis of the person, of the foreigner),31 have Christian cult, an approach in- identity of the priest. Pope John played a certain role. But the Christological approach has In post-Apostolic literature The Benedictine rule, for ex- been of determining importance elderly people are increasingly ample, makes taking care of – in the sick person is to be exhorted not to neglect sick sick brothers a special duty of found the face of the suffering people.35 Precisely because it the community41 because ser- Christ which is expressed to us became ever more difficult for vice to the sick was service to calling for our love.32 bishops and the elders to visit Christ himself in line with Mt In the early community edu- all the sick people, the first 25. In a ninth-century commen- cation, treatment, care for the rules of behaviour were drawn tary on the Benedictine rule it soul and preaching were not ac- up.36 During the great epi- is said that the abbot must do tivities which were clearly sep- demics which struck the city of everything to ensure that ‘the arable from each other.33 This Rome with great violence in the sick confess their sins, receive was already to be found in the second and third centuries it the sacraments, listen regularly early sources where reference is was made evident with great to Holy Mass, are visited, com- made to spiritual care for the clarity that taking care of the forted and encouraged’.42 We sick. It is cited in the descrip- sick was a great expression of can understand these prescrip- tion of Christian tasks as one of the followers of Christ. Dion- tions and this rigour only if we the works of compassion and is iges of Alexandria expressed take into consideration the idea often employed in an apologis- this in the following way: of illness of this epoch that was tic perspective or in the context ‘without fear they (the Chris- adhered to in the monasteries – of normative rules for Christian tians) visited the sick, served illness was seen as a discipli- behaviour. them with joy, took care of nary instrument for health. It should be said that Christ- them according to the com- Care of the sick and pastoral ian love for the sick adopted mandments of Christ and with care of the sick thus had a reli- 112 and pre-supposed a new ap- joy separated them from this gious-moral character. The proach, evaluation and vision life...This way of dying should medical doctor was also oblig- of illness itself. In Greek medi- be seen as the fruit of a pro- ed to allow the patients first of cine as shaped and moulded by found spiritual life and solid all to engage in confession and Hippocrates there is also refer- faith which are in no way to be only afterwards could he treat ence to the sick person as such compared to death through their bodies – terrestrial medi- and the concern of the person martyrdom’.37 Two tendencies cine could act only when man who takes care of him is first of are to be found in this context: was spiritually pure.43 all directed towards his friends one which sees illness as a test As long as hospitals re- and their personalities, but this of the faith and patience of the mained a part of the monastery is not applied to all sick sick person and one which as- it was obvious that pastoral care people.34 For Christian love, on serts that the person who takes of the sick was a part of taking the other hand, the sick person care of the sick person can hope care of the sick. In the twelfth is a creature of God and a that his free service will receive and thirteenth centuries new neighbour, the concrete face of a celestial reward. At times we kinds of hospitals sprung up. In Jesus Christ. Seen as an image find bishops who are also med- the new cities many more poor of God made flesh and of the ical doctors and base them- people and sick people were to passion of Christ, the sick per- selves upon the tradition which be found. It was now up to the son enjoys special considera- goes back to Mk 2:17 which whole community to look after tion and attention. In this way refers to ‘Christ the physi- them. At the same time, through one can well understand why cian’.38 Thus was developed the thinking about the crusades and the letter of James lists amongst analogy between taking care of the movement of poor people, a the primary tasks of the bishop souls and medicine: just as the new approach to the poor and and the elders those of visiting illness is seen as an expression the sick came into being – they the sick and the poor (indeed of sin so sin itself is described were seen as ‘domini nostri these two categories are often as an illness. Prayer and peni- pauperes’. A papal declaration cited together), praying for tence are thus understood as described taking care of the them, anointing them with oil forms of medicine.39 sick as ‘pauperum Christi in the name of the Lord (the In the fourth century hospi- servituum’.44 In this context re- anointing of the sick), and for- tals were gradually established ligious orders were born which giving their sins (James in which all those in need were 5:14ss). received: foreigners, the poor, Prayer, anointing with conse- widows, orphans and the sick.40 crated oil, confession and the These hospitals were under the forgiveness of sins, probably al- authority of the bishop. Monks so linked with an evening meal in particular dedicated them- (agape fraterna), were the con- selves to looking after the sick stituent elements of spiritual and the poor. A sanatorium was care for the sick. They refer to often entrusted to the an understanding of illness as a monastery. Under the influence complex of relations between of the monks a strong link be- physical fragility and spiritual tween taking care of the sick weakness. This is why from the and ecclesiastical discipline outset taking care of sick peo- emerged with the development ple was not the task of all of the anointing of the sick and Christians but primarily of well rules for the monks on how to specified ministers. behave towards sick people. sought to achieve the love for of the sick person were taken (transient) loss of the function Christ and one’s neighbour seriously. It was understood as of one part of the body. In this through service to the sick. The an expression of the love of way pastoral care for the sick vision according to which, God which frees and feels com- has the urgent need not to lose through illness, the soul is test- passion for the suffering per- sight of the relationship which ed and enlightened, remained son. In this way new aspects keeps together illness and life strong. Illness was indeed seen were introduced, that is to say and to take seriously the emo- as the spiritual medicine by the individuality of the person tional isolation of the sick per- which to lead the sick person to and his freedom. Protestant son which takes place in mod- perfection (II Cor 12:9). It was pastoral care until Schleierma- ern hospitals. Care for the sick also evident that every form of cher was to be shaped by these should be understood as pas- treatment of the patients began two principles. toral care of the hospital. It with confession and the cele- Within the context of ratio- should become pastoral care of bration of the eucharist. Those nalism the aim of pastoral care the sick and of health care who took care of the sick of the sick was organised workers within the hospital in- gained a piece of paradise; their around the figure of the pastor stitution; it is not a continuation activity was a contemplation of as the friend and good compan- of the pastoral care of the parish the suffering of Christ and ion in suffering. Illness was community but must, rather, through such contemplation seen as an entirely earthly reali- develop its own aims and meth- they reached perfection. ty which had nothing to do with ods. Pastoral care for the sick This system of pastoral care sin. The task of the hospital should therefore be understood of the sick was closely linked to chaplain became that of com- – by analogy with the God of confession and the authority of forting and of offering moral Israel who walks with his peo- the priest remained unchanged and psychological support, and ple – as the accompanying of a 113 until the sixteenth century.45 thus he was required to have a man during the crisis of his ill- With Luther, pastoral care of good knowledge of man and his ness with the goal of bringing the sick fundamentally received psychology. During the twenti- together with the other his suf- the character of being accompa- eth century this required a per- fering and his needs so as to ar- nying, support and comfort. sonal relationship with the sick rive together with him at an Confession lost its rigour and person which, however, be- overall understanding of what came to be seen as a joyous mo- came increasingly difficult for illness and life can mean.50 This ment of encounter in which the chaplain given the way in requires sound co-operation be- there was no need for a priest, which modern hospitals came tween the hospital chaplain and merely the presence of another to be organised. In this context the medical doctors and nurses, Christian.46 But it should be ob- one can well understand the and in certain cases this means served that in Luther himself way in which the concept of that the chaplain is involved as the ecclesial character of such chaplaincy was developed by a member of the healing team. care was not totally eliminated the Conference of Italian Bish- In this way pastoral care will and in the Lutheran Churches ops. With the movement which not be seen as something sup- of the sixteenth century there was primarily born in the Unit- plementary but as part of global was still a strong link between ed States of America, in the six- treatment and therapy which pastoral care and ecclesial min- ties and seventies, a change in covers the whole of man. This istries. This was even more evi- the conception of the hospital approach requires that the chap- dent in the reformed Churches chaplain took place. Emphasis lain has great abilities and ca- of Switzerland. However, there was very much placed upon pacities with regard to forming was great interest in pastoral ‘therapeutic pastoral care’, and maintaining relationships. care for the sick, those in something which required a It is only within the context of a prison, and the poor. Parish special training on the part of relationship that he can invite priests for hospitals alone were the chaplain and acceptance of the sick person to engage in figures who were brought into the developments which had prayer and proclaim the love of being in the great cities. In the taken place in psychoanalytical Christ in the concrete situation pietist tradition illness was seen science. In this context the of the sick person. All this must primarily as a suitable time ‘movement for pastoral care’ take place within a framework when the sick person could was born, a movement which, of a shared journey directed to- open himself up to the word of indeed, changed pastoral care wards searching for meaning. It God and engage in conversion. of the sick.48 is within this journey that the Pastoral care, indeed, was in eucharist, confession and the fundamental terms directed to- 2.2 The Present-day Situation anointing of the sick are to be wards conversion: ‘the sick per- placed. son must bear suffering with Within the context of the The lesson to be gathered patience...abandon himself to functionalisation, specialisation from these historical elements God, leave this world with and technologicalisation of hos- for the identity of the chaplain joy...strive to liken himself ever pitals, pastoral care for the sick is that his ministry has first and more to the image of the suffer- has undergone a profound foremost been organised down ing Christ...remain faithful until change in terms of its structural the centuries around the min- death’.47 But at the same time character.49 The technologicisa- istry of the Word, the eucharist, within pietism itself there tion of medicine goes hand in the forgiving of sins, and the emerged an understanding of hand with an objectifying and solidarity of the whole of the pastoral care of the sick as free reductive understanding of ill- community with its suffering conversion in which the needs ness, seen as a provisional member. It appears clear that these facts conform with the like the celebration of the ministry of Christ.54 And here it meaning of canon 564 which salvific minister of Christ the should be emphasised that per- defines the chaplain as a priest Head, are not separable. But haps the point of departure is because he is a collaborator Vatican Council II offers us an- more to be found in canon 785 with the bishop – the figure other way forward. The Coun- of the CIC of 1983. Compared who is primarily responsible for cil referred to the New Testa- to canon 517 § 2 this canon has taking care of the sick because ment when it dwells upon the the advantage of not subordi- he represents Christ the Head collaborators of St. Paul (Rom nating the collaboration of the and all the community. Howev- 16:1-6); Phil. 2:25; 4:3; Col. laity to the absence of a priest er, as has already been empha- 4:10-15; Phil. 1:24) and thus al- but of enrolling them in the sised in this paper, this defini- most developed a theology of ministry with reference to the tion requires at an essential lev- collaborators. fundamental rights and duties el greater co-operation between According to this theology, of all the members of the peo- the members of the laity in the because of their participation ple of God. unique ministry of Christ. (based upon baptism) in the If this is the intention of the Since Vatican Council II and salvific mission of the Church, document we should not, there- its ecclesiology of communion the members of the laity are di- fore, be at all worried about the we have become more sensitive rect collaborators in the unique prospect of a clercalisation of to the idea of the greater in- ministry of Christ.52 On the ba- the laity. A co-operative and volvement of deacons, mem- sis of their own mission they communicative responsibility bers of religious orders, and can take on certain tasks (mu- without fear would thus well members of the lay faithful in nia) which are closely bound up express the face of the Church pastoral care of the sick. Given with the ministry (officia) of as the family of God with the 53 114 the contemporary ecclesial situ- pastors. This is possible both diversity of its members and ation some local Churches are as regards teaching and with re- their various charisms.54 That is moving towards greater collab- spect to liturgical action and to say, we are dealing here with oration between the chaplaincy pastoral care (cura animarum). investigating and exploiting to and the medical team, that is to The Council speaks more the full the possibilities which say towards involving deacons, specifically about ‘cooperatio’ are offered to us by Vatican members of religious orders, in the carrying out of certain Council II which describes the and members of the lay faithful ministries but such ‘cooperatio’ lay member with reference to in the health care ministry. It is not at the same time ‘partici- his character of being in the seems to me that it is also in patio’ in the ordained ministry world (Weltcharakter: LG 31)56 this direction that the guidelines itself (LG 33; AA 24; cf in the and a collaborator in the exer- of this Pontifical Council are al- CIC can 228, 230, 759). The cise of the ecclesial ministry of so moving.51 lay member remains a lay Christ (LG 33 and 35). It does member even though he carries not seem to me that such col- out a task which is closely laboration needs to be recog- 3. Collaboration of the Laity bound up with the ordained nised as sacramental in the way in the Unique Ministry ministry. it which this has been under- of Christ in the In essential terms we have stood by Rahner and Hünner- Health Care Ministry before us the ‘cooperatio’ (LG man.57 One runs the risk of giv- 33; CIC can 129 § 2) or partici- ing rise to confusion58 and of It is here that we encounter pation of the laity in the tasks of absolutising ipso facto the or- the topical dimension of the the ordained ministry and thus dained priesthood rather than pastoral question. There are not in the guiding of the Church relating it to other ministries as enough priests today in certain (LG 37: CIC can 129 § 2) and different charisms for the build- churches for them to be made especially in the creation of ing up of the family of God in available to hospitals. What synodal institutions (parish march towards the encounter should be done? It is certainly councils, and here perhaps with the Father in the Son not right or sound to give in- should also be placed our dis- through the Holy Spirit. creasing tasks to priests who cussion of the chaplaincy with are already heavily committed the due caveats emphasised by in their activities. Thus it is now His Excellency Lozano), and Conclusion debated whether it might not be thus also in the carrying out of possible to entrust the entire re- the liturgy (through the creation We can conclude by saying sponsibility for pastoral care of of readers, acolytes, the min- that the identity of the hospital the sick to a member of the laity istry of the communion, the be- chaplain can be defined begin- or a group of lay members stowing of baptism and the ani- ning with the identity of the or- (whether paid or voluntary), or mating of the liturgy (Can 230 dained priest. This specific char- whether it might not even be § 2 and 3), and in the proclama- acter of his identity does not, possible for the deacon to be tion of the doctrine and the however, exclude an attempt to able to carry out the sacrament Word (LG 35; CIC can 229, find forms of collaboration with of anointing with oil. 230 § 3, 759, 766). These min- members of the laity in order to On the basis of what has been istries are conferred by a letter make the presence of Christ in said so far in this paper one can of mission by the bishop. With the world of those people who clearly answer that only an or- this the intention is to give suffer in their body, turn their dained minister can be a chap- greater emphasis to the shared gaze towards Christ, and need lain. The chaplain and the ad- responsibility of all Christians the accompanying of the Church ministration of the sacraments, in the participation in the triple in this stage of their lives, more effective and meaningful. This ‘Internationale Deutschprachige Gener- France Pays de Mission? “Rencontres”, alvikarkonferenz’ held at Quarten (the 12 (Editions de l’Abeille, Lyon, 1943). collaboration should not cancel diocese of St.Gallen) from 21 to 26 May From this idea of near presence one pass- out or diminish the identity of 1995. All three were published during the es to the figure of the priest worker: each of the members of the fam- nineties: ‘Au Nom di Christ. La Parole, le E.POULAT, Naissance des Prêtes-Ouvri- ily of God but must work for the Sacrement, le Ministère et l’Ordination. ers (Castermann, Paros, 1965). Lettere Pastorale de la Conférence Epis- 8 See CARDINAL SUHARD, Le Prêtes growth of all in mutual help. copale des Pays-Bas’, in La Documenta- dans le Cité, Lettere Pastorale du The situation of present-day tion Catholique, 4 October 1992, n. Carême de l’An de Grâce 1949 (Paris, crisis which faces us can cer- 2057, pp. 833-846; ‘Les Ministres Or- Editions A.Lahure, 1949). donnés dans une Eglise – Communion. 9 M.LABOURDETTE, Le Sacerdote et la tainly be a time of rebirth for Note Théologique de Bureau D’Etudes Mission Ouvrière, Une Etude de la Com- the Church, of renewal, but Doctrinales de la Conférence des Eve- mission Théologique de la Mission Ou- such rebirth cannot in any way ques de France’, in La Documentation vrière (Le Bonne Presse, Paris, 1959), n. Catholique, 3 January 1993, n. 2063, pp. 14. involve fracture with tradition, 420-429; W.KASPER, ‘Der Leitungsdienst 10 M.LABOURDETTE, Le Sacerdote et la Indeed, real originality is al- in der Gemeinde’ (I refer here to the Mission Ouvrière, n. 13. ways born within tradition. manuscript version). 11 Cf G.GRESHAKE, Priestersein. Zur 2 On the concept of the Church as Theologie und Spiritualität des Priester- With John XXII we can always ‘Communion’ in Vatican Council II: cf lichen Amt (Freiburg, 1982), 1991), pp. remain trusting of the Lord who W.KASPER, ‘L’Eglise comme Commu- 31-80. through the present-day crisis is nio. Réflexions sur l’Idée Directrice de 12. This idea of reppresentatio Christi l’Ecclésiologie du Concile Vatican II’, in is also present in other texts, as is borne preparing through the Holy idem, La Théologie et l’Eglise (Cerf, out by Luke 10:16 ‘Whoever listens to Spirit a new Pentecost for his Paris, 1990), pp. 389-410. you listens to me’. One can also recall Church. Re-reading Tertio Mil- 3 Padre Yves Congar described this here the sacramental character of the situation in a more effective way when he Word of God because it expresses the lennio Adveniente I was happy wrote that ‘Vatican Council II was fol- salvific mystery hidden since eternity in to encounter the same approach lowed by a profound socio-cultural muta- God: Rom: 16:25-7; Eph 3:9-11; Col of hope and trust in the pres- tion which has no parallel in thr history 1:25-27. The Apostle Paul is especially ence of the Spirit of the Lord of the Church in terms of its breadth, rad- filled with this idea of representatio ical character, speed, and cosmic nature’ Christi and sees the whole of his life and 115 which guides, renews, and vivi- and that ‘this crisis was not provoked by his apostolic journeys as an expression of fies the Church. the Council’ even though, according to the victory of Christ in the world: 2 Cor Congar, it is necessary to recognise that 2:14 and 2 Cor 4:10: ‘everywhere we its roots are to be found in it ‘because of carry the death of Christ in our bodies so Rev. DON JUVENAL MUYA, the simple fact that there was a council, a that his life too becomes manifest in our Professor of Fundamental Theology, debate’: Y.CONGAR, Le Concile Vatican bodies’. the Urbannian Pontifical University, II, Son Eglise, Peuple de Dieu et Corps 13 ST. AUGUSTINE, In Joan, 6, 7. 14 Rome. du Christ (Beauchsne, Paris, 1984), pp. The studies of E.SCHILLEBEECKX 69-70. have greatly contributed to the theoretical 4 This does not mean that the Church formulation of these questions: E. must not in the least feel herself the fami- SCHILLEBEECKX, Kirchliches Amt (Dus- ly of God where there reigns the principle seldorf, 1981); idem, Christliche Identität of equality (LG 32) in the diversity of und Kirchliches Amt (Dusseldorf, 1985). charisms amongst members raised by the 15. Cf P.J.CORDES, Sendung zum Diest. same Spirit who concedes to all believers Exegetisch – Histriche und Systematis- the supernatural meaning of the faith che Studien zum Konzildekret “Vom Di- (sensus fidei), who keeps the whole of the enst und Leben der Priester” (Frankfurt, Church in truth and is expressed in faith 1972). Notes and custom: LG 12, 35; GS 43; AA 2s. 16 See also PO, 12. 5 It will be remembered for example 17 Peter Lombardus emphasised this 1 The chaplain according to the Code how many reactions were provoked by double aspect when explaining why the is a priest: CIC can 564. The contempo- the thesis of Hans Küng to the effect that priest says ‘offerimus’ and not ‘offero’: rary debate revolves is essential terms two initial forms of ministry existed at PETER LOMBARDUS, Sent. Iv d.13, 1. Cf around this identity of the chaplain. That the beginning of the Church: in LG, 10. This character of representation the subject is topically relevant and Jerusalem the Church, he argued, had a of the Church through the priest has left touches upon an urgent and fundamental very institutional character, while in many traces in the tradition of the question of the Church on the threshold Corinth lived solely through the sponta- Church: cf Y.CONGAR, Jalons pour une of the third millennium can also be seen neous apperance of the charisms within Théologie du Laicat (Unam Sanctam 23, from the fact that a large part of the epis- it’ (Descléè de Brouwer, Paris, 1968), pp. Cerf, Paris, 1957); idem, ‘Le Sacerdoce copal conferences have concerned them- 554-610. We know that from a New Tes- du Nouveau Testament, Mission et selves over recent years with the sensi- tament point of view this position does Culte’, in J.FRISQUE AND Y.CONGAR, Les tive question of the relationship between not hold up and has no historical founda- Prêtres. Décrets Presbyterum Ordinis et the ministerial priesthood and the ordi- tion: cf COLLECTIF, Le Ministère et les Optatium Totius, Textes Latin et Traduc- nary priesthood. I would like to refer on- Ministères selon le Nouveau Testament tions Françaises (Unam Sanctam, 68, ly to two letters issued by the Dutch epis- (Seuil, Paris, 1974). Cerf, Paris, 1968), pp. 233-256. copal conference and by the French epis- 6 Without doubting in the least the im- 18 CYPRIAN, E.p., 66, 68. copal conference, and to the communica- portance of the collaboration of the mem- 19 ST. AUGUSTINE, Serm. 340, 1 cit. LG, tion of Bishop Walter Kasper to mark the bers of the laity in the unique mission of 32. Thomas D’Aquinas, for whom the Christ (cf CEI, n. 55), this paper seeks to minister represents the Church, argues the merely emphasise the fact that the in- same: THOMAS AQUINAS, S.Th. III, 82, 7 creasingly effective involvement of the ad 3; Suppl. 31, 1 ad 1; S.c.g IV, 73. laity through letters of mission has raised 20 CYPRIAN, E.p. 14, 4. questions about the very identity of the 21 One need only recall the question priest and his mission. An indicative sign which is still discussed today of the dis- of this concern can be found in the docu- tinction between ordinary priesthood and ment issued by the French Episcopal ordained priesthood. The formulation of Conference: Tous Responsables dans this distinction in LG 10 (‘the ordinary l’Eglise? Assemblée Plénière de l’Epis- priesthood of the faithful and the ministe- copat Français à Lourdes (Le Centurion, rial priesthood...however much they may Paris, 1973). differ essentially and not only in terms of 7 We need only recall here the creation degree are however ordered to each oth- in France of the ‘Séminaire de la Mission er’ requires further clarification. Of what en France’ in 1941 in Lisieux and in does this essential difference which is not 1944 of the ‘Mission de Paris’ to grasp one only of degree consist? It seems to the idea of the priest who shares the con- me that for the Fathers the intention was ditions of life of the people and thus al- to avoid confusing the ministerial priest- ready realises at his place of work the hood with the ordinary priesthood and missionary task. This idea is to be placed thus to emphasise on its specific charac- in the subsequent added part of a book by ter which does not derive from the ordi- two priests, H.GODIN AND Y.DANIEL, La nary priesthood. Vice versa the ordinary priesthood is not a derivation from the Salzburg, 1950), pp. 100ss. known since 1975 with Cardinal Joseph ministerial priesthood. Both have their 35 Cf Letter of Polycarp to the Philip- Malula how to apply this fine concept of source in the unique priesthood of Christ. penses, 6, 1. Vatican Council II subsequently carried The difference is found at the sacramen- 36 Cf A.HARDELAND, Geschichte der on in Ministeria Quaedem by Paul VI tal level (‘sacramentum tantum’): the Speciellen Seelsorge in der Vorreforma- (1972) and Evangelii Nuntiandi (1975) ministerial priesthood is the sacramental torischen Kirchen und der Kirche der and avoid this danger. I refer here to the sign of what from the point of view of Reformation (Berlin, 1898), p. 22. establishment of the Bakambi (the plural contents (‘res sacramenti’: communicat- 37 Quoted by EUSEBIO, H.E., 7, 22, of Mokambi), that is to say of a member ed salvation) is given to all believers, that 7-10. of the laity entrusted with the leadership is to say the representation of the salvific 38 Cf J.P.SCHALLER, I Sacramenti: of a parich, that is to say in the sense of service of Christ in the world. To be at Farmaco di Immortalità (Rome, 1990). the administration of the parish and the the service of this shared mission, to 39 Cf CYPRIAN, De Lapsis, 14. organisation of pastoral activity. He make it effective from the structural point 40 Cf G.UHLHORM, Die Christlichen works with a priest who is not the parish of view as well, and keep it alive is what Liebersthätigkeit, I, Alter Kirche priest but has the function of representing constitutes the specific character of the (Stuttgart, 1982), pp. 316ss. the bishop in sito because the bishop is priesthood in the Church: cf W. BEIN- 41 Cf Reg. Ben., 36. responsible for pastoral care. His func- HERT, ‘Autorität um der Liebe Willen. 42 A. HARDELAND, Geschichte der tion is limited here to the function of Zur Theologie des Kirchlichen Amtes’, Speciellen Seelsorge in der Vorreforma- ‘chairman’, as he is defined by can 517 § in K.HILLENBRAND (ed.), Priester Heute. torischen Kirchen, p. 90. 2. He exercises the responsibility of tasks Anfragen, Aufgaben, Anregungen 43 P.DOEPGEN, Über den Einfluß der which are specifically of the presbyter. (Würzburg, 1990), pp.32-66, pp. 56ss; Autoritaven Theologie auf fie Medizin Cf Archdiocese of Kinshasa, Les Min- K.LEHMANN, ‘Das Dogmatische Problem des M.A. (Wisebaden, 1958). istères Laics à Kinshasa (1985); des Theologischen Ansatzes zum Ver- 44 Cf C.PROBST, ‘Das Hospitalwesen L’Avenir des Ministères Laics. Enjeux ständis des Amtspriestertums’, in F.HEN- im Hohen und Späten M.A. und die Ecclésiologiques et Perspectives Pas- RICH (ed.), Existenzprobleme des Geistliche und Gesellscahftliche Stellung torales, edited by L.Santedi Kinpudu Priesters (Munich, 1969), pp. 121-175; der Kranken’, in G.BAADER AND G.KEIL (Signes de Temps, Kinshasa, 1997): A. P. NEUNER, Der Laie und fas Gottesvolk (eds.), Medizin im M.A. Abdenfland Matenkadi Finifini, Le Statut Juridique (Frankfurt, 1988), pp. 127ss; and G.GRE- (Stuttgart, 1932), p. 265. du Catéchiste en Territoire de Mission. SHAKE, Priestersein, pp.192ss. 45 See for example the comment of the Structure et Signification du Canon 785 22 PO, n. 2. rule of the Order of the Holy Spirit of the di Code du Droit Canonique de 1983 23 Commissione Teological Inter- fifteenth century: Liber Regulae S.Spiri- (Ottawa, 1988); idem, ‘L’Expérience 116 nazionale, Le Ministère Sacerdotale tus, edited by A.F.La Cava (Mailand, Pastorale des Bakambi: Histoire et Per- (Cogitatio Fidei, 60, Cerf, Paris, 1971). 1949), pp. 128ss. spective’, in Revue Africaine de Théolo- 24 E.PIN, ‘La Différenciation de la 46 His exhortation involves saying gie, 17, 1993, pp. 227-235; Oeuvres Fonction Sacerdotale, analyse Soci- leave us ‘to confess each other, advise, Complètes du Cardinal Malula, edited by ologique’, in Concilium, 43, 1969, pp. help and pray..and do not doubt the Yes L.de Saint Moulin, vol. 6; Textes Concer- 45-55. From this distinction one can un- of God towards us’: M.LUTHER, Von der nant le Laicat et la Société (Facultés derstand the move achieved by Jospeh Beicht, WA 8, 184, pp. 21-24. Catholiques de Kinshasa, 1997). This is Moingt who identifies different models 47 B.W. MARPERGER, Getreue An- different from the German system of of priesthood: cf his articles on ‘Essai sur leitung zur Wharen Seelencur bey ‘Pastoralreferenten and Pastoralrefer- la Mutation du Ministère Sacardotal’, in Krancken und Sterbenden (Nurenberg, entinnen’: cf H.J.POTTMEYER, ‘Thesen Etudes, April 1970, and ibidem, July 1717), pp. 212ss. zur Theologischen Konzeption der Pas- 1973; September 1973; October 1973. 48 H.G.PIPER, Klinische Seelsorge-Aus- toralen Dienste und ihrer Zuordnung’ in 25 PO, n. 7. bildung (Berling, 1972); J.SCHARFEN- ThGl, 55, 1976, pp. 313-337; W.KASPER, 26 PO, n. 2. BERG, Seelsorge als Gespräch (Gottingen, ‘Die Schädlichen Nebenworkungen des 27 One need only take into considera- 1972). Priestermangels’, in Stimmen der Zeit, tion his apostolic exhortations, his letters 49 J.J.ROHDE, Soziologie des Kranken- 195, 1977, pp. 129-135; K.RAHNER, ‘Pas- to priests on Holy Thursday and home- hauses (Stuttgart, 1974); J.SIEGRIST, Ar- torale Dienste und Gemeindeleitung’ in lies during ordinations to be aware of this beir und Interaktion im Krankenhaus Stimmen der Zeit, 195, 1977, pp. point. He formulates the question of the (Stuttgart, 1978). 733-743; P.HÜNERMANN, ‘Ordo un neuer identity of the priest in the following 50 Cf J.MAYER-SCHEU, Seelsorge im Ordnung? Dogmatische Überlegungen way: ‘Who am I? What is expected of Krankenhaus (Mainz, 1977); M.KLESS- zur Frage der Ämter und Dienste in der me? What is my identity? This is the anx- MAN, ‘In der Krise Begleiten. Probleme Kirche heute’, in F.KLOSTERMANN (ed.), ious question that the priest often asks und Aufgaben des Pfarrers am Kranken- Der Priestermangel und seine Konse- himself, and he is certainly not immune bett’, in EK 16, 1983, pp. 543-547; idem, quenzen (Dusseldorf, 1977), pp. 58-94; to the harsh effects of the crisis of the ‘Krankenhausseelsorge Heute’, in The- G.GRESHAKE, ‘Der Theologische Ort des transformation which is shaking the menheft WZM, 29, 1977, H.1. PAstoralreferenten und sein Dienst’, in world’: John Paul II, ‘Le Prêtre dans la 51 Cf Pontificia Commissio de Aposto- LS 29, 1977, pp. 18-27; idem, Priester- Societé Contemporaine, Homélie à la latu Pro Valetudinis Administris, Les Re- sein, p. 72; F.KLOSTERMANN, ‘Zur neuen Messe d’Ordination à Rio de Janeiro, le 2 ligieux dans le Monde de la Souffrance et Ordnung der “Pastoralen Dienste” in der juillet 1980’, in La Documentation, de la Santé (Rome, 1987); Les Laics dans BRD’, in Diakonia 9, 1978, pp. 129-139; 77/n.1791, 1980, pp. 751-754. See le Monde de la Souffrance et de la Santé H.SOCHA, ‘Der Dienst der PAstoralrefer- P.TOINER, L’Ordre Sacerdotal et l’Avenir (Rome, 1987); “Curate Infirmos” e la ented und die eine Geistliche Vollmacht’, de l’Homme, “Theologie Nouvelle” Vita Consacrata (Vatican City, 1994). in Archiv für Kirchenrecht 147, 1978, pp. (Fac-éditions, Paris, 1981), p. 167. 52 Cf CEI, ‘Linee per la Vita dei nostri 377-405; W.J.HENTSCHEL, Pastoralrefer- 28 JOHN PAUL II, ‘Motu Proprio Dolen- Seminari’, in Coll Documenti Locali n. enten – Pastoralassistenten (Eichstätt, tium Hominum (11 February 1985)’, n. 1 85 (EDB, Bologna, 1999), n. 55. Vienna, 1986); P.NEUNER, Der Laie und which recalls that for the Church pastoral 53 One can observe here how the das Gottesvolk (Frankfurt, 1988), pp. care of the sick is ‘an integral part of her Council itself is uncertain when setting 191-203. mission’. out the difference between ‘munia’ (LG, 56 Of illuminatinbg value here is the 29 Cf J.MAYER-SCHEU AND R.KAITZKY 33 with reference to the laity) and ‘sacra document of the Pontifical Council for (eds.), Vom Behendeln zum Heil. Die officia’ (with reference to priests). In- Pastoral Assistance to Health Care Vergessene Dimension im Krankenhaus deed, the tendency is towards outlining a Workers, I Laici nel Mondo della Sof- (Vienna, Freiburg, Basel, 1980), pp. distinction between the sacramental of- ferenza e della Salute (Rome, 1987), 138ss. fice and the non-sacramental ministries. which refers to the commitment of the 30 Cf H.W.WOLF, Antropologie des At But one can also note that on the one lay person in the field of pastoral care in (Munich, 1977), pp. 211ss. hand that in LG 18ss there is use of the health as a ministry, a diakonia which 31 Cf H.SCHIPPERGES, ‘Dies Entwick- term ‘ministry’ ‘ministerium’ for priests springs from the very nature of the lay lung der “Cura” im Verständis der Thera- and on the other hand that in various person as a member of the Church, as peutischen Dienste’, in J.Mayer-Scheu places the term ‘office’ (munus: LG, 33; someone who is in the condition of being and R.KAUTZKY (eds), Vom Behandeln sacra officia: LG, 35, 37) for the laity is baptised and secular: n.8. zum Heil.Die Vergessene Dimension im used: cf W.Beinert, Autorität um Liebe 57 Cf K.RAHNER, ‘Pastorale Dienste Krankenhaus (Vienna, Freiburg, Basel, Willen, p. 35. und Gemeindeleitung’, in Stimmen der 1980), pp. 40-55, p. 41. 54 CF K.RAHNER, ‘Über das Laienpas- Zeit 195, 1977, pp. 733-743; P.HÜNER- 32 In the poor and the suffering the tolat’, in Schriften zur Theologie, II, (Ein- MANN, ‘Ordo in neuer Ordnung? Dogma- Church ‘perceives...the image of her siedeln, 1961), pp. 339-379, p. 351; idem, tische Überlegungen zur Frage der Ämter Founder, poor and suffering’: LG, 8. ‘Sakramentale Gruddelgung des Laien- und Dienste in der Kirche heute’, in 33 Cf R.BONHOEFFER, Ursprung und standes in de Kirche’, in Schriften zur F.KLOSTERMANN (ed.), Der Priesterman- Wesen der Christl (Seelsorge, Munich, Theologie, VII (Einiedeln, 1966), pp. gel und seine Konsequenzen (Dusseldorf, 1985), p. 11. 330-350. 1977), pp. 58-94. 34 Cf PEDRO LAIN ENTRALGO, 55 It seems to me, indeed, that in the 58 See the detailed statements of Heilkunde in Gesch (Entscheidung, case of the Congolese Church it has been G.GRESHAKE, Priestersein, p. 72. The Catholic Chaplain of Pastoral Care in Health in Canon Law

1. Description themselves have very often been which deal with this subject are of the Contemporary founded by pious confraterni- concerned with chaplains of as- Regulations ties. The term ‘chaplain’ comes sociations. Indeed, very often from ‘cape’ and goes back to the the institutional context and a. In the CIC cape worn by St. Martin which arrangements of the particular is kept in the treasury of the Church does not manage to Canons 564-572 do not have basilica of St. Dioniges, which meet all the rights of the faith- their equivalents in the Eastern in turn became the colour blue ful. Special charisms are re- Code. But perhaps one can find of the French flag. This cape of quired which are traditionally something similar in the fact the poor man from Amiens was expressed through association- that the Eastern Code recognises a symbol – the chaplain became ism. The first associations of the the personal parish in canon a priest taking St. Martin as his faithful within the Church go 280: ‘si... id expedit, erigantur model and was entrusted with back to the third century AD, at paroeciae personales... vel alia handing out the charity of the a time when the Church was not 117 definita ratione determinatae’. Church. Thus, also, in French, yet able to bring its institutions the word ‘aumônier’ which is out into the open. These associa- a.1. Concept: the appellation for the priest tions were dedicated to care for Canons 564 and 568 who is entrusted with alms. the sick.1 When these charisms Two key concepts: priest and Canon 568 broadens the con- were institutionalised by the pastoral care. The chaplain is cept: referring to the Vatican universal Church these institu- the priest who is entrusted in a Council II vote expressed in CD tions became a gift made by the permanent – or at least partly 18 it is hoped that chaplains will universal Church to a large permanent – way with the pas- be appointed ‘for those who number of local Churches. toral care of a community or a cannot benefit from the normal group of the faithful, and this care of parish priests’. The Motu a.2. Appointment and should be carried out according Proprio Ecclesiae Sanctae I, 19, Removal to universal and particular law in discussing the application of The general rule is that the (564). this decree, calls on the Confer- appointment is made by an Or- There are many categories of ence of Bishops ‘to entrust to a dinary of the place: ‘except chaplains. The Code explicitly delegate priest or to a special where the law does not provide envisages the following: chap- committee everything to do with for a different approach or lains of the home of a secular re- the study and organisation of where someone legitimately has ligious institution; chaplains of pastoral service’ for special special rights, the chaplain is ap- hospitals or prisons; chaplains groups of the faithful. Here ref- pointed by the Ordinary of the of a ship; chaplains of emi- erence is made above all else to place, who also has the respon- grants, travellers, or sailors; mil- migrants, but the idea is valid sibility of appointing who has itary chaplains etc. Of these, the for all of the faithful. been presented or confirm who first two categories are especial- Some comments: these has been chosen (565)’. ly concerned with the question arrangements are new and come But there can be certain ex- of health because in reality from the Vatican Council II’s ceptions: many secular religious houses decision to make the episcopal – 1. The first exception con- are dedicated to taking care of conferences study how they cerns the preliminary part of the sick people. Indeed, hospitals should meet the right of those process of appointment and is faithful ‘who cannot benefit suf- contained in canon 567: the Or- ficiently from the ordinary and dinary must not appoint a chap- shared pastoral ministry of the lain of a secular religious insti- parish priests’ to receive the tute without having first consult- word of God in abundance, as ed the Superior who has the well as to receive the sacra- right, after hearing the opinion ments. of the community, to propose a Here attention was primarily priest (67/1). being paid not to the world of This is an innovation: because pastoral care in health to mi- this involves proposing and pre- grants. It is for this category that senting, the Superior is not during this century the concisto- obliged to propose the person rial congregation has made spe- designated by the community cial arrangements. But this prin- and the Ordinary is not obliged ciple holds for everybody. to appoint the person proposed. It is interesting to observe that – 2. With regard to public as- 17 of the canons of the Code sociations notice should be taken of canon 317, section 1, contexts except where the Ordi- which obliges the bishop to lis- nary of the place applies his ve- ten – where this is appropriate – to; to the higher officials of the as- b) to preach the word of God sociation before appointing the to them; chaplain. c) to administer the viaticum – 3. It is not made clear and the anointing of the sick to whether the ‘spiritual adviser’ them; envisaged for the private associ- d) to administer the sacrament ations in canon 324, and whose of confirmation to those faithful appointment follows a special who are threatened by death path of selection, has the charac- (566/1). ter of being a chaplain. Echever- C) A very special principle: in ria affirms that this is in fact the hospitals, in prisons and during case. sea voyages the chaplain also The Ordinary of the place, has: the faculty, which can be with good reason, can remove exercised only in these places, the chaplain from his office, fol- to absolve people from latae lowing a wise decision (even if sententiae censures which are es damage or otherwise the the chaplain had been chosen or not secret or declared, where, parish ministry (canon 559). presented by other people) as however, the provision to be long as the provision of c.682/2 found in c.976 (566/2) remains b. In Interdicasteral (cf 572) is obeyed. This is a in force. Instruction 118 principle which is valid for all This faculty is not granted to the offices whose tenure is re- parish priests or deacons and Article 1. The need for an ap- movable: the freedom of the Or- emphasises the range of the real propriate terminology dinary and the defence of the ‘pastoral care’ we are dealing § 3 The non-ordained believer right of the Superior to be noti- with. In this case the world of can acquire the general denomi- fied in good time about his sub- pastoral care in health is explic- nation of ‘extraordinary minis- ordinates. itly referred to. Given that the ter’ only if and when, and solely Given that one is dealing here verb ‘absolve’ is employed, in a substitute capacity, he is with a member of a religious or- commentators think that this is called by the competent authori- der, this person can be removed limited to the sacramental inter- ties to carry out tasks in line both by the Ordinary of the nal forum. with canon 230 § 3 (cf Pontifi- place and by the religious Supe- – Chaplains of the armed cia Commissione per l’Interpre- rior without the consent of the forces are governed by special tazione Autentica del Codice di other party (i.e. the Ordinary or laws (569). Diritto Canonico, Risposta (1 the Superior), and it is sufficient June 1988): AAS (1988), p. for the author of the removal to a.4 Tasks 1373) and canons 943 and 112. be informed of the fact by the 1. – The famous ‘pastoral Obviously enough, the practi- other party. care’ for which his office is cre- cal term which is canonically ated. determined for the task which a.3 Faculty c. 566 2 2. – To be a rector if there is a has been entrusted can be used: This is an important canon church attached to the office. for example, catechist, acolyte, because it allows us to have a 3. – To celebrate or direct reader etc. better understanding of the high liturgical functions when he is The temporary delegation of idea and view that the legisla- the chaplain of a secular insti- liturgical actions in line with tion of the Church has with re- tute, but without interfering in canon 230 § 2 does not confer gard to the figure of the chap- the internal government of that any special denomination on the lain. institute (567/2). non-ordained believer at all (cf A) General principle: the 4. In the exercise of his pas- Pontificio Consiglio per l’Inter- chaplain must have all the facul- toral appointment the chaplain pretazione dei Testi Legislativi, ties required for pastoral care must maintain a suitable rela- Risposta (11 July): AAS 86 which is of a virtuous and prop- tionship with the parish priest (1994), pp. 541-542. When er character. (571). there is envisaged a function for Example: Can 911: the chap- For example, the chaplain the beginning of the entrusting lains have the duty and the right cannot exonerate the communi- of a task of co-operation of the to carry the Most Holy Eu- ty from the prescribed holy pastoral assistants to the min- charist with them for the pur- days or days of penitence, nor istry of priests the coinciding or poses of the viaticum. commute them, because these unifying of this function with a B) Special principle: in addi- measures are the responsibility ceremony of sacred ordination tion to those granted by particu- of the Superior of the institu- is to be avoided, as is the case lar right or by a special delegations governed by pontifical with the celebration of a similar tion because of his office, he has law and of the parish in the case rite for the conferring of the role the faculty: of secular institutions or institu- of being an acolyte or a reader). a) to listen to the confession tions governed by diocesan law It is not legitimate, therefore, of the faithful who are entrusted (c.1245). for non-ordained believers to to his care; following regulation The Ordinary of the place is acquire, for example, the de- c.967, 2, this faculty, which is to decide if the solemn celebra- nominations of ‘pastor’, ‘chap- granted vi officii, is valid in all tions held in non-parish church- lain’, ‘co-ordinator’, ‘chairman’ or other denominations which the mission dedicated to caring were voted on, and they are still could confuse their role with for souls, and on the other the practically unpublished.5 In or- that of the pastor, a role exclu- simple ‘pastoral centre’ where a der to gain an overall picture, sive fulfilled by the bishop and certain form of care, specifically but in the absence of such a syn- the presbyter (Such an example also of charity, can also be en- thesis – because the Church is a must include all those linguistic trusted to deacons. Indeed, living body – I will principally expressions which in the idioms where there are no deacons, dwell upon the parts which have of different countries can be these can also be entrusted to in actual fact marked the view analogous or equivalent and in- members of religious orders or that the Church has of herself dicative of a directive role of to members of the laity who ex- on this specific point of collabo- leadership or something which ercise the functions provided for ration (not only with the ‘hierar- takes its form). by their statute. chical apostolate of the Church’ which has been practised since A Double ‘Collaboration’ the times of St. Paul and subse- 2. Three ‘Hotter’ Points of the Members of the Laity quently in innumerable fields Envisaged by Canon Law such as the associations of the This last teaching, that of in- The principle of collaboration faithful, the minor orders, terdicasteral instruction, oblig- with the priestly ministry is set Catholic Action, etc.) but also es us to take account of the pre- out in the contemporary canonic with the ‘pastoral ministry’ as sent-day debate. It seems to me corpus: the Code of Latin Canon such. to be a good idea to clarify cer- Law of 1983, first of all, refers tain points in order to see to canon 228 § 1, which talks The Founding Texts whether and what, at the level about a habilitas of the mem- of Vatican Council II of doctrine or at the level of bers of the laity in relation to ec- At the level of recognised 119 what is positive in a pastoral clesiastical ‘offices’ (officia) and principles, the commission for sense, doors are open, taking ‘functions’ (munera), and of the the interpretation of the Coun- into account the good of the possibility of ‘participating in cil, which subsequently became Church, to guarantee a service the functions which are closest the Commission for the Inter- which is more suited to sick to the office of the pastors’. Sub- pretation of Legislative Texts,6 people. These are ‘openings’ in sequently, the Code of Canons in relation to the Latin Code harmony with the overall disci- of the Eastern Churches of 1990 bases this very specific collabo- pline of the Church and not ex- reformulated this principle bas- ration on three texts: the dog- ceptions erected into a system ing itself on Vatican Council II matic constitution on the which have the goal of pene- in order to order two levels of Church, Lumen Gentium, n. 33; trating concepts into the collaboration in a more logical the decree on the pastoral office Church which in themselves way. It refers to the possibility of bishops, Christus Dominus, are extraneous to the Church. It of members of the laity ‘being n. 24; and the decree on the seems to me that there are paths entrusted with ecclesiastical apostolate of the laity, Apostoli- to be taken both in the field of functions’.3 cam Actuositatem, n. 24. The the definition of new ecclesiastical offices entrusted to mem- CDC 1983 CCEO 1990 bers of the laity – under the 228 § 2: members of the laity who 408 § 1: members of the laity who are known pastoral responsibility of a are known for their learning, for their due learning, experience and integrity priest – both in the field of the prudence and honesty, have the are able to be heard by the ecclesiastical widening of the faculties of the faculty to provide help to the authorities as experts or advisers, both as chaplain and in the field of the Pastors of the Church as experts individuals and as members of various creation of new chaplaincies. or advisers, in council bodies councils and assemblies such as those which But because the whole of this regulated by law as well. are parish, eparchial or patriarchal. system depends on the conception that one has of the priestly 228 § 1: members of the laity 408 § 2: In addition to ecclesiastical positions, identity and its role within the who are suitable can be legally to which they are admitted by common law, Church I will dwell above all – employed by holy Pastors in they can be employed by the competent those ecclesiastical offices and authority in other positions as well, except in order to establish a basis for in those positions which they those which require the holy order or which are the whole of the approach – on can exercise according to the expressly forbidden to members of the laity by the first point. provisions of law.4 the particular right of their Church sui iuris. a. The Question of the Priestly 408 § 3: In the exercise of an ecclesiastical Identity of the Chaplain position, the members of the laity are fully subject to the ecclesiastical authority. The chaplain ‘est sacerdos’. There can be other people in- The interesting aspect of this Eastern Code orders these three volved in the practice of pastoral first group of canons essentially references and adds others: Lu- care in health but they do not lies in the cited references men Gentium 33 is cited for the have this title and they do not which are exclusively from Vat- two types of collaboration; have these faculties. The direc- ican Council II. Christus Dominus 10 only for tory for the ministry of the bish- The documents of that Coun- the first, that is to say for the hi- ops, Ecclesiae Imago, section cil are still too unexplored at the erarchical apostolate; and Apos- 183, in discussing the creation level of their real meaning be- tolicam Actuositatem 24 only of special centres for the aposto- cause of the ‘speeches’ and for the second, that is to say for late, identifies on the one hand ‘ways’ with, and in which, they the pastoral ministry as such. In both cases reference is also only real novelty is provided by this reason, their training must made to Lumen Gentium 37. the following sentence: ‘the be in line with cultural progress For the first kind of collabora- members of the laity also have so that, as valid co-operators tion it also cites Christus Domi- the ability to be employed by (validi cooperatores) of the nus 27, Apostolicam Actuosi- the hierarchy to exercise for priestly order, they can carry out tatem 20b and 26, the decrees spiritual ends certain ecclesias- their task (munus) in the best on missionary activity Ad tical functions’. What are these way possible, something which Gentes n.30 and on the ministry ‘ecclesiastical functions’? The is becoming increasingly diffi- and the life of priests Pres- draft on letter F in relation to the cult with new and larger respon- byterorum Ordinis n.17. For the last text – that which could still sibilities. There must therefore second type it cites Christus include even substantial be an increase in the number of Dominus 27 and Ad Gentes 17. changes voted for by the Fa- diocesan and regional schools With regard to submission to thers – simply says that a ‘com- in which the future catechists ecclesiastical authority in all plementary idea’ has been intro- learn both Catholic doctrine, es- these functions the Eastern duced here taken from the long pecially with regard to biblical Code refers to Apostolicam Ac- list of proposals made by Cardi- and liturgical matters,M1 and tuositatem 20s.7 nal Suenens. But the reading of catechistic method and pastoral this ‘propositio nova ordina- practice, and receive a Christian Ecclesiatical ‘Functions’ tione capitum’9 of September moral training... for the Members of the Laity 1963, which had previously In addition, those who dedi- Because the question which been praised by the committee, cate themselves completely to interests us is the second type of does not help us to understand this work should be guaranteed collaboration, which may appear why the committee thought fit a decent standard of living and 120 to be the most innovative and the to keep it. The sentence in ques- social security with just nearest to the sacrament of the tion is used as it was at the end pay...Rel.A. Order, we must quote these texts of the section on equality and It is also to be hoped that the and the official clarifications inequality amongst the mem- correctly trained catechists, provided by the drafting com- bers of the Church of Christ, where this is suitable, should re- mittees.8 In LG we read the fol- and there are no explanations to ceive the public conferment of lowing: ‘In addition to this apos- be found in the other interven- the canonical missionM3 so that tolate, which is the absolute re- tions of the Prelate. It seems, they can serve the faith with sponsibility of all the faithful, therefore, that the sentence was great authority amongst the the members of the laity can also inserted in the constitution as a people.Rel.B. be called in various ways to col- general statement thereby al- Furthermore, once again in laborate more immediately with lowing a logical development at AG 17, the committee hopes the apostolate of the hierarchy the heart of this section. that the catechists will be able (cf Pius XII, ‘Alloc. Six Ans se The modus 18 shows that at to receive a canonical mission sont Ecoulés’, 5 October 1957), least for one Father this sen- without any distinction between along the lines of those men and tence lacked clarity, and he did auxiliary catechists and cate- those women which helped the not see whether here there was chists in a narrow sense – this Apostle Paul in the Gospel, en- something different from the fact means that it is not the gaging in great trial for the Lord ‘appeal to collaborate with the canonical mission which con- (cf Phil 4:3; Rom 16:3ss)M17. apostolate of the hierarchy’, fers the ‘ecclesiastical munus’ to They also have the ability to be not to speak of the mandate of which the hierarchy can call employed by the hierarchy (ad the associations recognised by somebody. In Modus 3 the com- hierarchia adsumantur) to exer- the Church. The committee mittee also recognises that this cise for spiritual ends certain ec- then refused to remove the text ‘canonical mission’ does not clesiatical functions (ad qaedam and made clear that one was have a ‘canonical’ value in the numera ecclesiastica, ad finem dealing here with ‘ecclesiasti- strict sense! It is stated that this spiritualem exercenda) Rel.F n.18 m.19.’. cal’ munera of which it gave is merely a widespread practice The drafting committees pro- two examples: the bursar of a and that the decree encourages vide various clarifications religious institution and the cat- this where a contribution can be through their explanations. The echist in a narrow sense. made with greater authority to If we turn to the text of AG 17 the service to the faith provided we can see that one is dealing by the catechists. not with catechists who are sat- This is most certainly an au- isfied with leading prayers and thority but it is not a ‘potestas’: having a mission of teaching in the possible letter of mission, their community but of cate- which the new Code recognises chists in countries of mission no more than the old, does not which have been employed full confer any ‘potestas’ and thus time and who thereby have the takes nothing away from the right to be paid: government of ‘pastors proper’, ‘During our time, when there that is to say the parish priests are not enough members of the and chaplains (by extension). clergy for the evangelisation of The text of the decree on the so many multitudes and for the apostolate of the members of exercise of the pastoral min- the laity, Apostolicam Actuosi- istry, the task of the catechists is tatem 24, is even more categori- of the utmost importance. For cal in the matter: ‘Lastly, the heirarachy en- ments which are spoken about canon III on the hierarchy) but trusts the members of the laity here, and which a ‘letter of sees them, rather, in a generic with other tasks (munia mission’ is not sufficient to sense of duty or role. quaedam committit) which are confer, are in reality offices. In- more intimately connected deed, the Latin term employed ‘Collaborators’ with the duties of pastors (pro- by LG 37 is explicitly ‘officia’, or ‘Co-operators’? prius cum officiis pastorum co- whilst LG 33 speaks about In the organisation of the niuncta sunt), and in the ex- ‘munera’ ‘to be carried out Church the members of the pounding of Christian doctrine, with a spiritual end’. This goes laity can therefore receive a in certain liturgical acts, and back in a rather clear way to the very special appointment, the care of souls. As a result of definition of ‘ecclesiastical of- which, indeed, is exalted, al- this mission the members of fice in a broad sense’ presented though offices are opened up to the laity, with respect to the in the first part of canon 145 § them relatively rarely, on the performance of their tasks 1 of the Code of Canon Law of whole being of a full-time na- (muneris), are fully subject to 1917 and canonised by Pres- ture, and they are more precise- ecclesiastical higher direction byterorum Ordinis 20 as the by ly defined than is the case in (moderationi).Rel.F.’ now general meaning of an of- numerous canonical missions, In order not to create confu- fice within the Church. Paper C and this is something which al- sion and to give the impression of the third-from-last draft of low ministers, including bish- that the power of jurisdiction this last decree shows further- ops, to exercise their native can be transmitted by a more that on 1964 it had al- ‘sacra potestas’.12 At the same non-sacramental route – a sub- ready been decided that one of time these are appointments ject much debated which does the principles for the reorgani- which are rather clearly defined not belong to common doctrine sation of legislation would in character. Christus Dominus 121 and upon which it is not possi- have been that in general of a 27 finds it ambiguous that the ble to base any discipline – the broad acceptance of the mean- title of ‘collaborators’ is also text was expurgated of every ing of ecclesiastical office and bestowed on members of the reference to the idea of ‘man- no longer the narrow definition laity who have an office in the date’, ‘canonical mission’ and which necessarily involved a diocesan curia, and indeed this ‘participation in the apostolate participation in the power of document limits their contribu- of the hierarchy’. Here one order or jurisdiction. Whatever tion to being the provision of should consult the appended the soundness of this reform ‘help to a bishop’: paper ‘F’. may be – indeed is it really pos- ‘Both the priests and the sible to structure the institution members of the laityM.99 M.100 who ‘Munera’et ‘Officia’ of the Church beginning with are part of the curia should be in a Broad Sense offices which do not in the first well aware of giving a hand Everything is based, there- instance take into account ei- (adiutricem operam praesta- fore, on two particular levels of ther the sacrament or the need re)M.101 to the pastoral ministry collaboration which are identi- for compulsory power? – this of the bishop. The diocesan cu- fied by LG 33 (councils and means that ‘the participation in ria should be ordered in such a possible appointments). LG 37 power does not belong to the way as to become a suitable in- does nothing else than go back concept of office’,10 and the strument for the bishop, not on- to this distinction but this time same may be said of participa- ly for the administration of the it describes the relations be- tion in the sacrament of the Or- diocese but also for the exercise tween the members of the laity der. of works of apostolate’. and the hierarchy from the We should observe in rela- The same may be said of the point of view of the pastors: tion to LG 33 that the text does term ‘collaborators’, probably ‘On the other hand the holy not make a distinction between because it already indicates the pastors recognise and promote ‘officia and ‘munera’. In sub- element of ‘sacra potestas’ con- the dignity and responsibility sequent extrapolations it has ferred on priests from the mo- of the laity within the church. been advanced that the local ment of ordination, and thus has They willingly avail them- Church enjoys a priority in re- a sacramental foundation. LG selves of their wise counsel, lation to the universal Church.11 says that priests are ‘providi co- with trust they entrust to them This is something which would operatores’ of the episcopal or- appointments for service to the imply an obligation to recog- der and not only its helpers or church (in servitium Ecclesiae nise the presence of sponta- its instruments. The decree of officia committant) and allow neous munera amongst the Vatican Council II, the pastoral them freedom and space to act, members of the laity (and in office Christus Dominus, never indeed they encourage them to particular in parishes) and at mentions the members of the undertake works of their own times their erection into real laity as collaborators, not even initiativeRel.K. They should con- and proper ecclesiastical of- in chapter 2-III on the co-opera- sider the initiatives, requests fices. But nothing of this kind tors of the diocesan bishop. Ref- and wishes advanced by the can refer back to a foundation erence is made to a duty to members of the laity attentively derived from Vatican Council co-operate which concerns in Christ and with paternal af- II: LG 33 does not distinguish parish priests but this is in rela- fection. With respect, then, the between munera and officia; it tion to co-operating with other pastors will recognise that just does not see the munera in an pastors – they do not have im- freedom which is due to all in ontological sense as the founda- posed upon them any duty at all the earthly city.Rel.M.’ tion of the Sacra Potestas con- to co-operate with the faithful Today the ecclesial appoint- ferred by consecration (as in as though this was a part of their mission. On the contrary, parts duties of the parish priest: ‘with and bless in front of the People 1, 3 and 6 in CD 11 explicitly the co-operation also of other but never in the presence of a excludes the members of the presbyters or deacons and con- priest. The common doctrine ex- laity and deacons from the defi- tributing to the work also of the pressed in the Catechism of the nition of Vatican Council II to lay faithful according to law’.14 Catholic Church or in the new the effect that the diocese is a Directory for the Ministry and ‘portion of the people of God The Members of the Laity the Life of Permanent Deacons which is entrusted to a bishop are able to ‘Preside’ begins pastoral responsibility who must nourish it with the In order to conclude on the only with the presbyterate.16 The co-operation of the presbyter’. subject of the possibility of grace specific to deacons, who When a Father asked if one members of the laity to take on are on the first level of the could not add to this definition offices of great responsibility, ‘sacrament of the ministry’, ‘with the co-operation of the which are at a level which is does not make them pastors. For presbyter and of the members of different from the sacramental this reason they cannot receive the laity’ he was forcefully told responsibility in relation to offices which involve them in that the members of the laity are souls, one should quote modus the full care of souls. The in- not involved in nourishing.13 2 of AG 17, and this because of struction recalls that they should the fact that it has been faithful- principally be entrusted with The Members of the Laity ly carried over into interdicast- tasks involving substitution be- are not ‘Pastors’ eral instruction and its tradi- cause they exercise a real min- Nothing therefore allows us tions.15 istry. However, in the case of to say that the co-operation, col- ‘Furthermore, the Church canon 517 § 2 as well, deacons laboration, or participation of must feel and will appreciate do not take part in the ‘pastoral’ 122 the members of the laity be- with gratitude the generous task but only in its exercise. All longs to the idea of the ‘pastoral work of auxiliary catechists, these distinctions between pas- charge of pastors’: in Vatican whose help they need. In their toral responsibility, ministry and Council II only the decree community they must leadM.2 ecclesiastical office can help us Apostolicam Actuositatem 10 prayers and provide teaching. to understand how little power speaks about care for souls in Concern must be duly felt in re- is in play in everything that con- relation to the members of the lation to their doctrinal and spir- cerns the armour of the institu- laity, and in does so in the fol- itual training.’ tion of the Church. Precisely be- lowing terms: Because the office entrusted cause one is dealing with graces ‘the laity co-operate with to members of the laity does not proper, based upon different dedication in communicating involve any power or relation- consecrations, the roles are not the word of God, especially ship with the sacrament of the interchangeable. through the teaching of the cate- Order, this is transferred to all Cardinal Ratzinger sum- chism; making available their their tasks of direction: the marises the doctrinal question skills they make care for souls Latin does not use the term in the following way:17 more effective, as well as the ad- ‘praesident’ in relation to them ‘The Instruction well identi- ministration of the goods of the but ‘praesunt’ or more strictly fies the three kinds of tasks and Church’. ‘praeunt’. This means that one services through which the lay As we have seen, AA 24 can entrust these members of faithful take part in the unique speaks about the possibility of the laity with the task of being mission of the Church: entrusting lay people with tasks those who accompany the com- 1) tasks and services involv- which are ‘more strictly linked’ munity, of being their anima- ing the apostolate of the laity, to the duties of the pastor, in tors, of setting an example, or that is to say their special way terms of the three aspects of the even of leading the way, guid- of making Christ present in the single munus, and thus also of ing them, and directing them. structures of the temporal and care for souls. But it does not But they do not ‘preside’ over civil order; speak about entrusting such anything, not baptisms, not 2) tasks and services in the care to them. From the research prayers, not funerals, not coun- various organisational struc- carried out on the basis of the cils – presiding is specific to the tures of the Church which are ‘Magistra’ data there is no offi- sacramental hierarchy. entrusted to the laity by the cial text which speaks about the competent ecclesiastical author- laity, other than under the head- Not even the Deacons ity through offices and func- ing of collaboration, when one are ‘Pastors’ tions; is dealing with cura animarum. This, indeed, has a conse- 3) tasks and services which Even less is reference made to a quence which has never been are proper to the holy ministers right held by them to collabo- explored in relation to deacons: but which nonetheless because rate in this cura animarum – they are members of the sacra- of special or serious circum- they can collaborate with the mental hierarchy but not of the stances, and in practical terms apostolate, with the mission of priesthood. They receive the ca- because of a lack of presbyters the Church, and even with the pacity to offer in the name of the and deacons (one hopes of a transmission of the Word, but People and to distribute in the transitory character) are tem- not with the care of souls, that is name of God, they are in front porarily exercised by members to say with that which is in fact of the Church, they are the im- of the laity, after receiving the the sole responsibility of the age of Christ in the dimension juridical faculty or mandate pastor. The present-day Code of service of his priesthood, but from the competent ecclesiasti- identifies the limits to these of- they are not the image of Christ cal authority. In this case one is fices when it summarises the the Head: they can thus preside dealing with the already referred to supplementary tasks which do not describe in an in- CIC 1983 CCEO 1990 trinsic way from the character 274 § 1. Only priests can obtain 371 § 1. Priests, with the required of the holy Order’. offices whose exercise requires canonical elements, have the right to obtain We can recognise here the the power of order or the power from their own eparchial bishop an distinction made by Vatican of ecclesiastical government.274§81 office (officium), ministry (ministerium) Council II recalled further on, to or appointment (munus) to be exercised which is added the distinction in in the service of the Church. cases of substitution. One can- 129 § 1. From the power of 979 § 1. Those who belong to the holy not but realise that this doctrine government, which exists in the order are able in power of government, immediately involves implica- Church by divine institution, also which by divine institution exists within the tions for the order of govern- called power of jurisdiction, Church, according to the norms of law.979 § 1 ment. The apostolate of mem- according to law those who belong § 2. In the exercise of the power of bers of the laity is always pro- to the holy order are able subjects government all the other Christian faithful moted. Their co-operation in ec- in line with the canons of law. 129§1 can co-operate according to the clesiastical offices should not be § 2: In the exercise of such power norms of law. 979§2 promoted. It is a possibility that the laity can also co-operate in itself this will not contribute according to the norms of law.129§2 anything to the members of the 150: An office which involves the laity but from which bishops full care of souls, whose can benefit in the organisation performance requires the exercise of their dioceses to the extent to of the priestly order, cannot be which this does not introduce a validly conferred on a person who confusion of identity. With re- has not yet been promoted to the gard to substitution, it is possi- priesthood. ble only as a temporary remedy in response to a situation of cri- A ‘Legalistic’Assertion Council II these authors refer to sis. It is, therefore, a minor evil Commenting on all these LG 33 as though this text envis- to be escaped from as soon as texts and the tradition to which aged the possibility for mem- possible. they belong would take too bers of the laity to exercise a ju- much time. Once again, Vatican risdiction: it has already been Other Canonical Aspects Council II did not want to ex- observed in this paper how The texts mentioned above plicitly choose the form of trans- things really are. We cannot show that the identification of mission of these two powers. even deny that in these desper- different levels of collaboration But one is greatly struck by the ate attempts there is a ‘search if derives from another distinc- fact that the thesis of K. Rhaner not for a theology at least for a tion, that between the power of of 195619 is periodically utilised practice which is alternative to the order and the power of gov- as the final consequence of the the ministries of the Church’ to ernment, and from the introduc- ecclesiology of communion.18 employ a stock phrase, when we tion of the principle of a possi- According to this thesis the pas- see these authors sign petitions ble ‘co-operation’ into this last. toral animators would lose their after petitions and agitate On this principle there is a secular state and would enter the around diocesan synods in order second group of canons which clerical state through the estab- to get their theses passed. But do not reinterpret only two or lishment in stable fashion of an the truth of the matter is that three passages from Vatican ecclesial function or office, these are disputes amongst Council II but which represent a something which would in itself priests for which members of rather consolidated tradition make them participate in the the laity are not responsible. whose interpretation is not yet sacramentality of the Church unanimous with regard to the because their function would The Teaching of the Catechism form of transmission of these make them signs of the order of of the Catholic Church two powers (order and jurisdic- sacramentum tantum. This the- I would like to quote only the tion). However, Vatican Council sis is completely knocked out of passage from the Catechism of II well established their sacra- court by the teaching of Vatican the Catholic Church which mental origins basing the ori- Council II on munera and sacra deals with these canons, and gins of collegial power in the potestas as an ontological foun- more precisely from sections bishops on the same ontological dation of the ministry. Whatever 908 onwards, on the participa- participation in the munera may be the polemical character tion of the members of the laity Christi, a participation received of these works which seem pri- in the royal office of Christ: from a personal consecration marily concerned to break open n. 910: ‘The laity can also feel which defines Christ according the padlock of the celibate state, called, or be in fact called, to to a new way at every level of understood as a hidden motive co-operate with their pastors in sacrament. The important edi- for the distinction between the service of the ecclesial com- tion of the Catechism summaris- priests and non-priests, they munity, for the same of its es this teaching when it substi- base everything upon a concep- growth or life. This can be done tutes n. 879 with the following tion which in the end is rather through the exercise of different statement: ‘the sacramental ‘legalistic’ and a little hyptroph- kinds of ministries according to ministry of the Church is there- ic of the power of jurisdiction as the grace and charisms which fore a service performed in the though this was the current us- the Lord has been pleased to be- name of Christ. It has a personal age of the Church. When they stow on them’ (Evangelii Nun- character and a collegial form’. search for support from Vatican tiandi, 73). n. 911. In the Church ‘lay only for those which are defined where there is a legal gap. The members of the Christian faith- and do not involve the care of absence of a norm does not ful can co-operate in the exer- souls. mean a licence to do everything. cise of this power (of gover- It is not a good methodology The Church has always recog- nance) in accord with the norm to found a theory only begin- nised the validity of the ‘praeter of law’ (CIC, can 129 § 2). And ning with the vocabulary of legem’ customs, but on one con- so the Church provides for the such a contingent text as the dition -rationality. This depends presence at particular councils, CIC. However, the same Code on objective criteria, the fruit of diocesan synods, pastoral coun- does not provide any basis to the experience of the Church, cils; the exercise in solidum of seeing baptism or confirmation which allows her to maintain a the pastoral care of a parish, col- as giving rise to a right to office: certain coherence and consisten- laboration in finance commit- they provide only an ‘apritudo’, cy in her work. These criteria tees, and participation in eccle- translated with ‘habilitas in the are those of analogy with the siastical tribunals’ (cf. CIC, CIC in relation to certain offices laws used for similar cases, the cann. 443 § 4; 463 §§ 1, 2; 492 § which are ‘nearer’ to those of general principles of law, ju- 1; 511; 517 § 2; 536; 1421 § 2). pastors. risprudence and the practice of It is to be observed that the In canon 150 the Code, begin- the Roman Curia, and lastly the important edition of the Cate- ning with a new broadened no- common and constant opinion chism removes the ambiguity of tion of office, introduced the of the Doctors of the Church. an ‘in solidum’ participation of possibility of entrusting true and These criteria allow, among the members of the laity in the real ecclesiastical offices to other things, the possibility of exceptional exercise of pastoral members of the laity, on the developing the idea of ‘cura an- care envisaged by canon 517 § condition that they do not in- imarum’. 124 2: given that the phrase ‘in volve ‘the full care of souls’. In Article 1 of the instruction re- solidum’ is applied to colleges practice the comparison with quires above all else a termino- whose members have equal re- canon 228 leads to an approach logical clarification. Perhaps it sponsibility it cannot be applied where only the offices envis- would be a good idea in this to pastoral care which belongs aged by law can be entrusted to sense to adhere to the classifica- solely to the specific pastor of members of the laity – those tion proposed by certain teach- the community, even though he which are institutionalised by ers of the clergy. might be a moderator. the CIC are much less numer- 1. Cura animarum is the ex- ous.20 All the others, therefore, clusive responsibility of or- Ministries and Offices of the are created by particular law and dained ministers (cf canon 150). Laity in the Code of Canon Law cannot take the post of offices 2. Pastoral care lies in the With regard to the ministries whose existence is obligatory. bishop, and the presbyter takes and offices of the members of Furthermore, as we have seen, part in it (CD 11). It cannot be the laity, reference should also the office entrusted to members based upon a letter of mission. be made to canons 224-231 of the laity does not involve any 3. Pastoral care is exercised which deal with the obligations power. It does not take the place by the parish priest and his and the rights of the lay faithful. of the pastoral responsibility for deputies take part in its exercise. These refer to a ministry only in souls, and it is a basic principle Participation in this exercise can canon 230 § 1 and 3 when dis- of the Church to ensure that be entrusted to members of the cussing instituted ministries. there is no community without a laity in the exceptional case of They talk about officium in a pastor, whether its criterion of canon 517 § 2. number of meanings: in canons aggregation is territorial or per- 225 § 2 and 226 § 1 in the gen- sonal. As Monsignor Cadilhac b. The Question of Special eral sense of duties linked to emphasises: ‘only he who is or- Faculties evangelisation of the temporal dained can be responsible for order and the family; in § 3 of pastoral care. A part of this exer- When one explores the canon 230 reference is made to cise can certainly be delegated sources of present-day legisla- offices of instituted ministries, to members of the laity but these tion one discovers that many and here, too, in terms of duties. last can carry out their task only faculties have been conceded In canon 228 reference is made in dependence of whom is re- for two categories of the faithful to certain ‘ecclesiastical of- sponsible for pastoral care’.21 If – migrants and members of the fices’, defined by law, in rela- the Directory for the Ministry armed forces.22 Our sick people tion to which the laity have a and the Life of Permanent Dea- have had their Pontifical Coun- habilitas. The meaning here is cons observes that they exercise cil only since 1985, a body en- thus rather technical – one is their ministry, even in contexts trusted with ensuring that they dealing with an office according which are less favoured and dis- receive the care of the universal to the meanings of canon 145. tant from the Church, always Church. We can deduce from this capaci- under the dependence of a pas- The Instruction Nemo Est of ty the fact that the munera are tor in everything to do with the 1969 dedicated to migrants be- said to derive from confirmation care for souls, this applies a for- stows upon them a chaplain who in the same way as their charac- tiori to members of the laity. is equivalent to a parish priest if ter derive from the sacrament of he has a ‘mission with care for order – the order also produces Being Careful with Regard souls’, and the same title with the character whilst confirma- to a Certain Approach, the rights and obligations of the tion only produces a habilitas, and not Saying Everything pastor proper if he is entrusted something which is not valid for It is important to remember with a personal parish. Article all offices and for all munera but canon 19 which deals with cases 39 says that this personal power is cumulative aequo iure with on the part of the Conferences of spoudaioi and philoponoi, faithful who lived in this world in a way very distinct that of the parish priest. For this of Bishops to study the most ur- from members of religious orders but reason, every emigrant has the gent questions relating to groups who helped them in the search for perfec- full faculty to freely turn to a of the faithful whom the min- tion and to whom vigils which were at times too long were entrusted; chaplain and the parish priest of istry of parish priests reaches – we find the use of ‘confratriae’ from the place for the celebration of only with difficulty. 658 onwards (the Council of Nantes) to the sacraments, including mar- In this area the Church does denote meetings of the faithful for the riage. Perhaps such an equiva- not deaden the imagination. In- purposes of piety (cf R.Naz, Traité de Droit Canonique, Paris, 1955). lence could also be used in cer- deed, it is its most solemn fea- 2 A classification in line with the terms tain cases with sick people as ture to call on everybody to en- employed by F.D’OSTILO, Prontuario del well. gage in an examination of their Codice di Diritto Canonico (Vatican City, 1955), p. 247. I would not like to provoke consciences with regard to re- 3 The concordance of canons between ill-founded hankerings but it sponding to the needs of souls. CDC and CCEO is that published by seems to me that the drawing up The only reservation felt by E.EID AND R.METZ in Il Codice dei Canoni delle Chiese Orientali (Libreria of a new list of faculties, per- the Church is that of the need to Editrice Vaticana, 1997). haps broadened in number after always act according to the 4 The translation of ‘munera quibus ip- hearing what the needs of the virtue of prudence. In the area of si secundum iuris praescripta fungi va- lent’ is based here on that recognised by chaplains of the universal ‘special pastoral care’ we have the Spanish Episcopal Conference. Church really are, and perhaps found only one ‘restrictive’ cri- 5 In addition to being published in the furnished with new indulgences terion in this sense: the Instruc- Acta Synodalia these texts can be found in F.Gill Hellin, Concilii Vaticani II Syn- which should be asked for from tion Solemne Semper of 1951 opsis in Ordinem Redigens Schemata the Apostolic Penitentiary, recalls a principle which is al- cum Relationibus Necnon Patrum Ora- would also be a way of demon- ways valid: tiones atque Animadversiones (Libreria strating two things: ‘Do not throw into the min- Editrice Vaticana). The acts of the dogmatic constitutions Lumen Gentium and 125 – the importance for the istry inexpert priests. We exhort Dei Verbum, as well as the decree Pres- Church of the world of suffer- you, venerable brothers, to byterorum Ordinis, have also been pub- ing; avoid, where this is possible, to lished. 6 Cf Pontificia Commissio Codici Iuris – and the special response of throwing into full pastoral activ- Canonici Athenticae Interpretando, the Church in this world. In- ity priests who are still inexpert, Codex Iuris Canonici, Fontium Annota- deed, the Church responds to and to send them to places tione et Indice Analytico-alphabetico Auctus (1989), canon 228 § 1; Pontifici- these needs not only at a human- which are very remote from the um Consilium de Legum Textibus Inter- itarian level but above all else seat of the diocese or other ma- pretandis, Codex Ecclesiarum Orientali- with pastoral care, which is typi- jor centres. In such situations, um, Fontium Annotatione Auctus (1995). 7 Henceforth in this paper I will use the cally priestly in character. Pas- indeed, isolated, inexpert, ex- following acronyms: AA: Apostolicam toral care, here, is the way in posed to dangers, deprived of Actuositatem, AD: Ad Gentes, CD: Chris- which the Church responds to prudent teachers, they would tus Dominus, LG: Lumen Gentium, PO Presbyterorum Ordinis. the right of the faithful to re- certainly encounter harm for 8 The translation here is based upon ceive the Word and the sacra- themselves and their ministry’. that translation, which is quite close to the ments with abundance. A priest- We can also see pastoral care text, of the work Les Conciles Oe- cuméniques 2/ (Paris, 1994). ly presence is a special presence in health as an area which is too M17 ‘Two Fathers advance observations of Christ, and the broadening of sensitive to be improvised – all concerning this call, or what is denomi- the priestly faculties means innovations are possible with re- nated by the ‘mandate’ of the apostolate. making the encounter of a spe- spect to entrusting souls but ‘to Another Father asks for it to be explicity declared that: ‘the mandate is not con- cial world with Christ easier. the extent to which this is possi- fined to one association only but extends ble’ the generations of priests to all the associations recognised by the c. The Choice of Creating who will be destined for innova- Church’. R: the draft deliberately avoids controversies relating to vocabulary. The New Chaplaincies tive forms of pastoral care must further definitions belong to the schema be trained at the school of their on the apostolate of the laity’. CD 18 expresses a decision of brothers, who should teach them Rel.F ‘This complementary idea concerns the ecclesiastical munera to be ex- the universal Church. It is a test the ‘sensus Ecclesiae’to ensure ercised by the laity derived from the al- which applies both to the Latin that they do not ‘run in vain’. ready parised proposta of H.E.Cardinal Church and to the Eastern Suens’. The ‘propositio Suenens’ says as follows: – (new arrangements of the Churches. There is thus a duty Mons. MARTIN VIVIES, chapters) -’the laity also enjoy the ability Professor of Canon Law, to be called by the hierarachy to certain The S. Martin di Blois Seminary, ecclesiatical munera to be exercised with a spiritual goal’. France M.18 ‘A Father proposes to eliminate the word ‘also’ because this coincides with the words which go before on the more immediate co-operation with the aposto- Notes late. R. this is another category, that is to say of those who exercise ecclesiatical 1 Ecclesial groupings go back to the munera, such as for example the bursars origins of the Church. Traces of legisla- of a religious institution, catechists in a tion in this area have been maintained re- narrow sense, etc.’. lating to: M.19 ‘A Father proposes to add at the – colleges of fossores, with a charita- end of this sentence a long exposition on ble purpose, during the fourth century for the various forms by which the laity can burial in the catacombs; co-operate with the hierarachy. R: such a – in the East the parabolani dedicated broad development cannot be allowed’. themselves to taking care of the sick from 9 Cf GIL HELLIN, op. cit., pp. 868-871. 250 AD onwards. Their number was lim- M.1 ‘The words ‘above all in biblical ited by the Theodosian code to 250 for and liturgical matters’ should be eliminat- the city of Alexandria; ed or it should be said ‘both the Catholic – once again in the East, brotherhoods doctrine and the liturgy, as well as the cat- echetic method’ (1 Father). R: the renew- M.99 ‘In the place of ‘the priests and populi vel potestatis saecularis consensu al of pastoral action carried out by the laity’ should be put ‘all and each of the aut vocatione irritos esse; aut eos, qui nec Council, with regard to the catechesis, collaborators’ (1 Father). R: The text of ab ecclesiatica et canonica potestate rite concerns above all else the biblical and the schema is clearer: on the contrary, the ordinati nec missi sunt, sed aliunde veni- liturgical catechesis. It is therefore suit- terms proposed suffer from ambiguity’. unt, legitimos esse verbi et sacramento- able that the catechists are trained in such M.100 ‘The words ‘the laity’ should be rum ministros: a.s. – Sess. XXIV, de ref., matters. The text remains’. omitted’ (1 Father). In the place of ‘is to c. 12. Innocentius III, eo. ‘Eius Exemplo’, Rel.A ‘A parenthesis was introduced so be welcomed’ (the creation of a pastoral 18 Dec. 1208, Professio fidei Waldensi- that this payment to catechists termed council) the following should be said: bus praescr; Leo X (in Conc. Lateranen. ‘full time’ could appear more clearly (2, ‘where it is considered suitable’ (10 Fa- C), const. ‘Regimini Universalis’, 4 maii 26 (Mons. Seitz IV, IV, 619); 5, 41 thers). R: The laity should not be omitted 1515, § 10; const. ‘Exsurge Domine’, 15 (Mons. Riobé IV, IV, 597). Indeed, it is because this comes from their condition iun. 1520, error 13, Martini Luther, damn; above all about them that the first three in the apostolate of the Church. The other ‘In sacramento paenitentiae ac remissione paragraphs of this number refer. In the words proposed are not accepted because culpae non plus facit Papa aut episcopus, fifth paragraph reference is made to ‘vol- the institution of the pastoral council is quam infimus sacerdos: immo, ubi non untary’ or ‘auxiliary’ catechists’. something which is really to be recom- est sacerdos, aeque tantum quilibet Chri- M.3 ‘The term ‘canonical’ should be mended’. tianus, etiamsi mulier aut puer esset. eliminated, or at least it should be justi- M.101 ‘A request is made to add the ‘Benedictus XIV, ep. encyclc. ‘Quaemad- fied in a note; indeed this term was reject- words: ‘but also with other forms of help, modum’, 23 mart. 1743, § 3, 6; Pius IX, ed by the decree AA on the apostolate of the laity included’ (1 Father). R: This is litt. ap. ‘Multiplices Inter’, 10 iun. 1851 = the laity (1 Father). R: Taking everything not accepted: because the diocese is a Syllabus errorum, prop. 54 ‘Reges et into consideration the modus is not al- portion of the people of God which principes non solum ab Ecclesiae iuris- lowed because even though presnt-day should be nourished, one cannot add ‘also dictione eximnuntur, verum etiam in law (ius conditum) does not know such a with other forms of help, the laity includ- quaestionibus iurisdictionis dirimendis canonical mission this is a practice fol- ed’ because it is not for the laity to nour- superiores sunt Ecclesia.’ ep. ‘Exortae’, lowed in very many places and not only ish the people of God’. 29 April 1876; S.C. Ep. et Reg., Arianen., in missions’. 14 Canon 519. 5 April 1593; Castellana, 22 iun. 1708, ad Rel.B ‘Only one Father (Mons. Mazé) 15 Cf Art 6 § 2; 7 § 1; 12 etc. In the 3: in Causa Castellana, seu Nullius raises the question of confering minor or- French translation although one uses the Provinciae Baren. Iurisdictionis inter ders on catechists. It seems enough for word ‘to preside’ for the priest or deacon, Monasterium S.Benedicti Conversani Or- the schema to propose a special liturgical for the lay faithful ‘to guide’ or ‘to ani- dinis Cistercensis ex una, et nonnullos de 126 action for the institution of a catechist’. mate’ is considered sufficient. Clero Castellanae partibus ex altera de et M.34 ‘Thirty-four Fathers ask that in the M.2 ‘In the place of ‘praesident – presi- super infrascriptis dubbis, etc. nempe: 3. place of ‘to the offices of the hierarchy’ dent’ write ‘praesunt – director’ or An dictae Abbatissae licear proponere ad there should be written ‘to the pastors’. ‘praeeunt – they set an example’ because Curam Animarutn Personas amovibiles One Father asks for ‘to the Ordinary’ and the term ‘praesidere – to preside’ ex- ad nutum, easque ad libitum amovere... another ‘to the bishops’. R: let the follow- presses the function of the sacramental hi- Sacra Cingregatio respondit: Ad 3: Nega- ing be written: ‘to the offices of the pas- erarchy (1 Father): R: the modus is active et interim per modum provisionis tors’’. (Acta Synodalia, vol. IV, Pars VI, cepted because of the Latin meaning. usque ad exitum Causa; Cura exerceatur p. 110). 16 The definitive edition of the cate- per Deputandum a Capitulo approban- Rel.F ‘The committee relies on the obser- chism, published at the same time as the dum tantum a Vicario Abbatissae per ex- vations of Mons. Jubany Arnau, and in new General Directory for the Catechesis aminatoroes sibi benevisos. – decr. I 5 uil. order not to enter into a question dis- in October 1977 is even clearer on this 1845: Sanctissimus Dominus noster Gre- cussed by canonists withdraws the words point. Whilst article 875 could allow it to gorius PP. XVI diu, serio ac mature per- ‘mission denominated canonical’ and be supposed that the deacons too receive pendit relationem, quae inscribitur Apos- ‘they participate in their way in the apos- participation in the sacra potestas of act- tolic Visit by Cardinal Pignatelli Arch- tolate itself of the hierarachy’. In the ing in persona Christi Capitis, this article bishop of Palermo in the venerable place of ‘in the preaching of the word of came to be corrected in the following monastery of St.George of the Olivetan God’ it is better to say ‘in the propound- way: ‘From him the bishops and priests Congregation of His Majesty Ferdinand ing of Christian doctrine’. The correction receive the faculty (the ‘holy power’) to II King of the Two Sicilies in Palermo 31 proposed by two Fathers (Mons. H.Ten- act ‘in the person of Christ the Head’, the March 1845, ita subscriptam: ‘I Maria humberg and Mons I.Hoffner) to add deacons the power to serve the people of Card. Pignatelli Arciv Di Palermo Regio ‘some’ before ‘liturgical acts’. Here too God in the ‘deaconship’ of the liturgy, of Vistiatore Canonico Salvatore Calcara the note concerning the canonical mission the word and charity, in communion with Regio Visitatore – Pietro Giuseppe Leone is eliminated for the same reasons as that the bishop and his presbyter’. dei ministri degl’infermi convisatore’, ar- used above in relation to the mandate (Ac- 17 See the interview in 30 Giorni, De- que magno cum maerore cognovit omnia ta Synodalia, vol. IV, pars. II, p. 355). cember 1997. in ea peracta apparere nomine, iussu, et Rel.K After the description of the rela- 274§1 Canon 118 of the CIC of 1917; auctoritate laicae potestatis, quin mentio tions between the members of the laity C.1, D.XCIV. q. 7; c.2 D.I., de cons.; c.2, fiat Pontificii mandati, ac si regii iuris es- and the heirarchy this new sentence, in X, 2 de aetate etqualitate et ordine paefi- set Apostolicam Visitationem indicere, et opposite fashion, sees the question from ciendorum, I, 14; c. 6, X, de transaction- Visitatoribus peragenda praescribere. the point of view of the pastors (cf Cardi- ibus, I, 36; c. 2, X, de iudiciis, UU, 1; c. 2, Quapropter eadem Sanctitas Sua decrevit nal de Barros Camara and ninety Fathers X, de institutionisbus, III, 7; c. 4, X, de relationem ipsam sub tali forma ac ter- from Brasil). The parenthesis ‘dignity... immunitate ecclesiarum, coemeterii et re- minis non esset admittendam, utpote add’ is taken from the decree on the apos- rum pertinentium, III, 49; c. 1, X, de Supremae Pontificiae auctoritati sum- tolate of the laity tit. 2 c.1. n. 21, as sug- clerico non ordinato ministrante, V, 28; mopere laesivam, et Apostolicae Sedi ini- gested by Mons. L.Trevor Picchy, with c. 10, X, de poenitentis et remissionibus, uriossimam; ed hoc decretum sionificari the agreement of the committee on the V, 38; Conc. Trident., sess. VII, de sacra- mandavit per me infrascriptum S.Congre- apostolate of the laity. In the place of ‘ad- mentis in genere, Can. 10; Si quis dixerit, gationis EE. Et. RR. Praefectum eidem vice according to their proper responsibil- christianos omnes in verbi et monibus E.mo Archiepiscopo Panormitano in tab- ity’ here is placed ‘prudent advice’ be- sacramentis administrandis hanbere ulario actorum Visitationis asservandum. cause ‘responsibility’ has already been potestatem: a.s. – Sess. XIV, de poeniten- – S.C.C., Derthonen., 19 Aug 1730. Sacra much discussed and it would not be clear tia, c. 6, Can. 10; Si quis dixerit, sacer- Congregatio pro Doctrina Fidei, Ep. if one is dealing here with the responsibil- dotes, qui in peccato mortali sunt, potes- (Prot. 151/76), 8 Feb. 1977. ity of the laity or of the hierarchy’. tatem ligandi et solvendi non habere; aut 129 § 1 PIUS VI, cost. ‘Auctorem Fidei’, Rel.M ‘What is said here about the free- non solos sacredotes esse ministros asolu- 28 August 1874, prop. 2, Synodi Pisto- dom of the laity in temporal things meets tionis, sed ominbus et singulis chrisifi- rien., damn,; PIUS X, lett. enc. ‘Pascendi’, the suggestions of Cardinal Silva Hen- delibus esse dictum: Quoecumque lig- 8 Sept. 1907; S.C. deProp. Fide (C.P. pro riquez (with thirty-nine bishops), of averits super terram, erunt legata et in Sin.), 16 Jan. 1797, ad 2. Mons. Joseph Hoeffner, Samuel Ruiz, coelo; et Quorum remiseritis peccata, re- 129 § 2 SCConc Resol., 14 Dece. 1918 Marc McGrath.’ mittuntur eis, et quorum retinueritis, re- (AAS 11 (1919), 128-133); Pontificio 10 J.MANZANARES, in Code de Droit tenta sunt, quorum verborum virtute Commissio Pro Russia, Ind., 20 Jan. Canonique (Paris, 1989), commentary on quilibet absolvere possit peccate, publica 1930, SA Resp. 19 Nov. 1947; Pius canon 145. quidem per correptionem dintaxat, si PP.XII, All., 5 Oct. 1957 (AAS 49 (1957) 11 There is a rejection here of the coreptus acquieverit, secreta vero per 927); LG 33; AA 24: SA Decisio, 11 June judgement expressed by the letter of the spontaneam confessionem: a.s. – Sess 1968: Scris Rescr. 7 Feb. 1969; Scris De- Congregation for the Doctrine of the XXII, de ordine, c. 4, Can. 7; Si quis cr. Clericali Instituta, 27 Nov. 1969 (AAS Faith ‘on some aspects of the Church as dixerit, episcopos non esse presbyteris su- 61 (1969) 739-740) Sec Facul., 1 Oct communion’ in n.9. Cf DC 2055 (12-16 periores, vel non habere potestatem con- 1974; EN 73a: Scris Rescr., 26 June Auguesr 1992), p. 731. firmandi et ordinandi, vel eam, quam 1978, 3; Scris Resp., 21 Aug. 1978. Sacra 12 Cf Nota Explicativa Paevia n. 2 con- habent, illis esse cum presbyteris com- Congregatio Pro Clericis, Notae directi- cerning chapter 3 of Lumen Gentium. munem; vel ordines ab ipsos colatos sine vae Postquam Apostoli (25 March 1980) 7, 17: La Chiamata dei Laici. All the of ministries or charisms, as the Apostle tasks that the lay faithful can perform laity, because of baptism and confirma- teaches us, must be understood in the within the organic structures of the tion, are called by the Lord to an effective sense that ‘these members do not all have Church’. apostolate: ‘The Christian vocation by its the same functions’, but in serving each 21 Eglise de Nìmes, 5 December 1997. nature is also a vocation to the aposto- other they form a single body of Christ 22 For the members of the armed late’. The apostolate of the laity, although (Rom 12:4) in order to carry out their forces: it is exercised principally in the parishes, mandate in a more effective way. The SCDS Resp., 8 Oct. 1943; SCC Inst. must be nonetheless extended also to an whole of the Church, indeed, is pushed by Solemne Semper 23 April 1951 (AAS 43 inter-parish, diocesan, national and inter- the Holy Spirit to co-operate so that the (1951) 564); Instructio De Vicariis Cas- national level. The laity, indeed, must design of God is realised. trensibus; SCC Instr. Divinum Perse- take to their hearts ‘the needs all the peo- 979 § 1 PIUS XII, m.p. ‘Cleri Sanctitati’, 2 quens, 2 June 1951 (AAS 43 (1951) ple of God throughout the world’. This June 1957, canon 138. Pius VI, cost. 565-566); SCR Inst. Sacrorum Admin- can take place helping missionary work ‘Auctorem Fidei’, 28 August 1794, prop. istri, 2 Feb. 1955 (AAS 47 (1955) 93-7); both with material support and with per- 2, Synodi Pistoriem., damn. ‘The propos- SCC Inst. Per Instructionem 20 Oct. 1956 sonal service. al which declares: ‘The power is given by (AAS 49 (1957), 150-163); SCC Decr. The laity, in addition, can be called by God to the Church so that it is communi- Ad Sacra Limina, 28 Feb, 1959 (AAS 51 the hierarachy to a more direct and im- cated to the pastors who are the ministers (1959) 274); SCC Decr. Sacramentum mediate co-operation with the apostolate. for the salvation of souls’, if understood Poenitentiae, 27 Nov. 1960 (AAS 53 The Church, indeed, over recent decades in the sense that the power of the ecclesi- (1961) 49-50). has discovered the rich possibilities and atical ministry and of government derive For migrants: the vast resources which the collaboration from the community of the faithful to the SCC Ind., 31 Aug. 1953: Consistori- of the laity can offer to her mission of sal- pastors, (is) heretical’. alem benigne indulsit, ut Cappellani vation. The apostolic exhortation Even- 979 § 2 LG 33 ‘Praeter’; AA 24 Apostolatus maris munere augerntur min- gelii Nuntiandi on the basis of recent ex- ‘Quaedam’; Paul VI, Lett Ap. Cum Mat- istri extraodinarii Confirmationis pro fi- periences bestows various tasks, such as rimonialuim, 8 Sept 1973, artt. V.VI; Se- delibus suae iurisdictioni obnoxiis. SCC that of being a catechist, that of Chris- cret. Status, facultas data Sign. Apost., 1 Facul., 19 March 1954 (AAS 46 (1954) tians dedicated to service to the world of Oct 1974: Ochoa V, 4347. 415-418); 1. Legitime assumpti in offici- God or works of charity, that of heads of 18 Cf J.RIGAL, L’Ellésiologie de Com- um Cappellani navigantium. SCC Resp., small communities etc. This collaboration munion (Cerf, 1997), p. 299: or the more 7 July 1956: Dubia-1. Utrum durante of the laity, which is useful everywhere, journalistic work by B.SESBOUE, N’ayez itinere maritimo...SCE Instr. Nemo Est, is useful above all else in lands of mission pas peur – Regards sur l’Eglise et les 22 Aug. 1969, V (AAS 61 (1969) with respect to the foundation, fostering Ministères Aujourd’hui (Desclée de 632-633. 127 and development of the Church. All the Brower, 1996). The Chaplains or missionaries of mi- members of the Church, therefore, 19 Cf NRT 1 (1956); Über das Laien- grants: whether they are pastors, members of the apostolat: Schriften zur Theologie II SCE Decr. Apostolatus Maris, 24 laity, or members of religious orders, par- (Einsielden, 1964), pp. 339-373. Sept. 1977 (AAS 69 (1977) 737-746) – ticipate each in his or her own way, in the 20 Note 74 of Christifideles Laici Second part – Faculty for priests who ex- missionary nature of the Church. The di- would provide a list of sixteen canons ercise spiritual assistance for sailors or versity of her members, due to the variety which present ‘different functions or travellers.

The Catholic Chaplain and the Health Care Ministry on the Threshold of the Third Millennium – Emerging Problems

This paper takes as given the looked after in the local area, 1. General Introductory exposition which preceded it of that is to say at home or by Considerations the theological and canonical ground-level clinics. This also bases of the pastoral action of involves important changes in a. A New Concept of Health the Catholic chaplain with re- the practice of the health care and Illness gard to the health care ministry. ministry. This ministry must be My task now is to outline the thought about in a new way and The contemporary sensibility guidelines of such pastoral ac- reorganised not only in hospi- seems to be especially con- tion. In order to provide what I tals but also within the context cerned with the positive dimen- say with continuity, harmony of parish care where it would be sion of man’s existence – health and consistency I will have to a very good idea to ensure the is a primary subject and interest make a brief reference to what presence of parish vicars or from a social and cultural point has already been said. Howev- communities of ordained reli- of view. And given that all ill- er, I will limit myself to what is gious entrusted with the specif- nesses have become treatable strictly necessary. ic task of spiritual and religious and many have become curable, In addition I will have to take assistance to sick people in health has become a ‘right’, a into consideration the develop- their homes. normal and ‘due’ fact. In this ment which has taken place in Taking this new situation into new concept, health is not only the management of health care account and after a number of related to physical and physio- and its pastoral consequences. preliminary reflections, I will logical factors – it is also linked After the conversion into com- proceed to speak about the ac- to the mental and spiritual di- panies of institutes of care the tive and creative presence of mension of the person. It also sick person who is not in a ter- the Church in the world of involves the physical, emotion- minal condition is kept in hos- health and health care and of al, social and moral environ- pital only for as long as is nec- certain characteristic aspects of ment in which the person lives essary to define his illness and pastoral action in relation to and works; this is something its treatment. Once the treat- health care in parishes and hos- which can generate a deep exis- ment has been decided he is pital institutions. tential harmony between health, quality of life, and well-being. b. The Health Care Ministry fering; and in addition accompa- Health, it may be observed, is as Accompanying nying him with prayer and the above all else a human experi- in Personal and grace of the sacraments so that ence, indeed biographical. It has Christian Growth he responds to his fundamental a close relationship with the ex- vocation as a man and as a bap- perience that the individual has In saying that man is healthy tised person. of his own body and his place in when he is habitually able to live the world, and with the values out his situation and his con- c. Ethical Questions Raised upon which he bases his exis- crete resources positively means by New Illnesses and tence. Health, therefore, is not that he is healthy when is able to New Forms of Treatment only a fact which emerges but live in a way which favours his and Care also an objective, a goal, a task personal growth and develop- which involves his freedom to ment as a creature and as a son The increased sensitivity of the full. A new definition of of God because of the grace public opinion and the augment- health, after that offered by the which dwells within him. I em- ed responsibility of men of gov- World Health Organisation in phasise the comparison between ernment has enabled us to accel- 1946, has still not yet been for- the healthy man and the man erate scientific research directed mulated, but we have an idea of who is habitually able to live in a towards developing new tech- the clear principles upon which positive way because this capac- niques and drugs and medicines such a definition should be ity is a fundamental reference which allow the treatment and based. Trabucchi says health is: point in establishing the task of possibly the cure of new illness- ‘harmony between body and the health care ministry. Indeed, es such as AIDS, drug-addiction, spirit, harmony between person from a Christian point of view and in general those illnesses 128 and the environment, and har- health seen as the habitual ca- which so far have been consid- mony between personality and pacity to live one’s own vocation ered to be incurable. But at the responsibility.’1 in a positive way should also in- same time the new achievements The idea of health or of the clude the commitments of the of diagnostic, pharmacological healthy person can be expressed baptised man, just as there and surgical medicine have in- in the following way: ‘a person should also belong to the con- creased the ethical questions is healthy when he is habitually cept of health that being in posed to the consciences of able to live using all the facul- Christ of the Christian which is health care workers and of soci- ties and energies he possesses carried to a sufficient develop- ety as whole. The field of and which are really available to ment of authenticity and maturi- bioethics is greatly expanding. him in order to fulfil his mis- ty: its full realisation corre- Quite rightly, suitable answers sion, in every situation that he sponds to holiness. Indeed, the and practical replies are awaited encounters, even when it is dif- Christian is holy when at every which can regulate, for example, ficult or painful, or in other moment he comities himself to the questions and issues con- words in order to develop the charity without leaving any of nected with assisted fertilisation, highest oblative love in Christ in his resources unused. In this pharmaceutical trials, trans- every situation of which he is context we can better understand plants and the giving of organs, practically capable at that mo- the definition which sees the and, lastly, human cloning. ment’.2 Like the concept of health care ministry “as the pres- Mankind urgently needs light, health, the concept of illness has ence and the action of the but it also needs uncrossable also changed. No longer defin- Church devoted to bringing the barriers with respect to research able as a mere pathology which light and the grace of the Lord to and experiments when these do can be grasped through a labora- those who suffer and to those not safeguard the defence of life tory analysis, illness is now un- who take care of them” (“Note”, and the dignity of the human derstood as an existential ill-be- n.19). According to this defini- person. ing, the consequence of certain tion the presence and action of life choices, of changes in val- the Church in the world of health d. New Figures at the Side of ues, and of a mistaken manage- and health care unites people in the Bed of the Sick Person: ment of the human material en- a single concern or relationship Interdisciplinary vironment’ (“Note”, n. 7).3 The of help and of accompanying: Collaboration medicine of necessary care and the sick person, the relatives treatment, after passing through who need help in order to live Over recent decades there has the concept of preventive medi- out the illness of their dear ones been a marked increase in the cine, is now giving way to the without traumas and in a spirit of presence at the side of the bed of medicine of desires. Today, faith, and the health care work- the sick person of professional much more than to health and ers who should be trained to figures with different roles and illness, reference is made to a adopt a sense of responsibility, a kinds of training who in the past sick or healthy man, and illness readiness to engage in service, were not thought in the least to takes the form not only of physi- and respect for the fundamental be needed. In addition to the cal pathologies but also of con- values of the suffering person. classical figures of the medical trasts between desires and their In other words the health care doctor, the nurse and the reli- achievement, between promise ministry has the task of integrat- gious helper, today one now reg- and frustration, which in taking ing all these forces around the ularly encounters such figures as on the connotations of a resis- sick person so as to advance him the psychologist, the social tant disharmony become psy- in a moral sense and to help him worker, the philosopher, the ex- chological discomfort and exis- to accept and to have a positive pert in bioethics, the expert in tential ill-being. evaluation of his situation of suf- the rights of the patient, the legal expert, the voluntary worker, Indeed, what for reason remains the wardship of children, and and the expert in health care an unanswerable enigma, for bioethical committees. He also management and economics. faith, and thus in the light of the advises taking part in various This multiplicity of presences death and resurrection of Christ, kinds of voluntary work, social during the time of illness on the becomes a message of hope. initiatives and political commit- one hand points to an increased In the post-Synodal Exhorta- ment. sensitivity towards human suf- tion ‘Christefideles Laici’ the Amongst the documents of fering and on the other draws at- Pope is largely concerned with the Church on the health care tention to the complexity of the mission of the lay faithful in ministry we should also list the health care problems and con- the Church and in the world, but messages of the Pope for the cerns. in sections 53 and 54 he directs world days of the sick; the docu- The Church is called upon to a message to the sick and the ments of the Pontifical Council reflect on these new presences suffering and in decisive fashion for Pastoral Assistance to Health and to improve her own pastoral re-launches a pastoral action for Care Workers – for example the action so that she can dialogue in and with the sick which is able ‘Charter for Health Care Work- an effective fashion with other to sustain and promote attention, ers’; and the declarations of the health care workers. Just as is nearness, presence, listening, di- various national episcopal con- the case in every sphere of pro- alogue, sharing and concrete ferences. fessional work, so too in the help towards man during mo- health care world it is not possi- ments when, because of illness b. The Creation of Structures ble to work alone. In scientific and suffering, not only his trust and Organisms Dedicated research, as in the routine care in life but also his own faith in to the Promotion of the and daily help which is provided God and the love of the Father Health Care Ministry to the sick person, it is necessary are subject to major trial.(54) 129 to work together, in a harmo- The Church, insists Pope John Religious institutions, groups, nious way, and with the same Paul II, is called upon to search movements and associations in- objective. for encounter with man in a spe- volved in the health care world cial way on the way of suffer- have always been present within ing. And in this encounter man the ecclesial community. Their 2. The Active and Creative becomes the way of the Church action, which has displayed the Presence of the Church and this is one of the most im- variety and richness of the in the World of Health portant ways.(53) In the encycli- charisms presents within the and Health Care cal ‘Evangelium Vitae’ (1995) Church, has been characterised the Pope condemns the culture hitherto by spontaneity and gen- a. The Actions of death which pervades con- erosity, although at times such of the Magisterium temporary society and stimu- action has been repetitive and and of Pastoral Care lates the faithful to be witnesses perhaps dispersive in effect, to the gospel of life in the vari- something which has brought The observations which have ous opportunities which are of- out the need for structures of so far been made in this paper fered to them today. In the co-ordination, communion and lead us to reflect upon the ini- fourth part of this encyclical programming.6 The response to tiatives of the Church in the (78-101) the Pope points out the this need has only emerged re- face of the developments which steps of the Christian commit- cently, and has taken place at the have been taking place in the ment in the service of charity level of the universal Church world of health care: they have and even provides a list of con- and the Church at a national, re- been thoughtful, opportune, and crete initiatives which can be gional and parish level. meaningful. Certain documents taken: family and marriage con- of the Church have already sultants, centres to know about b1. At the Level of been referred to in this paper.4 I natural methods of birth control, the Universal Church would like to refer here to the centres of help and of accompa- At the level of the universal most recent such documents: nying in life, communities Church a very important event the Apostolic Letter ‘Salvifici which serve special kinds of was the creation by the motu Doloris’ of 1984; the post-Syn- sick people, the adoption and proprio Dolentium Hominum of odal Apostolic Exhortation 11 February 19857 of the Pontifi- ‘Christifedeles Laici’ of 1989; cal Commission for Pastoral As- and the Encyclical ‘Evangelium sistance to Health Care Workers Vitae’ of 1995. which subsequently became the In his Apostolic Letter ‘Salvi- Pontifical Council for Pastoral fici Doloris’, the Pope addresses Assistance to Health Care Work- himself to the Christian meaning ers.8 of human suffering. This was the Amongst the tasks of this first document in which a Pontiff body is to be found the study of was to deal with this great ques- directions in terms of pro- tion in an overall way.5 In this grammes and the practical initia- letter the Pope wants to help tives of the world of health care people to look to the Crucified policy both at an international Christ and accept the “Gospel of and a national level in order to suffering” with love and trust in understand their relevance and the mysterious but always lov- their implications for the pas- ing design of divine providence. toral work of the Church; the co-ordination of the activities of brotherhoods of the sick, and the council, as do chaplains, the various Ministries of the Ro- co-ordinators of the six commit- Catholic associations active in man Curia in relation to the tees established within the Sec- this area, and various experts. health care world and its ques- retariat. These six committees This council has promoted a tions and issues; and contact are respectively responsible for number of initiatives. It has with the local Churches and in hospitals, health in the parishes, closely followed the health care particular with the Episcopal mental health, Christian health reforms which have been imple- Commissions responsible for the care professionals, pain killing mented in the country, in which world of health care. The Acade- treatment, and training. it has acted “to ensure that the my for Life which was created The Secretariat has engaged presence and activity of Catholic on 11 February 1994 by the mo- in a number of initiatives and health care service was defended tu proprio Vitae Mysterium9 is amongst them we may list the and suitable space was given to closely connected to the Pontifi- national conferences (held in the action of the religious assis- cal Council for Pastoral Assis- Agradulce in 1975 and in tant in hospital centres”.13 Three tance to Health Care Workers. Madrid in 1994), the celebration national conferences have been This Academy has the task of of the world day of the sick organised, the most recent of studying, providing information, (held in 1985), the Concordat on which (23-25 April 1995) was and instructing people in matters Catholic assistance provided in concerned with “pastoral plan- connected with biomedicine and public hospital structures, and ning in the world of health and law within the context of the the publication of the document health care”.14 The activity of promotion and defence of life. In “Religious Service in Hospitals. fostering and training is gaining this it illustrates the relationship Pastoral Guidelines” of 1987. In increasing importance through between such matters and Chris- every diocese there is a “delega- specific goals such as, for exam- 130 tian morality and the guidelines tion” which is led by a priest, a ple, the preparations of the days of the Magisterium of the member of a religious order, or a of the sick and the training of Church. member of the laity. Since 1977 diocesan authorities. Activity at The Pontifical Council for there has been the annual cele- the level of regions and dioceses Pastoral Assistance to Health bration of the “national days of is guaranteed by regional and Care Workers has also become delegates” which have been an diocesan councils and commit- responsible for certain duties opportunity for encounter, in- tees. which were previously the pre- struction, communion, reflec- rogative of the Pontifical Coun- tion, and interchange. The inte- cil “Cor Unum” (1971) such as diocesan secretariats are the 3. Pastoral Care in Health the co-ordination of Catholic bodies which act to link the var- at a Local Level medical activity and support for ious diocesan delegations to- and in Institutions: the health and health care sector gether. the Parish and the Health in order to secure the promotion In Italy the Episcopal Confer- Care Ministry in Parishes of what is a really human ap- ence established the “National proach.10 Council for the Health Care a. The Christian Community Ministry” in 1962. After that as a Primary Subject b2. At the Level date this latter body underwent a of the Health Care Ministry of Local Churches number of modifications until At a national level the struc- reaching its final form in 1978. The decree Apostolicum Actu- tures and systems of communion It is led by three bishops who ositatem states that “the Church and the mechanisms fostering it, represent separate geographical was born with the goal of mak- although they vary from country areas, and one of these bishops ing – through the spread of the to country, nevertheless have is its president. In 1996 this Kingdom of God – all men par- certain shared features. There is Council was given a permanent ticipants in the salvation the presence of Episcopal Com- office at the headquarters of the achieved through redemption, missions which have the task of Italian Episcopal Conference.12 and through them the direction co-ordinating the health care The regional delegates and the of the whole world to Christ. All ministry within the boundaries representatives of the hospiteller the activity of the mystical of their local nation through re- religious orders belong to this Body, directed towards this end, gional or interdiocesan and is called “apostolate”: an aposto- diocesan committees. Let us late which the Church carries out take Spain and Italy by way of through all her members, natu- example to illustrate this reality. rally enough in different ways” In Spain11 in 1970, in response to (AA, 2). a grass-roots request, the Epis- It is in this context that the lo- copal Commission created the cal Christian communities must “Secretariat for Pastoral Care in become aware of the grace and Health” which was a body under the responsibility which they re- the supervision of the Episcopal ceive from the Lord with respect Committee for Pastoral Care. to the sick faithful, and they This Secretariat is led by a bish- must offer them comfort, the op and organised by a director word of God, the sacraments and who has a special team com- brotherly concern. Christ is real- posed of representatives of the ly present in the elderly, the sick, interdiocesan secretariats, of re- the suffering and the desperate. ligious orders, of the Christian A community which does not renew itself through this presence, average stay of sick people is es- served in this paper, is not con- which does not perceive this timated at being around five cerned only with the sick but al- presence of God in the poor, and days. so refers to the healthy. This which does not honour it with should take place in particular social and charitable activity b. From the Christian through the generation of a cul- ceases to be a living Church of Community to the ture of greater sensitivity to- Jesus Christ. Parish Community wards, and awareness of, suffer- In this action of fostering and ing, marginalisation, and the val- co-ordination the diocesan office b1. The Parish and the ues of life and health. Here spe- for the health care ministry has a Health Care Ministry cial attention should be paid to strategic role. It is called upon to at a Parish Level the family of the sick person. In- keep in close contact with the re- Here it is evident that because deed, the commandment of the gional office and the national of- the parish priest is a presbyter Lord to visit the sick is first and fice to provide the local effort who as a special pastor takes foremost directed towards the with a wider vision of the ques- care of the parish community (cf family of the sick person. The tions and issues. According to CDC,519) then it is he who has meaning of this elementary duty the “Note” of the Italian Episco- the task of providing special at- must be developed from an early pal Conference the tasks of the tention to the sick people of his age. diocesan council are as follows: parish and the promotion and It is also necessary for the 1. to foster and co-ordinate the fostering of the health care min- family to be educated to look af- health care ministry of the vic- istry with special reference to ter its relatives who are in diffi- ariates and parishes and promote the sick in their homes (CDC, culty within its own confines. a shared and common action 528-529). Because of these insti- The warmth of the family envi- amongst the various associa- tutional tasks the parish priest is ronment has an irreplaceable 131 tions, groups and charitable bod- the principal force behind the therapeutic function. And in ies which are active in the dio- health care ministry in his own contrary fashion the abandon- cese; 2. to promote the presence parish. ment of relatives to rest homes of sick peoples and health care and nursing homes generates workers in the diocesan ecclesial b2. The Functions and feelings of loneliness and sad- bodies; and 3. to promote forms Implementation of the ness, and even at times of des- of initiatives involving training Health Care Ministry peration. This is something and up-dating in this sector (see at a Parish Level which certainly does not work to the “Note”, 78). The three classical functions the benefit of health. In such The tasks outlined by this of pastoral care – evangelisation, moments, and especially if the “Note” deserve special attention the sacraments and service – are illness is long and serious, the because they belong in an excep- also the necessary steps – on a members of the family, too, need tional way to the innovations single road which leads to salva- support and solidarity. “Substitu- which are underway in the world tion – of the health care ministry. tion” in providing care for the of health and health care. Indeed, The sacramental moment is sick person which is offered now the general tendency of health made meaningful by a suitable and then can be of great help to care is by now well-known: we path of faith and by warm hu- them. have before us a slow process of man participation. However, the In this context it is important de-hospitalisation, that is to say specific functions of pastoral to raise the awareness of the the sick person spends and will care must also include every- Christian community in relation increasingly spend less time in thing to do with the human, to the need to create reserve hospital and will be looked after, health care, and social promo- health care services at a local as has already been observed, at tion of sick people, and respect level which can allow the most a local level – at home or in mo- for the values of life and health common health problems to be bile health care structures. (cf “Note”, 6). The humanisation solved at home rather than As a result proposals in favour of care, of services and of health through recourse to hospitalisa- of home-based care are moving care institutions is recognised as tion or nursing homes. There are ahead gradually but inexorably. a specific function of pastoral personal, family, social and eco- This requires a radical change in care because of its evangelising nomic reasons which lead us to the way we think about medi- value. suggest that emphasis should be cine, in the mentality of health placed on home service rather care workers, in the relationship c. Some Initiatives in Relation on than hospital service, wher- with the patient, and in the to the Health Care Ministry ever, of course, this is possible. meaning and the goals of thera- at a Parish Level These services could also be peutic activity. In particular it re- provided by permanent groups quires greater involvement on c1. Support and organised by the parish. the part of the families of the pa- Awareness-Raising tients and the participation of the in Relation to the Family c2. The Laity in the civil and ecclesial community. of the Sick Person Health Care Ministry With regard to the health care The health care ministry, at the Parish Level ministry this new development which is seen as the presence Hitherto the responsibilities of involves a greater organisation and action of the Church whose the laity in pastoral care at a at a parish level of religious help aim is to bring the grace and the parish level have been carried provided at home and a review light of the Lord to those who out in the main through the cate- of the pastoral methods used in suffer and to those who take care chesis, in liturgy, in pastoral care hospital institutions where the of them, as has already been ob- of the young, etc., but it has been rather limited in the case of the living member of the mystical group of faithful made up of the pastoral care of the sick. Perhaps body of Christ (today). sick and their family relatives this is because in objective terms and health care workers. His it is more difficult or perhaps be- d. The Creation of a Parish principal task is to preach the cause the contemporary mentali- Group of Co-operators for good news and to communicate ty does not give a central posi- the Health Care Ministry through the administration of tion to the sick person, some- sacraments the redemptive love thing, however, which should Every parish, in addition to of Christ to those who suffer the take place in an authentically having a priest, should have a consequences of the finite condi- Christian community. This is group of co-operators dedicated tion of man in body and spirit, why this sphere of pastoral care to the health care ministry which accompanying them with soli- at a parish level should receive a is able to promote practical ac- darity-inspired love” (“Note”, greater level of awareness. In the tivity in favour of those who suf- 38). pastoral programmes of parishes fer. This group should not only and dioceses greater attention on lend support to the action of the b. The Ministry of the Word the part of the community parish priest but could also be a and Communication should be paid to sick people. As channel of penetration in areas long as such kinds of attention which are resistant to the The faith is rooted in the are absent the parish community Church, a way of achieving con- Word. This explains why every will lack an important and char- tact with people who would oth- form of apostolate sees evangeli- acterising dimension. erwise remain excluded or for- sation and the catechesis as be- gotten about by the community. ing of primary importance. This c3. Seeing Pastoral Care For these co-operators of the also takes place through the 132 as an Activity “with” health care ministry we need to health care ministry. One is deal- the Sick and not only create effective human and spiri- ing here with healing or at least “for” the Sick tual training and specific reducing the fracture between In his exhortation “Christifi- grounding for this pastoral min- the Gospel and culture, and pre- delis Laici” (n.54) John Paul II istry. This is something which senting in the right way the expressed a profound instinc- should be done through special- Christian point of view about, tive perception: he spoke about ly designed courses. The cre- and the Christian approach to- a relaunching of pastoral action ation of a parish group for the wards, pain, death, health, and for and with the sick and suffer- health care ministry is justified the meaning of service towards ing – the sick person must not by the need, in this area as well, those who suffer. only feel himself the object of to pass from spontaneous and However, one cannot con- attention but must also become dispersive charitable action to ceive of evangelising a sick per- an active subject in the ecclesial organised and functional com- son, especially if he is in a seri- vitality of the parish communi- munity activity which has stabil- ous condition, as being the same ty, a channel of attention on the ity and a network of services thing as evangelising a healthy part of Christ and the Church which defend, safeguard and person, that is to say the health towards the world of suffering. promote what is human, reli- care personnel. In the first exam- At an even deeper level, the sick gious and social. The existence ple evangelisation is carried out believer must acquire aware- of such a group could avoid im- first and foremost by a face to ness of the fact that he takes provisations in service and guar- face dialogue, made up of listen- part in a special and privileged antee on-going grounding and ing, silence and a word which it way in the redemptive action of training. is felt corresponds to the needs Christ in the world, being there- The activity of the group of the sick person. In the second by able to repeat with the Apos- should also be extended to the example there is a field where tle Paul: “in my flesh I complete sick members of the community enormous possibilities are what is lacking in Christ’s af- who are in hospital, in rest opened up for the hospital chap- flictions for the sake of his homes or nursing homes, and lain involving pastoral actions body, that is, the church” (Col other health care institutions in based upon the programming of 1:24). The sick person must not the locality. One important as- pastoral care and training direct- feel marginalised from his fami- pect of this is the need for links ed towards more human assis- ly or the community. Despite and co-operation with other tance for patients. his physical malady, his handi- groups and bodies in the parish. Another basic need which cap or his disabilities, the sick emerges during our epoch in re- person, as an “icon of God”, is lation to evangelisation is the always a human being in the 4. The Health Care Ministry relevance of moral questions fullness of his dignity and his in the Locality and and issues and the pastoral task rights, and is worthy of full re- in Institutions: of offering suitable answers to spect and proper treatment. If the Pastoral Activity the serious problems raised by the sick person sees in the visi- of the Hospital Chaplain15 scientific and technological tor not a boring consoler but a progress which has taken place brother who has come to in- a. The Hospital Chaplain in the world of health care. A volve him in a useful undertak- hospital religious assistant must ing – asking him, for example, The religious assistant or have a grounding which makes to pray in relation to the events chaplain in health care institu- him able to engage in such a and problems of the parish – he tions is the priest, and to him “is task. And this is true not only at will certainly manage, despite entrusted in a permanent way a personal level but also in rela- everything, to feel that he is a the pastoral care of that special tion to the training of health tinguish between the pastoral with the diocesan church and its care provided to the sick and the local realities, activities directed pastoral care provided to the dy- towards humanisation etc”. ing. In the case of the first the These activities are certainly not sacraments of penitence, the Eu- the exclusive task of the chap- charist and the anointing of the lain but he certainly has the task sick are suggested; in the case of of ensuring that these are real ec- the second the anointing of the clesial experiences. Visits to the sick, the viaticum, and the last sick are one of the most signifi- rites are the sacraments which cant actions of the ministry of are called for. pastoral care of a hospital chap- The anointing of the sick is lain. Personal conversation must the natural and most typical be the principal and classic arena form of the encounter of man of every expression of the health with Christ in that difficult and care ministry. It takes place in fundamental human situation regular visits, in wards or indi- which is known as illness. From vidual rooms and during it there the rediscovery of this sacrament is an identification of the need care workers at every level – through suitable catechesis and for pastoral conversation with where it is necessary to promote meaningful individual and com- the sick, their family relatives, initiatives and use structures munity celebrations designed to and the health care personnel. At which are already present with- create a new mental approach the same time a presence of the in the structures: the teaching of and understanding – great spiri- Church is established. professional ethics, the creation tual advantages will follow in- When the illness is serious 133 of ethical committees, advice volving consolation and comfort and long-lasting it is no longer a concerning hospital pastoral for those whose condition of physical phenomenon but some- care, and so forth. health is seriously compromised thing that extends into the men- by illness or by old age. This is tal and spiritual dimension of the c. The Ministry of why it is necessary to spread the person, and the sick individual Sanctification: idea and principle that the not only feels the need to be sup- the Celebration of the “Anointing of the sick is a sacra- ported in a physical way but also Sacraments and Prayer at ment which should be received expects a spiritual and psycho- the Side of the Sick Person in full awareness in order to gain logical support: the health care from it all the spiritual help pos- worker is then called to engage In parishes as in places of care sible, as well as physical well- in a ministry of consolation. The and treatment the celebration of being”.16 healing of the sick person to a the sacraments is one of the fun- great extent will depend upon damental and cardinal elements d. The Ministry of the quality of the spiritual and of the health care ministry. It is Pastoral Care psychological support which is important, however, to bear cer- offered to him. tain pastoral guidelines in mind: The chaplain of the hospital The actions of the pastoral the sacraments can be under- could be defined as “the minister workers in these circumstances standable and effective if they of communion” within the hos- should not be of a routine char- are placed within a path of faith. pital ecclesial community. Theo- acter but should take as their They cannot be presented and logical reflection since Vatican starting point the concrete spiri- received as an isolated act within Council II, indeed, has rediscov- tual difficulties of the concrete the overall life experience of the ered the centrality of communion person that they have to deal baptised sick person. Further- in the ministry of the Church and with at that particular moment. more, they must freed from in pastoral activity. Ecclesial Spiritual accompanying must magical and superstitious inter- communion, which is above all work to stimulate and reawaken pretations and expectations. The else a gift of the Spirit and a re- the physical, psychological and sacred and ecclesial character of flection of the life of the Trinity, spiritual powers of the sick per- the sacraments must be per- requires to be lived out and son so that he can achieve the ceived and grasped. Jesus estab- translated into an experience of ability to reject hopelessness and lished them by entrusting to his the community. In the Church receive the hope offered by faith. disciples the task of “doing in each person has his own gift It is then that spiritual assistance his memory” what he did for the from the Spirit, and each person can become religious assistance salvation of all men. has the grace and the task of and become complete through In the health care ministry in- working for the building up of an enlightened celebration of the sistence is placed upon the im- the ecclesial community and its sacraments. portance of the encounter be- growth through faith in Christ. The hospital chaplain, as a tween the sick and Christ in the The chaplain “carries out this man of communion, is also sacraments of reconciliation, the task through a vast range of ac- called upon to be a man of rela- eucharist, and the anointing of tivities and initiatives: visits and tionships, a man who facilitates the sick. Each of these sacra- meetings with the sick person, the relationships between the ments has its own sacramental helping his family, the encour- sick person and his family rela- grace and thus in pastoral care agement of groups and associa- tives, between the patient and provided to the sick it is a good tions dedicated to voluntary the parish, and between the hos- idea to bear this grace in mind. work and/or which are profes- pital institution and the local Normally it is necessary to dis- sionally based, a relationship church. Indeed, the isolation of hospital pastoral care from tions: the creation of groups of d. Hospital Pastoral advice parish pastoral care and dioce- voluntary workers; the estab- and the Project of a san pastoral care should be lishment of courses, days, and “New Form of Chaplaincy” overcome, and in the same way meetings dedicated to profes- the distrust between the parish sional-ethical training; the in- “One of the most effective in- clergy and chaplains, and be- volvement of associations of struments by which to express tween priests belonging to reli- sick people; and support for shared responsibility in the pas- gious orders and diocesan families of sick people who find toral care of a health care institu- priests, should also be removed. themselves in situations of diffi- tion is hospital pastoral advice. The aim is to manage to inte- culty. Amongst its general goals one grate hospital pastoral care with It should, however, be em- emerges as being of especial im- diocesan pastoral care and at the phasised that in relation to the portance: “the promotion of same time make the local humanisation of the world of Christian brotherhood within church more aware and con- health care the centre of atten- hospitals” (“Note”, 42). Other scious of the problems of the tion and concern should always general goals are: the planning health care ministry. be the dignity of the sick person of evangelisation and humanisa- and the quality of the relations tion, the promotion of the sacra- e. The Fostering and between the patients and the mental and liturgical life; and, Humanisation of Assistance staff and personnel. It is indeed lastly, co-operation with the lo- Provided to Sick People at this level that tensions can cal ecclesial realities. arise which threaten certain fun- The “Note” of the council for Amongst the important tasks damental values. These may be the health care ministry of the of the hospital chaplain is that of listed as follows: Italian Episcopal Conference 134 fostering co-operation in – the centrality of the sick goes beyond discussing the achieving the humanisation of person. Health care service chaplain and also proposes a the environment of care and should not be seen as a means new pastoral structure – the treatment for which he is re- by which to meet a personal re- “hospital chaplaincy”. This is sponsible in a pastoral sense. He quirement. It should be seen, in- conceived as an “expression of must promote or activate all stead, as a response to the needs the religious service of the those energies directed towards of a person for whom, at a cer- Christian community in health the promotion of the greater hu- tain point in his life, his condi- care institutions”. The document manisation of hospital institution of health has become a argues that this should be “com- tions. This is a task which, in source of major concern and posed of one or more priests to line with all the respective worry. whom can be added deacons, charismatic diversities, is the re- – A healthy relationship be- members of religious orders and sponsibility of the whole of the tween the personnel and the sick members of the laity” (“Note”, ecclesial community which person. The sick person should 79-81). lives in such places, but it is also not be seen as an opportunity for The novelty of this definition a special responsibility of the work but as a being who has a lies in the fact that it opens the laity (see LG 31) who through dignity equal to one’s own. The hospital chaplaincies to deacons, their respective professional and debilitation caused by the illness to members of religious orders occupational roles have a spe- should not be an opportunity to who are not priests, to members cial responsibility with regard to establish a relationship with the of female religious orders, and the management of the adminis- sick person which is based on to members of the laity. This is trative, therapeutic and technical power. an opening which was not envis- services. The chaplain should – The responsible participa- aged by the new Code of Canon encourage and stimulate them tion of the patient in the thera- Law. The words of the document with advice and encouragement peutic process. Through more make clear that this is first and but he himself should not take careful and detailed information foremost the fruit and outcome upon himself all the tasks and the sick person should be able to of a growth in the “communion responsibilities in this sphere. In pass from an approach of mere mentality” which was developed the same way he should not act passivity to taking responsibili- in a significant way in Vatican in a delegating fashion as ties in relation to his own illness Council II and post-Vatican though the members of the lay and the consequences which can Council II thought and reflec- faithful were mere agents of the arise from the therapeutic tion. As the chaplaincy is an “ex- decisions taken by the members process. pression of the religious service of the clergy. – The respect of the person of of the Christian community in The humanising initiatives to the health care workers. The health care institutions” then it is which reference is usually made world of health care becomes an important that this Christian are as follows: the promotion of inhuman environment for the community is represented by all respect for fundamental values personnel when health care its components (cf LG, 12; AA, (that is to say life-health-free- workers are forced to endure 2; cf, 23). However in my opin- dom); the defence of the rights forms of work which offend ion the term “chaplaincy” is not of the sick person, also to be their dignity and oblige them to right: in order to avoid ambigui- achieved through the creation of engage in forms of behaviour ty the chaplaincy should be the ethical committees or bodies which they would willingly prerogative of priests, of those whose task it is to defend the avoid or which are contrary to who administer the sacraments. rights of the sick person; the their ways of thinking about the The other moments of the term positive evaluation and utilisa- provision of assistance to the of religious service could re- tion of professional associa- sick. ceive the appellation “pastoral co-operators”, or, in line with loyalty of the action of the Notes what happens at a national, re- Church carried out throughout 1 See C.TRABUCCHI, ‘Benessere Fisi- gional or diocesan level where her history on behalf of the sick co, Mentale and Sociale’, La Casa, 44 councils exist for the health care – there is a radiant history of the (1984), pp. 151-157. ministry, one could speak of a witness of saints which should 2 See L.CICCONE, Salute e Malattia (Questioni di Morale della Vita Fisica hospital pastoral council which be brought back to life because (II) (Ares, Milan, 1986), p. 34. has the same objectives and is of the impact that they have had 3 The “Nota” entitled “La Pastorale composed of the same people as and can still have through a re- della Salute nella Chiesa Italiana” (“The outlined by the “Note” for newed and enlightened commit- Health Care Ministry in the Italian Church”) of the national pastoral consul- “chaplaincy” (“Note”, 80-1). ment which matches the needs tative body of the Italian Episcopal Con- The presence within the pas- of our times; 2) an awareness of ference (CEI) is to be praised for having toral team of deacons, of mem- the changes which have taken outlined for the first time in an overall fashion the guidelines of the health care bers of male and female reli- place or which are taking place ministry: contexts, motivations, subjects gious orders, and members of in the health care world at a cul- and structures. This “Note”, although it the laity, could enable the chap- tural, structural and pastoral lev- is a document produced by a local Church, has a universal value because it lain to organise pastoral work in el: at a pastoral level we should recognises, accepts and synthesises in a a more effective and valuable be especially aware of the novel- unifying way the documents of the uni- way. He would be freed from ty of the opening towards family versal Church on the subject from Vati- can Council II to the date of its publica- many suppport services which relatives and health care work- tion (1989). The documents to which I do not really have a basis in the ers, the primary importance of refer are the following: the Apostolic sacred order and in this way he evangelisation, the various forms Constitution ‘Sacram Unctionem Infir- could be left free to dedicate his of voluntary work, the new kind morum’ of 1972; the new ‘Ordo Unctio- nis Infirmorum Eorumque Pastoralis energies to tasks which are more of chaplaincy, and the hospital Curae’ of 1972; the CEI document specifically priestly in character. pastoral councils; 3) respect for ‘Evangelizzazione e Sacramenti della 135 Lastly, hospital pastoral care the dignity of the sick person, Penitenza e dell’Unzione degli Infirmi’ (‘Evangelisation and the Sacraments of could gain a greater richness and seen in terms of his subjectivity, Penance and the Anointing of the Sick’) variety of roles and actions from as an image of God and of the once again of 1974; the Apostolic Letter the special vision of the lay per- suffering Christ, as a person in ‘Salvifici Doloris’ of 1984; and the Apostolic Letter ‘Christifideles Laici’ of son, from the charismatic per- all his physical, mental, familial, 1988. spective of the female or male social, spiritual and transcenden- 4 See note 3. members of a religious order, tal dimensions, which are also 5 See A.BRUSCO AND S.PINTOR, Sulle Orme di Cristo Medico (EDB, 1999), and from the sensitivity charac- therapeutic dimensions; 4) the pp. 207ss. teristic of women. need for training in the face of 6 A.BRUSCO, ‘La Pastorale Sanitaria Let it be well understood that the ethical questions and issues nell’Attuale Contesto Sociale’ in the new chaplaincy can only in- which have arisen because of AA.VV., Progettualità Ecclesiale nel Mondo della Salute (Salcom, Vasere, crease the ecclesial meaning of new illnesses and advances in 1995), p. 41. the presence and pastoral action the techniques of medicine; 5) 7 EV 9/1410-1418. of the chaplain, and would allow the promotion of voluntary 8 EV 11/984-985. 9 EV 14/538-563. him to foster in a stronger way work, as a sign of our time, in its 10 See G.GIANNINI, ‘Pontificio Con- the Christian forces which are most typical forms, that is to siglio “Cor Unum”’, in DTPS, 921-922. present in the hospital communi- say: voluntary work which is 11 See S.PELLICER, ‘Pastorale Sani- taria in Spagna’, in DRPS, 854-858. pastoral, participatory or direct- 12 ty through groups, associations, See S.PINTOR, ‘Dite il Vangelo e and in a special way, the hospital ed towards the provision of as- Curate i Malati’, Settimana 23 (1998), pastoral council. sistance. pp. 8-9. 13 G.SANTORO, ‘La Consulta della I would like, finally, to bring CEI per la Pastorale della Sanità’, In- to mind the words of Paul VI: sieme per Servire 2 (1988), pp. 10-13; Conclusion “the techniques of evangelisa- See also R.MESSINA, ‘La Consulta tion are good but not even the Nazionale e le Consulte Regionali e Diocesane della Sanità’, in A.BRUSCO In conclusion, I would like to most perfect of them can substi- (ed.), La Pastorale della Salute nella emphasise certain key points tute the discreet action of the Chiesa Italiana (Camilliane, Turin, which emerge from what I have Spirit. Even the most sophisti- 1992), pp. 203-202. 14 See the acts of the conference in argued in this paper. They are as cated training of the evangeliser Progettualità Ecclesiale nel Mondo del- follows: 1) the continuity in the cannot operate without the Spir- la Salute (Salcom, Varese, 1995). it. Without the Spirit the most 15 I am referring here to hospitals but I am also thinking of the other health care convincing dialectic is power- institutions to be found at a local level less in relation to the spirit of such as rest homes, nursing homes, men. Without the Spirit the high- homes for the elderly and residences for the relatives of patients, counselling cen- est sociological and psychologi- tres, mobile clinics etc. cal approaches are empty and 16 For this section important reference valueless. One can say that the should be made to The Charter for Holy Spirit is the principal agent Health Care Workers (1994), and in particular the sub-sections entitled “pastoral of the evangeliser” (EN, 75). care and the sacrament of the anointing of the sick”; “the terminally ill”; and “religious assistance for the dying”. Rev. RENATO DI MENNA, 17 See CEI, Evangelizzazione e Sacra- Camillian, menti della Penitenza e dell’Unzione Consultor to the Pontifical Council for degli Indermi, nn. 137-140. Health Pastoral Care, Professor of Theology at the “Camillianum” International Institute of the Theology of the Health Care Ministry. Conclusion

The twenty-five priests who parish community in supporting An agreement was reached attended came from twenty-two a specialised group of ‘visitors on achieving an immediate countries from four continents to the sick’. In this the medical shared objective: the establish- (only Oceania was not repre- side of things was also attended ment of an ‘International Feder- sented). They gave rise to a live- to through the financing of the ation’ which will unite and keep ly dialogue with the heads of the work of a nurse to carry out dai- in communion the already creat- Ministry, and with those who ly visits so as to follow the im- ed national associations, and to gave papers, in describing the plementation of treatment. Fur- help all those who were present real state of the pastoral world thermore, the relations with the who want to set in motion a of the countries where they centres of care of the city have similar experience in their own work and in narrating the expe- also been begun and intensified countries. In order to expedite riences now underway which in order to receive information this project the participants at work for evangelisation in the on the members of the parish. the seminar accepted the pro- field of health. Nearly all those speakers who posal made by the President of What follows is a brief de- gave a paper, however, ob- the Ministry, His Excellency scription of what emerged from served that there is a major lack Mons. Javier Lozano, to entrust the fraternal exchange which of priests in this kind of pastoral the task of being ‘continental took place. care. Hence the need to broaden coordinators’ to the following 136 As is obvious, there were as matters to include a new form of delegates who took part in the many differentiations as there ‘members of the chaplaincy’ – seminar: are cultures of the countries members of the faithful who, al- where the Church is present: though they do not have the AFRICA pronounced secularisation in the ministerial priesthood, are Rev. P. Edgar Yameogo, MI so-called ‘Western’ countries, trained with specific courses Parroisse St. Camille - Centre Medical difficulties in acting in those and under the direct responsibil- 01 - B.P. 364 countries where the Church in ity of the diocesan bishop, and OUAGADOUGOU - 01 Burkina Faso Tel: +226 361097 - FAX: +226 360349 numerical terms is ‘in a minori- are placed at the side of the E-Mail: [email protected] ty’ and where it lives together priest who is sent by his bishop with ‘different’ religions. Every- into the world of health care. An AMERICA body, however, drew attention account of a detailed experience A. Nord e Centrale: to the radical change which the along these lines was presented Rev. P. Stephen R. Ryan, OSM Presidente of N.A.C.C. - P.O. Box 97473 way of providing health care by a delegate from a country of 3501 Sout Lake Drive MILWAUKE, has brought about: a very brief old Europe, and this had been Wisconsin 53207 U.S.A. presence of the seriously ill in studied and approved by the rel- Office - Tel: +1 414 4834898 institutional structures, and thus evant national episcopal confer- FAX: +1 414 4836712 the need and the urgency to de- ence. E-Mail: [email protected] velop a new approach, presence, In absolutely clear fashion it Private - Tel: +1 212 9134863 FAX: +1 213 6632448 and form of pastoral action. emerged that for the priest who E-Mail: [email protected] This adjustment is also required is sent to engage in this form of B. Latina: for those places of care which pastoral service there is a need, Rev. Don Juan Josè Estrada look after the chronically ill giv- indeed a duty of conscience, for Santiago 1165 en the profound change which him to train himself in a suitable 2000 ROSARIO Argentina human society is facing with re- way and to seek out the neces- Tel: +54 155 481795 gard to the religious meaning of sary forms of periodic updating FAX: +54 0341 4213511 life. This is also the result of through attending courses E-Mail: [email protected] ‘globalisation’, a process to which involve permanent train- ASIA e OCEANIA which this aspect of life is not ing. Rev. Don Alex Vadakumthala immune. A broad exchange of infor- Executive Secretary Commission An urgent objective was per- mation was provided by dele- for Health Care Apostolate - C.B.C.I. ceived in the study of how to gates who in their own countries Centre 1 - Ashok Palace Goledakkhana link the action of the priest sent have theological faculties which NEW DELHI 110 001 India to places of care with the pas- are specialised in the health care E-Mail: [email protected] tors on the ground, and with the ministry, or simular study cen- parishes, where by now the ‘sick tres. This set in motion the be- EUROPA person’ continues with the ac- ginning of a fraternal collabora- Rev. Don Vitor Feytor Pinto Rua da Beneficiencia, 7-1 tion of recovering and restoring tion with those who do not have 100 LISBOA Portogallo his health. similar realities in their own Tel: +351 1 7931435 One of those present de- countries but who declared FAX: +351 1 7954212 scribed his ground-level experi- themselves very interested in E-Mail: [email protected] ences. After years of the co-or- the whole idea. dination of the health care min- The seminar, although it did istry in structures dedicated to not last very long, was very Rev. FELICE RUFFINI, MI care, and shortly after being sent dense and rich in terms of the Under-Secretary of the Pontifical by his bishop to engage in this reciprocal exchange of knowl- Council for Health Pastoral Care new service, he involved the edge and experiences. The Holy See