DOLENTIUM HOMINUM N. 38 Ð Year XIII Ð No. 2, 1998 JOURNAL OF THE PONTIFICAL COUNCIL FOR PASTORAL ASSISTANCE TO HEALTH CARE WORKERS

ARCHBISHOP JAVIER LOZANO, Editor-in-Chief CORRESPONDENTS REV.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 PROFESSOR SALVINO LEONE, EDITORIAL BOARD REV.JORGE PALENCIA, Mexico REV. GEORGE PEREIRA, India REV. CIRO BENEDETTINI MRS.ANVERLINDE, Belgium DR. LILIANA BOLIS PROFESSOR ROBERT WALLEY, Canada SR.AURELIA CUADRON REV. GIOVANNI D’ERCOLE, F.D.P. DR. MAYA EL-HACHEM DR.GIOVANNI FALLANI REV. GIANFRANCO GRIECO EDITORIAL STAFF REV. BONIFACIO HONINGS MONSIGNOR IRIGOYEN DR. COLETTE CHALON REV.JOSEPH JOBLIN DR. ANTONELLA FARINA REV.VITO MAGNO, R.C.I. PROFESSOR MATTHEW FORD DR. DINA NEROZZI-FRAJESE SR.MARIE-GABRIEL MULTIER DR. FRANCO PLACIDI REV.DAVID G. MURRAY REV.LUCIANO SANDRIN DR.SIMONA NOVELLI MONSIGNOR ITALO TADDEI DR.GUILLERMO QWISTGAARD

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Cover: Glass window Rev. Costantino Ruggeri

Spedizione in a.p. - art. 2, comma 20/c, legge 662/96 - Roma We ask precisely you, that are weak, to become a source of fortitude for the Church and mankind (Christifideles Laici, no. 54) Contents

3 A CHURCH SYMPOSIUM ON DRUGS: 59 The Spiritual and Pastoral UNITED FOR LIFE Accompaniment of Drug Addicts VATICAN CITY Rev. Adriano Yugueros OCTOBER 9-11, 1997 Organized by the Pontifical 67 Message Council for Pastoral Assistance to Senator Pino Arlacchi Health Care Workers 68 Message from WHO 6 Words Addressed Dr. Mario Argandoña Yánez to the Holy Father Javier Lozano 70 EMCDDA: Intersecting Fields 9 Greeting and Introduction Mr. Gregor Burkhart Archbishop Javier Lozano 73 Conclusions of 10 Opening Address the International Symposium 3 Angelo Cardinal Sodano Rev. Tony Anatrella

14 The Harmony of the Person and Drugs: Anthropological-Theological 77 THE SIXTH WORLD DAY Reflections OF THE SICK Monsignor Carlo Rocchetta LORETO, ITALY FEBRUARY 8-11, 1998 17 Drugs and the Value of the Body 78 Loreto: Rev. Bonifacio Honings An Account of the Sixth World Day of the Sick 22 Education to Promote Life Rev. Vitor Feytor Pinto 81 The Holy Father’s Letter to Cardinal 26 From Treatment to Self-Discovery: The Person as a Value 82 Christ Reveals the Meaning Dr. Bianca Costa Bozzo and Value of Suffering John Paul II 33 Report by the French-English-Italian Study Group 83 The World Day of the Sick Rev. Oreste Benzi Pope John Paul II

34 Report by the Spanish Study Group 84 Being Close to Pain with Rev. Manuel Zubillaga the Gospel of Love Angelo Cardinal Sodano 35 The Family and Drug Addiction 88 To Be Fishers of Men Cardinal Alfonso López Trujillo Archbishop Javier Lozano

40 Medical Aspects of Drugs 89 Statement from the Swiss Professor Bruno Silvestrini Confederation Hon. Flavio Cotti 44 Drug Addiction and Organized Crime THE FIRST MEETING Professor Vincenzo Scordamaglia OF EUROPEAN BISHOPS RESPONSIBLE FOR THE HEALTH MINISTRY 55 The Fight Against Drugs IN THEIR BISHOPS’ CONFERENCES and International Norms Professor Talitha Vassalli 90 Introduction of Dachenhausen Archbishop Javier Lozano 91 The Bishop Responsible 109 THE FOURTH PLENARY ASSEMBLY for the Health Ministry OF THE PONTIFICAL COUNCIL in the Bishops’ Conference FOR PASTORAL ASSISTANCE TO Most Rev. Javier Osés HEALTH CARE WORKERS VATICAN CITY, MARCH 9-11, 1998 95 Summary of the Work Groups 110 Greeting, Introduction INTERNATIONAL MEETING ON to the Session, and Remarks THE ECONOMICS OF HEALTH CARE: on Methodology PRIORITY AND EQUITY IN Archbishop Javier Lozano DISTRIBUTING RESOURCES 112 Christ Suffers in Our 97 I. The Sociological Dimension Sick Brothers and Sisters Professor Stefano Zamagni Archbishop Javier Lozano

101 II. The Political and Economic 113 To Make Known Dimension the Church’s Doctrine Dr. Fernando Antezana on the Meaning of Human Pain Pope John Paul II 104 III. The Theological-Pastoral 4 Dimension 115 Proposals of the Fourth Plenary Archbishop Javier Lozano Assembly for the Future Activity of the Pontifical Council Archbishop Javier Lozano Rev. José L. Redrado

The illustrations in this issue have been provided by the VELAR archives. A Church Symposium on Drugs: “United for Life”

Organized by the Pontifical Council for Pastoral Assistance to Health Care Workers

October 9-11, 1997 Vatican City Words of Greeting for the Holy Father

Most Blessed Father, finish with this Symposium, but will be fol- Health Care Workers involved in the fight lowed by preparing a kind of manual which against drug-addiction along with persons will be a great help in the pastoral orienta- who work in the juridical, social and politi- tion of health care workers in this particu- cal fields of our reality, coming from various lar sector of drug-addiction, and without countries, are meeting these days in the doubt a valid instrument also for those men Vatican to discuss pastoral approaches that of good will who pursue our own goals. are more suitable for solving problems aris- Being aware of the importance Your ing from drug abuse for many persons who Holiness attaches to our work, we humbly are under its evil influence. request your authoritative word, so that we We have reflected on theories and pas- may be sustained, enlightened and shown 6 toral applications, recalling different expe- the ways for our future activity. riences that emerge in preventive Centers We will listen with religious attention to involved in the cure of drug-addicts in vari- your orientations. ous parts of the world. Our task will not +JAVIER LOZANO B.

The Struggle Against the Scourge of Drug Addiction Is Everyone’s Business, Each According to His Own Responsability

THE HOLY FATHER’S ADDRESS ON OCTOBER 11, 1997 TO THE SYMPOSIUM HELD AT THE VATICAN

“The struggle against the scourge of drug casion of the international meeting on drug addiction is everyone’s business, each ac- addiction. I thank Archbishop Javier Lozano cording to his own responsibility... I encour- Barragàn, President of the Pontifical Council age the public authorities, parents, teachers, for Pastoral Assistance to Health-Care health-care professionals and Christian com- Workers, for his words of welcome and for munities to be jointly and increasingly in- organizing this meeting. Indeed, it is particu- volved in the work of prevention among larly appropriate to reflect on the serious young people and adults,” the Holy Father questions arising from the phenomenon of said on Saturday, October 11, to those taking drugs and on the urgent need for research that part in an international colloquium on drug will help political and economic leaders, addiction organized by the Pontifical Coun- teachers and families tried by the tragedy of cil for Pastoral Assistance to Health-Care drug addiction. Workers. Here is a translation of his address, which was given in French. 2. For some years the has been able to express its ideas on this subject, mak- Dear Brothers in the Episcopate ing pastoral, educational and social propos- and the Priesthood, als. We must unfortunately note that today Dear Friends, this phenomenon is reaching every milieu and region of the world. More and more chil- 1. I am pleased to welcome you on the oc- dren and adolescents are becoming con- sumers of toxic substances, often because courageously, but they do not always feel they were first tried casually or defiantly. supported, especially when the media spread Parents and teachers often find themselves un- morally unacceptable messages which serve prepared and discouraged. Doctors, as well as as cultural standards in all the countries of health and social services, encounter serious the world, advocating, for example, many problems when it is a question of helping family models which destroy the normal im- those who seek their aid to escape the drug age of the married couple and disparage fam- scene. It must be recognized that a crack- ily values, or which consider violence and down on those who use illegal substances is sometimes drugs themselves as signs of per- not enough to contain this scourge; in fact, a sonal liberation. significant criminal network of trafficking and financing has been organized on an interna- 4. The fear of the future and of adult com- tional scale. Most of the time the economic mitments which can be observed in the power connected with the production and young makes them particularly vulnerable. commercialization of these substances es- Often they are not encouraged to struggle for capes the law and justice. a good, upright life; they have the tendency It is therefore not surprising that a great to withdraw into themselves. One can no feeling of helplessness and powerlessness is longer minimize the devastating effect of un- overrunning society. Some are of the opinion employment to which young people fall prey that the production and sale of certain drugs in proportions unworthy of a society that should be legalized. Certain authorities are wishes to respect human dignity. The forces 7 prepared to do nothing, seeking merely to lim- of death then urge them to abandon them- it drug consumption by trying to control its ef- selves to drugs, to violence, sometimes even fects. Consequently, in school the use of cer- to the point of suicide. Behind what can ap- tain drugs is becoming common; this is en- pear as fascination with a sort of self-destruc- couraged by talk that tries to minimize the tion, we must see in these young people a call dangers, especially by distinguishing between for help and a deep thirst for life, which soft and hard drugs, which leads to proposals should be taken into account, so that the for liberalizing the use of certain substances. world will radically modify what it offers and This distinction disregards and downplays the its ways of life. Too many young people are risks inherent in taking any toxic product, es- left to themselves and do not benefit from an pecially behavioural dependency, which is attentive presence, a stable home, normal based on the psychic structures themselves, schooling or a social and educational frame- the blurring of conscience and the loss of work that arouses a moral and intellectual ef- one’s will and freedom, whatever the drug. fort in them and helps them to steel their will and master their emotions. 3. The drug phenomenon is a particularly serious evil. Many young people and adults 5. The struggle against the scourge of have died or will die as a result, while others chemical dependency is everyone’s business, find their personal capacities diminished. each according to his own responsibility. I Young people resort to drugs for many rea- first urge husbands and wives to develop sta- sons. At critical moments in their growth, ble conjugal and family relations, based on a drug addiction is to be considered sympto- love that is exclusive, lasting and faithful. matic of problems in life, of difficulty in They will thus create the best conditions for a finding a place in society, of a fear of the fu- peaceful home life, offering their children the ture and of an escape into an illusory, artifi- emotional security and self-confidence they cial life. Youth is a time of trial and question- need for their spiritual and psychological ing, of searching for meaning in life and of growth. It is also important that parents, who making future commitments. The increased have the primary responsibility for their chil- selling and consumption of drugs show that dren, and, with them, the whole adult com- we are in a world pressed for hope, lacking munity, be constantly concerned about the vigorous human and spiritual prospects. education of youth. I therefore invite every- Hence many young people think that all be- one who has an educational role to intensify haviour is the same, and do not differentiate efforts with young people who need to form between good and evil or acquire a sense of their conscience, develop their interior life moral limits. and create positive relationships and con- Nevertheless, I value the efforts of parents structive dialogue with their brothers and sis- and teachers to inculcate moral and spiritual ters; they will help them become free and re- values in their children, so that they behave sponsible for their lives. Young people who as responsible people. They often do this have a structured personality, a sound moral and human formation and harmonious and spiral of drugs and become free and happy trusting relationships with their peers and adults. The Church’s mission is to transmit with adults will be more likely to resist the the word of the Gospel that opens us to God’s enticements of those who spread drugs. life and enables us to discover Christ, the Word of Life who offers a path of human and 6. I invite the civil authorities, the econom- spiritual growth. Following the example of ic decision-makers and all who have social her Lord and in solidarity with her brothers responsibility to continue and intensify their and sisters in humanity, the Church comes to efforts to improve anti-drug abuse legisla- the aid of the lowliest and the weakest, caring tion at every level and to oppose all forms of for those who are wounded, fortifying those drug culture and trafficking, sources of who are sick, seeking the personal growth of wealth scandalously acquired by exploiting each one. the frailty of defenceless persons. I encour- At the end of our meeting, I salute the mis- age the public authorities, parents, teachers, sion undertaken by the Pontifical Council for health-care professionals and Christian com- Pastoral Assistance to Health-Care Workers munities to be jointly and increasingly in- in carefully considering the human and spiri- volved in the work of prevention among tual problems posed by drug dependency and young people and adults. Wise and accurate by all health-care and social issues, in order medical information must be given, especial- to offer solutions for situations that are ly to young people, stressing the harmful ef- gravely harmful to men and women, our 8 fects of drugs on the physical, intellectual, brothers and sisters. Likewise, in conjunction psychological, social and moral levels. I am with the Pastors of the particular Churches, aware of the tireless devotion and patience of the faithful and the competent services in- those who care for and attend to persons en- volved in supporting those with a drug addic- snared in drugs, and their families. I invite tion and their families, the Council is called the parents whose child has a chemical de- to offer its support to local initiatives. pendency never to despair, to stay in commu- I entrust you and your activity to the inter- nication with him, to show him their affec- cession of the Blessed Virgin Mary; I also be- tion and to encourage his contacts with facili- seech her for the young people who are in the ties that can care for him. A family’s warm grip of drugs, and for their loved ones. May attention is a great support for the interior she surround them with her motherly con- struggle and for the progress of detoxifica- cern! May she guide the world’s young peo- tion. ple to an ever more harmonious life! May the Holy Spirit go with you and give you the 7. I salute the tireless and patient pastoral necessary courage for your work on behalf of commitment of priests, religious and lay per- youth! I impart my Apostolic Blessing to you sons in the world of drugs; they support par- all, to your collaborators and to the members ents and are keen to welcome and listen to of your families. young people, to understand their radical questions in order to help them escape the JOHN PAUL II Greeting and Introduction

It is with great hope and gratitude, that I, difficult field of their daily activity. as the President of the Pontifical Council for The Symposium will commence with an- Pastoral Assistance to Health Care Workers, thropological and theological reflections on greet all of you participants in this Sympo- the harmony of the person and drugs, on sium on Solidarity for Life. You are all drugs and the value of the body, and on edu- most welcome to this work, which without cation for the promotion of life and regard- doubt will be of great benefit to all, espe- ing the person as a value. These reflections cially those under the harmful influence of will be followed by the sharing of various drugs. experiences on the prevention and recovery In a special way, I welcome His Emi- of drug addicts and the role of the family nence Angelo Cardinal Sodano, the Secre- and society. Tomorrow we shall consider tary of State of His Holiness, who kindly the biological roots of substance abuse, 9 agreed to give the opening address to this drug addiction and criminality, and the fight Symposium. against drugs through international regula- This Symposium arises from a request tions, and, as on the previous day, we shall made by the Executive Director of the UN continue sharing experiences on both pre- International Program for the Control of vention and the recovery of addicts. Finally, Drugs, Dr. Giorgio Giacomelli, stationed in we shall consider our reflections on spiritual Vienna, Austria, to the Holy Father, John and pastoral assistance to drug addicts and Paul II, in connection with what the conclude with three messages: one from the was doing to solve the Office of the United Nations in Vienna, an- enormous problem of drug consumption other from the WHO Office for Drugs, and around the world. a third one from the European Data Center Our Council received, then, through His on drugs and substance abuse. Eminence, the Cardinal Secretary of State, We shall have an audience with the Holy the mission of responding to this justifiable Father at the appropriate time. And our concern. whole Symposium will have as its soul the As a follow-up to this, an informal study Eucharistic Sacrifice, which will be group was set up which for nine months presided over by different personalities ac- dealt with answers to the question. It is now companying us. completing its work with this Symposium. We entrust our Symposium to the special This group was created within our Council, protection of the Holy Virgin Mother, Salus and, under the immediate direction of Mon- Infirmorum. We ask for her help, that we signor Jean-Marie Mpendawatu, has carried may be able to identify in the concrete pas- on its work up to the point where we are toral action of the Church the needed re- now. sources so that the many people under the The objective of this Symposium is to fatal influence of drugs can find sufficient draw up both theoretical and practical direc- light and guidance to emerge therefrom vic- tives for efficacious pastoral care by the toriously. Church to help drug addicts.The papers and statements will be collected by a group of experts of the Symposium with the ultimate + JAVIER LOZANO B. goal of producing as soon as possible a pas- President of the Pontifical Council toral manual for assistance to addicts. In for Pastoral Assistance to Health Care Workers this manual we shall convey appropriate doctrinal principles and different experi- ences at the international level in the cure of addicts; and it will be directed especially to the bishops of the Catholic Church, pastoral workers, and all those interested in the topic as a help in the work they carry on in this The Address by Secretary of State Angelo Cardinal Sodano

Venerable Brother Bishops ry task particularly easy, for I derground stream and its con- and Priests, can then limit myself to con- nections with delinquency and Ladies and Gentlemen, veying the Holy Father’s ap- crime are such that they con- preciation for the initiative of stitute one of the principal fac- It is with great satisfaction the Pontifical Council and his tors of general decadence.” that I am taking part in this warm greetings for the differ- (Teachings of John Paul II, meeting on drugs, which, ent speakers and all the partic- VII, 2, 1984, p.347) through the initiative of the ipants, and lastly his wish that Behind such strong words Pontifical Council for Pastoral the reflections of these three are facts well known to you Assistance to Health Care days will result in significant all. It is true that, with regard Workers, brings the Holy See principles, not only for further to statistics, it is difficult to get once again to the forefront on deliberations and inquiry into precise data, given the nature 10 the issue of drugs. Given the this serious problem, but also of the use of drugs, which is number of victims it produces, for the development of an ap- extensively clandestine. But it with families thrown into dis- propriate strategy for eradicat- is a common conviction based tress and young people struck ing it. on facts that the phenomenon down on the threshold of life, However, I consider it ap- is expanding in all directions. it constitutes one of the most propriate to draw our attention The use of synthetic drugs, as serious problems in contem- to some of the many affirma- compared to those derived porary society. tions of the present pontificate from plants, has the sad advan- In a special way I welcome on the problem of drugs, tage of bringing the drugs to all of you present and at the pointing out the salient as- the consumers, making their same time wish to express my pects. From these magisterial control ever more difficult, for sincere thanks to the promot- pronouncements, rather than you may have, on the one ers of this symposium, which general information about the hand, excess production fol- confronts a subject with such a phenomenon, which others are lowed by diversions and, on great personal and social im- capable of providing with spe- the other, totally illegal pro- pact. In fact, the drug phenom- cialized competence, there duction (Cf. United Nations enon is both an expression of emerge the criteria for both a International Drug Control the criminality that asserts it- careful and enlightening inter- Program, World Drug Report, self economically and socially pretation of the phenomenon Oxford University Press, p. with unprecedented force, from the Church’s point of 41). Looking at the estimates making huge and dishonest view. offered by the United Nations’ gains, and a symptom of the Program for the International great malaise affecting the cul- Control of Drugs, we learn that ture and ethics of societies The “Drug Scourge” in order to be able to reduce which are economically more the profit of the traffickers it is advanced. Because of its man- On observing the repeated necessary to intercept at least ifold implications, the issue of pontifical statements on the 75% of the international drug drugs goes beyond the limits problem, the first thing one traffic. However, this objective of a medical question and can- notices is the marked attention is far from being realized, and not be limited to a particular which the Holy Father gives to is indeed very difficult to sector. It attacks crucial as- the drama of the phenomenon. achieve, given the fact that the pects of life, posing unavoid- Here are some of the ringing trafficking of heroine and co- able questions on the meaning terms which the Holy Father caine is controlled by transna- of life, on personal and social uses in speaking about the tional organizations and man- ethics, and on the profound problem: “Today the drug aged by criminal groups that motivations of civilized com- scourge rages in shocking pro- are strongly centralized, with a munity life. portions and cruel forms that wide range of specialized per- Consequently, the range of overwhelm many provisions. sonnel ranging from chemists topics to be considered at this Tragic episodes show that the to experts in communication meeting is fairly broad. As disgusting epidemic has at- and money laundering, from such, the symposium presents tained wider ramifications, lawyers to security guards etc. itself with a wealth of special- supplied by a vile market that (ibid. p.123). As noted, in the ized contributions from quali- surpasses national and conti- last 20 years the organizations fied international authorities nental boundaries. The malig- of traffickers have extended and that makes my introducto- nant implications of this un- their interests into other forms of illicit activity which incredi- izes why the moral assess- 1996, L’Osservatore Romano, bly increase the profits and ment of the Church in this 22-23 April 1996). consequently the excessive field is particularly serious. However, this particular as- power of this unscrupulous Hence the automatic condem- pect does not exempt public criminality. nation of all who are directly authority from the responsibil- responsible for the phenome- ity of undertaking the other non, through the clandestine necessary measures. In this re- Devastating Effects drug production and traffick- gard, the Church follows with ing, as well as those who indi- particular concern the debate In these years, besides the rectly become accomplices. that has been going on for a quantitative dimension of the Moreover, the Catechism of long time between so-called phenomenon, the voice of the the Catholic Church also re- “prohibitionists” and “anti- Magisterium has been preoc- minds all drug abusers or prohibitionists.” It is to be not- cupied with guarding against those tempted in this direction ed, in fact, that the latter have the devastating effects of that “aside from strictly thera- in an ever more vigorous way drugs, not only on health, but peutic grounds, the use of promoted the legalization and also on one’s conscience, as drugs is a grave offense” liberalization of drugs—at well as on culture and the col- (CCC 2291). Surely, the in- least those called “soft lective mentality. This is in tention here is not to make a drugs”—with varied forms of fact both the fruit and cause of judgement on subjective re- argumentation, raising the great ethical degeneration and sponsibility, given the fact point that prohibition politics a growing social disintegra- that, once one has entered into may have not only failed to tion which corrupt the very this dreadful dependence, he solve the problem but even ag- fabric of morality, of interper- also becomes at least partly gravated it. The prohibition- 11 sonal relationships, and of civ- incapable of the necessary ists, however, hold that the ab- ilized community life. radical choice to emerge from sence of sanctions would pro- Furthermore, in these years this distressing slavery. How- voke problems which are increasing physical damage ever, the moral principle re- more serious than those al- has also appeared, ranging called without hesitation is ready in existence, thereby from hepatitis to tuberculosis not only a norm, but also a giving a wrong signal to the and AIDS; we need not men- help to the conscience to ac- young and facilitating the first tion the violent environment, quire strength and coherence. step that might lead them to sexual exploitation, arms hard drugs. Liberalization trade, and terrorism associated would move in a direction op- with this phenomenon. And Public Responsibility posite to that of education and who can ignore the way fami- prevention and would involve ly relationships have been Facing the enormity of the serious risks to health and ma- harmed by it? A particular phenomenon and its tragic ef- jor costs for society and would burden falls on women, often fects, there is no doubt that the neither eliminate the black forced into prostitution to sup- greatest responsibility to con- market for narcotics nor re- port addicted husbands. front it and subdue it falls on duce violence and criminality. It thus seems far from an public authorities. This is an One of the major risks would exaggeration when John Paul appeal, which John Paul II has be the irreversibility of such II describes drug traffickers, on several occasions renewed, an option and the difficulty of as “merchants of death” that at both national and inter- such a regulation. (Teachings, XIV, 2,1991, p. national levels people may re- In the face of this “regula- 1250). A death which, though spond to the challenges of tion debate,” the position of not always physical, is never- drugs in a decisive way, adopt- the Church has always been theless always a moral death, ing resolutions that discourage clear. It does not deny the fact a death of the liberty and dig- the dreadful trafficking in its that the problem is complex nity of the person. Drugs tend initial stages. Of course, for and that among the anti-prohi- to enslave the person. The regions where the illicit culti- bitionists there are people who Pope noted this during his vation of crops destined for pose the problem with a sense pastoral visit to Colombia in the production of drugs seems of responsibility and serious- 1986. He referred to narcotics to be the only profitable op- ness. But the issue in question traffickers as “traffickers in tion for farmers, such an issue is too big and the reasons that the freedom of their brothers, is both difficult and delicate. It lead to a different line of enslaving them in a slavery is clear, therefore, that in such thought are more convincing. sometimes more terrible than cases one must foresee and of- Speaking to the therapeutic that of the black slaves. The fer other resources in their communities in 1984, John slave traders used to hinder place “which can guarantee Paul II said, “Drugs are an their victims from the exercise workers and their families a evil, and one does not give in of freedom. These narcotics situation in accordance with to evil. Legalization, even if traffickers reduce their vic- the dignity of persons and of partial, apart from being dis- tims to the point of destroying children of God” (Address to putable in relation to the na- the personality.” (Teachings, the Bishops of the Bolivian ture of the law, does not evade IX, 2, 1986, p.197). Looking Bishops’ Conference during the already established effects. at these effects, one then real- the ad Limina visit, 22 April This is confirmed by an al- ready common experience. the same time the collective An Appropriate Strategy Prevention, suppression, and ethos, culture and social rela- rehabilitation are the focal tionships. The Pope calls for Given the nature of the points of a program conceived attention to this issue. He ob- problem, it is obvious that pro- and applied in the light of the serves that usually at the root hibition, though necessary, is dignity of man, sustained by of the addiction problem there not enough. “This evil,” says the honesty of relationships is an “existential void caused the Pope, “has to be overcome among people; such a program by an absence of values and by a new pledge of responsi- enjoys the trust and support of lack of self-confidence, trust bility within the structures of the Church” (Teachings, VII, in the others, and life in gener- civil life, and in particular 2, 1984,p.349). Recently the al” (Teachings, XIV, 2, 1991, through the proposals of alter- Pontifical Council for the p. 1249). Furthermore, drug native models for life” (Teach- Family in one of its pastoral use involves an interior empti- ings, XII, 2, 1989, p.637). reflections, specifically on this ness that seeks to escape and This is the strategy of pre- topic, urged the avoidance of leads first to the darkness of vention, for which, empha- generalization and simplifica- the spirit before physical de- sizes John Paul II, the assis- tion and, “above all, the politi- struction (Teachings, XIII, 2, tance “of the whole society— cizing of an issue which is 1990, p.1579). There is a con- parents, schools, social envi- deeply ethical and human.” nection between illness caused ronment, means of social In regard, then, to the distinc- by the abuse of drugs and the communication, international tion between soft and hard pathology of the spirit which organizations—is necessary, drugs it observed that “the leads the person to run away as is a commitment to form a products may be different, from himself and seek illusory new society on a human scale: 12 but the underlying motives re- satisfactions avoiding reality, education for being human” main the same. It is for this to the point of negating the (Teachings, VII, 1, 1984, p. reason that the distinction be- significance of his own exis- 1541). This entails concerted tween “hard drugs” and “soft tence. action proposing authentic drugs” leads to a dead end. However, one cannot deny values and, in particular, spiri- Addiction does not work the fact that drug addiction is tual values at all levels of through drugs themselves, but also closely related to the pre- community life. in what leads the individual to sent state of a secularized per- For those already entangled addiction... The legalization of missive society in which he- in the abuse of drugs, there is drugs brings with it the risk of donism, individualism, pseu- need for appropriate forms of effects opposite to those that do-values, and false models treatment and rehabilitation are being sought... In the le- prevail. Familiaris Consortio which exceed simple medical galization of drugs... it is the considers this to be the conse- treatment because in many reasons which lead to the con- quence of a society risking be- cases one finds a complex set sumption of such products that ing ever more depersonalized of problems which require the are ratified.” (Liberalization of and standardized and also in- help of psychotherapy for both Drugs? Pastoral Reflections human and dehumanizing the individual and the family by the Pontifical Council for (Teachings, IV, 2, 1981, nucleus, together with appro- the Family: L’Osservatore Ro- p.1087). priate spiritual support, and so mano, 22 January 1997). In such a “sick” context as- on. The replacement drugs to sailing both the individual and which people often resort do society, those who get addict- not offer sufficient treatment; To the Ethical-Cultural ed, in the words of the Holy they are more or less a veiled Roots of the Phenomenon Father, are “like people who, way of surrendering to the while on their way, searching problem. Only the personal ef- These considerations bring for something to live by, fort of the individual, his own us to the key aspect of the fall instead into the hands will to revive and ability to re- problem, upon which con- of merchants of death who cover, can guarantee a return verges the attention of the overcome them with the to normality from the halluci- Church in a special way: why allurement of deceptive free- nating world of narcotics. do people get addicted? It is in dom and false prospects However, one undergoing fact clear that beyond all the of happiness” (Teachings, such a demanding process also conditioning of irresponsible XIV, 2, 1991, p. 1250). One has need for social help. The trafficking and all that orga- could as well say that the great family remains, of course, the nized crime offers, it is always “trip” that people seek in principal reference point for the individual with his free- the drugs is the “endless any preventive action. This dom and responsibility that perversion of human aspira- has been emphasized by the crosses the dangerous thresh- tions..., the pseudo-ecstasy Holy Father on various occa- old of drugs, ending up at a of a world that does not be- sions, without overlooking the point of no return. lieve, but all the same cannot importance of “therapeutic Why do they do it? The ex- shake off its shoulders the ten- communities,” “which by tension of the drug phenome- sion of the soul towards par- aiming at and indefatigably non makes one think of a adise” (J. Ratzinger, Svolta keeping their attention fixed deeply rooted malaise which per l’Europa, Ed. Paoline on ‘human value,’ under their touches the conscience and at 1992, p. 15). various aspects have shown themselves to be a good sys- to the victims of drug abuse. uous optimism. However, we tem” (Teachings, VII, 2, 1984, Christian families, parish com- should not forget that the mo- p.346). munities, and the different ed- tives for Christian hope are ucational institutions must based not only on human en- commit themselves to this deavor, but, above all, on the A Challenge for the Church task. The means of social com- help of God, who knows how munication also have to play a to multiply our efforts. In hop- In this concerted effort there special role at the various lev- ing this meeting may prove to is a duty that involves the els of the ecclesial community. be a major contribution to this Church in a specific way: the A special and concrete wit- noble cause, I would like to Church feels called into action ness, moreover, is that of the conclude with the words of the not only as a herald of the therapeutic communities of Pope about the extension of Gospel, but also as an “expert Christian origin, whose meth- this sad phenomenon in his in humanity.” To those under- ods, though varied, maintain address at the conclusion of going the tragedy of addiction the characteristics of adhering the Fourth International Con- she brings the good news of to the Gospel and the teaching ference on Drugs and Alcohol: the love of God, who wants of the Church. “Indeed, in such a situation the conversion and life and not reasons that lead to the loss of death. The Church then comes all hope would seem convinc- close to them in order to help The Horizon of Hope ing. Well aware of this, how- them embark on the itinerary ever, you and I would like to of liberation that leads them to We are here at this sympo- show that the reasons for con- the discovery/rediscovery of sium, which, with the support tinued hope do exist and are in their proper human dignity of the present pontificate, fact stronger.” 13 and their dignity as children of would like to offer not only These words are reassuring God. proposals and elements for re- and, indeed, invite us to work It is, above all, by this wit- flection to the entire society, with renewed vigor at the ness, which comes through the but also in a certain way give a service of all who might varied forms of evangeliza- new impulse to the duty of be drowned in the deadly tion, liturgical celebrations, Church in this sector. whirlpool of drugs. and community life, that the We know very well the Church renders a service of complexity of the problem ANGELO Cardinal SODANO prevention and rehabilitation does not leave room for ingen- Secretary of State, Holy See Drugs and the Harmony of the Person Theological-Anthropological Reflections

The purpose of this Con- spond to the real identity of his self-realization in relation vention is to examine the pos- the human person. The Holy to body-spirit unification as an sible ways of both averting the Father has several times re- ethical task entrusted to the spread of the drug phenome- peated that “there is an exis- human person and his free- non and helping drug addicts tential void at the root of drug dom. recover their full dignity as addiction.” Proper therapy – Grace as an event “from free and responsible human must therefore work at a deep above,” as an event of recon- beings. Theological-anthropo- anthropological level to be ciliation in the Spirit and the logical reflection, rather than able to remove the disharmo- ability to acquire the harmony giving direct answers for oper- ny and educate the person to restored through Christ’s re- ational purposes, gives the vi- live in unity and harmony with demption. sion of the person, reference to himself, with nature, with oth- which is necessary for solving ers, and with God. “The 14 recourse to drugs from its very Gospel of grace” moves in this 1. The unified totality roots and in this way showing direction. The announcement of the person and its meaninglessness and absur- of the mystery of the Only-Be- the task of self building dity. The title of this presenta- gotten, incarnate Son is pre- tion rightly puts drugs and the sented to the faithful as the The concept of “harmony” harmony of the person into proclamation, the magna char- refers above all to the original opposition. The “and” in the ta, for overcoming any dual- unity of the human person. title, rather than being a con- ism or division within the per- The person is constituted by junction, is indeed disjunctive; son and as a possibility grant- the harmony established be- it is intended to indicate the ed for the realization of that tween the body and the spirit, absolute contrast between the deep longing for unity hidden psyche and soma. Every indi- human person as a being with in the human heart. This vidual person is an incarnate harmony, called to unity and shows the real profound con- spirit. relational nature, and recourse nection that exists between the Ð A spiritual ego, unique to drugs as the shattering and inclination to harmony in- and unrepeatable, that presents loss of unity and relationship, scribed in the heart of the hu- and realizes itself in the corpo- a crack and void, to use the man being and the gift of real state; very language of the drug ad- grace poured on those bap- Ð A corporeality that is dicts. tized by the risen Lord. more than just the body, inas- The topic that I would like The problem concerns the- much as it carries in itself the to develop here seeks to an- ology, anthropology, and infinite demands of the spiri- swer the following question: Christian education at the tual ego and thus transcends Doesn’t resorting to drugs in same time. What is “harmo- corporeal physicality. the final analysis derive from ny” for a human being, when The human person is made the problem of body/spirit theologically considered, and up of both a spiritual and cor- disharmony, which makes the how can one understand the poreal whole, in a relationship human person, especially the gift of grace as an event of re- of reciprocal and dynamic in- young, dissatisfied and void— covered unity and new rela- terdependence: such is the a dissatisfaction and void to tionship? What are the funda- unified totality to which the which the very image of addic- mental lines of action for the Holy Father repeatedly refers tion refers? The young and education of the young for (see, for example, FC 11). One even adults do not become po- “harmony,” understood in a may not speak of the body if tential addicts only by the act Christian sense? not in relation to the spirit and through which they begin us- its infinite extension; just as ing narcotics, but in the mo- one may not speak of the spirit ment they are not educated to I. THEOLOGICAL- if not in relation to the body live in “harmony with” and ANTHROPOLOGICAL and the realization role it “in harmony for;” it is this sit- PERSPECTIVES plays, at least as far as our uation of anthropological in- historical condition is con- disposition, of the pathology The theological-anthropo- cerned. The origin and effects of the person, that gives rise, logical aspect involves two of the drug drama are to be after all, to recourse to drugs fundamental points of particu- found in the relationship es- as an attempt—obviously lar importance. tablished between the three wrong—to come out of a con- Ð The unified totality of the components, spirit, body and dition that does not corre- human person and therefore person. The initial track of re- flection on the drug addiction meant for unity and not for di- plan of God. It is necessary to problem is contained in such a vision. All history, the history emphasize this “gospel of frame of reference; the resort of religions, philosophies, and grace” as an event of unity, to that blissful illusion called ideologies, is nothing but the and self-realization, of “rela- drugs rises from the person, difficult, uncertain, and often tionship with” and “relation- spirit, and body in disharmo- vain attempt to reconstruct the ship for.” Grace in the New ny. lost unity and the shattered re- Testament perspective is a gift The original unity men- lational nature. The original of new harmony; it is the tioned above is characterized sin described by Genesis ex- beauty of the Son radiated by the infinite extension of the presses this situation symboli- over all of us, as new beauty, spiritual ego, in a real rela- cally. GS affirms that “the di- “gracefulness.” tional nature in both the verti- chotomy affecting the modern cal and horizontal senses. B. world is, in fact, a symptom Paschal said that “man sur- of the deeper dichotomy that is II. TOWARDS THE passes man infinitely.” Many in man himself. He is the meet- EDUCATION OF contemporaries say that the ing point of many conflicting THE PERSON AND body is more than the body; it forces. In this condition as a CORPOREALITY carries in it the demands of the created being he is subject to a spirit and the symbolizations thousand shortcomings, but There is not enough time at in its very physique. Here one feels untrammelled in his in- this session for dwelling fur- thinks of the upright position clinations and destined for a ther on the above-mentioned of the person, upwards, high higher form of life... Feeble aspects. However, I hope that up, towards the transcendent, and sinful as he is, he often it is clear enough that the the- to whom we stretch out with does the very thing he hates ology of the person and his 15 all our being; one also thinks and does not do what he corporeality require an ade- of the disposition towards re- wants. And so he feels himself quate and corresponding edu- ceiving and giving, helping to be divided...” (GS 10)1 cation of the two, with regard each other, in a true compan- to both prevention and cure in ionship of life. The relational the case of drug addicts. In mystery of the person is in- 2. Grace as harmony this direction, one can briefly scribed in the body: his exis- restored through indicate four pedagogical tence is characterized by his Christ’s redemption tracks corresponding to the freedom and rationality, facul- anthropological aspects al- ties that control the opening of The realism of this anthro- ready mentioned. the human person towards pology expresses the concrete- ever-wider horizons, towards ness, the realism of the Christ- 1. Educating to live out the a relationship with the other, ian message. GS adds that “in unity of the very being of the and in the final analysis to- reality it is only in the mystery person, with awareness that if wards a relationship with the of the Word made flesh that the body is transformed absolutely Other, God, the in- the mystery of man truly be- through spontaneous automa- finite interlocutor. comes clear... Christ... in the tism, the spirit is transformed Both original unity and rela- very revelation of the mystery only in relation to given val- tional nature, in the vertical of the Father and of his love ues which it assumes in a per- and horizontal sense, are en- fully reveals man to himself sonal and convinced way: it is trusted to man and woman as and brings to light his most the unity of the spiritual ego an ethical task, as ability and high calling.” (GS 22) Chris- around a cognitive chart of responsibility tied to freedom tology is a fulfillment of an- values and authentic ideals and vocation before God. It is thropology. The only-begotten that establishes the unity of the the personal ego, the incarnate Son, who was made flesh, person and represents the prin- spirit, that has to respond posi- died, and was resurrected, is ciple of his harmonization. tively to this appeal: the har- the great reconciler between mony of the person as unity heaven and earth, the reunifier 2. Educating the human and relational nature thus rep- of man, the reharmonizer of spirit towards transcen- resents the result of an ethical his being. It is only in the dis- dence, with awareness that task which bursts open before covery of Christ that we are the body, insofar as it is hu- the freedom of the human be- able to rediscover our own man, is more than a simple bi- ing and demands his consent. selves and overcome the divi- ological fact; it carries in itself The biblical creation narra- sion of sin. It is in this per- the infinite aspirations of the tives express this fundamental spective that we have to un- spirit, which call upon it un- anthropology in a different derstand the mystery of the ceasingly. Therefore, authen- and complementary way. God, Easter grace. tic education for the experi- who is both unity and relation- As a gift of the Spirit of the ence of corporeality cannot ship in himself, creates the hu- Risen Lord, grace is both the limit itself to a merely natural- man being as a creature of uni- gift of a “healed finiteness” istic affair; it must educate the ty and relationship, in harmo- and the possibility of partici- spirit to giving and receiving ny with himself, with nature, pating in the Trinitarian ontol- love, giving and accepting, in with the other, and with the ogy—rediscovering oneself in both the vertical and horizon- Creator. The human person is the fullness of the original tal senses. 3. Educating for the ethi- 4. Proclaiming the “gospel It is clear that the four tracks cal task of becoming adult of grace” as the fullness of are not automatic formulas; persons, learning to experi- life and a gift of self-realiza- they require intelligent educa- ence bodily existence not just tion. Christ, the ultimate truth tional ways and models, in- as a simple historical fact, but of human existence, is the pro- cluding ways of a true educa- as a duty, entrusted to the re- totype of any authentic person- tion for contemplation and sponsibility of every individ- al realization and the icon of prayer. I shall conclude with ual: the body is not just an ob- the new relational nature inau- the beautiful invocation of the ject that I have, but the very gurated in history. If it is true Indian poet R. Tagore, which subjectiveness in which I am. that every human being has a should be voiced by every Accepting the toil of becom- deep longing for unity and har- young person in difficulty: ing adults means accepting the mony in himself and even out- “Lord, that I may make my life duty of making one’s corpore- side himself, then the grace of something simple and upright, ality the sign of interpersonal the Lord Jesus is a real gift of like a flute which you can hear communion, making it a “nup- true and effective reconcilia- with melodious music.” tial reality.” And this requires tion which is both a task and a sacrifice and perseverance. possibility offered to the bap- Msgr. CARLO ROCCHETTA Here the analysis of K. tized so that they may be able Professor of the Theology Lorenz, in which he speaks of to overcome any form of divi- of Corporeality at the Camillianum, the general softening of the sion and live in unity and har- International Institute for the Pastoral Theology young, caused by the disap- mony, in this way offering of Health Care, Rome pearance of sentiments and prophetic testimony to all. This emotions, is quite acceptable. “gospel of grace” does not im- 16 “Technological and pharma- pose itself on created beings, Notes cological progress have fa- but accepts them, recovers vored an increasing intoler- them, and directs them to their 1 “Man therefore is divided in him- ance towards anything that full realization. There is no du- self. As a result, the whole life of men, both individual and social, shows itself causes pain. In this way one alism between nature and to be a struggle, and a dramatic one, be- looses the ability to obtain grace; on the contrary, one tween good and evil, between light and that type of joy which comes calls for the other, and it is only darkness.” (GS 13) 2 Gli otto peccati capitali della nostra only by overcoming obstacles together that integral education civiltà (The eight capital sins of our through tough strains.” 2 for life can be achieved. civilisation), Adelphy 1970, p.30. Drugs and the Value of the Body

The topic of this meeting hind this experiment lies the shall move on to suggest a very much concerns the hope that they will be able to strategy related to the value of Church. All the problems of reduce the crimes committed the body. man are at the same time by these people in the effort to problems of the Church. In satisfy their needs as drug ad- fact, since the Church is the dicts. Besides, the experiment 1. Different Moral sacrament of Christ it cannot should contribute to the inte- Appraisals but be concerned about both gration into social life of a the totality of every individual small number of people. The Responsible policy on the and all human beings togeth- Dutch press was filled with problem must include insight er. When the Son of Man took the issue, presenting the argu- into the difference between on human nature—or, rather, ments for and against the toxicant-addictive substances when He became one with measure used by various po- and tobacco and alcohol. Facts every human being—He did litical parties; however, at the do confirm that alcohol and 17 so in order to redeem man in- suggestion of the ministry of tobacco also lead to dependen- tegrally. In other words, the health, parliament decided in cy or enslavement. However, Word Incarnate wants to save favor of the experiment on a such a condition is the result not only every single soul reduced scale.4 of a prolonged period of from the spiritual death of In this episode one notes abuse, whereas drug addiction mortal sin, but also each and something strange: the same is simply a consequence of every body from physical minister intends to prohibit use of the substance, which death, which is the penalty for the use of both alcohol and to- then leads to permanently en- mortal sin.1 Now if the bacco by minors below the slaving and dehumanizing Church, through the express age of 18. The main reason abuse. In any case, I would will of the Divine Redeemer, for this prohibition is not only consider it improper to classi- should continue “historically” the numerical but also the fy narcotic substances un- this same redeeming2 mission, quantitative increase in con- equivocally alongside tobacco it is clear, then, that it must at- sumption, with all its negative and alcohol. It is true one can tend to the problem that consequences for both their use either to become addicted, scourges our times. health and civilized, peaceful thus becoming enslaved or de- More and more people fall community life.5 Discussion pendent;7 nevertheless, one into drug addiction. Those hit has focused on the benefits of should not confuse the inten- most by the problem are the such a prohibition and come tion of the user with the en- young, who are most fragile to the conclusion that it is slaving nature of the substance and most vulnerable, easily more a question of a problem and/or the content of what is influenced by the temptations with many causes which can- being taken. of a so-called alternate experi- not be resolved just by prohi- Indeed, I do not agree with ence arising from a provoca- bition.6 It appears contradicto- the position of one commis- tive and rebellious3 attitude ry, when, on the one hand, sion in Holland which holds and an erroneously libertarian you foster the abuse of drugs that alcohol and tobacco are in culture. From this provocative and, on the other, do not seek effect drugs, since nicotine and libertarian culture one ar- to permit moderate use of al- and alcohol are themselves rives at the political tendency cohol and tobacco. The real toxic-addictive substances.8 I in a number of European alcoholics and chain smokers prefer to speak of drugs as countries of accepting the sta- could ask why they do not al- narcotic substances and alco- tus quo of many people who so start an experiment offer- hol and tobacco as substances are enslaved for years by their ing alcohol and tobacco. In that “may be used.” This lin- dependence on heroin. In Hol- any case, I feel such experi- guistic distinction also implies land, for example, they are ments do not deal with the a difference in moral evalua- about to start the experiment problem of either drugs or al- tion. of free distribution of heroin, cohol and tobacco, but only From a moral standpoint, three times a day, to people seek to reduce the harmful drug use is always illicit since who have been enslaved to consequences. it causes an unjustified renun- this drug for almost five Given its ethical-moral ciation of thinking, willing, years... If the experiment goes character, my presentation and acting, which are all du- on successfully in the pioneer will first of all be an in-depth ties expected of any free and city, it will then pass on to an- moral evaluation of drugs, to- reasonable person. They are other eight or nine cities. Be- bacco, and alcohol, and then I duties regarding which no hu- man being should be found being toxic to the physical or- poses a problem of dissuasion lacking, without justifiable ganism; on the contrary, alco- and prevention which should reasons. Yet drugs are known hol is a valid element for the be carried out especially to reduce the reasonableness body; 87% do not agree with through health education and of thought, free will, and the statement that “one drinks information, even by way of responsible action, even to overcome sad moments,” advertisements.”16 in small quantities. The so- but at the same time a quarter From what I have set forth called “love pill,” XTC, of the students claim that one realizes that there exist which is frequently used by “drinking a bit to ease oneself quite diverse ethical assess- the young in both Holland and from tension does help.” We ments. To grasp this clearly Belgium, has disastrous con- find that 32% of the young re- one must not focus too much sequences, not only for physi- gard alcohol as a very pleas- on the real danger of depen- cal health, but also for the dig- ant drink.13 dency because all consumers nified behavior of a human Nevertheless, I note that the of alcohol and tobacco, be- being. Some observers are up- judgment on licitness certain- cause of the possibility of set about the harmful effects ly concerns moderate use, yet abuse, run the risk of becom- of this intoxicating pill.9 One any abuse becomes illicit and ing addicts, especially when Belgian priest reports that therefore condemnable just they are still young. It is people coming out of dis- because it enslaves people therefore necessary to offer cotheques under the influence and disorientates their minds, health education and humani- of drugs drive at a suicidal jeopardizes the use of their tarian guidance aimed at ei- speed towards a “thrilling will, and therefore reduces ther abstinence or a moderate death.”10 I would like to note their sense of responsibility. use which is acceptable and 18 immediately that such a moral Many car accidents are a relaxing, offering momentary judgment of the use of drugs proof of this. Consequently, pleasure. However, by turning and their consequences is not there is justifiably very rigor- to drugs one does not only run a condemnation of the person ous legislation concerning this the risk of dependence, but— who uses drugs. Such a per- matter. Furthermore, when it is here I find the reason for son often experiences an un- abuse has reached a chronic the varied evaluation—the free life condition from which stage, the entire organism and substance itself is essentially he would like to be liberated.11 the spirit of the person suffer toxic. It is therefore harmful In any case, the attribution serious damage.14 to health, and, as regards hu- of illicitness, motivated by the I would like to caution that man dignity, it is both dehu- great harm done to both the I do not intend in any way to manizing and depersonaliz- life of the person and his dig- condemn the alcoholic per- ing. Because of this, health in- nity, demands that one should son, since often in such cases formation should be provided never speak of the freedom to one has to deal with a person and a humanitarian education use drugs. Nobody has the who is already seriously sick given as well as personalizing right to harm himself or re- and therefore in need of both and moral guidance. It is to nounce the dignity given to medical treatment and thera- this guidance that I would him by the Divine Creator; on peutic assistance which must now like to turn, beginning the contrary, we all have the aim at the integral recovery of with the dignity of the human duty to preserve this human the person.15 It is indeed evi- person. dignity and take care of the dent that prohibitions up to a health of both our body and particular age do not solve the psyche.12 problem but simply cover it 2. An Axiological Concerning the evaluation up and in a certain sense Approach to the of alcoholism from a moral legally approve what they Human Body standpoint, one may say that seek to prohibit. alcohol in itself is not illicit, The same goes for tobacco. What follows does not seek nor is its moderate use as a Its use per se is not morally to deny the pedagogical value beverage in contrast to moral unacceptable. In fact, ethical of specific legislation on the prohibitions. Within reason- illicitness arises not from its matter, but to arrive at a pro- able limits, as indicated by use, but from abuse. Exces- posal that calls upon all, in- common use among European sive use of tobacco is illicit cluding the users of alcohol populations, beer and wine because it seriously endangers and tobacco and, above all, are considered as nourish- one’s health and also causes drug consumers, to conduct ment. In relation to this point, dependency. However, mod- reflection which, more than I find the answers of a certain erate use is licit because it is all other proposals, would group of youths very interest- not harmful to health and does lead to serious personal, so- ing. About 92% of them con- not create dependency; more- ciopolitical, and pastoral-ec- sider the habit of taking wine over, the moderate smoker clesial dedication to liberation at meals a normal practice, does not seek to get from from enslavement, and even- and 40% are of the mind that nicotine the effects proper to tual integration into both the drinking wine and other alco- drugs, but just a pleasant sen- life of society and that of the holic beverages helps diges- sation. In all this, however, I ecclesial community. tion; 20% do not consider do not want to deny or under- Both believers and nonbe- drinking large quantities as value the fact that “smoking lievers have long been con- vinced that the human being is beatific vision, as He is: Tri- the prime cause and ultimate the center and summit of the une.18 end of all that exists, and this created world. Nevertheless, According to the Council cause, this end, is called God.22 when man poses questions Fathers, man justly considers Here, therefore, is the dig- about his identity and, above himself as being above the nity of the human mind. Is it all, his very finality, then the whole material world because the true magnitude of free- answers touch the extremes. he transcends it by virtue of dom? In effect, when he looks at his his mind, which is in fact a With this query we come to scientific progress and his al- participation in the light of the an important theme greatly es- most unlimited technical ca- Spirit of God. A convincing teemed by our contempo- pacity, man is tempted to con- proof of this transcendence raries, one that they jealously sider himself as a being that is comes from all the progress try to safeguard. And rightly completely autonomous and achieved by humanity through so, for God Himself willed also touches almost “divine” history, in the fields of empiri- that man should be responsi- power and knowledge. It is cal science and technology, ble for his decisions,23 so that this postmodern man who art, and the sciences of the he within himself might seek considers himself absolutely spirit. Today this is also partic- his Creator and adhere to Him empowered to determine good ularly demonstrated by the ex- in full freedom, to reach his and evil in a world of his own traordinary results of research own fullness and joy in this making. On the contrary, on the material world and mas- way.24 Freedom is, then, a touching the other extreme, tery over it. Nevertheless, in power rooted in reason and when he searches his own all this progress and research, the will to act or not to act, to heart, he discovers a radical man has always sought the do this or that in other words, division within himself, for, most profound truth. Ultimate- to perform acts that are well 19 on examining his existence, he ly, in his search for truth, thought out. Freedom is there- experiences a deep social whether he knows it or not, fore the God-given capacity of disharmony, and, on turning to man is in search for God.19 If every human being to order the world, he often finds it al- we want to know the intrinsic himself. And so, freedom is a most hostile to him. Thus he is reason for the “religious” char- force placed by God in every prone to desperation, which acter of all man’s research, we human being to enable both depersonalizes and dehu- must search for it in the sub- him/her to grow and mature in manizes him, filling him with ject himself. If, indeed, God truth and goodness. Of course, uncertainty and fear. created all things, these things this possibility for freedom to The Church has been in- not only have their own con- grow and mature is condi- creasingly aware of this “ex- sistency, with a real truth and tioned by the search for real tremist” approach, and the goodness, but also their own truth and the adherence to true Second Vatican Council even rules and structures. So, then, goodness. And since, ulti- offered a response. when man seeks to discover in mately, God is real truth and the material world this real true goodness, for He is, in- 2.1. Human Dignity truth and goodness, these char- deed, the source, it is evident and the Great Gift acteristic rules and structures that the freedom of man grows of Freedom of things, in the final analysis and matures in the measure in Inspired by divine revela- he is not seeking anything but which he turns towards God. tion, the Church teaches that Him who is the primary cause It is thus clear that man be- man is created in the image of of this, their creaturely cohe- comes freer the more he dedi- God, capable of knowing and sion.20 This explains why God cates himself to doing good, loving his Creator, who en- in the Book of Wisdom and and there is no true freedom if trusted to him the responsible the Apostle in Acts teach that not ordered to moral good. use of all creation, not as an nonbelievers are capable of Consequently, the choice of ultimate end, but while honor- knowing the Divine Creator evil is an abuse of freedom ing God.17 It is exactly this just by reflecting with their and leads to the “slavery of “religious” orientation of man minds on the created world.21 sin.”25 This true freedom, and all creation that gives the In fact, I do think that God and which prefers true goodness to human mind its true dignity the Apostle can still expect evil and in fact avoids the lat- and human freedom its true from every man of our age to ter, is the sign par excellence magnitude. The CCC teaches an even greater extent what of the image of God in man. It that God created everything, they expected from the people is therefore clear that human not to increase his glory, but of that time. In effect, today dignity demands behavior that to manifest and communicate more than ever, it seems un- is based on free and conscious it. Here, then, is the reason for questionable that man and the choices that spring from one’s the dignity of the human mind world testify that they do not conscience and confirm the and the magnitude of human have their prime principle and voice of God speaking to dignity; this communication ultimate end within them- one’s heart.26 and manifestation is living selves and depend on a Being One who is liberated from man, one destined to see God with no end or beginning. any form of enslavement to “face to face,” to love Him Therefore, man can in various his passions acquires such freely for all eternity. In short, ways arrive at awareness of dignity, moving towards his to know and love God, in the the existence of a reality that is ultimate end through the free choice of the good and dedi- soul rejoins with the body at This is why, according to the cating himself thereto serious- the moment of resurrection.37 Second Vatican Council Fa- ly and zealously.27 Freedom is, Here the philosophical speci- thers, it is illicit for man to de- then, a great gift of God and a fication that “the unity of the spise physical life; he is, on duty for which man is answer- soul and the body is so pro- the contrary, expected to con- able. There thus arises a ques- found that one must consider sider his body as both good tion about the link connecting the soul as the “form”38 of the and worthy of respect, for, the dignity of the mind, the body is both interesting and having been created by God, great gift of freedom, and the important. The major anthro- it is destined for the resurrec- value of the body. pological significance of this tion on the last day.43 precise statement is the uni- This axiological judgment 2.2. Man: The Union tive relationship of the body of the human body is made of Body and Soul and the soul. “Thanks to the more evident by God through The answer to the above spiritual soul, the body made the resurrection of the human question comes from reflec- of matter becomes a living body of his Son. The same tion on the constitutive ele- human body; spirit and Holy Trinity that intervened ments of man. The human matter in man are not two in the resurrection of Christ person, created in the image natures united, but, rather, will also intervene for us hu- of God, is at once a corporeal their union forms a single na- man beings at the end of time. and spiritual being. Holy ture.”39 The importance of the resur- Scripture reveals this to us in This unity of nature in all rection of the body of Christ a very symbolic account when its entirety constitutes every and hence that of our bodies is it says, “God shaped man human being in the dignity of for the Apostle so crucial that 20 from the soil of the ground a person, or, rather, as a being upon it depends the salvific and blew the breath of life in- capable of knowing himself, validity of Christ’s death and to his nostrils, and man be- controlling himself, freely preaching. “If Christ was not came a living being.”28 Man giving himself, and entering raised, then our preaching is willed by God is, then, that into communion with other without substance, and so is whole, a being with an ani- people. At this point it is also your faith.”44 In effect, the mated body or an incarnated significant that the spirit is “Resurrection constitutes, soul. Man is not, therefore, a separated from the soul be- above all, the confirmation of being that has a body and a cause this fact greatly increas- everything that Christ Him- soul, but a being that is a es the value of the body and self taught and did. In it all the union of the body and the hence the duty to respect it. truths, even those inaccessible soul. Indeed, Sacred Scripture The Apostle prays that our to the human mind, find their often uses the term “soul”29 to whole being, “spirit, soul, and justification; by rising from indicate human life or the body, be kept blameless for the dead, Christ gave the de- whole human person.30 It also the coming of our Lord.”40 We finitive proof (which He had designates all that is inner- immediately note that the dis- promised) of his divine au- most to man31 and of greater tinction between soul and thority.”45 value,32 and, above all, what spirit does not introduce dual- makes him the image of God: ity into the soul or into the “soul” signifies the spiritual unity of the body and the soul. Conclusion principle in man.33 By the term “spirit” St. Paul It is this meaning of “soul” wants to indicate that the soul Evidently, the human body in particular that determines has the transcendent capacity has a transcendent value in the the value of the body in all its of being gratuitously elevated plan of God. The fact of its basic dimensions and offers to communion with God.41 resurrection that is, participa- all its anthropological aspects. However, even the body tion in the resurrection The human body is, in effect, shares in this elevation of hu- of Christ though it is to human precisely because it is man nature, precisely because happen at the end of time, al- animated by a soul, by of its constitutive unity with ready demands that all which—and this is very im- the soul in human nature. human beings respect their portant—it participates in the The body arrives in this bodies and see to it that they image of God.34 The human way at the summit of its val- increasingly become a reflec- body is thus raised to the ue. In fact, with the “unity of tion of the spiritual soul. One greatest heights by the Creator body and soul man through who recognizes the body as Himself. This is what the his physical condition synthe- the image of God, for it is ani- Church means when it teaches sizes in himself the elements mated by the spiritual soul di- that “every spiritual soul is of the material world in such a rectly created by God, must created directly by God,”35 not way that through him these el- never relinquish this transcen- “produced” by parents, and is ements both reach their peak dent dignity. immortal.36 As a result, at the and praise the Creator in free- However, that is what moment of its separation from dom.42 Because of its ontic happens when the use of the body at death, the soul condition the human body drugs and the abuse of alcohol does not die, but is aware, synthesizes the whole materi- and tobacco prevent the mind waiting to uplift the value of al world, for which it becomes from being a flash of divine the body once again, when the the instrument of “worship.” light and the freedom of the will from displaying the sign the body in particular, willed 8 Vrijheid en Verantwoordelijkheid: Over Verslaving en Jongeren (“Free- par excellence of being the by God himself. dom and Responsibility: Dependence image of God. That is why the In summary, the dignity of and the Young”) (Amsterdam: Sticht- Church may never accept cer- man as the image of God, ing de Regenboog, 1997), pp. 6-7. 9 “Veel stappers Zuid-Limburg tain “political” solutions even from a corporeal point of slikken XTC,” in Limburgs Dagblad, which consider the enslaved view, demands liberation of July 17, 1997, 1. human person as one inca- the drug addict and not the 10 “Dood als ultieme Kick” (“Death as the Last Kick”), in Dagblad de Lim- pable of recovery. For he is liberalization of drugs. We burger, February 3, 1996, 47. fundamentally one created in must therefore not liberalize 11 Cf. Charter, no. 94. the image of God, with a vo- toxic substances, but liberate 12 JOHN PAUL II, “Address to Partici- cation to become more and the addict from the slavery of pants in the Eighth International Conference, on Drugs and Alcohol,” more a person in the likeness addiction. November 23, 1991, in Insegnamenti of God. VII, 2. Indeed, we must cry out 13 Data Center on Young People and Rev. BONIFACIO HONINGS, Alcohol, Condizione giovanile e con- against strategies that aim at O.C.D. sumo di alcool. Dalle motivazioni alla just reducing “social” dam- Member of the Pontifical regolazione (Rome: OTET, 1993), pp. age; these are not worthy of a Academy for Life, 170-171. Consultor to the Congregation 14 Cf. Charter, no. 97. civilized society. A society— 15 for the Doctrine of the Faith Cf. Ibid., no. 98. and, above all, a political sys- 16 Ibid., no. 99. and the Pontifical Council 17 tem—which treats some of its for Pastoral Assistance Cf. Gaudium et Spes, no. 12. 18 Cf. CCC, nos. 293-294. members as unrecoverable so- to Health Care Workers 19 Cf. Gaudium et Spes, no. 15. cial rejects, especially when 20 Ibid., no. 36. they are still young, is not 21 Cf. Wisdom 13:1-9 and Acts 14; 15:17; 17:27-28. 21 worthy of the name “civi- 22 Cf. CCC, no. 34. lized.” Besides, one must cen- 23 Cf. Sirach, 15:14. sure the mentality which from 24 Cf. CCC, no. 1730. 25 Cf. Romans 6:17. a moral standpoint confuses Notes 26 Cf. Gaudium et Spes, no. 16. the use of toxic substances 27 Cf. Ibid., no. 17. with the use of normally 1 Cf. Gaudium et Spes, 22. 28 Genesis 2:7. 2 Cf. Matthew 28:19-20 and The 29 Cf. Matthew 16:25-26; John agreeable substances and Catechism of the Catholic Church, 15:13. gives rise to “free” distribu- 849-851 (hereafter cited as CCC). 30 Cf. Acts 2:41. tion of heroin and, even 3 Drugs: Resistance or Surrender? 31 Cf. Matthew 26:38; John 12:27. Proceedings of the Fifteenth Confer- 32 Cf. Matthew 10:28; 2 Maccabees worse, to legalizing it and lib- ence on International Problems orga- 6:30. eralizing the sale of so-called nized by the Rezzara Institute of Vicen- 33 CCC., no. 363. “soft drugs,” while at the za, September 9-11, 1982 (Vicenza, 34 Cf. ibid., no. 364. same time prohibiting all use 1983), p. III. (Hereafter cited as 35 Cf. PIUS XII, Humani Drugs.) Generis; Denzinger, 3896; Paul VI, of tobacco or alcohol by mi- 4 One article presents political advo- Creed of the People of God, 8. nors under age 18. Obviously, cacy of limiting the sample group of 36 Cf. Fifth Lateran Council (1513), I do not want to underestimate addicts to a few people in one city in- Denzinger, 1440. stead of 750 in several localities. Cf. 37 Cf. CCC, no. 366. the difficulties of drug addic- Dagblad de Limburger (a newspaper in 38 Cf. Council of Vienna (1312), tion; rather, in the name of hu- the Province of Limburg), August Denzinger, 902. man dignity and the value of 18,1997, 1. 39 CCC, no. 366. 5 Cf. Limburgs Dagblad, July 11, 40 1 Thessalonians 5:23. the body, I ask that the prob- 1997, 3. 41 Cf. PIUS XII, Encyclical Humani lem be faced by using mea- 6 Cf. Dagblad de Limburger, July Generis, Denzinger, 3891. sures and instruments which 19, 1997, 21. 42 Gaudium et Spes, no. 14. 7 Cf. The Charter for Health Care 43 Ibid., no. 14. are in conformity with this Workers (Vatican City, 1994), no. 92. 44 1 Corinthians 15:14. dignity and with the value of (Hereafter cited as Charter.) 45 CCC, no. 651. Education to Promote Life

Introduction The prevention of drug ad- the integral formation of the diction is carried out particu- human person through the It is a great honor for me to larly through global education systematic and critical assimi- contribute to reflection at this of the person, over the course lation of culture (Document Church Symposium which of an educational process on the Catholic School). the Pontifical Council for which is carefully directed, Pastoral Assistance to Health especially in the early years 1.2. The need to overcome Care Workers has wished to of life. Michel Merson, Coor- a restricted view hold on the problem of drug dinator of WHOs programs of education addiction. on AIDS, was once asked Examples of restricted I thank Archbishop Javier about the age at which pre- views are traditionalism (to Lozano for having invited me vention of this illness should follow traditions) and utilitar- and hope I will not disappoint begin. He replied, At age six, ianism (to pursue interests). 22 his expectations regarding my at the latest. As regards drugs, Educate must liberate, bring- participation. we may say that it is appropri- ing the person to adopt atti- ate for prevention to begin at tudes which will serve the 1. Drug addiction is situated about age two, when the child common good. So that they in the so-called death culture, starts to say no. It is a prob- will not let themselves be which, as Pope John Paul II lem of global education. dominated by the freedom of states, dominates a large part instincts, but live out the free- of human behavior. How can 3. The Church, expert in dom of the spirit, the freedom we fail to consider...the sow- humanity, having devoted of the children of God, as St. ing of death which is effected herself to education for cen- Paul says in his Letter to the by the imprudent disturbance turies, must be at the forefront Galatians (cf. Ga 5:13-19). of ecological balances, the in preventing this disease of To achieve this freedom al- criminal spread of drugs, or our time, drug addiction and most a whole lifetime is need- the fostering of models of sex- AIDS. She must take on her ed. The coordinates of educa- ual practice which, in addition responsibility to educate by tion in this connection are to being morally unaccept- preventing and to prevent by quite clear. The first one em- able, also bear serious risks to educating. braces all of mans life; the life? (EV, 10). second demands dialogue for Drug addiction compromis- complementarity among peo- es the basic values of life, 1. To Educate for Life ple; the third involves atten- freedom, health, and the ca- tion to our surroundings so as pacity to construct projects 1.1. What is education? to be consistent with the ma- for the future. Society has the For some it consists of cre- jor problems of the human be- duty to organize itself so as to ating habits; for others, of ing and the basic currents in offer all, especially the learning rules; and for others, contemporary society. youngest, the values needed of following traditions. I pre- Education also possesses to build a life of quality. fer to say that to educate is to some characteristic aspects. It liberate, help people take up is built in freedom to achieve 2. Aware of this, we know their own freedom with the responsibility; in justice, for that the problem of drug ad- responsibility demanded by Love; in the values which are diction is not resolved by re- social life in relations with the foundation for human pression, though it is an im- others. Butwhat is freedom? rights. Moreover, it demands portant aspect in the fight As Vatican II affirms, free- attention to sexuality and af- against the drug traffic; nor is dom is the capacity to choose; fectivity as essential elements it resolved even by medical in- it is the chance to opt for the in the formation of the person. tervention, though it is indis- better of two things; it is to Finally, education must con- pensable for some who have accept and prefer what is template transcendence, open- already let themselves get good for others, even with ing out to faith, prayer, and hooked; furthermore, it is not personal sacrifice. In the hap- community life. resolved by liberalization or py phrase of the Council, We might speak of the vec- mere depenalization, though freedom is the special sign of tors which should be borne in this might be agreeable to all the image of God in mans mind. Indeed, without them who like to immerse them- heart (GS, 17). the personality is not con- selves in the easiest experi- Education, which frees and structed. We educate when we ences. bestows responsibility, is thus respect and promote self-es- teem, when deep affective re- alcohol, tobacco, drugs, and Him readily accept Him as lations are completed and ac- licit pharmaceuticals, are the the only absolute, as a perma- companied, when the initia- result of aggression provoked nence reference point en- tives of adolescents and by the misuse of freedom and abling them to be guided by young people in doing what of substances which ought to the Spirit (cf. Rm 8:14), expe- they like and what is positive be used for other purposes. riencing the freedom of the are supported, and, finally, Drug consumption often children of God (cf. Ga 5:15) when prospects for the future occurs because an adolescent, and attaining to the joy of liv- are opened up which will per- a young person, or even an ing fully (cf. Jn 15:15). mit the construction of valid adult is unable to bear the an- To educate for promoting projects, projects for life. guish of existence. life is, then, to educate people There is escapism, an effort who want to be free and hap- 1.3. Let us educate for life. to get free. The availability of py, in a community seeking to To do so, each educator a substance facilitates this ex- realize itself justly and frater- must possess a global concep- perience, and, in terms of de- nally. tion of life: pendence, the consequences life and health as biopsy- are not long in coming. chosocial and cultural reality We know that many began 2. Promoting Life: and well-being; after dropping out of school The Churchs life as the integral realiza- or while waiting for their first Responsibility tion of the person; job or during serious family life as rights and duties, as crises. At root, existential an- 1.1. The Churchs first concern a gift for which each is re- guish is always present, psy- is to educate sponsible and an inalienable chological suffering which is the new generations 23 good which is not at anyones apparently insurmountable. It in full Christian life disposal; is clear that if life were orient- This is the responsibility of life as a consuming dy- ed and educated in times of each Christian family, catech- namism, the source of all pos- crisis as well, the road would esis in parishes and Catholic sible creativity, openness to a really be different. schools, and youth move- happiness which is constantly In the final analysis, the ments, especially in this time recreated; meaning of life is involved in of new evangelization. life with quality, not a qual- the educational process. The announcement of the ity of life mainly or exclusive- Gospel with new ardor, a new ly interpreted as economic ef- 1.5. To educate to promote method, and new forms of ex- ficiency, disorderly con- life involves providing pression also means fostering sumerism, beauty, and the en- orientation for personal attention to the new problems joyment of physical life which fulfillment and the in todays society and the dif- overlooks the deepestrelation- meaning of life ferent coordinates motivating al, spiritual, and religiousdi- Many of our contempo- and providing the context for mensions of existence (EV, raries have lost sight of the teenagers and young people. 23), but an overall quality of meaning of life. How can When in the Synod on cate- life wherein the aspirations of they convey it to the young? chesis there was reference to the person involve, above all, In terms of culture and life education in faith, it was ex- integral improvement of life projects, most people have pressly stated that what was conditions in all dimensions. lost their reason for existence, being debated was initiation or it has become diminished into Christian life (CT, 21). 1.4. Educating for life through the influence of less- And a Christian is always re- involves er motives which at most pro- quired to live in the freedom anticipating risks vide ephemeral pleasures. of the children of God. Many risks appear in the The result is an immense As a result, the concrete ob- normal course of human life: void. jectives of Christian educa- illness and underdevelop- In the educational process it tion are the development of ment, accidents and disabili- is thus necessary to tend to- the person for the sake of in- ties, and behavior which may wards the dignity and free- tegral realization, the an- provoke threats to health and dom of each person, individ- nouncement of Christ so that life, as well as social violence, ual and social development, He may give meaning to life ecological imbalance, and ethical sensitivity, and the so- and become the basis for all consumerism. It is time to ed- cial values which are indis- options, and the introduction ucate for life and the quality pensable for human relations. into Christian communities a of life, especially if they de- Tolerance, community life, sense of faith and prayer, in- pend precisely on human be- dialogue, and solidarity are cluding the sharing of goods. havior itself. indispensable values for con- Logically, promoting life con- A moral theologian, Bernard structing a project which will sists of this educational re- Hring, clearly stated, God al- give meaning to life. sponsibility of the Church and ways forgives; human beings Not all find the reason for implies preventing all that sometimes forgive; but nature their lives in Christ. Those may be harmful to life. never forgives. Many situa- who one day received the gift Biopsychosocial, cultural, tions of dependence, involving of knowing and following religious, and supernatural development involves orga- the educational process is systematically and critically nized action in the area of more pleasant for both educa- assimilate Christian culture preventing drug addiction. tors and teenagers or young for Christian life and behav- For many, prevention people. ior. means speaking about drugs, To convey a balance be- The first major sphere is about the different drugs, with tween the new culture and tra- the family, the social place their characteristics and con- ditional values; there can be where life is born, grows, and sequences, ongoing attention no contradiction, but, rather, develops (CFL). The family whose purpose is to keep complementarity imposes it- is a community of persons young people, above all, self; whose duty is to educate away from drug use. This is To develop the idea and the through the constant presence specific prevention which is practice (experience) that a of parents who offer ongoing justifiable when the target profession is a service and not witness and speak at the right group is made up of people at just a source of gain, since time and where a simple but risk. money is not the most impor- happy environment is created. When the whole population tant thing; Parish catechesis is a sec- is being addressed, the main To direct people towards ond educational sphere; it strategy is nonspecific pre- art and aesthetic perception to must not be limited to teach- ventionthat is, global educa- educate the sensibility of chil- ing doctrinesconcepts are cer- tion providing elements to in- dren and young people: mu- tainly important, but even hibit all behavior which may sic, painting, drama, and more important is teaching harm human life and divert many other arts are basic to people how to live, beginning people away from the reason integrally building the per- Christian life with positive re- 24 for their lives. sonality of each individual; lationships with others, as We may thus speak of pre- To support the practice of well as a continuous relation- vention of drug addiction sports, not as a form of com- ship with God. Fraternal love through a global process in- petition, but rather as a source and prayer, involvement in volving education in of physical and psychological temporal duties and apostolic responsible freedom; stability; responsibilities, the use of a healthy lifestyle; To open oneself to ethical free time, and, above all, the balanced affection in inter- and moral concerns as a refer- openness of ones heart are al- personal relationships; ence for relations with others, so factors which dissuade a sexuality whose aims for only by respecting the people from taking drugs and transcend momentary plea- rights of others will we arrive engaging in negative behavior sure; at a just society; respect for which cancels out dreams. the major values at the root conscience is related to the The Catholic school has a of life: justice, solidarity, and establishment of brotherhood; specific mission in this educa- peace. Not to fear the challenge of tional process. If it comple- Primary prevention, as re- Christian faith and the expres- ments the family and often re- ferred to by those working in sion of religiosity, for human places it as well, it must for the struggle against drug ad- beings encounter full realiza- the same reason overcome the diction, involves speaking tion only in transcendence temptation to be just a place about life, the meaning of life, and a relationship with God is for learning and really consti- rather than about drugs. the best way to encounter tute a global educational con- When teenagers and young oneself in the depths of ones text where the human being is people know why they are being. built up on an overall basis. In living and how they ought to Every human person finds going beyond mere knowl- live, they do not need drugs. self-realization only in this edge, the Catholic school ac- This is the challenge of an ed- global process. It is along companies and develops the ucational process which leads these lines and in this context person as a whole so that to the happiness that everyone that educators can develop young people will be useful to has a right to, lasting happi- their educational program. society, friends to all men, ness. The Church has a large re- and also Gods co-workers. sponsibility in this whole Youth groups and lay apos- 2.2. There are essential area. tolic movements are also elements for promoting Such realization is the places for initiation into life without which source of true joy enabling Christian life, in terms of time educators feel frustrated one to respond, Drugs? No, and worship. No one can give To educate does not mean thank you. I dont need them. what he lacks; no one con- to teach concepts or impose veys something he is not. attitudes. To educate is to ac- 2.3. A time of How can young people free company people in their nor- new evangelization others if they are prisoners? mal growth. This accompani- It is the duty of Christian How can they convince others ment calls for pathways communities to renew their if they themselves are vulner- where it is easy to move at the efforts in the educational able and let themselves be same pace. sphere in those places fre- caught up easily in compro- It is helpful to recall some quented by teenagers and mising experiences? frameworks for action where young people so that they will The youth apostolate in groups and movements is in- To provide information to men by which we can be disputably a special context and guidance in the frame- saved except that of Jesus for preventing drug addiction, work of specific prevention as Christ (Ac 4:12). not because of prohibitions or regards groups at risk in cer- threats, but because it initiates tain situationsthat is, not to be them into responsible free- afraid to talk about drugs, but, Conclusion dom and provides fulfilling, above all, to convey values happy experiences of group which will enable people to The drug problem is clearly life. With social concerns and grasp that drugs are of no use. the most serious one at the a positive relationship with To work on the recovery of close of this millennium. We God and others, young people people who have fallen into all have a responsibility. No have no time to devote them- the trap. This can be done one is exempt. The Church, selves to drug taking, which through a bold effort to re-ed- expert in humanity, has a ma- cuts off the road they want to ucate character and personali- jor duty to perform. If it is travel. ty until obtaining a conver- good to work on treatment of In all educational action the sion, a change into a new drug addicts, it is much better Church prohibits nothing, but creature. It is a very difficult to keep teenagers and young presents certain objectives but essential process in which people from falling into this which, if pursued, help people Christian values can be quite nightmare. We shall do so on- to be happy. positive. ly if we educate them in life. To effect the social and May Mary, the source of 2.4. A summary of our professional reintegration of life, who has given us to collective responsibility those who recover, in collabo- Christ, also be a source of in education to ration with businesses and in- hope for those of us who want 25 promote life stitutions that are prepared to to transmit life, Jesus Christ, In terms of preventing drug accept people who, once the to the young. addiction, we may perhaps crisis is overcome, want to be make some suggestions on useful to society. Rev. VITOR FEYTOR PINTO the action to be taken. To bring the light of faith High Commissioner for the Fight To act with all possible to bear on all of this action, in Against Drugs in Portugal means towards global educa- the certainty that, even if we Consultor to the Pontifical Council tion as a nonspecific form of do all we can, there is no oth- for Pastoral Assistance prevention. er name under heaven given to Health Care Workers From Treatment to Self-Discovery: The Person as a Value

The life of drug addicts is themselves from a bitter slav- change undergoes oscillations marked by risky ventures. Ad- ery or achieve their goals. It al- in decisiveness and intensity. It dicts are often forced to hide so seems to make our interven- cannot be induced from out- acts and occasions even from tion more rational, more pre- side, but it can be prompted by their intimates and loved ones; dictable and programmable, one close to the addict, by af- caught up in difficult relation- making us feel apparently fection offered through a ships; often in conflict; condi- more secure and capable of modality that is the fruit of re- tioned by the need to manipu- managing our decisions. flection and continued meeting late and exploit both their own But the causes of addictive with others, including profes- sentiments and those of others, behavior are varied. A number sionals who have specific ex- and marked also by self-de- of factors are hidden within perience in the field. It is nec- ception. the history of people who take essary also to propose ways The violent negation of to the fatal use of narcotics, that are appropriate to the par- 26 one’s situation, the inability to underestimating their dangers, ticular situation of the user, realize the need for help, inter- and making them both desir- identifying solutions in refer- nalized contempt and loss of able and part of their very ence to the uniqueness of his prospects, a kind of moving on lifestyle. And therefore the problems. hopelessly, the weight of problem of drug-addicts must Only through self-care by rankling defeats, the painful be considered from various the drug-addict with all the memory of harm suffered and points of view. burden of his suffering, and caused, the loss of confidence The definitions formulated without external stress or pre- and the disappointment of a so far mostly offer the perspec- conditions, is it possible to es- growing mistrust—all these tive of the one defining rather tablish a helping relationship enclose them within the circle than the nature of the phenom- that gives rise to an initial mo- of their solitude. enon as such. None of them tivation capable of dealing Alternating between the de- can be taken as being defini- with his moods, always ac- sire to change and the dream tive. All must be understood companying him even when of dominating the drug, the de- and taken as an interesting the chosen activities are not sire for tranquillity and nor- contribution to the understand- shareable, without giving up or mality and the impossibility of ing of the background of drug giving in to his slumps and holding up the daily routine addicts. failures. plus the boredom of an ordi- Like fever, drug-addiction is There are some necessary nary life, the fragmentary im- a condition caused by a num- qualities, such as having extra pulses to free oneself from the ber of interacting factors hope and the readiness to re- spiral of an existence bound up which mutually reinforce each ceive and listen to people, by a very intense attraction, other, and, just like the former, which one may not attain just the burden of pervasive anxi- it is not a disease, but a symp- by professional training alone, ety, and the aspiration towards tom. but only through choosing a serenity make his internal The uniqueness of the mani- coherent and clear life, also world both contradictory and fested disturbance may be re- outside the work schedule. An lacerating. lated to personal, relational, authentic faith, enriched by a and social problems different permanent search for the face from the self-evident uneasi- of Christ in the poor, the lost, Taking care of oneself ness that acts in behavior as a and those with bewildered character disorder, sometimes hearts, can greatly help to Contact with these brothers manifesting neurotic or even maintain and enlarge these di- and sisters of ours cannot but psychotic disturbances. Be- mensions. It is the passion for raise a long series of questions, cause of this complexity and man that makes professional about which we feel greatly the plurality of factors, the knowledge fruitful and helps concerned. It seems to us that psychological approaches to one persevere gratuitously in the hope or the illusion of find- the cure of addiction are diver- an often frustrating relation- ing the cause of the problem sified, and experience shows ship. that afflicts them could lessen that none of them can produce Every addict has his own the seriousness of the damage remarkable results when history different from the oth- we notice in them, make less singly applied. It is therefore ers. He has his own name. His painful and paralyzing the necessary to use them in con- uniqueness is often dangerous- powerlessness experienced in junction. ly sought, obstinately pursued trying to help them to free Moreover, the motivation to by going against all advice re- ceived. He has potentialities ple relationships which are blaming situations and other which have never been fully spontaneous and immediate people for causing this suffer- expressed, a memory of posi- and do not demand any effort ing. It requires both going be- tive experiences in life and bits for confrontation, dialogue, ac- yond the anger of rebellion in of kindness experienced and ceptance of change, readiness falling back into victimization yet marked by contradiction to admit difference, or manag- and looking back over one’s and negativity. ing conflict and frustration. history in order to overcome This person who is internal- These myths, which often unassimilated sufferings and ly broken is to be accepted and impress people with images of conditions which interfere recognized without being jus- self-value and realization por- with the present, hindering the tified. He needs to be listened trayed as material and social action of appropriate behavior. to, without allowing self-justi- success, take a strong hold on It is also necessary to re-exam- fication, encouraged, and fol- individuals who do not accept ine family, friends, and social lowed with demands that stim- themselves in their hearts and relations in order to reorient ulate his potentialities and do do not value themselves for relational styles in a manner respect his dignity. the human qualities and poten- that better meets one’s affec- He needs a partnership, not tialities they possess. tive and communicative needs. sympathy; sharing, not pity; They are like people off This work of liberation re- warm and demanding relation- track, following the very way quires the active and attentive ships, not permissiveness. He that leads them far from them- presence of well-prepared ex- does not need to have someone selves. They either do not perts who set up positive dy- take his place in duties he is know how or are unable to ex- namics and work in a team capable of accomplishing. He press themselves as they within a definite educational needs one who can inquire would like to, nor can they re- plan, with clear objectives and 27 with firmness about the re- late themselves according to appropriate instruments. They sponsibilities he is capable of their needs. Their affectivity must keep themselves up-to- assuming. needs to be rehabilitated. The date and be able to verify both He needs to be considered a use of drugs, which is a very their work and the suitability person and not a problem, a strong emotional experience, of proposed rehabilitative person to be loved and not a accelerates self-deterioration measures for the problems of case to be analyzed, not an in- and always locks them deeper the people in question. dividual to condition and in- into a dissatisfaction that ap- Though the creation of this doctrinate, but one to be appre- parently sees the temporary re- consciousness is necessary, it ciated and helped to discover lief given by a binding and is, however, not sufficient himself in his needs and rich- narcissistic pleasure of disor- alone to remedy the situation. es. der as the only solution. They In order to recover the trust are adolescents fixated in the that helps one live as an indi- anxious phase of self-discov- vidual who can both love him- Self-discovery ery who, having been lost in self and others and is also ca- shallow fruitless attempts, are pable of dedication and gratu- The difficulty of recogniz- forced into repetitiveness with itousness, there is need for ing one’s basic needs, such as rigid behavior which is not sharing of experiences in the a sense of belonging, being es- constructive, but only ends up life of a group or in a common teemed, being loved, valuing isolating them more in the life where reciprocal exchange oneself, and searching and tragic and seductive cocoon of and interest in others facilitate finding meaning in existence, their own emotions. the discovery of the peculiarity generates confusion in adopt- Self-knowledge is indis- and uniqueness of oneself, the ing suitable behavior to meet pensable if one is to escape maturation of one’s potentiali- these demands effectively. from this prison in which peo- ties, and the ability to give and An inability to identify the ple stay badly within them- receive. sources of pleasure and the selves, very suspicious of the Self-discovery is, therefore, satisfaction of joy is the source external and paradoxically putting up with both one’s own of the indisposition that tor- clinging to their own chains. It weakness and that of others, ments the person tied by is a process that requires mo- communicating while sharing chains of addiction. ments of reflection, meeting the difficulties of others, and A drug-addict is incapable with others, and the expression assuming responsibility for of orienting himself among of one’s sentiments. both one’s own change and values, attitudes, and behavior To come out of the sad situa- that of others. proposed by educational agen- tion, one must have the Ð It is experiencing and ex- cies and by messages con- courage to admit both the dra- pressing the beauty and power veyed through the media. Con- ma of it and the impossibility of sentiments, without using temporary myths propose hap- of being able to free oneself them for exploitation and ma- piness as the immediate satis- from such a complex problem nipulation, and the courage to faction of one’s desires, pre- without the help of others. be consistent with oneself. senting a mature person as one It is necessary, however, for Ð It is devoting oneself to a who is self-sufficient, with no one to assume responsibility temporary environment and need of being with others, and both for one’s own actions and accepting the discipline estab- thus present the dream of sim- condition and also to stop lished for practical purposes and the formation of a commu- The vigor of the educational these sentiments, so that one’s nity life in which each partici- environment depends upon the action is not a result of just an pates according to his own ca- intensity of the involvement of external effort that one makes pacity. all, plus their sincere participa- in particular circumstances or It is facing together with tion. The objective is to create for a certain period. It should others the will to set objectives conditions that help people in be part and parcel of us. for personal growth and be difficulties to work out choices Ð Which of us agree to be able to reach them. It is also directed towards the taking on approached and touched by making daily choices, know- of a new lifestyle, based on val- others without the barrier of ing how to plan. ues that are truly internalized. social conditioning and per- One cannot condition or di- sonal fears, or without the rect people according to pre- shadow of opinions and preju- The educational process established schemes; one can dices, or with a clear and will- only offer opportunities that ing heart, as sinners were ap- The concept of self-help lead to self-discovery and the proached by Him? clearly expresses this convic- making of choices. Neither is Ð Which of us can break the tion. The experiences of recov- it possible to force the stages circle of condemnation and the ery programs for alcoholics, of change. One must instead wall of solitude, as He did with like A.A (Alcoholics Anony- offer stimuli and hints in order the adulterous woman? Which mous) and C.A.T (Club for Al- not to leave the person idle and of us are capable of intuiting coholics on Treatment) and the bent on himself, and also wait the ability to love hidden in in- fundamentals of therapeutic coherent and destructive be- communities for drug-addicts, havior? 28 initially organized by people Ð Which of us can invite who had the problem them- ourselves into the inner house selves, are based on this as- of others with absolute liberty sumption, which today is even and gratuitousness, as He did accepted and proposed in aca- with Zaccheus? demic circles. Ð Who has the power to It is they who transformed awaken the desire for conver- their own personal experience sion and change, as He did into an educational project. with Matthew? They assert that, despite the Ð Who can tolerate weak- fact that many factors con- ness of heart and inconsistency tributed to favor the onset of in behavior, keeping others addiction, the individual re- company, as He did with Pe- mains to a certain extent re- ter? sponsible for his own behavior Ð Which of us can approach and is capable of exercising an others, pervaded by absolute active role in his recovery. trust in meeting brothers and In this way therapist-patient patiently while keeping a cer- sisters to whom we can an- polarity is overcome, and the tain pace. nounce by our presence the intervention concentrates on One can and indeed should good news that they are sons the person, who is asked to as- demand without imposing. Af- and daughters of God, chosen, sume responsibility for him- ter failures, it is necessary for accepted, favored, and loved self and get himself to act by one to go beyond personal exactly because of who they investing all his potentialities emotions and be able to start are, regardless of whether they in the educational context. anew, allowing the other to re- are suffering, sick, or sinners? Though he must be helped, he cover confidence and take on Of course the concept of also does his best. He is helped his own responsibilities. self-help does not convey all of by helping both himself and The human person as a val- this, but it contains or proposes others, who then become the ue has always been at the cen- an approach to the person that mirror for his needs and stimu- ter of reflection and effective both points to and recalls late his efforts. action. This is at the heart of Christ the Lord as the ultimate The helper should not be the Gospel, and Jesus shows horizon. It is a preamble that lost in the defense of his role, himself as the healer par ex- leads to Him, if one is able to however; he must be able to cellence. Every believer follow all its development. It is establish a helping relationship should draw inspiration from not a matter of mere chance based on listening, empathy, Him in both helping and that it was indicated for the and sharing. Though he must agreeing to be helped, not only sick and not for the healthy, for be able to propose clear direc- as an example for adequate be- sinners and not for saints. tions for growth which are havior, but also as a source of The self-help experience is firm and destined towards per- motivation and the foundation undergone in fixed meeting sonal development, he ought of being. groups at definite times during to participate in the education- His relational must be the week or in residential and al process and the dynamics of ours, but this can only come semi-residential communities relationship, while at the same from a heart purified by asceti- relating to the history and time exercising his role. cism, to be able to conform to characteristics of the person. It is practiced in two types his goodness is an end and can their situation, enclosing them- of situations. never be a means. He con- selves into self-sufficiency or serves his dignity even when victimizing themselves, at- a) During meetings he is lost in feelings of discom- tributing the blame to others These are of various types: fort and deviation. He is al- (that is, certain individuals or individual, group, family, ways redeemable. He is ac- society) and in this way justi- community, etc. Here more cepted with total openness fying their failures. An involv- varied psychological ap- without prejudices. The suffer- ing common life where people proaches are used, making ing that is part of every human know how to take care of each sure that they are geared to- life is listened to and shared. It other paves the way towards wards facilitating relations in is a guide that leads to the dis- trust and the possibility of be- the group and in shared life, covery of the essential, and the ing true to oneself, sustained and also helping the individual genuineness and deepness of a by the warmth of being wel- to program himself to be able meeting with others. come and the absence of accu- to build up an autonomous and I cannot declare myself un- sation. When I feel myself responsible life in society. This concerned about the suffering welcome, the fear of my weak- corresponds to the need for of my brother; on the contrary, nesses is reduced, and the sup- self-awareness. I am even united to his sin. In port I receive is transformed his inconsistencies, I can read into trust and the discovery b)In the community my own inconsistencies, and I that expressing one’s need for or group context am both involved and respon- help is rewarding because it The knowledge and discov- means experiencing closeness. ery of oneself is an element of 3) Learn to recognize, un- one’s process in change, which derstand, and express one’s 29 runs the risk of being weak, emotions and sentiments partial, and unverified if it is The use of drugs, involving not transformed into an experi- very intense emotions, reduces ence that provides the individ- sensitivity to perceiving the ual with a way of measuring many nuances in normal exis- himself in the concreteness of tence: the beauty of life, the relations and difficulties value of small gestures, and brought about by participation the recognition that one re- in community life. ceives by accepting responsi- Self-knowledge has mean- bilities. Everything becomes ing if it is learning to open up uninteresting and boring and oneself and make significant provokes anxiety and fear. The decisions for oneself, in rela- emotional life flattens, and one tion to the lives of others. In is reduced to feeling either fact, man is what he becomes. downcast or in high spirits. This experiential aspect of Feelings of inferiority, inad- knowledge is much more nec- sible in a certain way. I cannot equacy, guilt, unworthiness, or essary when the individual is answer the question “Adam, unrealistic security; the need to negatively marked in his back- where are you?” if I cannot at hide oneself; and the impossi- ground. the same time answer the oth- bility of being sincere even to There are factors that con- er: “Cain, where is your broth- loved ones provoke the inabili- tribute to the quality of com- er, Abel?” My place is next to ty to recognize sentiments and mon life and its transforming my brother, and I am asked to the habit of using them for ar- capacity, within which the in- walk with him in order to make bitrary ends. dividual is called to look into an appeal for change, prompt One’s emotionality must be himself and make choices. longing for a full life. To this re-educated by following spe- These factors can partly be end I must be able to cope with cific techniques in such a way measured by following certain my own consistency and make as to help the individual ex- approximate criteria for verifi- demanding requests directed press himself in a direct and cation which takes into consid- towards personal growth and appropriate way what he really eration parameters applied to an aptitude for choice. feels. It is only in this manner human action. A life plan cannot be im- that he will be in a position to Here are some of them.: posed; rather, it is discovered develop relations in which rec- 1) A clear anthropological through listening to the needs iprocity and interdependence vision of the person, facilitating con- allow an authentic and reassur- In order to bring about scious and responsible accep- ing exchange. change it is not enough to have tance of the objectives which 4) Knowing how to deal a well-defined methodology are gradually identified, with with the behavior of others in and follow techniques in an determination and patience. order to motivate them to- appropriate way; one needs to 2) To recognize the need to wards change have a vision of man capable be helped and be able to ask The narcissistic retreat into of attracting and liberating. for help his emotions and his concern Our vision of man is inspired Drug-addicts have a tenden- for pleasure make the drug ad- by the Gospel. The person and cy to deny the complexity of dict incapable of acting in the true interests of others. With the community, experiencing because the external environ- his isolation from the rest of approval in maintaining rela- ment puts both personal objec- the world as well, he gets used tionships which are not only tives and proven values to the to relationships of complicity friendly, but also functional, test. Internalization then takes and silence. The other drug- and in seeking and bringing place, with a daily confronta- addicts serve as a prop and about collaboration in the tion in a setting where values confirm continual behavior process. not so pervasive and evident as contradictory to social and pri- 6) Presence of positive pres- in a protected situation. The vate life. sure from the peer group group backed up by the pres- Changing this manner of re- The intensity with which ence of helpers is an accept- lationship is particularly diffi- people dedicate themselves to able reference to the individual cult, for it requires a sense of common life, the will with for the verification and one’s identity that is already which they follow up the real- strengthening of his personal solid. To use confrontation in ization of the objectives of per- convictions. order to contribute to the be- sonal growth, and the degree 9) The change of negative havioral change of the other of honesty and genuineness in attitudes to life into positive without causing harm entails relationships exert positive ones going out of oneself, overcom- pressure on every involved Deep sentiments, like feel- ing the fear of being rejected member towards change and ing inadequate, lacking rights, and remaining alone after ex- foster the overcoming of the not deserving to be loved, a pressing what one really rule of complicity and mistrust sense of uselessness, and an thinks, with the result that one inability to confide in others, accepts the conflict and ten- are common among drug-ad- 30 sion demanded by any authen- dicts and determine their atti- tic relationship. As one exer- tude towards life. They consti- cises oneself, self-confidence tute a serious obstacle to well- also develops, trust emerges, being and are a source of con- and protection decreases; one tinued lack of motivation. experiences the joy of being However, the experience of accepted just as one is and common or group life, the fab- loved for what one is, with no ric of immediate and warm re- need for demonstrating or hid- lations, along with the accom- ing. panying involvement and par- 5) Strengthening self-esteem ticipation, influence more than through participation in com- anything else both the mitiga- mon life and the acceptance of tion and overcoming of nega- responsibility tive sentiments. One starts to The effort to build authentic think of a different future and relationships is tied up with the experiences a new mode of ex- duty to exercise responsibili- istence in the world. ties which the individual ac- that often characterizes drug- 10) The improvement of cepts and are entrusted addicts, especially when they one’s relations with one’s fami- to him. However, this is an have suffered long imprison- ly uncommon position for the ment. One opens up to the con- The time spent in the reha- drug-addict, whose usual ten- struction of a new scale of val- bilitation program establishes dency is to isolate himself ues. a sufficient distance from the from the environment in which 7) Internalization of the sys- parents to help overcome re- he lives and practice negative tem of values sentment and guilt feelings, to criticism, alternating rebellion The ability to listen, taking feel tranquil and be able to en- with indifference. He learns to care of others, the sharing of dure positive criticism. The make decisions by considering problems, sufferings, and suc- desire to ameliorate one’s rela- the thoughts, sentiments, and cesses, honesty in relation- tions with one’s family grows reactions of others. ships, acceptance of responsi- and is destined to elicit a re- If the participation in shared bility, attention to and respect sponse. concerns is a stimulus for the for people, agreeing to enter improvement of one’s poten- into discussions, the practice tialities, for the development of solidarity, the exploitation The Family and exercise of relational com- of everyday life—all this facil- petence, and a source of posi- itates not only adaptation to Putting the individual at the tive affirmations that strength- the environment, but also the center of our discussion means en the self, then the acceptance internalization of values. both respecting his situation of responsibility in such a con- 8) Growth through crisis and treating his family with in- text facilitates the understand- The educational process is terest and discretion. By work- ing of organizational aspects marked by crises which char- ing in this direction, the help and the significance of roles; it acterize the moments of deci- offered to the drug-addict ac- also obliges one to come out of sion and passage involved in quires major value because it one’s individualism and share every change. Re-entry into allows him to process and the objectives and purposes of society is especially delicate overcome deep afflictions and also contributes to the stability possible for them to go and personal history which of the new-found equilibrium. through the conflict in a con- need to be revisited in order to The family that presents it- structive way, avoiding the in- overcome them and be able to self at the rehabilitation center effectual explosion of emo- cope with life. Achievable is one that has suffered serious tions, but learning how to ex- change has limits. One needs internal conflicts. Usually, press feelings opportunely. to learn to recognize the dif- each of its members has devel- ference, be tolerant, and eval- oped convictions and attitudes c) Decision uate objectively whether life towards drug-addiction which Going over one’s personal together is still sustainable are different. Overwhelmed by history and current situation without causing harm to shame, they isolate themselves together and becoming aware oneself, and, in any case, from the environment, reduc- of one’s sentiments helps one be able to reach agreement ing relationships with the pri- to go beyond anger, pain, guilt without demanding impossi- mary and secondary systems. feelings, disappointments, and ble changes. Failure, guilt conscience, help- unrealistic expectations. It al- lessness, and resentment hin- lows the exercise of an effica- f) Participation der them from having a clear cious ability for decision mak- From the very beginning, the vision of the problem and be- ing and favors the identifica- centers for rehabilitation ask ing able to make constructive tion of educational and rela- for the participation of the fam- decisions. tional objectives, unmasking ily. At first, they come to the Such a family needs, above the old mechanisms, recurrent meeting for their own matura- all, to be accepted without be- tion; then they are gradually ing judged, sharing its suffer- asked to collaborate in carrying ings with other families expe- on activities to assist individu- 31 riencing the same problem, so als when they have reached as to feel protected and regain serenity and are at a sufficient confidence. It should not be distance from the painful expe- taken as a problem, but a re- rience. This helps the individu- source to be exploited. It there- als feel themselves to be useful fore must be helped in the fol- and also avoid passive behav- lowing areas. ior in shirking responsibility, typical of people who pose as a) Expression consumers (want to be at the To be able to express emo- receiving end). tionally one’s solitude, anger, and pain in a trusting environ- g)Getting into action ment opens up communication Participation in life at the and gives rise to a desire to centers promotes the internal- change. The family is then ization of values like sharing open to correction, ready to and solidarity. The awareness present itself for discussion copying and manipulation. of being a responsible citizen and accept the suffering that The acceptance of daily reso- in the face of the problems af- this process entails. lutions prepares one to meet flicting society produces more those which are more demand- sensitive people involved in b) Clarification ing. finding solutions. When this and communication happens, the guarantee of sta- Acceptance, the possibility d)Discovering the ble results is great, because the of self-expression, and the fact joy of change individual rediscovers or ac- of belonging to a group where Step by step, as the family quires values and interests that one experiences comprehen- straightens out relations, it give a new sense to life. sion and support are not learns to overcome conflicts. enough alone to modify family The process of self-esteem of dynamics. One must also assist the members is started anew, Voluntary service the family to redefine the man- and the joy is perceived of ner of relation (adequately re- staying together in a different Just like other deviations, appropriating roles, straighten- way, and a desire for and open- the problem of drug-addiction ing out relationships, avoiding ness to change also develop. cannot be reduced to a person- substitution, and overcoming Starting and keeping this al or family problem. It is a the attribution of guilt or lack process dynamic, thus activat- manifestation of deep and ex- of decision). This work helps ing inherent potentialities tensive malaise manifested in the drug-addict go over his without imposing pre-estab- various ways and is connected personal history together with lished models, helps one arrive to lifestyles in our society, family members. It helps the at positive results under favor- which suffers particularly from family to develop a certain able conditions. the disintegration of both pri- sensibility so that they are able mary and secondary ties and to see the reasons for both the e) Reconciling oneself social fragmentation. discomfort of the addict and There are painful experi- The priority, therefore, of other related factors, making it ences in both the family both prevention and recovery work is to set up solid systems not give rise to fear and defen- just to speak out for the down- that are capable of ensuring a siveness in the collective trodden, acting as an accusa- sense of belonging, offering imagination capable of making tion and stimulus for institu- support and occasions where solutions involving expulsion tions; there is a need to stop one feels both capable and in- or repression seem desirable. society from bending back up- volved in the tackling of a Volunteer service thus does on itself, with the result that it problem. valuable work in mediation, no longer listens to the wealth Recovery centers that arise promoting the building of a of the questioning and the ap- from voluntary service are bridge between the marginal- peal to transcendence which quite aware of this function ized and the normal, and suffering and limits carry with- and duty. They always aim at through its widespread pres- in themselves. the involvement of a maxi- ence brings institutions closer The experience at centers of mum number of persons, in- to citizens. It thus keeps pre- beneficiaries, volunteers, work- cluding families that come to vents numerous groups of citi- ers, and families is character- them seeking help, making zens from falling into anonymi- ized by a plurality of opinions sure, however, that they give ty and non-involvement and and orientations; however, this adequate formation to all. Af- impedes the censuring and iso- vision of man, when accepted firming the centrality of the lation of those who find them- in its integrity and complete- person as a value, with his de- selves in difficult conditions. It ness, represents the dynamic mands, necessities, and poten- also promotes contact and com- factor of unity which opens up tialities, is tantamount to rec- munication by each individual perception of the presence of ognizing him in the concrete- with different people, aspects what is beyond the existence of ness of the environment in which are the foundation of individuals; a stronger experi- 32 which he lives and attending to fundamental democracy. ence, a greater love. the fabric of his relations. This patient work of integra- And so it happens that some To arrive at this objective tion or inclusion does not mean seek and find that love which the centers promote volunteer simply adapting to the rhythms is gratuitously given, an unpre- activity that not only offers of society as it is, but proposes dictable and ever-awaiting su- specific assistance to people in and expresses a strong demand perabundance of divine life difficulty, but seeks also to for change in order to set up a that transforms, when accept- maintain processes of reflec- civil community at the pace of ed: Jesus Christ. tion within civil society, in or- the poor, so that the weak are der to avoid a distorted percep- not crushed and overwhelmed BIANCA COSTA BOZZO tion of problems, so that the by the strong. President of the Italian Federation new forms of indigence will However, it is not enough of Therapeutic Communities Report by the French-English-Italian Study Group

REPORTER: REV. ORESTE BENZI DIRECTOR OF THE JOHN XXIII COMMUNITY IN , ITALY

Ð The Church presents it- 70%. What is more painful Christian faith. Those who do self in a specific fashion, goes and incomprehensible is the not belong to the Church its way, communicates in a attitude of important sectors in would like to see what Christ- particular manner, and makes the Church that called for the ian faith has to offer in regard suggestions that originate rejection of the referendum. to the drug problem. from its identity as the univer- One expects greater unity of Ð Even in poor countries sal sacrament of salvation. the Church on such important drug abuse is on the increase. One needs, therefore, to em- questions so that we may have In such places so-called phasize the primacy of the a convergence of opinion “drugs for the poor” are being spirit over psychological as- founded on faith. used, such as gum, petrol, and pects, which should not in any Ð The observation by a other local substances. case be underestimated. A Palestinian couple is interest- Ð We must not legalize community that reflects com- ing: drug addicts should be drugs. You cannot fight drugs munion in Christ takes prece- taken care of by the whole by using drugs. Instead, we 33 dence over therapeutic meth- community. In other words, no even have to face other drugs, ods. Integral education also in- one should feel unrelated to like alcohol. cludes prevention. the situation of drug addicts. Ð We must not limit our- Ð With great pain, reference Ð Since 85% of addicts selves to consideration of drug was made to the case of come from separated families, dependence. We have to aim Switzerland, where the popu- a community directed by a at liberating people from all lace was asked to opt for free- family is a genuine way of re- types of enslavement. ing young people from drugs. habilitating them. Those who responded nega- Ð There has been marked tively to the request exceeded reference to the demands of Report by the Spanish Study Group

REPORTER: REV. MANUEL ZUBILLAGA FROM THE INTEGRAL YOUNG PEOPLE’S HOME RUN BY CARITAS, MEXICO

1. Participants: a total of teer service that plays a funda- give up their duties in educa- nineteen people from seven- mental role in prevention. tion, which means renuncia- teen Spanish-speaking coun- Ð Adults should offer more tion, self-negation and the tries. supportive assistance to the chance to opt for the maxi- youth, since it is often from mum values of brotherhood 2. Specific points on the the relationships between the and meaning in life. questions that came up during two age groups that misunder- Ð We should not condemn the symposium on drugs. standings crop up leading to or stigmatize the young; Ð The Church should train the eventual use of drugs, and rather, we should make them people to deal with this prob- it is therefore here that one understand that their problems lem. should effect true prevention; are a sign of our problems and Ð The Social service net- Ð In the centers for preven- those of the Church. One work should be organized in tion give primary considera- should not look at drug addicts 34 such a way that it comes into tion to the poor. in the community as a renun- closer contact with the young. Ð One needs to prepare lead- ciation but as a new opportu- Ð The education and catech- ers who in the populated areas nity for growth. Neither esis offered should accompa- will operate within the com- should we call for the social ny the life of every individual mon family routine. exclusion of youth. in order to be able to respond Ð The Church should facili- Ð It is necessary for candi- to the questions posed by chil- tate work with universities and dates being trained for the dren and the young when also collaborate with all initia- priesthood to know about drug faced by difficult situations. tives, including those of the problems. Ð Turn parishes into preven- young, aimed at raising aware- Ð Promote professional ac- tive communities with strong ness of the need for education tivities and those of the laity in community ties. in true values. general which will include all Ð Develop a family volun- Ð The families should not who can work in this area. The Family and Drug Addiction

Some time ago the Pontifi- by the void that has to be thrust of certain phenomena. cal Council for the Family or- filled, one gives in to the phe- I do believe that the so- ganized an International Con- nomenon of despair. The gap called “Peter Pan syndrome” ference on the above theme. may be filled artificially (of helps us to understand a num- As a conclusion to the three course, thereby aggravating ber of phenomena by way of working days, we were re- the phenomenon) through the general approach con- ceived by the Holy Father, turning to the same drug or, by veyed by the book bearing that who, summarizing the itiner- a slow process which is that of title. At one of our meetings ary of a drug victim, told us liberation by entering into some time ago, Professor that there was a shift “from oneself, one takes on the bibli- Tony Anatrella told us to desperation to hope.” This had cal attitude of the prodigal watch out for “indefinite ado- been the title of the final docu- son, which enables one to re- lescence” (a title of one of his ment, thanks to the contribu- gain the dignity that to some books), which is the state or tion of institutions and indi- extent he was no longer aware situation of one who never 35 viduals who have considerable of. The core of the problem is matures. The Peter Pan syn- experience in liberating peo- an anthropological issue drome helps us to see a whole ple from this new slavery. which extends to the area of set of behaviors according to Some of the reflections that relations whose crux is in life which the protagonist’s choice I will put forward in this im- within the family and society. to ever remain a child, is portant Congress involve ele- The person experiencing linked in a disastrous conspir- ments taken from discussions drug-addiction is in a way acy to the attitude of a family that I have had on different oc- both a victim and a sad prod- that hesitates to educate. Such casions concerning the topic uct of society, sick in many re- a family renounces its central which has brought us here. spects, incapable of giving mission, so that we are faced Since that conference a meaning to life and experi- with parents who, though they number of years have gone by, ence, who only transmits his are essentially generous, can- and during this time I have own emptiness. Here we are not be described as good par- been reassured on certain po- dealing with a confused soci- ents, since they neglect the de- sitions and orientations that ety from which faith is uproot- mands of their mission, ap- are, we may say, indispens- ed, and it no longer shapes ei- pealing in fact to their chil- able. ther individual or collective dren’s right to be free. They do existence. The justifications not educate because they fear for life itself are overshad- encroaching on the freedom of 1. The Seriousness of a owed, fomenting a confusion their children. This is worse Profound Human Problem that becomes a gnawing at the when the life of the parents soul. themselves is not exemplary, Drug addiction reveals a A disjointed society off its either, and does not offer a whole set of symptoms that hinges produces phenome- process of self-realization in are evident signs of a distress- nona typical of it. It transmits responsible love. ing problem which has much or transfers them to families From our vantage point at to do with the truth and digni- (without the deliberate inten- the Pontifical Council for the ty of man, and the very mean- tion of parents, who are most Family, we can affirm that to- ing of existence. Drugs offer a often good and well-inten- day many families are like a kind of escape or flight by tioned persons with irre- running tape of a wrong con- which one seeks to fill in gaps. proachable behavior), which ception of man which pro- It is the void of an existence suffer the impact of a society duces children in its own like- that is not based on fundamen- that suffocates them, causing a ness. The void becomes a cari- tal values and as such remains felt void in their actual capaci- cature, a parody of an insuffi- rootless, unprotected, and ex- ty to embody values that serve cient human project or the posed to every storm. This as a mainstay to illuminate lack of one. void deprives life of meaning. and orient existence. When we What has been said so far It is something that touches state that families are rootless, must be contrasted with what the root of the identity of the this is not to increase the di- is and ought to be the family, individual, who, when caught mension of their tragedy by in line with authentic human- up in such a situation, under- making them feel guilty. The ism, as a place in which the goes a terrible and painful ex- intention is not to point out person is rooted in the initial perience of enslavement. Be- who is responsible, but to un- stage of developing his own cause of the giddiness caused derstand both the causes and personality. The family is a formatter of persons. This so- moral universe, according to ing up, as if the light of the cial and essential mediation of the measure in which, through Word Incarnate, the image of the family cannot be replaced. a dialogue of love, he experi- God, was being reflected in Allow me to use the expres- ences his worth, his dignity, them (and, indeed, it was). sion of St. Thomas, which he by becoming an object of par- The other complementary ex- attributes to early childhood, ents’ love and the center of ample has to do with what I but whose significance can to- their life; this constitutes a experienced in a dialogue with day be extended to adoles- prelude to the moment when drug addicts, during the first cence in regard to the process he will discover that, in the stage of their liberation, which that fosters maturity. The ex- depth of his dignity as a per- is both difficult and painful. I pression of the holy doctor son there is the fact of being asked them how they felt. goes as follows: the family is loved as a person (one not Their answer was, “We are the “spiritual womb” (II,II, treated as a thing or instru- discovering what we are.” All 10.20). ment) by the Creator himself. in all, every individual human What significance does this Many of the great pioneers being continuously discovers concept have in terms of edu- in the liberation of their broth- what he or she is or ought to cation, or integral formation? ers and sisters well knew how be; however, for those who go This notion detaches us from to accompany and guide them through the drama of drugs, the biological conception in through this process in such a this itinerary of liberation and which giving birth to some- way that human beings man- hope is a special moment of body is not separate from the age to internalize or enter into discovery. process of education and for- themselves, in order to begin In many dialogues and visits mation in love and responsi- the journey (which in most to various institutions, above 36 bility. cases is one of conversion and all in the diversity of positive The family is a life-long return) that leads to the Father, Italian experiences, I gradual- community, one of love in to God. Man in his entirety ly came to understand some- which education builds the ex- needs to experience the reality thing which, I must confess, I istence of the children accord- of his worth in feeling that he did not understand entirely at ing to a model, project, or is loved. This worth increases the beginning: not only that truth of man. It is an environ- in unlimited measure when “you cannot use drugs to fight ment or an atmosphere of pro- one becomes aware of the fact drugs,” but also that the prob- tection for the growth of the that he is an object of the love lem of drug addiction, in children as persons. A few God Himself. which man is deeply entan- moments ago, the professor May I here give two com- gled, is not a question without presenting the Pope at the seat plementary examples, which an answer or a tunnel without of Lublin, noted that in Polish for me were useful lessons of an exit. It is in the first place a the word rodjina means to “anthropological experience.” question of values, one that ‘make grow,’ or ‘give birth The first one was the assur- calls for a return to the center to’. This is the reason why the ance I received at the Interna- of existence, where man is not two poles are inseparable: tional Congress on the Meni- an obscure entity, but a mys- family and life. A family that nos da rua, “street children,” tery (the idea of Gabriel Mar- is not a dynamic source, can- which we organized in Rio di cel). New ways are being not be a subject of growth in Janeiro. The fact that street opened up and daybreak is ad- the process of life and has no children or abandoned young vancing, according to the mea- reason for existence! To give people have no fear of death sure in which those who have life or make someone grow had always attracted my atten- been enslaved by the void of entails certain questions: What tion. Many times they are used society (for the moment, with- life, quality, and style? We to carry out criminal ventures, out considering what comes find ourselves at the heart of which they execute without from personal responsibility) an anthropological context in even realizing what they are see the doors of their dark and which the social being of man doing. They have no self-es- restricted world opening onto discovers its very self in the teem. They believe they are a journey that leads to the Oth- first community, which is the “more than what they are.” A er and others, by way of incar- primary cell of society. series of testimonies con- nate values that are recovered. Within the family there is vinced me of one reality: I was very touched by some contained the truth of man when these children or young of the letters of Victor Frankl brought to life, not only in the people start experiencing that and what the experience of perspective of human wisdom they are loved, that they have survivors of Nazi concentra- present in it in a precious syn- a value and are persons, for tion camps meant to him. De- thesis, but also in the whole them this is like a resurrection. spite everything, these people extraordinary illumination re- For this reason the institutions managed to survive and over- ceived from the Lord, in that care for these children come every torture and abuse. which the mystery of man is ought to transmit respect and They loved life and still found revealed and discovered. In love, which is like giving them meaning in it, for the ideals in the family the human person what they missed in their fam- them had not died out. He has opens to his very reality, as an ilies. I really saw many faces translated much of this experi- individual subject. Besides, in of children and young people ence into his “speech therapy,” it one goes on enlarging his being changed and brighten- which is a method used to re- vive ideals and transmit values velops the divinity. He throws family, rendered capable of where everything has been burning coal on the frozen fulfilling the sacred mission to muddled and lost. night. However, it is as elastic which it is called by God Him- In view of these considera- as rubber. It shrinks...” (Cf. Il self in which the duty of edu- tions, I very much agree with Pensiero Debole, ed. Feltrinel- cation is seriously taken into the idea of following ways of li, p. 212). consideration. recovery based on profound To one who has faith, and Forming families as domes- anthropological insight into for cultures that have been tic churches provides assur- the processes of liberation. In profoundly penetrated by rev- ance of overcoming gaps and fact, in societies that have elation, God does not reign in considering life as a mainstay. deep Christian cultural tradi- shadows. He is the sun from The duty of the family as a tions, this process must take above that enlightens man’s “formatter of persons” where the form of a personalized movement in the world, sav- parents are the primary evan- evangelization, in such a way ing him from moving on hesi- gelizers ought to be fulfilled that when one undertakes the tantly like a blind man. In a step by step. Births lead to the journey of discovery and re- word, the itinerary of internal- formation of the family, which turn to the Father, it becomes a ization entails the dialogue of as a spiritual womb permits passage into resurrection and man with God. Man alienated genuine growth similar to that hope, a meeting with the Lord, from himself, one who, ac- of the Son of God in the a meeting with God. In the cording to the expression of Nazareth family. parable of the prodigal son, Hegel, breaks away from his With regard to this mission, there is a key word which is center towards X, becomes an I would like to stress the im- the Greek term anastasis, obscure entity marked by “dis- portance of adequate sexual meaning ‘resurrection’, but al- enchantment.” formation in love and the con- 37 so ‘standing up or rising to On various occasions this tent of our Document on this one’s feet’, as a vital decision aspect has arisen when the re- subject, entitled Human Sexu- by one who in an actual dia- covery and incarnation of val- ality: Its Truth and Signifi- logue, even if more hidden ues takes place in the presence cance. In summary, we may than the conscience, has man- of (at least implicit) faith and briefly state that the truth of aged to enter into himself and Christian values, or explicit man embraces the unity of all come to terms with himself. In evangelization, or where there that is truly human sexuality this sense, liberation goes is Christian culture (at least (not beastly), in which the re- through a new network of hu- where it is not completely ality of the human personality, man relations, whereby insti- overshadowed or where it has body and soul, takes on its full tutions act as a family, a “com- not completely disappeared). dimension: sexuality in love, munity,” or centers in which Liberation is a fruit of true as opening out, altruism, re- one experiences new dimen- evangelization, in which the sponsibility, and respect for sions of a love that liberates, good news of Christ operates others. A love which in matri- redeems, and transforms. In in such a way that the lofty mony becomes concrete and other words, the liberation dignity of life is liberated. In achieves its greatest depth and process is a question of per- this case, if we are talking seriousness as total love and sonalization and not a medical about physicians, Jesus is the fidelity, both exclusive and one, or at least a process in one. It is, however, obvious fruitful, and at the service of which medicine is an aid and that in countries where the the family, which is in turn at not a principle factor. Gospel has not yet penetrated the service of society. The lifeblood in processes into society or has not yet giv- I would now like to tackle of internalization involving en rise to a Christian culture the issue of families hit by the the identity of the human per- the process cannot be identi- drama of having their own son, or his “irrepressible thirst cal. Nevertheless, even where children caught up in drugs for dignity,” less deeply felt in the young have had some con- that are, however, not afraid of situations of derangement, is tact with a Christian educa- making an examination of the discovery of the fact that tion, the bulk of the process is conscience or deciding, in any man is not an obscure entity, simple work permeated by case, to help these children but that the sense of his exis- reasons illuminated by faith. overcome a struggle in which tence and his profound reality their own joy is involved. It is is exalted in God. He is the not possible for families to just Veritatis Splendor that illumi- 2. From a Damaged ignore the drama of their own nates the truth of man. He is Family to an children, as if it were some- not someone totally unknown Accompanying Family thing that did not concern to man; indeed, he would not them. In our experience, at op- even have approached the We could ponder a lot about portune moments institutions threshold of his Transcendent what may be necessary so that do associate more and more existence. It is as if what Kaf- the drama which leads many with families during the ka poetically wrote were true: people into the tentacles of process of liberation and rein- “Therefore God must remain this modern slavery may be forcement. Families need, hidden in obscurity. And since avoided, starting from the above all, to be helped and man cannot approach Him, he family. The complete answer formed, so that they may exer- arrives at the obscurity that en- is a profoundly evangelized cise a positive role and avoid being an obstacle on the way many highly qualified ob- tion is concerned, other con- towards hope. One day I met a servers. But, for reasons of ceptions may be of minor in- group of families that had time, I would like to place my- terest (Cf. RP no. 16). gone to visit their children at a self in the perspective of what, Social sin can more or less rehabilitation center. Someone after various clarifying discus- be particularly bound up with said to me, “As usual, we are sions, the Apostolic Exhorta- and go through a considera- here this week ‘to get a fill-up’ tion Reconciliatio e Poeniten- tion of an anthropological na- (comparing it in this way to tia called “social sin.” Today ture. This does not just con- the fact of filling up the fuel there are many forms of life cern the severe conditioning tank of a car)—that is, to be which are widespread and ac- which the individual suffers in charged with all the necessary cepted and are also reinforced a society where oxygen is rar- energy that enables them to be by laws and institutions, but efied, but, what is worse, it is good collaborators, facilitating have all the requisites neces- connected with a certain con- the complete recovery of their sary for being labelled a social ception of man that debases children. sin. In a society bombarded him. It is a conception that Certainly, there has been a day after day by numerous generates a particular type of lot of progress in recent years, messages and experiencing a person. This is the drama of and new experiences have series of alterations in its spir- this age, in which, amid moral been accumulated in this field. it, to the point of undergoing erosion and conceptual confu- Together with the Pontifical serious forms of spiritual ill- sion, hypotheses that destroy Council for Health Care ness, we cannot but be preoc- man are being spread. It is not Workers, we have for some cupied about the human be- only a question of a wrong at- time been thinking out and ings, especially the frail ones, titude, but also a defense and 38 preparing a special meeting on who thirst for truth and mean- dissemination of error as if it this particular task, with all the ing in life in order to emerge were the truth. This amounts creativity that this challenge from their tragedy. to defending a void, a situation demands. Here we have to take into where disorder and deteriora- One may not expect that consideration two comple- tion pass for the conquest of those leaving recovery centers mentary conceptions, concern- freedom. With things going on after having attained hope and ing the significance of origi- like this, we find ourselves are in possession of new rea- nal sin which are dealt in the with a sick society, which not sons for living can avoid Recon- only does not educate, but also falling back into the problem ciliatio et Poenitentia. The disintegrates, and does not al- without the active involve- first one refers to the human low the family to fulfil its es- ment of their families. This solidarity of original sin, sential function. One arrives at and many other questions, to- which is very mysterious and a categorical pluralism, where gether with the pertinent an- imperceptible, yet very real people have to protest in order swers, are to be the object of and concrete. One could speak to denounce a certain situa- the meeting mentioned above. of a “communion in sin” be- tion. Just as Cyprian back in cause of which “a soul degrad- his time complained of crimes ed by sin degrades the Church, which, when committed by 3. The Role of Society too, and to some extent the en- the state, passed for virtue (De tire world. In other words, no Unitate Ecclesiae), so Evan- Here we are taking the con- sin exclusively concerns the gelium Vitae denounces the cept of society in its broader one who commits it, even that acceptance of crimes as rights dimension, above all in refer- which is innermost and secret because of unjust laws. ence to the wide scope of cul- or most strictly individual” In this case the social illness ture. (Cf. no. 16). We could speak is more dangerous and disas- In fact, cultural changes to- of an expansive force, like an trous, for both the individual day have a lot to do with the explosion of sin, that pulver- and society at large, because it political community, the role izes human relationships and is equivalent to a systematic of legislators and govern- ruins both human society and burying of values which are ments, inasmuch as many the persons themselves. The necessary for the formation of laws with a manifest relation second aspect is social, inas- a person within the dimension to the common good involve much as sin tends towards di- of true humanism and also for implicit anthropological con- rect aggression of one’s neigh- the building of society. In such cepts or forms of behavior. bor. This implies sin commit- cases the “culture of love” be- When we speak of serious ted against justice, sins against comes a mere ideal, for time gaps, one might think that we the community. In the case of bombs have been put in place are exaggerating. However, aggression against the rights to demolish the human person. there are many thinkers who of the human person, begin- Is this not a disastrous situa- today complain of a situation ning with the right to life and tion, one which like a wave of pronounced pessimism and without excluding that of the uproots, disturbs, and confus- desperation, in a society that is unborn or any sin against the es man? I do think that all this intoxicated, if you will, with common good or the sin of applies when we speak of a its successes and the myth of a commission or omission by void society. progress that is sustained and leading politicians and econo- All that concerns the rela- constant. We could even cite mists, etc. As far as this reflec- tionship between the Family and the State ought to be given honestly into oneself, rise to vise caution so that the com- special attention so that the one’s feet, and embark on the fortable but destructive per- family may not only be re- return journey, a journey of missiveness of governments spected, but also helped in its freedom which in the Gospel may not be used as an instru- duty of formation. When, parable is described as a “res- ment for aggravating the exist- through the conspiracy of the urrection.” He who was dead ing problem. This social con- means of communication, at- has come back to life. This res- version goes hand in hand tempts are made to harm so- urrection is possible because with the conversion of the called “human ecology,” the man recovers his dignity at the family to what constructs the result is that the foundations very moment when he meets plan of God. Only a few days are laid for a dangerous in- God and in Him comes to ago, at the International Con- crease in the number of per- terms with himself. Therefore, gress of Rio di Janeiro, the sons who take refuge in drugs. this resurrection becomes a Holy Father, in a beautiful im- These are especially people passage from despair to hope. provisation, referred to both who not only have experi- The Church must occupy a the divine and human archi- enced a void, but have also prominent position in this un- tecture of Rio di Janeiro. All been disturbed by the organi- dertaking, and that is why we this concerns the family, zation of life offered by a are gathered here. which is, above all, architec- crumbling culture, commonly In these simple reflections, ture of both God and man. It is known as the “culture of then, rather than insisting on the harmony of this construc- death.” the obligations of organized tion that will permit the har- society or the state in the face monious development of chil- of the crime of drug traffick- dren in such a way that they Conclusion ing or reminding them of the both grow in humanity and do 39 assistance they ought to give not become victims of the In reference to this anthropo- to institutions that are dedicat- drug tragedy. logical concern, it is evidently ed to the liberation of the necessary during the journey young from drugs, I would Cardinal ALFONSO of the son who returns home to like to launch an appeal in fa- LOPEZ TRUJILLO his Father to recover certain vor of social conversion to the President of the truths which allow one to look dignity of man. We must ad- Pontifical Council for the Family The Medical Aspect of the Drug Phenomenon Definition, Drugs and Disease, Ethical Reflections

This presentation starts with of abuse, addiction, tolerance, organism reduces it by dissi- a brief compendium of defini- and other negative conse- pating excessive heat through tions and clarifications. To quences on both the individ- sweating; if, however, the some they may appear unnec- ual and social level. Drugs temperature goes down, the essary and tedious; however, I have, therefore, two distinc- adjustments take the opposite have the impression that con- tive characteristics. On the direction. trasts of opinions are more of- one hand, they influence the The same happens with ten due to semiological or lan- mental processes which pro- drugs. Their fundamental guage misunderstandings than vide self-consciousness and characteristic, that which be- to substantial motives. It thus awareness of the world, con- yond their distinctive proper- seemed opportune to me to tributing in this way to the de- ties unifies them, is to liberate bring them forward here. To termination of one’s behavior, the mind from bonds that keep avoid uncertainty, these defin- in a manner that is “good, de- us in the area of normal be- 40 itions have been extracted sirable, and sometimes even havior which is perhaps re- from pharmacological treaties useful.” This first characteris- stricted, but well checked and and from documents of the tic presents one of the princi- secure. One derives from World Health Organization pal motivations for their use. them a sense of pleasure, of (WHO, 1973 and 1991), On the other hand, they in- liberation from both physical about which doubts on author- volve various risks and forms and mental suffering, of ity should not arise. Besides, I of damage which render them strength and confidence, of will be making references to a both dangerous and dreadful. I escape from reality, but also book of mine (Silvestrini, consider these profound as- the risk of supinely abandon- 1995) in which many basic pects well known to all, and I ing oneself to the course of notions on drugs were ex- would not dwell on them if events, of overestimating pounded in a much more de- not for the issue of drug ad- one’s capacity, and losing tailed way than one could do diction, about which it is self-control. The organism no- within the limits of a presenta- worth making some clarifica- tices this danger and takes tion like this. tions. measures capable of neutraliz- After clearing the field of It is defined as “the irre- ing it. The operation takes on possible causes of divergence pressible and conscious need varied modes and proportions, and misunderstandings, in the which generally manifests it- depending on the effects second part we shall try to self after repeated consump- caused by each class of drugs. draw attention to some med- tion to take a particular drug, The opiates ease, subdue, ical aspects of the drug phe- not just to arouse the initial and clear up physical and nomenon which up to now effects, but more to avoid the mental suffering. These have been underestimated or disturbances caused by its de- changes are contrasted with ignored. This is done follow- privation and to maintain an adjustments of the opposite ing the line of argument acceptable state of both physi- symptom: hyperexcitability which I have already set forth cal and mental well being.” against sedation, hypersensi- in other conferences of this This is a feared phenomenon, tivity to suffering against al- Pontifical Council (Silvestri- continuously cited to demon- gesia, and so on. Cocaine and ni, 1992 and 1997). In the strate the dangerousness of amphetamines stimulate, ex- third part these same aspects drugs; however, it is not very cite, and cause a sensation of are briefly reconsidered for well known. Despite its dra- power and strength. And then the purpose of offering an eth- matic negative consequences, the organism slows down and ical interpretation of the phe- dependence is an expression restrains the corresponding nomenon. of homeostasis, a defensive mental processes. These mechanism which is at the ba- homeostatic changes are not sis of life in all its manifesta- prompted as long as the drug Definitions tions, even the most elemen- counterbalances them. Their and Clarifications tary ones. This capacity al- presence is demonstrated by lows for the safeguarding of the fact that with the advance- Drugs or addictive sub- one’s internal state through in- ment of dependence the or- stances are those natural and ternal functional or physiolog- ganism becomes more resis- synthetic compounds produc- ical adaptations capable of tant to drugs. In this way the ing effects of mental pleasure, neutralizing all that tends to phenomenon known as toler- desirable and sometimes use- disturb it. For example, if the ance begins. A typical case is ful, but associated with risks temperature is too high, the that of heroin. At the begin- ning its effects are manifested enslave and lead to the worst These are simple elemen- by just a few milligrams, but crimes in order to satisfy the tary concepts; however, I do in time one might need quan- compulsive need of having hope that the reader can now tities up to 100 times higher. them and less dreadful be- agree with me that it was use- Through these homeostatic cause they elicit a defensive ful to repeat them here. reactions the organism recov- mechanism that contrasts the ers its proper functional state, direct effects of the drug, in- but, as we have seen above, cluding those that are harmful. Medical Aspects of Drugs this is done through adjust- That is why, other conditions ments that must be counter- being equal, cocaine and hal- The frequent occurrence of balanced by the force of a lucinogens cause more deaths serious mental disturbances, contrary symptom in order to than heroine. especially those of the depres- attain the desired effect. In Incidentally, while the term sive, schizophrenic, phobic, other words, the organism at- toxicomania is used to desig- obsessive, and maniacal na- tains a new state of equilibri- nate all forms of drives due ture, among addicts is based um, different from the initial to consumption of drugs, in- on ample evidence (see Sil- one, which required the pres- cluding even those that do not vestrini, 1995). To establish ence of drugs to maintain it. If lead to addiction, the latter when and if these distur- this last one is then lacking, designates only those that bances precede or follow the the abstinence crisis arises, cause it. taking of a drug is not easy. In during which the functional The final clarification is the the first instance, they can act adjustment of the organism is fact that addictive drugs be- as predisposing factors, since no longer counterbalanced, long to the larger family of a mentally ill person is an and it therefore surfaces. With medicines, a term that indi- easy prey to the drug dealer. 41 heroin there arises a state of cates “all the natural and syn- Besides, he can take refuge in hyperexcitability and hyperal- thetic substances, which when drugs, instinctively seeking gesia, and with cocaine, de- introduced into the living or- relief from his discomfort. In pression. One is therefore ganism, can modify one or the long run the remedy might faced with defensive mea- more of its functions” (WHO, turn out to be worse than the sures that paradoxically end 1973). The quality of this disturbance for which it was up in a state of enslavement modification, known as intended to provide relief. to that very agent against “pharmacological effect,” de- Bleuler (1924), one of the fa- which one is being stimulated. pends more on the dose and thers of modern psychiatry, The intensity of the homeo- mode of application than on had already recognized and static response generated by the intrinsic characteristics of reported the antidepressive dependence varies from drug the medicine. For example, action of morphine in his fun- to drug. It is highest with opi- insulin damental treatise. In the sec- ates that act on mechanisms is an antidiabetic, but with ond instance, mental distur- that are indispensable for sur- increased doses it becomes a bances are consequences of vival, which are represented lethal poison. On the other the devastating effect that by a warning sign inherent in hand, botulinus toxin is a many drugs have on the or- physical or mental pain. It is potential poison, but when ganism. A devastating action, intermediate with psychostim- used in a proper manner which for the reasons men- ulants, acting on mental it becomes medicinal. The tioned in the above paragraph, processes which the organism fundamental characteristic of is particularly striking with usually leaves to oscillate anticholinesterasic agents is drugs that do not lead to ad- freely between two directions. that they turn into medicines, diction. What interests us here It is absent with hallucino- insecticides, poisons, or bio- is not so much to establish gens, whose point of attack is logical weapons depending whether the mental distur- not subjected to any strict on the way they are applied. bance opens the door to addic- control: to understand this one In other words, a medicine is tion or whether it is its conse- only needs to think about like a knife that can kill, but is quence, but more or less to sleep, during which the mind also used to slice bread. underline a fact of great prac- wanders physiologically with- This principle also holds for tical relevance, besides the out any sort of constriction, drugs and implies an impor- theoretical interest, which is freeing itself from the reality tant postulate. Drugs are not the existence of two different of circumstances. such in themselves, but in re- types of toxicomania, simple From this there follow two lation to the use made of and complicated. consequences which any per- them. For example, morphine Simple toxicomania is in- son speaking about drugs can- can duced in drug consumption by not ignore. First, dependence be a drug in certain circum- contingent external motives, is not a necessary connotation stances, but when used in very which are environmental, cul- of drugs. The drugs that lead painful conditions, like infarct tural, or social. However, the to it are under certain circum- or acute pulmonary edema, personality can for long re- stances the most dreadful ones it becomes medicinal. We main integral. As a conse- and yet are less dreadful under shall come back later to this quence, withdrawal has reso- other circumstances; they are issue, in relation to the atti- lutive effects, as long as it most dreadful because they tude of the Catholic Church. takes place before the drug causes irreparable damage sulin. It is true, however, that not successful, then rigorously and the contingent factors that drug addiction is different controlled drug administration triggered it are also eliminat- from this illness in that it is al- is preferable to both the med- ed. In the case of complicated ways due to an initial mistake ical and social drawbacks as- toxicomania, the drug prob- of the affected individual; sociated with its illegal distri- lems are dominated by a dif- nevertheless, on the medical bution.” (Silvestrini, 1992). I ferent type of disturbances, level this makes no difference. then confirmed this opinion, sometimes mental, sometimes Otherwise all those who are adopting it in the book quoted psychosomatic. Here with- sick as a result of their own above (Silvestrini, 1995). On drawal may not only fail to re- mistake would not pass for the other hand, I am perfectly solve the problem, but also be patients: the victims of car ac- aware of the practical difficul- inopportune in some cases. cidents caused by their own ty of medicalization, for its ef- This is clear in the case of an imprudence, or a cancer pa- fect is very limited. In short, incurable illness, like a tumor, tient who is one because of this is a very complicated is- which requires the administra- the vice of smoking. This is sue, involving a lot of suffer- tion of morphine to alleviate surely not licit. ing, with individual and social the sufferings that accompany Accepting the medical tragedies, too complex, in- it. Yet it may not be the same component of drug addiction deed, to be approached rigidly in the case of a serious depres- and of some toxicomanias by moving behind antithetical sion, whereby the recourse to does not mean a lowering of lines. If I am not mistaken, drugs, as mentioned above, the level of vigilance. On the even the Church in her wis- could represent a kind of self- contrary, this permits con- dom maintains an open posi- medication. Even this, howev- frontation of the drug problem tion; the Catechism explicitly 42 er, is a sickness, during which in a more direct way, and as a speaks of the therapeutic pre- mental suffering can reach in- result more effectiveness. It scription of drugs. Of course, tolerable levels, to the point of permits a differentiated ap- this expression does not refer pushing one to suicide. How- proach to simple and compli- to the medical utilization of ever, the difference from a tu- cated toxicomanias. For the the active principles of drugs, mor is that today depression first group one focuses in the like that of morphine, to re- can be cured in other ways, ei- first place on information, ed- lieve pain, because in these ther by psychotherapy or by ucation, and the values of in- cases the drug becomes medi- antidepressive medicines. It dividual and social solidarity; cinal. I explained this in the would nevertheless be a grave and with the second, one con- first part of this presentation. mistake to think that for a tox- centrates on the sickness that It is therefore an open prob- icomaniac who also suffers torments them. In both cases lem, which no doubt needs from serious depression the one ought to aim at disintoxi- further study. giving up of drugs alone could cation, keeping in mind, how- act as a resolutive measure; on ever, that its effectiveness de- the contrary, it could result in pends on the underlying Ethical Reflections a crisis with dramatic conse- pathology. There are some quences, like suicide. It is forms of addiction, though, Drugs and suicides have therefore important to be which are extremely resistant many things in common. Both aware of this particular form to any type of intervention. He of them are an escape from of toxicomania and also offer who denies this need only life, achieved first of all by re- the appropriate care. think of how difficult it is to lying upon an illusory instru- Let us now pass on to drug liberate oneself from the vice ment, which in the long run addiction. Its medical impor- of smoking, which is a form worsens the problem instead tance is implicit in the defini- of addiction that is a thousand of alleviating it, and secondly tion cited above. For your times weaker than that of by voluntarily destroying benefit we repeat it here in its heroine. What must one do in one’s own personality. As a essential terms: “Drug addic- these specific and particular result, both are strongly con- tion consists of the inability to circumstances? Is the med- demned by the Church. This maintain an acceptable physi- icalization of drugs to be con- is the statement about suicide cal and mental status, without sidered licit as an extreme in the Catechism: recourse to drugs.” It is there- remedy? This is not to hit the Everyone is responsible for fore an infirmity, a sickness criminality fed by clandestine his life before God, who has caused by a functional imbal- trafficking in drugs, but to al- given it to him. It is God who ance which finds in drugs an low the person who is not able remains the sovereign Master element of equilibrium. Once to get out of enslavement a of life. We are obliged to ac- this element is lacking, then dignified and relatively nor- cept life gratefully and pre- the crisis of abstinence ap- mal existence. serve it for his honor and the pears, with its set of symp- A heated debate on this salvation of our souls. We are toms, which, in the case of problem has been going on for stewards, not owners of the opiates or other drugs, could some time. In one of the pre- life God has entrusted to us. It even lead to death. Under this ceding conferences of this is not ours to dispose of. aspect drug addiction is not Pontifical Council, I did say Suicide contradicts the nat- different from diabetes, which that “some people are of the ural inclination of the human is caused by the lack of in- mind that, when withdrawal is being to preserve and perpet- uate his life. It is gravely con- attenuate the guilt of the sui- tence. I have sought here to trary to the just love of self. It cidal is now explicit here, but make my own humble contri- likewise offends love of neigh- also a relatively recent accep- bution. bor, because it unjustly breaks tance, the fruit of a long and the ties of solidarity with fam- painful journey. Professor ily, nation, and other human Here, then, is the judgment BRUNO SILVESTRINI societies to which we continue on drugs. Director of the Institute of to have obligations. Suicide is The use of drugs inflicts Pharmacology and Pharmacog- contrary to love for the living very grave damage on human nosy at La Sapienza University, Rome Consultor to the Pontifical Council God. health and life. Their use, ex- for Health Care Workers If suicide is committed with cept on strictly therapeutic and Member of the National the intention of setting an ex- grounds, is a grave offense. Council for Bioethics ample, especially for the Clandestine production of and young, it also takes on the trafficking in drugs are scan- gravity of scandal. Voluntary dalous practices. They consti- cooperation in suicide is con- tute direct cooperation in evil, trary to moral law. since they encourage people Serious psychological dis- to practices gravely contrary turbances, anguish, or the se- to the moral law. rious fear of hardships, suffer- Apart from the mention Bibliography ing, or torture can diminish made of strictly therapeutic Bleuler, E., Textbook of Psychiatry, the responsibility of one com- reasons, for which the inter- MacMillan, New York 1924. mitting suicide. pretation is, moreover, am- WHO, Technical Report, 1973, 516; 9-10. We should not despair of biguous, we are still far from WHO, Responding to Drug and Al- 43 the eternal salvation of the acceptance of the medical as- cohol Problems in the Community. An- persons who have taken their pects of the substances nex 1. Commonly abused Substances. Edited by Grant M. and Hodgson R., own lives. By ways known to abused, despite the fact that Geneva 1991. Him alone, God can provide this is equally or even more Silvestrini, B., “The Psychoactive Drugs Used in Therapy Subject to the opportunity for salutary widely documented than the Abuse,” in Dolentium Hominium 19 repentance. The Church prays case of suicides. To the study (1992) 92-96. for people who have taken of these aspects I think that Silvestrini, B., Malati di droga, Sper- ling & Kupfer Editrice, Milan 1995. their own lives. everyone should make his Silvestrini, B., “Aberration in the The acknowledgement of own contribution, in the field Natural Order of Things,” in Dolentium illness and other factors that of his own specific compe- Hominium 34 (1997) 77-80. Drug Addiction and Crime

1. The complexity of the rent effect are certainly un- cloaking another serious drug problem, particularly as able to avert or eliminate it problem, that of the “drug in- regards the “development of because voids, disturbances, dustry.” A perverse plot— the human person,” indicated or other psychic sufferings, as even collusion—could in fact as the basic task of a modern well as absence, conceal- be established between those state by the Italian Constitu- ment, or reticence and emo- charged with combating tion (article 3), brings under tional or relational privations drugs and those putting on consideration the very mean- or impediments, might prove the market—especially by ing of life in a society at to be unmeetable needs, gaps way of small dealers—the “high risk” because of lacera- which could not be filled amounts required for their tions in the connective tissue through the additional, deeper maximum profit, with no of its values, and people to- loneliness of prison, as would concern, needless to say, day seem not to have thor- occur in the event personal about the obvious and imme- 44 oughly assimilated the lesson freedom were restricted by diate harm and danger to the of this century, with its story having to serve a sentence or life or health of drug buyers. of the horrors of war and in- be subjected to protective Such a disturbing, wide- conceivable massacres at the custody. Indeed, to seek to spread human situation, on core of the human race. The counteract addiction—or, both a personal and social drug problem has been care- rather, enslavement to level, has thus demanded ad- fully examined by many in its drugs—by way of that other ditional commitment from multiple aspects. Different form of subjection, incarcera- legislators around the world moments have thus been tion, might well correspond to deal with so many insidi- grasped in a world marked by to the not-at-all new idea of ous snares from both drugs treachery, concern, anguish, the “vice model”—involving themselves and that human misdeeds, and death. And blameworthy conduct which environment acting on the from one standpoint or anoth- is thus deserving of punish- fringe of a society where er—but always referring to ment—but it would certainly proper attention to current the invariably devastating not represent a rational ap- forms of poverty—deviance, consequences of drugs— proach to the addict’s recov- degradation, exploitation, and there have also been analyses ery of physical and psycho- different kinds of corrup- aimed at hoped-for normative logical health and integration tion—is largely diverted by action or other possible reme- into the mainstream of soci- well-being and affluence. dies and, therefore, at instru- ety. Furthermore, it has hap- ments for combating drugs On the other hand, avoid- pened that more than one leg- which would really ensure, if ing entry into the drug circuit islator—while showing un- not complete victory, at least is clearly the task of general derstanding for the state of a reduction of this serious social prevention, as is uni- people who are already a prey malaise, which may not be versally recognized. And to drugs or have just begun regarded as superior in with good reason there is in- use and thus need care so as strength to effective commit- sistence upon the indispens- to get off them, if possible, ment by man to man. able role of adequate infor- rather than punishment as de- mation and concrete discour- terrence from crime, which is Broadly-based cultural re- agement of drug-taking by all an epiphenomenon of the search and reports by “inves- social agencies, especially the very nature of drugs—has, tigative commissions” have ones closest to the lives of however, ended up support- in the past contributed to de- young people, with particular ing the “need for punish- termining the symbolic and emphasis on those who are ment,” a widespread notion other meanings of drug-tak- prevented by a lack of real among citizens, who with ing in general and of each of love in a true family from ex- good reason, especially to- the different substances, es- periencing progressive and day, have lost patience every- pecially by young people. It appropriate realization of where on observing a daily has thus been necessary to re- their personalities, both indi- increase in the number of alize that malaise, marginal- vidually and socially, in the people who, already caught ization, degradation, and self- more sensitive time of ado- in the drug net, come to com- destruction are usually asso- lescence, for example. mit even serious, violent ciated with the use of psy- Today there is still talk of a crimes, which are thus even chotropic elements and also “drug culture,” which may to less tolerable, in order to get that punishment and its deter- some extent be a way of their required “fix.” And it has also happened Very soon, however, that recourse to common action that legislators inwardly pre- same community had to gain by the whole international pared to support the despotic awareness of the unity need- community, should not have profit motive of individuals ed for its effort and, therefore, been lacking. and groups devoted to drug of the demand for coordinat- The UN Convention per- production and traffic have, ed strategy in a dynamic fected in Vienna on Decem- perhaps as a result of circum- common front to fight the ber 20, 1988, though admit- stances, provided for relative- drug traffic, which had quick- tedly insufficient in some re- ly mild punishment of such ly become worldwide and spects, stands out, however, acts, while also resorting to was already organized to for its increased awareness of fine shades of interpretation some extent, especially in its the enormous danger of drugs of presumed misdeeds so as kingpins. But what specific for individuals and society to give magistrates the broad- response was made to this de- and of their effects on gener- est discretion in relating real termined, intense offensive? ating crime directly and indi- actions to the criminal Apart from appeals and ges- rectly. And consequently, code—in substance, a deval- tures, there was perhaps not alongside a clear statement of uation of the principle of le- even careful reflection on the social and health policy on gality, which then becomes a need for a serious, rational, the obscure world of drug collapse of the very guaran- and unified war on drugs. consumption, we find an tees of penal law. With the New York Treaty equally clear commitment by A criminal policy in keep- of March 30, 1961 (amended nations to legislation contain- ing with the complexity of by the Geneva Protocol of ing the obligation to com- the drug phenomenon we March 25, 1972), however, bat—by deterrents and the have touched upon which is countries agreed not only to imposition of punishment— 45 able to translate into opera- “provide for limiting the use production of and traffic in tive terms a conscious re- of drugs to medical and sci- these substances and also to sponsibility for freeing per- entific purposes,” but also prohibit the purchase and sons from a real form of slav- (and this should be stressed) possession of drugs, even ery (more treacherous in its to “devote special considera- when intended for “personal apparent benevolence to- tion to measures aimed at use” or involving circum- wards weakness and strongly treating drug addicts and thus stances regarded as “minor,” suggestive—and no less per- fostering their effective social with the possibility in such suasive—when the lure de- rehabilitation” (article 38). cases of accompanying or re- rives from ideologies) cer- Promoting health, then, came placing sanctions with mea- tainly requires robust sol- to express a broader perspec- sures for treatment or social idary tension with a view to- tive differing from the prior rehabilitation. wards adequate care and re- one, limited to punitive ac- The expansion of this habilitation of victims, but tion, which was then regard- treaty beyond the 106 nations must be equally committed to ed as the only effective signing it and its both broad an intelligent, serious strug- means of prevention. and detailed content should gle against those who, for the In terms of evaluating the have allowed the countries sake of drug profits, do not drug phenomenon in its ca- involved to keep the commit- hesitate to overturn basic hu- pacity for generating crime, ments they had made by way man rights: the life and health however, there was reference of specific legislation and to of their fellow men. to a very limited, if not defi- create (in ten years) an organ- cient, sensitivity to the need ic system for action in every 2. As pitiless as it is far- for a common front against area of this complicated field. reaching and resistant to all the drug traffic. The docu- Yet, aside from norms not ap- dissuasion, criminal involve- ment in fact points to a lack propriate for the exigencies ment in drug production and of attention to induced crimi- of prevention, care, and reha- traffic—usually structured in- nality and even to the bloody bilitation of drug addicts, it to organizations with chang- battles among bands to domi- should be noted that these ing personnel which faces nate and split up markets and and other more advanced le- high risks, but is extremely a neglect of the many-sided gal systems lack penal norms well remunerated—has never (and very intricate) world of able to respond effectively to concealed its true visage from the small dealers, at once the the offensive of criminal the community of nations, authors and the victims of groups—the ones devoted to which, since it perceived the crimes, to be combated with drug traffic—which, it must enormous offensive potential measures appropriate not just be repeated, are almost al- of this attack on vital human for some of the goals to be ways organized; powerful, interests—blinded by a pro- pursued. thanks to enormous human gressive thirst for profit (how An obvious hesitation may and material resources; and could it be otherwise?) thus be noted regarding the well-armed, because they are through a mad multiplier ef- criminal-capitalistic expan- spurred on by high profits fect—sought, at least initially, sion of drugs, in the face of which are increased by more to involve each nation in the which from that very moment and more extensive recruiting “fight against the drug the adoption of a clear posi- and distribution. scourge.” tion of real opposition, with Not only on account of the inadequacy of the different antee the certainty of law and, tration of heroine in doses on- national laws, however, par- therefore, the sure, effective ly as an immediate cause. The ticularly as regards the de- protection of the basic legal kingpins of criminal groups, it mands of prevention and re- concerns of individuals and should be observed, always pression, but, above all, in society. keep an eye on the checker- terms of a strategy to deal The attack, it is true, is seen board of market influence and with the characteristics and to be more massive than ever expansion; they do not hesi- potential of the above-men- here, but for this reason gov- tate, then, if necessary, to cor- tioned criminal groups work- ernment response should be ner the market with violence ing throughout the world, and even more intelligent and se- or split up part of the product in view of the lofty values at rious, though it ought not to truculently to gain hegemony stake, it would perhaps have take up at once the (two- over a territory. Consequently, been necessary for the whole edged) sword of punishment, who can doubt that they hesi- international community and since this can only be the ex- tate to resort to overdoses (or the UN itself to face up to trema ratio of criminal poli- adulterations or mixtures “drugs as a major power” cy, alongside other measures which are just as toxic) for the with the support and commit- to be resorted to according to sake of a market strategy? ment of each Member State, circumstances, always pro- Perhaps just to invigorate or with the modes and condi- portionate to real human and depress sales by way of quali- tions proper to a real battle, social needs. tative/quantitative modifica- though, let it be understood, tions of drugs? The risk to the with respect for effective lives of drug users would not guarantees regarding persons. suffice to block the projected 46 If it had adopted this posi- maneuver, just as the threat of tion—particularly towards punishment would not be the large-scale drug distribu- enough. tors and dealers, who would The activity of the criminal otherwise have been quite un- associations usually working likely to undergo the sanc- on an international scale thus tions established by govern- becomes clear: their goal is to ments, which, though severe, expand the already enormous are so hard to enforce—all of proceeds from drug traffic (if humanity could have effec- the return on cocaine is about tively protected basic univer- 1:200, the return on heroin is sal values which differ from a good ten times higher), per- everything else it readily pro- haps with a view towards tects. compromising vital sectors of a nation’s economy or its po- 3. Ultra vires suas could litical and administrative in- thus be applied to each coun- stitutions. try in the face of the major In the face of this reality, criminal action of the drug the permanent opposition be- traffic! And it must be added In the firm conviction, tween prohibitionism and an- that, in response to wide- then, that the international tiprohibitionism rears its head spread and understandable community’s battle is indis- up, not just in the eyes of leg- apprehension among those pensable against a juris gen- islators, and the latter is sup- who are affected by macro- tium crime—the drug traffic, ported (aside from a vindica- and microcriminality arising unassailable by any other tio libertatis) by the long list from drug consumption and means—the task of legal pol- of social evils attributed to denounce the inadmissible in- icy in each country remains the former. The tétes de action of government, legisla- urgent to seek out rational chapitre of the dispute tors (the experience of Italy measures, within existing ju- (whose ideological aspects speaks loudly in this regard) ridical frameworks, to re- must intervene at times to sometimes do not hesitate to duce, if not exclude, the seri- keep it from losing all inter- turn over to the judiciary or— ous individual and social ef- est) remain depenalization, by way of a referendum, in fects of drug production, traf- legalization (of hard drugs), spite of the complexity of the fic, possession, and consump- and liberalization (at least of subject in all respects—to the tion. Indeed, everyone is dis- “minor” drugs). And there is population itself the task of turbed over the advance of no lack of attention to new adopting a basic determina- such a high-risk phenomenon criminological and therapeu- tion, particularly for limit sit- and its effects, like deaths tic views, not involving the uations, where political re- from overdoses, which are in- liberalization of sale, but the sponsibility clearly is greater. creasing everywhere each administration of drugs by In this way, however, govern- year. medical prescription, as part ment displays its gruesome People wonder about the of health programs for the so- inconsistency rather than its reason for this enormous sac- cial integration of addicts. intrinsic weakness. It is in rifice of lives, which can be This prospect is sometimes fact not in a position to guar- linked to an incorrect concen- marked by a glimmer of en- thusiasm (and optimism) for 4. The sense of community we know, by immediate pos- proposals which would seem life which ought to animate session of reserved informa- “new” if they were not in- government and point to the tion. Links among usury, re- debted to orientations appar- limits needed for a humane ceiving stolen goods, money ently not aimed at protecting perspective on law demands laundering, and jobs in eco- personal life and health, but, constant attention to the fac- nomic and financial activities rather, the search for social tor of money in drug traffic involving money, goods, or tranquillity, which we do not and consumption and of mo- other drug-derived assets are feel authorized to link to the mentary flights from reality extremely productive. These meaning and value of legali- involving solitude, frustra- are almost unimaginably ty. The ambiguity of legal ad- tion, opposition, or malaise. huge resources which also ministration of hard drugs (il- Drug merchants and users are move over the—riskier, but legal consumption is not to be ready to sacrifice or risk their equally profitable—routes of combated with legal use own lives and others’, as well major construction and ser- when the good to be protect- as health, in terms of genuine vice contracts, where compe- ed is health), in logical terms, physical and psychological tition can be eliminated by does not warrant approval; well-being. persuaders who do not mince and, empirically, the “legal The perception of the val- words. medical dose” might prove ues at stake here, even more To this picture we must add insufficient and thus give rise so from the standpoint of underground dealings in to a parallel black market— arms, tobacco, and prostitu- this is not the place to deal tion, either as subsidiary ac- with its negative dimensions. tivities or directly financed The option of antiprohibi- by the drug traffic, with its 47 tionism, aside from all con- army of recruiters and distrib- traindications, to be imple- utors. mented effectively would re- The small pushers, usually quire uniform international working for a daily fix, are norms which are now lack- recruited by the middle- or ing, since the Vienna Con- small-range distributors. vention chose the opposite, Whether they are students, though moderate, solution for clerks, nurses, soldiers, or users of complementary mea- prisoners, they must ensure sures to rehabilitate them or that a drug supply is always substitute for drug use. available at the workplace In reality, apart from ac- and seek, for an appropriate tions performed under the ef- reward, to expand the market. fect of drugs, the additional Myriad small businesses or cumulative interference are involved in distribution; between criminality and drug profits aside, risks for them consumption or traffic shakes can get very high. Invading up prospects for the criminal another’s territory brings policy which a welfare State “human rights,” enables us to down the harshest sanctions, based on law is committed to ponder all the reasons for ef- and claims to control over an applying. Arguments and fective commitment—not on- area extend to the practice of counterarguments succeed ly by government, by way of usury, which represents a each other, if only because of law—on everyone’s part to prime conduit for employing marked ideological/political use all licit means to contain, large profits where the multi- tensions. And the State would if not overcome, the drug plier is not left to the discre- appear not to have at its dis- scourge, so as to impede its tion of workers. At the same posal any real means of pro- advance to the utmost. time, other routes, involving tecting the legal goods asso- The State itself, it must be commerce or real estate, ciated with the persons affect- stressed, is at risk in its nerve though controlled, are gener- ed. For instance, how can the centers. In the drug market- ally not blocked. vinculum servitutis which is place criminal groups are at Closely associated with so strong in the small-scale work which are so well orga- distributors, in addition to the dealer/user be broken? How nized that they can surmount small dealers, are immigrants can we avoid the periculum almost any obstacle—by and minors, especially in the clam proficisci of the drug bloodshed, if necessary. Rival Western countries. The for- addict in the face of the con- bands fight over profits and mer, usually not deterred by crete risk of punishment? influence, with no holds incarceration (their massive And what would be an effec- barred. Political and adminis- presence in jails is no acci- tive strategy to fight against a trative corruption provides dent), invest or find them- drug traffic which is almost safe-conduct to reach other- selves needing to invest their always tied to one mafia or wise inaccessible points and human capital in drug deal- another whose extraordinary illuminate dark or shadowy ing. Mere survival may be economic power is able to areas. Economic activity it- gained, or certain comforts corrupt government itself? self is greatly facilitated, as may be in store for those demonstrating good results in the fact that governments community of nations of the the volume of business. End- have not integrally imple- limits of each regarding ef- ing up in prison is certainly a mented the Vienna Conven- fective resistance to an in- risk, but it is, however, cov- tion represents a significant creased offensive by the drug ered in terms of legal defense failure, especially as regards traffic, it is far from easy to and economic aid to one’s the agreed-upon economic grasp the reasons for blame- family from those who have measures to combat the ad- worthy inaction or delay, cer- profited from one’s service. vance of “drugs as a major tainly to be avoided in the fu- This model has been func- power.” Crop replacement, in ture, if liberating man from tioning for some time among the ten years or so which drugs truly falls within “the workers capable of barbarous have gone by, could, for ex- aims shared by all and which crimes on commission and al- ample, have notably reduced all intend to pursue.” so among some minors, who the production of substances To desire the life and free- are clearly willing even to kill and contributed to the eco- dom of others for their own and are apparently less in- nomic and social develop- sake ought to represent the clined to turn state’s evidence ment of the populations normal basis for regarding or “collaborate with justice.” growing these crops. Is it the oneself as honest in relations For compensation, they are resistance of the governments with others. This has rightful- quite active in “home deliv- specifically involved or the ly been stressed as the princi- ery” of drugs, supplying inaction of others that could ple for an ethics also applying “group” or “street” fixes, and, to the community of nations. above all, reviving demand if An effective response to a it declines. drug trade which is ferocious 48 The criminal and economic because it is wealthy (even in turnover undergoes the in- comparison to the oil market) evitable instability of figures. is thus urgent, for, once again But in all likelihood about in this century, man’s life and 33% of all those jailed in freedom are at stake. Italy, who are incarcerated for As usual, there has been a drug traffic and consumption, succession of solemn official account for a similar propor- declarations of purpose con- tion of all the yearly income cerning a unitary, operative attributed to criminal activity “international front.” But not as a whole. At this moment even the most severe lesson there are thought to be about of this time has sufficed to 240,000 heroin addicts in prompt real action. Conse- Italy, and this market is felt to quently, unopposed, drugs be the leading one by far, fol- have continued their advance lowed, in order, by the sale of involving violence, marginal- cocaine, morphine, LSD, ization, and mourning. And cannabis derivatives, and am- their terrible wake has served phetamines. Italy, it is true, is to strengthen the tones of an- now a hub for drug import- have contributed in one way tiprohibitionism, which has ing, refining, distribution, and or another to crop replace- gained a comprehensible fol- transport and is also regarded ment operations and the con- lowing among those who, as a center for the production version of local economies? while not directly caught up of synthetic drugs, but crimi- It perhaps remains to won- in the matter, cannot remain nal involvement in this field is der why other measures, such indifferent to a drama of such seen to be markedly on the in- as the confiscation of income human scope. crease everywhere in the and the overriding of bank se- The idea of liberalizing mi- world and for this reason crecy, appropriate for com- nor drugs and legalizing hard prompts the greatest concern bating to some extent money drugs, perhaps as a result of in those conscious of the ethi- laundering, illicit financing, the social extenuation cal dimension of individual and other uses of the huge brought about by the phe- action and shared responsibil- proceeds from the drug traf- nomenon, has widely and in- ity in respect for the basic fic, have been relegated to the creasingly been pointed to as values of the person and the sphere of mere good inten- worthy of consideration, at community. tions by many governments. least with a view towards su- And this question must be perseding the drug trade. Ac- 5. To assume that any followed by another one con- cording to the manifest terms State, independently of a sol- cerning the real implementa- of antiprohibitionism in cit- id network of intelligent part- tion of the obligations agreed ing the “social harm” of pro- nerships aimed at real organi- to in the aforementioned hibition and its inevitable ac- zational integration, could Convention as regards mutual companying effects on drug deal with the gigantic crimi- juridical assistance, particu- production and traffic, collu- nal potential of the drug traf- larly in terms of penal en- sion between the two poles fic would be an inexcusable forcement. And yet, in the has even been concealed. The mistake. At the same time, light of the awareness of the twofold visage and noose of drugs thus seem to have integrating the weak, and inevitable drawbacks. The emerged, along with their drug addicts certainly are Italian experience, especially identity. Once the drug traffic weak, for their human—per- after the referendum of June is forced to obey the first law haps not material—poverty 1993, admitted by the Consti- of the market, it virtually col- escapes no one, but drug mer- tutional Court on the basis of lapses, in the case of liberal- chants also are, inasmuch as a daring mental construction. ization/legalization, because they have not discovered the The compatibility between the drug user—an addict for true meaning of life. And we the “lawfulness of consump- the criminal world—is no know the State constantly has tion” and the “unlawfulness longer dependent, though this to draw from culture to vivify of possession for the purpose outcome is neither certain nor law reflecting life needs. of consumption” (Sentence complete, as has been noted. Both prohibitionism and 28/1993), for example, while Such a consequence, cer- antiprohibitionism, then, with striking a blow to the certain- tainly not to be taken for their varied approaches to ty of penal law (after elimina- granted, is usually presented one aspect or another of the tion of objective reference to as the least harmful way out. complex drug problem, must the “average daily dose,” it is But it is precisely here, it certainly remain ideological- now up to the judge to deter- must be stressed, that the trap ly and politically committed mine the amount of the active lies: addicts’ life and health to seeking solutions or even ingredient in the substance would not be safe. Indeed, if suggestions leading in the and also its being destined for administration were insuffi- personal use), since separa- cient, the risk of overdose tion between nonpenal and would become real, as in re- penal unlawfulness remains course to clandestine drugs, directly linked to the purpose 49 with all the dangers of infec- of personal use, has also in- tions and other illnesses. volved a substantial depenal- Nor would the intricate ization of small-scale drug knot of the user/dealer be un- dealing. Indeed, it is common tied, as is apodictically af- for addicts to possess drugs firmed by the supporters of with the intention of devoting legalization/liberalization. In part to their own consump- reality, breaking this bond is tion and part (perhaps not a not easy—and experience has great deal, but not a “reason- been careful to demonstrate able” amount, either) to sale, this through the effects ob- and this situation is not pun- tained by the substantial de- ishable, provided unlawful penalization of small deal- acts are presumed not to exist ing—because a firm decision from a penal and administra- to recover freedom is indis- tive standpoint. pensable for real liberation This norm led the Supreme from drugs. And if, as we Court (United Sections, May know, enticement is frequent- 28, 1997, Cass. pen., 1997, ly resorted to by the mer- right direction. How can leg- 3350, 1833; 1998, 399, 205) chants of heroin and cocaine islators find clarification for to decide that the following to draw into their net those effective norms which meet actions are “not punishable who have shown an ability to the needs of different people and are classified as adminis- multiply profits by taking fix- in a complex society, espe- tratively unlawful: the pur- es wherever demand is great- cially when they are weak, if chase and possession of drugs est, it is also evident, on the not by way of a debate open destined for personal use other hand, that people may to all serious contributions? which occur, from the outset, flee from this strong attrac- It is also indispensable to with a view towards the inter- tion if the fragile opposition stress that personal drug con- est of other parties as well, of users/dealers is reinforced sumption—whether initial or where the latter’s intention is by intense, empathetic sup- occasional, with the different verified of later acquiring the port rooted in human solidari- effects of habituation, depen- drugs for their own consump- ty as a real sharing in life situ- dence, or addiction on gener- tion,” and the possibility for ations. ating crime—in almost all “group consumption” to con- countries is now distin- stitute a crime (as provided 6. No matter how enlight- guished from other illicit uses for by article 73, d.P.R.n. ened and expert a State is, in because it is regarded as war- 309/1990) is thus excluded. terms of its system of norms ranting rehabilitative treat- The disconcert arising is, of and judicial structures, it is ment, either to substitute for course, understandable. But always faced with diverse ob- or complement a sanction, this outcome is to be taken stacles when taking on the in- which should preferably not for granted in the light of the sidious, cunning, and aggres- be penal. premise on which the Council sive drug offensive. The wel- Is this a fortunate choice? It made its decision to admit the fare State based on law is also is certainly the result of care- aforementioned referendum aware of its role in socially ful reflection, perhaps with hinge. And there is also a very high price to be paid, ed, depenalized, but on the passport, and any equivalent which a diligent legislator basis of an ambiguity, which document” established by ar- would could perhaps better be ticle 75 t.u. clearly does not perhaps have been unable to termed a purely mental dis- contain any major dissuasive impose on health, which the tinction, involving “means” force in the matter at hand. Republic seeks “to protect as and “end.” The Constitutional But the terrain is so rugged a fundamental right of the in- Court (in Sentence 28/1993) that it shakes up ordinary ref- dividual and concern of the indeed declared, “There is no erence points. In reality, the collectivity” (Italian Consti- contradiction between the human dimension of the drug tution, article 32). It will thus permanence of the sanction problem relativizes the power be up to future legislators to for narcotics possession for of sanctions, and it is up to return to this premise and personal use and the abroga- the legislator as a human be- once again not lose sight of tion of the prohibition of the ing (who can certainly con- the basic value referred to. personal use of these sub- ceive of narcotics as capable This Italian experience— stances as behavior consid- of altering the psyche) to see whether or not it is to be ered in its own right.” And it the drug phenomenon as a deemed “utopian” in insisting felt it could prop up the asser- current reality—not, though, on the “personal and social tion with the tautology “The with cynicism and detach- recovery of an offender/vic- behavior sanctioned is not the ment, but with awareness and tim”—will certainly be useful personal consumption of nar- empathy—to which the com- to legislators in other coun- mitment, solidarity, and re- tries when responsibly pro- sponsibility of individuals tecting the health of those en- and the community must re- 50 slaved to drugs. spond. Serious and, therefore, ef- 7. The repressive penal sys- fective criminal policy re- tem now in force in a large quires that the State be very part of the world is generally alert to addicts’ decision to limited to actions connected set out upon the hard road of with the production of and personal and social rehabili- traffic in narcotics and psy- tation in the certainty that chotropic substances, as well they are not alone and can as instigating and facilitating feel helped along the way. their consumption. Habitual But how can the restric- personal use (not the occa- tions on the freedom of those sional variety, for which so- in precautionary custody or cial services are created to re- serving a sentence be recon- move the malaise and its ciled with a full recovery pro- causes), on the other hand, is gram? The Italian experience usually dealt with by way of may provide further help, medical and social/rehabilita- since norms have gradually tive treatment. In Italy, article been trimmed in the light of 122 t.u.n. 309/1990 thus cotics, but possession for per- the most frequently observed states, “The public service for sonal use,” a proposition needs. Indeed, article 89 t.u. drug addiction, after neces- which is evidently crippled. 309/90—whereby precau- sary verification and dialogue An antilogy (lawful/unlawful) tionary custody in jail must with addicts, establishes a would certainly have been not be applied or is revoked, personalized therapeutic and verifiable, not, however, by unless there are exceptional social/rehabilitative program isolating the terms (personal reasons for custody, when the aimed at full social integra- use as lawful/possession for convicted person is engaged tion through guidance and personal use as unlawful), but in or intends to begin a treat- professional training or so- by evaluating them in their ment and recovery pro- cially useful activities. In the recognizable teleological gram—is paralleled by the framework of the program, nexus. Only after demonstra- norm in article 90 whereby where there is recognized ur- tion that consumption of “in the case of a person sen- gent need, the service can ap- drugs without their posses- tenced to a prison term not ply disintoxication therapies sion was possible—that is, surpassing four years for as well as appropriate psy- the full independence of the crimes committed in connec- chosocial and pharmacologi- two terms—could legal com- tion with a state of drug ad- cal treatments; in all cases it patibility and incompatibility diction the surveillance tri- verifies implementation of (lawful/unlawful) have been bunal may suspend enforce- the program by addicts.” determined and asserted. ment of the sentence for five The unlawful possession of The mental procedure here years if it sees that the person narcotics for personal use—as betrays the malaise of a real has accepted or is engaged in a result of the 1993 abroga- void regarding sanctions a therapeutic or social/reha- tive referendum and the new which is rooted in depenal- bilitative program.” And it is norm in the above-mentioned ization. The “revocation of a not by chance that the text article 75 c.t.—is, as we stat- driver’s license, arms permit, adds, “Suspension of impris- onment also makes security tion of everyone’s life and every State which has incor- measures inapplicable.” health deal with the serious, porated the Vienna Conven- The intention of freeing insidious, and ongoing offen- tion into its norms to adopt people from drugs is thus sive of drug traffic? and implement the penal and pursued by seconding the Basic human rights, to judicial measures in keeping idea that a twofold status which we have just referred, therewith, which for years captivitatis (narcotics and a first of all demand (hominum should have been supporting jail term) would make the re- causa omne ius constitutum other positive effects or even covery of full freedom even est) the universal protection acting as a basis for addition- more difficult. This idea also of international law, all the al internal steps within coun- animates “entrusting some- more so when, on seeing iure tries. one to social service on a trial gentium legal goods offended To fight the drug traffic, as basis,” which the surveillance or subjected to risk (how, in- some have rightly requested, tribunal can resort to (even deed, can the drug traffic not flexible, but clear and precise twice, cf. article 94 ¤ 5) by be termed a hostis humani responses are urgently need- suspending imprisonment, generis?), the international ed from government. These even if it does not result from community cannot fail to feel are quite different from penal crimes connected with a state itself stricken by this blow measures alone and even less of drug addiction, provided and danger and therefore (as opposed to what happens the request aims at “continu- negated in its intrinsic val- in most nations) very severe ing or embarking upon thera- punishments, which are, peutic activity, in keeping moreover, used only as with an appropriate pro- threats. In Italy, for example, gram.” Finally, also to ensure imprisonment from eight to 51 full physical and social reha- twenty years is established by bilitation for convicted drug article 73 ¤ 1, t.u.n. 309/90, addicts who are not eligible for each of the twenty-two for alternatives to incarcera- forms of conduct by one per- tion, as with addicts in pre- son involving hard drugs; cautionary custody, there is and, significantly, in the case provision for “confinement at of minor drugs prison terms facilities suitable for imple- for the same actions range menting therapeutic and so- from two to six years (¤ 4), cial/rehabilitative programs,” and from six months to four to be created by local health years in cases where “be- administrations, to which cause of the means or modali- “those directing peniten- ties or circumstances of the tiaries must indicate the per- action, or the quality and sons who, when freed from quantity of substances, the prison, still need care” (cf. ar- actions are seen to be of ticles 95 and 96 t.u.). slight import” (§ 5); and, Among the measures serv- above all, “confinement may ing as alternatives or substi- ue—justice, protection, secu- not be inferior to twenty-four tutes or complements to pun- rity, and understanding years when three or more per- ishment, particularly incar- among peoples. sons associate for the purpose ceration, Italy (as we have Yet a realistic vision of the of committing the crimes of observed in the norms cited), potentialities of international producing and unlawfully in a perhaps imperfect, but law as a system of organiza- trafficking in narcotic or psy- nonetheless praiseworthy tion of social life and thus of chotropic substances, and the manner, has clearly sought to the current exceptional re- association is armed”; finally, stimulate, support, imple- pression of international the same punishment (¤ 2) ment, or contribute to creat- crimes (among which, it must “may not be inferior to ten ing a therapeutic and be stressed, the drug traffic years for those taking part in social/rehabilitative program should be included) demands the association.” for drug addicts. One of its an observation: effective pro- This is a picture whose basic interests—also shared tection today can only be that harshness is increased by by the collectivity—is indeed which is seen to be necessary various aggravating circum- the recovery of their physical and implemented by national stances involving actions by and psychological well-be- States, which punitive power individuals and associations. ing—in a word, their health, and criminal sanctions allow On the other hand, there is especially their liberation to act incisively, particularly provision for mitigating fac- from drugs by regaining free- in the sphere of personal free- tors and also for the possibili- dom, to be used with respon- dom, so as to avoid socially ty of judicially recognized sibility in a society which is undesirable behavior through amendment after a crime has not hostile. the dissuasion which is at the been committed—for exam- root of the system for protect- ple, on the part of those con- 8. How should a State dedi- ing juridical goods. tributing to keeping “criminal cated to the necessary protec- It is certainly the task of activity from leading to fur- ther consequences by helping obstacles and delays, and in an equally lonely society, police and judicial authorities would lend itself to comple- locked into its increased ma- to remove resources needed mentary forms of action. terial well-being, which is at to commit crimes” (article 73 Moreover, this punishment the root of the neglect regard- § 7), or “those acting effec- would allow drug traffick- ed as intrinsic to the current tively to guarantee evidence ers—whose reformation is complex society. This is the of crimes or deprive the asso- pursued after their loss of re- explanation for a supposed ciation of resources which are sources which may have been need for “coexistence of decisive for committing acquired over a long period— drugs and social life,” which them” (article 74 § 7) , or, fi- to seek self-renewal and real can give rise to nothing but nally, those providing aid in social integration. “ties among different forms the case of a danger of death of loneliness” and a definite or personal lesions to drug 9. Drug addicts and traf- absence of the vivifying con- users (article 81). As we see, fickers represent two com- nective tissue of authentic re- in this picture the inhumanity plex poles of extreme malaise lations among human sub- of those producing or selling that deserve careful analysis jects, who are certainly de- drugs is avenged (perhaps and adequate personal and sirous of not being left alone. proportionately, given the of- social action based not only Drug dependence in current fense, with some openings to- on the antithesis defense/of- society is, in plain terms, wards re-education and a fense, but also on solidarity, slavery—only an illusion of marked desire for emotional freedom, revealing nothing reassurance) by a State un- but man’s loneliness, indi- able to prevent or avoid (in gence, and vulnerability— 52 keeping with its mission) from which law, two thou- such a serious attack on per- sand years after the incarna- sonal life and health. tion of God in Jesus Christ, The limits and insufficien- must liberate man. “The so- cy of punishment, especially cial forms of training where incarceration—in view of the [man’s] personality develops, unending debate on it—do [in carrying out] their impera- not require further observa- tive duty regarding social sol- tions here. But recognition idarity (Italian Constitution, that the threat of excessive article 2), may never to any punishment is an index of a degree be exonerated from “subrogating function” in pe- contributing to the physical, nal legislation (as compared psychological, and social re- to other purviews of the law) covery of drug addicts. Fami- must exist, along with a much lies, schools, parish recreation more serious realization of centers for children, youth as- the evident injustice (proper sociations for culture and to a “scapegoat”) perceived sports, military bases, and by those undergoing punish- therapeutic communities, ment and not seeing it as con- which allows freedom not to among others, must respond ducive to rehabilitation, in be separated from man’s re- to calls for help from those addition to its obvious inef- sponsibility for man. who, in the noose of drugs, fectiveness, which is even Drug addicts/dealers repre- are even afraid to ask for it, so more pernicious than insuffi- sent an antithesis, offend- as to break the heavy bond of cient punishment. ers/victims, as regards crime. dependence, at least through The fight against the drug Slaves to drugs, they say they treatment incentives, which traffic, then, aside from se- want to live this way to vindi- have been resorted to as an al- vere, but just punishment, al- cate their freedom; they say ternative to punishment— so requires from the State in- they want to combat hostile though the hardest task, but telligence and—not occasion- society, but they only with- perhaps the most stimulating al, but constant—commit- draw into themselves, in the one, is to lead addicts back to ment in using available desperate loneliness of those the adventure of freedom, means, beginning with rigor- carrying out their own physi- tearing them away from the ous control of all economic cal and psychological de- trap which is driving them in- activity, with the indispens- struction—a tangle of contra- to flight. “It is precisely in able seizure and confiscation dictions, as we see, which is this utopian view that there is of all gains, which would oth- encountered in all drug users, situated the false conviction erwise be channeled at once who are clearly fleeing from that freedom begins where into money laundering and responsibility to seek refuge need diminishes,” observes the most disparate enterpris- in unreality. These are the Hans Jonas, also specifying es. Ex rebus dissuasion would two dimensions of a single that “only the most radical prove effective here, because act whereby they give up try- misunderstanding of the very it would be immediate and ing to overcome anxiety by nature of freedom can give less complicated within each seeking solutions to the intri- rise to such a conception, State, would not meet with cate problems of life—alone [for] freedom lives in con- stantly confronting need..., ty—the responsibility of each plemented if there are no and separation from need by reason of one’s position truces, surrenders, compro- would remove freedom’s ob- and capacity to act—to con- mises, or defections. If deter- ject, without which it would tribute to the liberation of mination remains strong, suc- be destined to be annulled, those enslaved to drugs cess may take time, but will like force without resistance. through serious commitment be ensured. Empty freedom, indeed, like to fight them and all manifes- Not the harsh sentence, but empty power, suppresses it- tations of criminality associ- the just sentence represents a self” (cf. Das Prinzip Verant- ated with them. response to the drug offen- wortung, Frankfurt, 1979). sive. Defeating it lies entirely The analyses regarded as 10. The State’s war on in condemnation, in the social most perceptive of the data drugs boils down to this sense discredit associated with the and real significance of drug of responsibility. The State fact that these “pretentious consumption around the may not renounce the values swindlers” have offended or world always point to serious at stake, but the enemy is brought serious risk to the malaise and loneliness asso- treacherous and by way of very life or health of many ciated with it and exacerbated corruption can sometimes re- persons—and such weak by the increasing rent in the ly even on parts of the gov- ones—for the sake of enor- web of personal and social ernment apparatus claiming mous, but squalid personal values. It is almost as if, more to combat drugs. And the ad- gain. The sad part of this hu- and more often in the most man episode is that one man advanced areas, an adult free- has betrayed humanity by re- dom has to include cupio dis- ducing others like himself to solvi and human dignity— slavery in taking away their 53 which also means respect for freedom for the sake of profit. one’s life and health as pre- The ruinous nature of the suppositions for the con- drug trafficker’s influence scious exercise of freedom— upon his victim consists of can be real without affirming having acted not to make him its value. Liberation—defini- freer and more alive, but to tive departure—from drugs extinguish or obscure his thus implies personal com- freedom, if not his very life. mitment, or usucapio liber- In the light of this terrible tatis, by human subjects who harm and laceration, can grasp their responsibility to those who have caused such themselves and other mem- evil to mankind be left alone? bers of society. The marginalization of the Just as to be rescued from guilty for the sake of the slavery of crime it is in- vengeance, perhaps with the dispensable to engage in true false spoils of justice, may renewal and recover aware- never acquire logical or ethi- ness and freedom in the light cal meaning. Nor can civil so- of a judgment of how one has versary is also efficient, given ciety, by way of punishment, acted, so those seeking to the extraordinary material re- absolve itself of a shared re- “emerge from the drug tun- sources available and the var- sponsibility for crime (it was nel,” though feeling them- ious overlapping or indepen- Max Scheler who recalled selves to be supported by the dent organizational structures that a plant grows only in a help of others, must commit at work. The battle must thus certain soil, in a suitable cli- their full selfhood to recover- be relentless, intelligent, and mate) or for the series of ing freedom, which is their effective, in the conviction crimes committed (only in a human dignity. that we can eventually get the law of June 26, 1990, article To discover in legal norms better of events regarded as 26, no. 162 was provision (especially at their origin) a inevitable and factors deemed made in Italy for “the Min- sense of community life, thus insurmountable. istry of Education to promote impressed with the values of The first urgent measure, it and coordinate the different freedom and solidarity and must be stressed, is to deprive educational activities on bound together by the respon- the drug traffic of its posses- health and information con- sibility of the individual to sions and conspicuous gains. cerning the harm caused by others and vice versa, means This requires rigorous verifi- narcotic and psychotropic to note (as Jonas does) that a cation of the use and camou- substances, as well as related sense of what should be is flaging of goods to avoid pathologies”). concretely contained in one’s money laundering or transfer The rehabilitative dy- existential being and one’s to other branches of the drug namism of punishment, in the capacity for acting causally business. Only if seriously context of its necessary hu- implies an objective obliga- damaged in its income will it maneness, and personal penal tion, in the form of external begin to yield, for voids must responsibility (Italian Consti- responsibility. We may thus be filled before long. An tution, article 27) certainly state that it is everyone’s du- overall clean-up can be im- raise questions for the con- science of the jurist and of all make up for the harm they sumptions, correctly deemed men regarding the full re- have caused. On this assump- a right of convicts, as in Sen- demption of those who have tion, as, for instance, articu- tence 201/1974) may consti- committed serious crimes. lated in Italian law (article tute the most significant ex- Hans Jonas, referring to the 176 c.p.), those who, on con- ample of renewed friendship courage of responsibility, has ditional release from confine- between man and the law, also specified that “responsi- ment, decide to use their new- where the legal order thereby bility lies in care for another found freedom differently displays a desire to show faith being when it is recognized (positively, as opposed to the in those who have changed as a duty and becomes appre- past) can show how useful their outlook and firmly de- hension in the event the vul- the lesson received has been cided to amend their lives. nerability of that being is for them and orient them- An act of faith by the State threatened” (cf. op. cit.). selves towards definitive re- in man’s recovered con- The guilty, in order to re- spect for the goods protected science, which is a synthesis turn to community life with by law. of awareness, freedom, and those whose basic shared val- The Vienna Convention, responsibility. Clearly, an act ues have been offended by with evident attention to the of faith to be made—in the their criminal action, once seriousness of the crimes of creature willed by the Creator they have served a significant the drug traffic, notably limit- in his image and likeness. part of their sentences, must ed measures alternative to in- offer assurance of their carceration and other benefits Professor VINCENZO amendment by their efforts in related to confinement. There- SCORDAMAGLIA work or study and by show- fore, conditional release Professor of Penal Law 54 ing interest in their victims (which the Italian Constitu- at Tor Vergata University, and also a real intention to tional Court, on certain as- Rome The Fight Against Drugs and International Regulations

I would like in the first mainly in the countries of the hundred narcotics indicated in place to thank Archbishop European Union and Central the annex tables, which can be Lozano for the invitation ex- Eastern , drugs which, modified or supplemented by tended to me to participate in as observed, are more eco- the UN’s Commission on this symposium, prepared by nomical than the traditional Narcotics at the recommenda- the Pontifical Council for Pas- ones of plant origin and are tion of WHO.6 This control, toral Assistance to Health even more available on the which is intended to regulate Care Workers, to address the free market.4 the production and sale of nar- problem of drugs, which is of As indicated by the first cotics for legal purposes and extreme and worrisome gravi- agreement on the control of avoid improper use and their ty because of its constant de- the trafficking in and con- being destined to illegal ends, velopment, despite the long- sumption of narcotics, which involves approval by the In- standing commitment of the dates back to the beginning of ternational Organ of Control international community, the this century, the drug phenom- of reports which every con- 55 Church, and many states to enon, with its intrinsic tracting state is supposed to hinder its spread and redress transnationality, has drawn the submit containing the relative the harm done and the disas- attention of the international estimates of legitimate nar- trous effects on both the indi- community since its appear- cotics needs and annual statis- vidual and society, and if I ance.5 Concentrating on the tics on the substances pro- may say so, on nature, too, current responses of the inter- duced, imported, and export- taking into consideration the national community to the ed.7 ecological damage that is drug problem, I will proceed The convention of 1971, caused, as reported by ex- by outlining first of all the which is presently in effect in perts, in the Andean countries, framework of regulations, so 146 states, is also founded on where increased cultivation to speak, with basic and glob- the principle which forbids and refining of cocaine has al concerns, elaborated in the the use of psychotropic sub- brought about massive defor- sphere of international coop- stances beyond the needs of estation and pollution of eration, which all converges medicine and science. Like rivers.1 into the UN system. I will the 1961 convention, it pro- The development of the subsequently indicate the part motes the legal marketing of drug phenomenon concerns, played by international orga- narcotics, and even though in above all, the universalization nizations in a more restricted a less rigorous way, subjects of the illicit traffic in drugs: in sphere, be it spatial and/or to similar control an addition- fact, the recent statistics sup- functional, and, above all, al one hundred substances not plied by the UN’s Commis- dwell upon the action of the included in the previous con- sion on Narcotic Substances European Union. I will con- vention, such as hallucino- show that illicit traffic in hero- clude with a brief comment on gens, amphetamines, and bar- in and cocaine is extremely the prospects and effective- biturates.8 These conventions widespread, even in ness of the system outlined. do not provide direct mea- and the Middle and Near East, The current framework of sures for the suppression of il- where a new traffic route has the regulations drawn up in licit trafficking in narcotics, been opened along the Tran- the sphere of the UN compris- but limit themselves to re- scaucasian corridor.2 And, es the single convention on questing the contracting coun- back in 1990, the reports of narcotics of 30 March 1961, tries to cooperate in the sub- the UN’s International the convention of 21 February ject and also introduce in their Agency for the Control of 1971 on psychotropic sub- own regulations offenses con- Narcotics observed that uni- stances, the protocol of 26 nected to narcotics and psy- versalization also involved the March 1972 for the amend- chotropic drug production, abuse of drugs, with the con- ment of the single convention, trafficking, and sale. sequence that the distinctions and the most recent conven- The need to improve, on the between supplying, consum- tion of 20 December 1988 one hand, the functioning of ing, and transporting countries against trafficking in illicit the International Organ of were becoming increasingly narcotics and psychotropic Control and, on the other, to evanescent.3 substances. specify the procedures for the Besides, the phenomenon The convention of 1961, prevention of addiction and of drugs concerns the emer- which is currently in force in the social recovery of drug ad- gency of the spread of new 150 states, subjects to interna- dicts led to the adoption of the “synthetic drugs,” produced tional control more than a Protocol of 1972 for the amendment of the single con- which, while presenting sig- 1988 UN convention, formu- vention, presently in effect in nificant similarities to the lated the 1990 Strasbourg 142 states.9 multidisciplinary document of convention on money laun- And, finally, the 1988 con- 1987, is different inasmuch as dering, investigation, seizure, vention, to which 138 states it assigns to the UN the role of and confiscation of illegal and the European Union are a center for consulting and co- earnings. This convention, parties, constitutes the central ordination of the activities of which reflects the need for instrument for cooperation in the states and also ensures collaboration, above all by the fight against drugs, espe- their uniformity in approach states with a high rate of in- cially because it expands the and methodology in combat- dustrialization, where, in fact, one-sided vision of the previ- ing the drug problem.13 the problem is greatly devel- ous conventions, inspired by Presently, preparations are go- oped, provides a basis to at- the philosophy of controlling ing on for another special ses- tack laundering, allowing ho- supply, or production and also sion of the General Assembly mogeneous planning in the tackling the problem of de- to take place in June 1998, al- various signatory states, and mand (hence consumption), so dedicated to the fight adopts strategies for combat- and proposing, therefore, ing the problem, with mea- global regulation of the drug sures such as blocking finan- phenomenon, with the sup- cial transactions, seizure, and pression of illegal trafficking confiscation of illegal pro- and the recovery of addicts.10 ceeds.15 The European Coun- Besides, the convention cil also formulated the most broadens the strategy of the recent convention, of 1995, 56 fight against drugs in three di- specifically dedicated to the rections, with the monitoring suppression of drug traffick- of precursors and the chemi- ing by sea.16 cal substances needed for the Central within the European fabrication of drugs listed in context is the action of the Eu- the two annex tables; mea- ropean Union, which with the sures to check the transporting Maastricht Treaty expressly of narcotics by sea (since vigi- mentioned the fight against lance at boarders and airports drugs in the new forms intro- had indeed been more assidu- duced, as a matter of public ous and had reduced the expe- health (Document 10, dition of narcotics by both art.129), and in cooperation in land and air, thus making the matters of justice and internal seaways preferable); and, affairs (document 6), and, be- above all, identification of the sides, the sector was singled criminal channels for launder- out for primary action within ing the proceeds derived from the field of external politics the cultivation, buying, sale and common security (so- and exportation of narcotics called “EPCS”). For the im- and confiscation of such pro- plementation of such provi- ceeds.11 sions the Commission has al- The 1988 convention situ- ready worked out two pro- ates itself in the framework of grams for action by Europe in the intense activity of the UN the fight against drugs. The which culminated in the Inter- against drugs, in which the second, for the period 1995- national Conference of 1987 budget for carrying out such a 1999, outlines a global strate- on the abuse of drugs and ille- program or even that of the gy which treats demand re- gal trafficking, which con- 1988 convention will be duction, fighting illegal traf- cluded with both the adoption worked out, along with other ficking, and international ac- of a political declaration, ac- matters. The session will tion, with both more intensi- knowledging the “collective study the most suitable mea- fied cooperation in the UN’s responsibility of states” in sures for both eradicating ille- program of International Con- fighting the illegal drug trade, gal crops in favor of other trol of Drugs and the Pompi- and a multidisciplinary docu- forms of agricultural develop- dou Group of the European ment that is a kind of epitome ment and fighting organized Council and the insertion of for the anti-drug action of crime engaged in narcotics clauses related to the fight governments, international or- trafficking.14 against drugs in the agree- ganizations, and nongovern- Passing on to the second ments made by the Communi- mental organizations.12 Later a point in my report, concerning ty with developing countries.17 special general assembly on regional cooperation in the A central element of these the drug problem was held in fight against drugs, I will only programs is the provision of 1990, which proclaimed the mention the most recent con- preventive measures (e.g., period 1991-2000 as the UN ventions drawn up in the do- provide information to the decade against drugs, adopt- main of the European Coun- groups at risk, health educa- ing a global plan of action, cil, which, on the basis of the tion, and professional train- ing), measures for rehabilita- mined will of the international limits intrinsically proper to tion and social integration of community in opposing the application of internation- drug addicts, and supporting drugs. Such a will is also ex- al norms, which definitively recovery initiatives.18 pressed by the existence of depends upon the political Among the most recent and equally impressive institution- choices of the individual significant normative results al machinery (e.g. the UN’s states—that is, questions of of common action we note International Program for strict domestic jurisdiction. In adoption of the council’s reg- Drug Control, the Pompidou other words, the system func- ulation of 31 March 1992, Group of the European Coun- tions, but it always hovers be- which contains measures in- cil, the European Committee tween the need to ensure the tended to discourage the di- to Fight Drugs, the Trevi effectiveness of international version of certain substances Group, and the European data action against drugs and the towards the production of il- center for drugs and addiction need to respect the legislative, legal narcotics or psychotrop- in the European Union), a ma- judicial, and administrative ic substances;19 the current di- chinery which I chose to con- independence of the states.26 rectives which the govern- sider because of its close rela- This explains why the choice ments of the European Com- of a conventional instrument, munity follow in regulating even though it is the preferred the manufacture and sale of one, is not the most recurrent precursors;20 the policy for the one, since, as is well known, prevention of the use of the pacta sunt servanda. In fact, European financial system for the risk is that the states will the purpose of laundering not take part in the agreement. proceeds from illicit activi- Take the case of Switzerland, 57 ties;21 the agreements with the where experiments for the lib- Andean countries on the con- eralization of drugs are cer- trol of precursors and the tainly facilitated by the drugs themselves, and the for- Switzerland’s failure to ratify mulation in 1995 of the Eu- the 1988 convention, whereas ropol Convention, which con- in the case of Holland the stitutes an extremely impor- UN’s International Organ for tant element for the coopera- the Control of Narcotics, in its tion of police in the member 1995 report, expressed its states.23 In the same way we concern for similar initiatives, note also the Schengen agree- questioning, in fact, their ment of 1984 and the perti- compatibility with the obliga- nent 1990 convention for its tions of the convention agreed application, agreed upon by to by the state.27 European states, which pro- No wonder, therefore, that vides for the abolition of in- most of the norms for the fight ternal border controls even against drugs within the for foreigners who have legal- framework of the internation- ly entered and are travelling al organizations mentioned within a Schengen state.24 above belong to so-called soft However, since criminals law—that is, they have rec- could take advantage of free ommendatory, programmatic, circulation to further expand and persuasive value, but are their illegal activities, in order tionship with the topic as- not really binding; they carry to guarantee the safety of the signed to me. Such a will by on the function of forming the contracting states, the agree- the international community conscience of the States, pre- ment provides norms for mu- is also identifiable in the ten- disposing them towards later tual assistance by police dency to classify the traffick- development of conventional forces, which agree to carry ing of drugs among “crimes instruments or even of hard on surveillance or follow up against humanity.” This is ex- law. The only exception in people who have committed pressed in the deliberations of such a situation is the Euro- crimes, including the traffick- the Commission on Interna- pean Union, which is capable ing of drugs in a Schengen tional Law when dealing with of intervening in a binding state. such criminals.25 way in sectors removed from I now turn to concluding re- If, however, as I noted at the the sovereignty of the states, marks. The system of norms beginning, the drug problem thus making its action notable, for international cooperation continues to expand, univer- above all in the fight against in the fight against drugs, salizing itself, then there aris- drugs. which we have just treated in es an immediate question its major concepts, appears about the level of effective- Professor TALITHA VASSALLI impressive, broad, and inci- ness of such a system of coop- OF DACHENHAUSEN sive for the whole range of eration. The answer could be Professor of International Law at the Faculty of Political Sciences problems posed by drugs, thus positive, but ought to be inter- Frederick II University, displaying the clear and deter- preted in the light of those Naples Notes vol. XLIII, 1990, p. 1231ff. Chronique ONU (1996), p. 77 and UN 6 For the text of the Convention, see Doc. E/CN. 7/1997/PC.3 of February 1 On this last aspect, see G. GATIANIS, United Nations Treaty Series, vol. 520, 26, 1997. La dernire victima de la cocaine: Quand p. 151ff. 15 For the text of the Convention, see rougissent les rivires, in Chronique 7 Regarding this control mechanism, Riv. Dir. Internaz. (1993), p. 834ff. ONU (1995), p. 66ff. see M. BETTATI, Le controle interna- 16 For the text of the Convention, see 2 See the following documents: tional des stupefiants, in Rev. gen. di in- Rev. Gn. dr. internat. pubblic. (1995), E/CN. 7/1997/4 of February 3, 1997 ternat. public (1974), p. 180ff. p. 212ff. and Gilmore, Narcotics Inter- and E/CN. 7/1997/4/Add. 2 of March 6, 8 For the text of the Convention, see diction at Sea: The 1995 Council of Eu- 1997. United Nations Treaty Series, vol. rope Agreement, in Marine Policy, vol. 3 See the OICS Report for 1992. 1019, p. 175ff. 20, no. 1, p. 3ff. 4 For the general picture of the prob- 9 For the text of the Protocol, see 17 See Doc COM (94) def. of June 23, lem and the European Unions strategy United Nations Treaty Series, vol. 976, 1994. in response, see the Commissions com- p. 3ff. 18 On this point, also see GUCE/C 37 munication to the Council and Euro- 10 For the text of the Convention, see of February 9, 1996, p. 1; GUCE C 141 pean Parliament on controlling new Comunit internaz., 1989, p. 799ff. of May 13, 1996, p. 42; Doc COM (96) synthetic drugs, in COM (97) 249 def. 11 Regarding the 1988 convention, 201 def. of May 8, 1996. of May 23, 1997 and also the joint ac- one of the references is F. Rouchereau, 19 In GUCE L 96 of April 10, 1992. tion of June 16, 1997 adopted by the La convention des Nations Unies contre 20 In GUCE L 370 of December 19, Council on exchanging information, le traffic illicite de stupefiants et de sub- 1992, p. 76ff. evaluating risks, and controlling new stances psychotropes, in Ann. francais 21 In GUCE L 166 of June 28, 1991, synthetic drugs, in GUCE, no. L 167, of Droit Internat. (1988), p. 613ff. p. 77ff. June 25, 1997. 12 See R. SALERNO, Conferenza Inter- 22 In GUCE L 324 of December 30, 5 This is The Hague Convention on nazionale sullabuso e il traffico illecito 1995, p. 1ff. Opium of January 23, 1912 (in the di droghe, in Comunit Internaz. (1989), 23 In GUCE L 326 of November 27, Treaty Series, League of Nations, vol. p. 562ff. For the text of the Declaration 1995, p. 1. 8, p. 187ff.), partly replaced by the and the multidisciplinary Compendium, 24 For the text of the agreements, see Convention to limit production and reg- see International Legal Materials Riv. dir. internaz. (1991), p. 355ff. ulate distribution of drugs (Geneva, Ju- (1987), vol. 26, p. 1638. 25 See Report of the International ly 13, 1931, ibid., vol. 139, p. 301ff.). 13 See Resolution S-17/2 of February Law Commission, for May 2-July 21, The Convention for the Repression of 23, 1990 and R. Salerno, Il recente di- 1989, p. 170ff. 58 Illicit Traffic in Harmful Drugs (Gene- battito internazionale sulla droga: gli in- 26 On this point see G. PORRO, “Le va, June 26, 1936, ibid., vol. 198, p. contri di New York e Londra, in Comu- competenze comunitarie per la lotta alla 299ff.). For commentary on these con- nit internaz. (1990), p. 301ff. droga e al traffico di stupefacenti,” in Riv. 14 ventions, see L. SBOLCI, the entry on See Une session extraordinaire sur dir. internaz. priv. e proc. (1992), p. 40. stupefacenti (dir. internaz.), in Enc. dir., les drogues recommande pour 1998, in 27 See the OICS Report for 1995. Spiritual and Pastoral Accompaniment of Drug Addicts

Introduction heroin, cocaine, and synthetic drugs, and many in the same drugs. or similar negative circum- When I was asked to speak Young people who, in stances have not turned to here, my spontaneous reac- seeking to live without drugs, drugs. tion was to refuse. The ven- have begun a rehabilitation People do not slip into hard ture surpassed my experience process at one of the multiple drugs all of a sudden. They and knowledge. But at the Therapeutic Communities. take a number of steps in the same time there awakened in My reflections refer to these direction of addictive behav- me a sense of challenge, so to young people and this con- ior before getting there. speak, and a clear awareness text. “Drugs do not enter a per- of bearing the concerns of They are no doubt an im- son’s life like a lightning bolt many other pastoral workers portant part, but not the out of a clear sky, but like a who in one way or another whole complex world of seed taking root in soil which seek to be witnesses to the drugs. has long been prepared” 59 living, liberating God in a (Pontifical Council for the context of death and slavery, Family, From Despair to as is the world of drugs. 1. The Drug Addict: Hope, 1992). As I worked out my paper, An Anthropological One observation based on the statement by Saint-Ex- Approach statistics concerning the start upéry in The Little Prince of use is that people seldom came to mind: “When the The UN’s official data for begin alone. The inception of mystery is too impressive, it is 1994 referred to forty million tobacco use is a good exam- not possible to disobey.” drug addicts. And the figure ple of group learning. Mass is growing. We may thus psychology is highly devel- speak of a sort of pandemic. oped in some people for the Delimiting the Field: It is present at all social and simple reason that they do not Experience in cultural levels of the vast hu- identify with good parents a Complex World man community. and are capable of following In spite of social givens, fashionable trends, but not To come to earth in the however, it is impossible to their own vital tendencies. drug world is to look out over define a specific type of per- a coarse, obscure, complex sonality or family and eco- a)Reasons for Taking Drugs terrain of planet-wide scope nomic situation which deter- I shall not attempt an ex- and fatal repercussions: it mines addictive behavior. haustive study of motiva- cuts down life and slashes “...There are no psycholog- tions, but stress the symptoms possibilities for human ical profiles, fixed models of which may invite or stimulate growth. inner conflicts, or specific pastoral action. A world rooted in the in- phases of development se- At the outset it is appropri- evitable human tendency to quences which can be set ate to specify that drug addic- seek happiness. A world tak- forth beforehand as decisive tion is essentially a symptom. ing the model of our society factors in the history of drug And symptoms require de- to a crisis point. For believ- addiction or other forms of tailed analysis because they ers, it manifests the power of addiction” (Zinberg, 1975). are a result of one or several evil embodied in social struc- In addicts we find the same unresolved conflicts which tures and individual lives. An problems and situations remain repressed or denied. enslaving world. In short, a which may lead other person- Symptoms have a hidden lan- serious social problem. alities to different personal guage which must be deci- My framework will not and solutions and/or successful, phered, for they proceed from cannot be this complex, vast useful outcomes. conflicts enveloped in the un- world, but the concrete per- The young addict is no dif- conscious. To decipher them son who is a drug user or ad- ferent from other people. it is necessary to understand dict. Though familial, scholastic, them, and that is the task of The backdrop to my paper and environmental factors all therapy. Within the multi- consists of the faces of hun- have an influence, they are ple causes of drug addiction dreds of thousands of young not decisive for addictive be- we point to the following: re- people between eighteen and havior. Many other young gressions, emotional alter- thirty-five who are victims of people in more favorable ations, and attacks by others deadly substances, especially conditions also fall into on mental health in work, family, or school environ- not they are tolerated by soci- and selfish, but lacking a ments, where self-esteem and ety. sense of guilt. self-image are assaulted. Ð Lack of motivation. They Wurmser says drugs are b)Listing of cannot rely on their will, “used by people with an in- Addicts’ Behavior Patterns which is undermined by tense feeling of loneliness, and Character Traits masochistic attacks, and their emptiness, and depression to Ð Compulsive behavior. selfhood is debilitated. This try to defend themselves from Addicts want things at once generates guilt. the impact of those senti- and cannot stand delays Ð A low level of under- ments, eliminate or reduce or long, arduous mental ef- standing due to scanty cultur- rage over their limitations and fort. They seek to satisfy al tools. Most have not fin- shame over weakness and im- desires which cannot be ished elementary studies potence, repair the feeling of satisfied. This can explain (Pampuri statistic: 80%). being wounded and rejected, their compulsive conduct Ð They lack conviction and maintain an infantile and the obsessive ritual about the power of goodness world of idealized objects. they create around the use and positive motives to hold The effect of some drugs is of drugs, to which they on to. used to try to palliate a lack of also attribute supernatural Ð If we have focused on personal meaning, goals, and powers. these behavior patterns and values.” In an attempt at sum- character traits, it is because marizing, specialists speak of they relate to the pastoral “structures with a narcissistic task, for without detailed, ex- deficit in self-esteem” when haustive knowledge of these 60 determining the “basic lack or people we cannot seek to do fundamental defect” which much for them. This is the the addict seeks to correct initial conclusion and the with drugs. Moreover, the ad- starting point for pastoral as- dict’s capacities for mental sistance. elaboration and introspection Ð A lack of interest in peo- are limited. ple and things. We know many people use Ð Concentration of intelli- all kinds of drugs to escape gence on everything regard- from apathy. We are even ing the drug world. sold the idea that life without drugs is very boring. At heart this defense of drugs reflects 2. The Church a weak self and fear when and Drug Addicts dealing with suffering and depression. “Addicts’ self- a)Theological-Pastoral hood is weak and they lack Ð A lack of tolerance of Approach the strength needed to face frustrations. The Church possesses an suffering.” Drugs of every Ð Altered judgment of their unsuspected kairos in regard kind are used “to erase and reality out of excessive or de- to drug addicts in both pas- mollify persecution by the ficient self-esteem. toral care and her presence superego. In fact, many ad- Ð A basic note of depres- among the least favored, so- dicts begin with self-adminis- sion, with a need to depend cially and religiously. tration of drugs to deal with on groups and leaders and lit- In dealing with them, pas- the anxiety produced by the tle esteem for relations with tors can again learn that per- superego’s persecution, to their equals. sons cannot be healed except treat the intolerable inner ten- Ð Easily influenced, though through unitary, integral com- sion caused by a suffocating not always in a good direc- prehension of them. Either superego” (Masson, Suffocat- tion. persons are saved in their to- ing Superego, 1981). Ð Restless and unstable, tality or there is no salvation These simple references with avid desires. for souls. This was the way lead us to the conclusion that Ð On account of low self- Jesus of Nazareth acted. it is necessary to consider the esteem, they always feel “To evangelize represents personality in which drugs threatened: “I did not deserve the joy and vocation proper to have become installed and in- to be born.” the Church, her deepest iden- dividual psychodynamics be- Ð Addicts experience the tity. She exists to evangelize” fore beginning the task of re- dissatisfaction and stress pro- (EN, 14). habilitation and pastoral care. duced by chronic self-dispar- The Church’s action de- Though there is no stable per- agement. rives from her being. The sonality structure necessarily Ð In general, they are cred- Church feels called to evan- leading to addiction, psychol- ulous, open, generous, and gelize. The Church needs to ogists point to some common unable to say no. They pro- understand the world and characteristics present in al- pose major projects and leave men as the destination of her most all, whether users of things undone. They are like mission, the object of evan- hard or soft drugs, whether or spoiled children—demanding gelization. “The cause of God is the cause of man.” ty and a powerful impetus. guide for mankind on its way As Christ took up all of hu- He gives them their dignity to God. From his Resurrec- manity, so the Church in her back. He brings them the cer- tion hope originates, and the evangelizing action must take tainty of possessing inde- certainty that pain and death up the concrete situation of structible dignity in the eyes do not constitute the last each and every person. of God—He prefers them. In word on human existence. “What is not taken up is not this certainty they can rise The followers of Jesus who redeemed,” states a classical from the prostration to which live out his spirit introduce theological axiom. they are subjected. God’s nearness and accompa- Jesus’ accompanying hu- niment into human times and man beings, in the confusion spaces. The Church is the lo- EMMAUS: of suffering and death as cation, the house, for practic- A Model for Pastoral well, reaches the point of ing diakonia and koinonia. and Spiritual identification. He identifies She makes visible what Jesus Accompaniment with the mortal destiny of did—to reflect God’s imper- man and travels the road of turbable passion for man. Jesus’ words and gestures man until death. are the necessary model for The cross on Golgotha be- b)“He Asked Them....” the Church. comes the symbol of nearness Pastoral Care In the Emmaus episode we and Healing Spiritual discover a pastoral model for Accompaniment disappointed people. The of Drug Addicts scene deals with introducing in Relation faith in the Risen Jesus into to Psychotherapy 61 the hearts of his disciples, Let us return to the Em- filled with questions and maus scene and Jesus’ first fears; it offers us the healing intervention to approach and process and Jesus’ personal accompany the two disap- strategy. pointed disciples on asking, According to the story, the “What are you discussing as first step in spiritual and pas- you go on your way?” (Lk toral accompaniment consists 14:17) of approaching and walking His question goes to the together. This model repro- heart of their experience. It is duces the style of Yahweh, not a question to satisfy cu- who “walks with his people.” riosity or request informa- He places Himself alongside tion—it goes to the core of those traveling “blindly and their concern. He forces them sadly.” It is an attitude or to relive the “painful events” movement of koinonia. and accompaniment. which affect their lives. And In Jesus there shines forth There is a fundamental arti- the Gospel concludes by say- most clearly God’s imper- cle in our faith: “to believe ing Jesus went in with them turbable inclination in favor that Jesus was true God and and sat down at the table. of the sick and suffering hu- true man.” In these brief references Je- man being. In the Crucified One God is sus’ manner and pastoral From the beginning to the present, and in the eyes of the “style” are suggested. Is the end Jesus draws near and ac- poor and oppressed the Chris- pastoral accompaniment of companies those needing tian believer must glimpse drug addicts so simple? guidance. The Gospels amply the disfigured face of Jesus. Of course it is, but since ar- narrate examples of the way Christ hands Himself over riving at simplicity requires He lets Himself be kidnapped to humiliation and abandon- previous travel over a long by the poor, the condemned, ment to become the brother road through complexity, I children, the disoriented, and of the humiliated and aban- shall attempt, though in sum- the sick. doned and take them to the mary fashion, to move along The signs of the arrival of Kingdom of God. Christ’s it with the help of the psy- the Kingdom are evident: sufferings are not his alone, chotherapy and philosophy “The blind see, the lame but include ours. underlying Therapeutic Com- walk, and the Kingdom is an- “The Christ who passion- munities. They are the con- nounced to the poor.” ately loved, the Christ who text in which I move and The surprise and scandal of suffered in the face of God’s from which I have drawn the normal society over Jesus are silence, is our brother, the tools that have helped me to reflected in the Gospel of friend to whom we can en- approach drug addicts pas- Luke: “He welcomes sinners trust everything, for He torally. and eats with them” (Lk knows and has suffered all I am aware that the “human 15:2). that can affect us—and even situation” cannot be resolved What does Jesus offer the more” (J. Moltmann, Christ by way of therapy. After at- ‘poor’? He does not give for Us Today). tending to wounds, there re- them wealth, but a new digni- Jesus Christ is thus the mains an incurable residue which cannot be treated in Drewermann), affirms, “Only insignificance and absurdity therapy. But the road to pas- in the sphere of religious in life. Others call it a “life toral accompaniment of drug thought can the inability to crisis,” referring to all that addicts passes through psy- accept oneself and fear of becomes imprisoning and un- chology and psychotherapy. finitude be healed.” bearable in life: illness, hid- They are indispensable vehi- Socially, addicts prompt re- den psychic wounds, radical cles for this kind of pastoral jection and condemnation in changes, loss of loved ones, care. Of course, pastoral many people, like the lepers deep disillusionment, and workers need not be special- in Jesus’ time. Indeed, many shifts in life direction. ists, but they must have some have an excessive idea of ad- Maslow sees the “will to training, be open, and main- dicts’ responsibility for their meaning” as the basic, lead- tain dialogue with psy- situation. ing motivation in human be- chotherapists. Psychology Addicts experience this havior. can give the pastoral worker sensation: they feel observed, This existential frustration more precise knowledge of judged, and rejected. And acts on all levels of personal the psychodynamics of reli- those who are excluded are psychology, dominating gious experience. With its deeply wounded in their self- thought, feelings, action, and help, pastoral care can speak esteem and feel like the dregs religious faith and manifest- concretely to announce God’s of humanity—hence their ing itself in a state of tedium salvation in a way drug ad- and boredom from which dicts can understand. people seek to free them- This call also involves a selves—by recourse to drugs, clear warning not to turn pas- in the addicts’ case. 62 toral care into a sort of psy- This existential void be- chology of religion—that is, comes a source of confusion limit itself to investigating ad- and the occasion for pastoral dicts’ religious or conversion work. experience, practices, and so From this experience in on, stopping, in short, at man there emerges, in the analysis of religious phenom- case of addicts, a so-called ena while neglecting or dis- “unconscious leaning to- pensing with Gospel models. wards God,” or, in a religious Moreover, in the dialogue sense, “the unknown pres- between pastoral care and ence of God in man” (Victor psychology it is vital to make Frankl). clear the limitations of psy- The pastoral worker must chological diagnosis from a not pass before addicts too theological standpoint. The quickly; he must profoundly transcendental dimension and interpret the reality present- the search for meaning es- partly justifiable self-disdain ing itself. In the desert of cape psychology, when it and self-hatred. On the other their spiritual lives there is- does not expressly exclude hand, if they meet someone sues forth, though in a falter- them. We must also expect who accepts them unre- ing manner, a need for a “new professionals’ fear—if not re- servedly, they feel encour- life.” The unconscious lean- jection—of dealing with aged and liberated. ing towards God arises in these questions. On the basis of repeated them, almost always mani- In any event, the pastoral experiences, we know addicts fested in terms of guilt, which worker must reinterpret an- harbor deep suffering, and spurs them towards a deeper thropological/psychological meaningless suffering with catharsis than the one analyses theologically, since no way out leads human be- achieved in therapeutic ses- the image of the human being ings to seek God by crying sions. to which psychology refers out or to despair. The deepest At that time the pastoral contradicts the Gospel’s im- roots of both faith in God and worker must be a messenger age of man. The pastoral atheism are in such pain. of hope and of the Gospel, worker, in the light of the At first glance, young ad- which is salvation and libera- Gospel, must order the differ- dicts’ religious experience tion, not condemnation, for ent human situations of ad- presents a set of foreseeable man. “He welcomes sinners dicts which psychology deficiencies. Religion is mar- and eats with them” was the brings out. ginal to their lives. On the remark people made about other hand, they feel impris- Jesus (Lk 15:2). oned by a life they do not like A Meeting Point: and wish to emerge from this To Look Beyond abyss. By Way of Conclusion: Appearances The whole drama of their Pastoral Suggestions lives may be expressed by Drawn from Experience One thesis, embraced by what Viktor Frankl calls “ex- some writers (including Jung, istential void”—that is, a The basic pastoral mission Guardini, Kierkegaard, and feeling of meaninglessness or is to accompany human be- ings in a state of crisis spiritu- tions thought to be unshak- ty and accept it is our first ally. It is proper to Jesus able, including the absolute pastoral task. alone not just to preach salva- value attributed to the word tion, but to seek to heal man’s as a means of evangeliza- bodily sufferings. The tion—the value of gestures is 3. Witnessing to Hope Basileia of God which Jesus discovered. In this context and Instilling Hope preached was an enormously many pieces of bread must be realistic question: He sincerely and genuinely Hope is crucial for those preached and healed all suf- shared before saying a word. whose “identity is failure.” It fering and illness (Mt 4:23). Addicts need encounters is necessary to believe to an And He commissions his leading them from outcry to incredible degree in the pos- apostles, entrusted with this words, from self-harm to self- sibility of change and growth ministry, to do the same and esteem, and from slavery to in the human being. This is gives them “power over freedom. And this process is the basic philosophy and demons and to cure illnesses” slow and tense. starting point for rehabilita- (Lk 9:1). Acceptance, or at least non- tion of addicts and for pas- We cannot regard pastoral rejection, is the first thing to toral workers as well. If al- care in this context as a matter be gained. It must never be most everyone doubts Him, of humaneness which then ar- forgotten that, no matter how may they at least find that we, rives at the specifically Chris- as followers of the Messiah, tian; rather, it is to relieve suf- who does not snuff out the ferings and make space for smoking wick, trust Him. the dignity which has been Furthermore, the possibili- stripped away to arise. ty of “being reborn” must be 63 awakened in them. In Thera- peutic Community language, 1. Pastoral Care “hope therapy” is spoken of. Inspired by Addicts have no confidence the Mystery in the future and feel basic of the Incarnation distrust of themselves and others. In relation to drug addicts, the Incarnation translates into an effort at “inculturation” 4. An Essential Pastoral since they have their own cul- Approach: tural world, with certain val- Going to the Core ues, like solidarity, a lifestyle, of the Gospel Message and special language. Their lack of concern for This approach examines religion must be taken into close we get, we are not situations and adapts content account; it is simply insignifi- them. There is no symmetry and demands with an educa- cant for them. The marginal- between them and us. It is un- tional purpose. In the tradi- ization into which they have doubtedly a privilege for tion of the spiritual life there fallen has led them to break them to accept you. Compar- is reference to the different with every allusion to mean- ative studies of the different phases of processes. To evan- ing, including the Christian schools of psychology con- gelize is much more profound one. Christian symbology clude that the therapeutic ef- that to obtain Church mem- does not connect with theirs, fect depends decisively on bership. Before arriving at the and, when before an image of the quality of relations be- explicit Word there is much Christ Crucified, they may tween the therapist and the to do. In this context one thus ask, “Who is that naked client. must not be conditioned by a man who is nailed onto those restricted or dualistic concep- boards?” Examples could be tion of evangelization. We multiplied. 2. Awareness of Complexity must give ourselves time. In addition, they display Proposing lofty goals or distrust and rejection of In addicts there is a syn- unreachable ideals generates norms and persons represent- thesis of experiences of up- very low self-esteem in ad- ing the dominant society and rootedness, marginalization, dicts. To deal with exaggerat- culture. What effort should youth, and drawing away ed goals they have resorted to pastoral workers make to en- from or forgetting religion. It drugs. ter the world of addicts? is a complex world, with pro- Alexander describes addic- Their disturbed and disturb- found and varied sources tion as a way of coping with ing state challenges our mes- which to some extent can be problems. In his model of sianism and oppressive haste. reduced to one aspect alone. adaptation, the people who It also forces pastoral work- Consequently, in the face face a high risk of addiction ers to put aside the referents of this group many questions are the ones who have failed which are meaningful to them are posed for pastoral care. in their attempt to reach the and relativize many convic- To be aware of this complexi- generally recognized levels of independence, compe- verbalization of the evil they dynamics of a Community. tence, social acceptance, and have done, produces a great Let us recall that the princi- self-confidence representing sense of relief. To be listened ples of humanistic philoso- basic adult expectations. to in a context of deep seri- phy, along with spiritual and Addicts have failed in the ousness possesses enormous religious characteristics, un- process of personal growth, therapeutic value. derlie the TCs, and some of and addiction provides them At Therapeutic Communi- their dynamics are inspired with a kind of identity and ties the chance to face guilt by religious communities. In life meaning. and confess bad action is ex- general, they start from the perienced as a crucial ele- conviction that if effective ment in healing. treatment is to be given ad- 5. A Capacity for Listening Unexpressed guilt feelings dicts, they must learn new without Condemning are thought to be the practical values and attitudes. or Clock Watching reason for acting self-destruc- Moreover, the objective of tively. On the other hand, rehabilitation is to move from Addicts wish to be helped, when all thoughts and feel- dependence—slavery to but at the same time are skep- ings are communicated, the drugs—to freedom. Addicts tical and distrustful. They person becomes a free indi- must be the main actors, and hide behind a defensive im- vidual. no one can take their place. It age keeping their true feel- is a long process of rehuman- ings from emerging. ization, and at heart what is When not under the effect being requested is a radical of drugs, addicts may experi- change in life—in religious 64 ence guilt intensely. Though terms, a conversion. they try to deny their guilt, Most communities have when they allow themselves adopted the Daytop Village to feel it, they are crushed. At approach in their therapeutic that special time for spiritual program. and pastoral accompaniment, “We are here because there they need to give vent to the is no refuge where we can feeling oppressing them. Par- hide from ourselves. Until ticular guilt is produced by people face themselves in the observing the ongoing faith- eyes and hearts of others, fulness of their parents—es- they escape. Until they let pecially their mothers—who, others share their secrets, in spite of their harmful be- they do not get free of them. havior and constant deceit, go If they are afraid to make on supporting and hoping for themselves known to others, their rehabilitation. This ex- in the end they cannot know perience has a twofold effect: Though we do not wish to themselves or others. They to dynamize their rehabilita- describe this experience as will be alone.” tion and act as a check religious in all instances, it “Where can we know our- through their fear of deceiv- definitely is a time of great selves better than in our ing their families again. depth for pastoral and spiritu- shared points?” In such a situation of over- al accompaniment. We may “Here, together, people can all judgment of one’s life, ad- call it the alpha point and, if manifest themselves clearly, dicts with prior religious ex- fully developed, the omega not like the giant in their perience often ask for Con- point for spiritually accompa- dreams or the dwarf in their fession. After they have given nying addicts, regardless of fears, but as human beings, vent to their interiority at dif- their religious convictions. part of a whole with their ferent therapeutic sessions, contribution to others.” there still remains an indefin- “On this basis we can take able dissatisfaction leading 6. In Keeping with root and grow, not alone, as them to speak with a priest. the Rehabilitative in death, but alive for our- Expiation is seen to be neces- Context selves and others” (Richard sary to be able to live, given Beauvias). the weight of sin or remorse. Pastoral workers must not In addition, communities Without forgiveness, the be snipers. For the complexi- have rehabilitation tech- guilty cannot live. Expia- ty of addicts, more than in niques which may be readily tion—beyond human scope, other pastoral fields, contri- incorporated into pastoral for the injustice of what oc- butions by other profession- care. curred cannot be “made up als must be relied on—psy- Ð Help and self-help. In for” by any human action—is chologists, therapists, and TC communities no one may re- projected upon the so-called monitors. frain from making an obser- “scapegoat,” whereby man Specifically, pastoral work- vation or correction for the frees himself of the evil ers can draw abundant crite- purpose of helping another. dwelling in him. ria and norms for action from Ð Encounters based on In addicts, confession, or the outlook and therapeutic communication and affection, where, thanks to others, one There should be instruction, witnesses more than teachers. may learn about oneself. but not solutions to the spiri- Emotional and concrete in- They seek to expose the tual problems they may pre- volvement with addicts is a points to which each is blind. sent. As a general rule, people pastoral need rendering the When people take a selfish have already used a lot of psy- pastor’s word credible. Such attitude, they are left in an ex- chic energy to find a way. Pro- involvement is often frighten- istential situation of loneli- viding a solution in an instant ing, for it is very uncomfort- ness, “and there is only one devalues the effort they have able, makes us vulnerable, pain in life: to be alone” (G. made and wounds them. and may generate unhealthy Marcel). Furthermore, proposed so- dependence. Christian dis- lutions create feelings and at- cernment is undoubtedly titudes of helplessness, impo- needed, but not flight or de- 7. Credible Pastoral Care tence, and dependence. Solu- fensive rationalization to tions are experienced as pre- keep a distance. As people with life experi- cepts, orders, and/or prohibi- ence, addicts put the authen- tions and reinforce addicts’ ticity of others to the test. The superego, not the needed de- 10. Not to Give attitudes demanded of a pas- velopment of their authentic More Than One Has toral worker may be summa- selfhood. rized by the terms consisten- We can speak of God only cy and transparency, which in approximate terms. Our arouse trust and enable others knowledge of God is always to lose fear of being deceived. quite limited and inexact. In regard to Mother There- One must be able to endure 65 sa of Calcutta, Cardinal Mar- silence and not rush to fill it tini writes, “She simply said with words. We must learn to what emerged from her soul. live with silence in pastoral That is why people under- and spiritual accompaniment stood her and regarded her as of addicts and not resort read- credible.” And, on comparing ily to the doctrinal formulas her to Pope John XXIII, he of faith. To speak not so added, “Both were simple much by concepts, but by and spontaneous. Both were “narrating stories of salva- capable of making them- tion.” selves understood by anyone Addicts, sick of words and and with no need for many turning their backs on the words. Moreover, in the di- dominant culture, see them- versity of their roles, they be- selves reflected better in came portraits of a fully cred- flesh-and-blood people rather ible Christian man and 9.Not to Preach than in ideals and doctrines. woman.” to Oneself Moreover, listening to stories (2 Co 4:5) represents an original need of persons and forms part of 8. Healing Pastoral Care One must nevertheless their nature. It may not be speak of oneself—“of what fashionable in present-day Addicts are sly manipula- we heard, what our eyes saw, culture, but at the heart of so- tors. Their ability to lie and what we contemplated and cial interest there is a need for deceive themselves is enor- our hands touched” (1 Jn stories of life and death, suf- mous—it is a sort of weapon. 1:1). Words of salvation and fering and love, conflict and And their tendency to live healing cannot be pro- reconciliation, and anguish outside reality is constant. nounced outside the context and consolation. The content Pastoral workers should not of personal faith experi- of biblical stories reflects this enter into these games. ence—not in speaking by rote need. Rather, they should confront or from a theological chair. In “Then Their Eyes Were addicts with objective facts awareness of the value of our Opened” (Lk 24:31) and bring them to reconcilia- personhood as a sign. Non- We shall conclude our pa- tion with a life different from verbal messages, spoken be- per. We began by turning to their childish demands. To tween the lines, suggest to lis- the Emmaus episode as a this end, they must be led into teners the way they should model for pastoral and spiri- the painful events they recall understand verbally ex- tual accompaniment of peo- and be helped to discover that pressed content. We some- ple at a crisis point. I also their whole life is accepted by times speak of a God of love wish to close with the end of God. They must accept their who addresses people. But that episode. story as the story of salvation. the way of speaking mani- Something utterly unex- This is achieved when the re- fests a God who condemns pected happens to the Em- lationship between pastoral and uses them, walking at a maus disciples because of workers and addicts is suffi- distance from man and hu- their encounter with the ciently stable. miliating him. We must be Risen Lord. The blindness which disfig- tion open up a new mode of indeed good for you to be ured them previously and accepting oneself and one’s alive.” People thus have an darkened their view of the life. He has conquered death absolute need for God, even cross on Golgotha, their lives, and all the little deaths in if it is not consciously recog- and their future disappears. On each man. God accompanies nized. Where persons find the contrary, their perception the critical moments in life. themselves, God, too, is with of reality is broadened, and The basic problem for them. their sadness vanishes. A com- modern man, according to R. In Jesus Christ God accepts pletely new light is shed on Guardini, is “self-accep- our existence, our mode of their situation. They become tance,” particularly as a result being, and ourselves as un- aware of their blindness and of of an incapacity to integrate conditionally good. how different things are from the dark side of one’s person- This is a great message the way they thought. ality. Self-acceptance is quite which it is good for addicts to Through the crisis they the opposite of an easy road hear—in short, it is the word have found themselves. They of selfishness. Cardinal God pronounces upon them: have found their identity on Joseph Ratzinger says, “Self- “You are my child, whom I being transformed by the acceptance is not at all natur- love” (Mt 3:17). Risen Lord, who has accom- al.” It is possible only when panied them on their way of one has experienced being Rev. ADRIANO disappointment. accepted by someone else, YUGUEROS, O.H. Jesus’ death and resurrec- when one has felt that “it is Expert on Drugs and AIDS, Spain

66 Senator Arlacchi’s Message

I feel greatly honored to production and trafficking of against money laundering, have been invited to deliver a drugs that demand concentrat- etc.) message on behalf of the ed action by the international One never hears of the suc- United Nations, to this presti- community. The strategies cesses achieved in the field of gious ecclesiastical congress adopted to combat at the grass drugs even when there are on drugs. I would like to take roots the causes and conse- many. This contributes to the the occasion to thank the Pon- quences of drug abuse, such as lack of confidence in solving tifical Council for having the necessary techniques for the problem, which is other- wished to give the necessary the rehabilitation of drug-ad- wise possible when confronted international dimension to this dicts, should be developed in with the trust and support of discussion, through both my the light of common experi- all. The responsibility of the participation and the presence ences and necessary informa- Catholic Church in the fight of many important guests. tion. It is only through a cor- against drug abuse, of which In fact, the whole drug prob- rect and broad vision of the this gathering of experts is a 67 lem in all its aspects and mani- problem and the collaboration manifestation, is always a festations, is to be interpreted of various sectors of our soci- great support and constructs a and confronted in a communal ety that a solution to such a precious point of reference for perspective. This is not only in complex problem can be many of the drug victims. respect to norms set by inter- found. The UNDCP has benefited a national operative treaties, but UNDCP is the promoter of lot from this support. On be- also for practical reasons relat- this difficult effort. It spear- half of the program which to- ed to the control and resolution heads the anti-drug activities day I have the honor of direct- of a transnational problem in of the United Nations and has ing, I would like to thank the all its components. The 25% also in the past year taken on Catholic Church and also ex- increase in opium production the important role of coordi- press again my gratitude to the in Afghanistan, reported in the nating the programs of various Pontifical Council for the invi- last month by the UNDCP, governments in fighting drug tation to this meeting, which should not represent a remote abuse. Governments which represents a significant step problem, but rather a serious contact the UNDCP for help forward in favor of the fight warning to all of us. Addition- receive legal, technical, and fi- against the serious phenome- al opium produced in a distant nancial assistance, which is fa- non of drugs. country will arrive very soon cilitated by 19 Field Offices in our own public squares, of- spread around the world, and fered to the youth at lower the numerous projects going Dr. PINO ARLACCHI Executive Director prices. on in the various sectors (the of the UN International Drug However, it is not only the rehabilitation of drug-addicts, Control Program, Vienna techniques of combating the crop conversion, the fight Message from the World Health Organisation

First of all, I wish to thank purpose is to create the condi- and rehabilitation, regardless Archbishop Lozano and the tions so that all people in the of the legality or illegality of Pontifical Council for Pas- world throughout their lives substances. toral Assistance to Health may enjoy the basic human Tobacco causes 3.5 million Care Workers for the invita- right to achieving and main- deaths a year—or 10,000 a tion they sent to Dr. Jorge Al- taining the highest possible day—but if current trends do berto Costa e Silva, Director level of health. The Health for not change, this figure is ex- of the Division for Mental All strategy is, then, a defense pected to double by the year Health and the Prevention of of social justice. 2020. This increase will take Substance Abuse (MSA), To achieve this aim in the place at the expense of devel- whom I am representing on twenty-first century, WHO oping countries, where an ex- this occasion. will seek a balance between ponential increase in tobacco ethical and moral demands use is being observed among 68 and the analytical formula- young people of both sexes, WHO Strategies tions of science and technolo- with an expected impact on in the Field of Drug gy. mortality rates within twenty Dependence The PSA takes up the prin- or thirty years. The developed ciples of the Health for All countries have meanwhile In the field of drug depen- strategy, including equity, ac- adopted forceful measures to dence, WHO performs one cess to Primary Health Care, reduce tobacco use and the function involving control intersectorial coordination, harm it entails. and another in terms of public solidarity, and the leadership Alcohol causes at least health. Both functions are part role of the community. PSA 750,000 deaths each year. In of the Substance Abuse Pro- stimulates intersectorial/inter- addition, alcohol is an impor- gram (PSA). national alliances to respond tant factor in the social and As for its control function, to the complex problems con- economic burden of illness WHO studies natural and/or nected with use of psychoac- due to disorders and disabili- industrial products to justify tive substances. Through this ties which, without producing inclusion of substances not strategy, the PSA channels in- death, affect many people for yet subject to control on the ternational technical and fi- years—e.g., psychoses, so- lists arising from the 1961 nancial support into the most matic disturbances, injuries and 1971 Conventions, trans- vulnerable countries and from accidents and violence, fer a substance from one list groups. loss of employment, and to another, or eliminate re- criminality. strictions altogether.1 WHO Alcohol consumption is has examined over 400 prod- Health and Psychoactive tending to stabilize or even ucts, and on the basis of its Substances diminish in many developed recommendations 116 sub- countries, whereas in devel- stances have been included on Though our planet has wit- oping countries there is a con- the narcotics list. There are nessed impressive advances stant increase in production 105 substances on the list of in health over the past thirty and consumption of alcoholic psychotropic drugs. These years, WHO laments the per- beverages. figures show that the produc- sistence of major forms of in- The deliberate inhalation of tion of psychoactive sub- equality among and within volatile solvents is a public stances is continuous, and it is nations. This inequality has a health problem mainly affect- thus necessary to exercise serious effect on users of psy- ing poor, unprotected popula- careful, untiring vigilance choactive substances when tion groups in many coun- over new products. discrimination and stigmati- tries, like street children, in- WHO supports Member zation are added to the ad- digenous peoples, and the in- States in their control policies verse consequences of their habitants of poor, neglected so that use of these substances habits. neighborhoods. will be limited exclusively to WHO stresses that con- The use of internationally medical and scientific purpos- sumption of any psychoactive controlled psychoactive sub- es. substance is potentially harm- stances, or illegal drugs, is on To perform its public health ful to health and recommends the rise in all regions, as are function WHO integrates its that, where appropriate, simi- its adverse effects on health. activities into the global strat- larities be considered in ac- These consequences involve egy of Health for All, whose tion for prevention, treatment, not only their toxic/pharma- cological effects, but also the In collaboration with the particularly with opioids. risks inherent in certain International Work Organiza- The PSA will begin new modes of use and the behav- tion, the PSA develops pro- projects this year, such as un- ior associated with the crimi- grams for prevention of the dergraduate education for nalization of users. problems deriving from con- health professionals and the Drug use by injection en- sumption of alcohol and other study of links between psy- tails serious risks. Drug injec- substances at the workplace. choactive substance abuse tion has been detected in 127 In regard to the most vul- and sexual behavior at risk. countries, and in 94 there is a nerable, unprotected popula- The PSA prepares manuals connection between HIV and tions, the PSA at twenty sites and handbooks to assist coun- needle sharing. The primary in different countries is devel- tries with epidemiological cause of death among these oping the methodology and and treatment-evaluation users is overdose, related to tools to work with street chil- studies and in specific areas various factors, including poi- dren who have problems with such as 1) sports and psy- soning and impurities. It is es- the use of psychoactive sub- choactive substances, 2) leg- timated that 200,000 people stances. The Indigenous Peo- islation on treatment and re- die annually as a result of ples Project is a shared activi- habilitation, 3) the effects of these nonmedical, deliberate ty stimulating initiatives by cannabis use on health, and 4) injections of psychoactive native communities to solve WHO/UNICRI research on substances. their problems by way of their cocaine. traditions and spirituality. In conclusion, I wish to A Work Group conducts convey to this distinguished WHO Activities field studies to include han- audience Dr. Costa e Silva’s dling of substance abuse deep interest in forming and 69 Working with the six Re- problems in primary health reinforcing alliances with gional Offices of WHO, the care and to promote commu- churches and those working PSA has reinforced and nity leadership. The Equal in the religious field, especial- broadened cooperation net- Opportunity for All Project ly with the Catholic Church, works, including new Coop- fosters Community-Based which has taken this initiative erating Centers and organ- Rehabilitation for those with in inviting WHO to deliberate isms in the UN system, physical and mental disabili- on a problem affecting us all. NGOs, and members of the ties which may or may not be Panel of Experts. related to psychoactive sub- The Tobacco or Health Pro- stance abuse. Dr. MARIO ARGANDOÑA gram coordinates national and The PSA develops and co- YAÑEZ international policies and re- ordinates an international net- Substance Abuse Program Division of Mental Health and search models for tobacco-re- work of researchers to study Prevention of Drug Dependence lated health problems. It orga- the behavior at risk of those Geneva, Switzerland nizes a world day to combat who inject drugs. This work smoking and is preparing an helps us to understand the international convention for factors contributing to propa- tobacco control. gation of HIV and identify the Notes The PSA develops and field most effective action to be tests innovative primary pre- taken. 1 United Nations, Single Convention vention models in several A project is under way to of 1961 on Narcotics, amended by the 1972 Protocol Modifying the Single Member States in different re- study and evaluate different Convention of 1961 on Narcotics (New gions. drug-replacement treatments, York, 1977), pp. 17-18. The EMCDDA: Fields of Intersection

1. The Aims of 4. The World Customs Or- CDDA experiences of stan- the EMCDDA ganisation dardising the information 5. The EUROPOL Drugs provided by our REITOX Fo- As a Community informa- Unit cal Points and of setting up a tion agency, the EMCDDA 6. INTERPOL structured and co-ordinated aims to provide “objective, reporting system may be use- reliable and comparable in- ful, if you plan to further de- formation at European level 3. Reitox velop your network of Epis- concerning drugs, drug ad- copal Conferences. diction and their conse- The work of the EMCDDA quences.” Since the drug phe- extends beyond its headquar- nomenon comprises many ters in Lisbon to a network of 4. Epidemiology complex and closely interwo- 15 National Focal Points or 70 ven aspects which cannot national “observatories” plus Modern epidemiology is a easily be dissociated, the the Focal Point at the Euro- general discipline that Centre has the task of fur- pean Commission. Together evolved as a medical science nishing an overall statistical, these form REITOX, the Eu- but incorporates influences documentary and technical ropean Information Network from sociology, anthropolo- picture of the drug problem to on Drugs and Drug Addic- gy, criminology and econom- the Member States and the tion. ics. The aims of our work in Community as they embark REITOX is set to become epidemiology is to provide a on measures to combat it. Its both a human and computer description of a phenomenon tasks are divided into 4 cate- network at the heart of the in a population by its nature, gories: collection and exchange of its extent and its distributin, Ð Collection and Analysis data on drugs in Europe link- as well as to identify factors of Data ing the information systems and processes related to Ð Improvement of Data of the 16 Focal Points. The changes over time, and differ- Comparison Methods Commission Focal Point pro- ences between groups or ar- Ð Dissemination of Data vides a general overview of eas. Ð Co-operation with Euro- activities within the Commis- Problems encountered are pean and International Bodies sion and at Union level. Each often definitions—(What is a and Organisations and with National Focal Point fulfils drug user?) and the illegal Non-Community Countries tasks, as for instance to pro- and hidden nature of the phe- As an information agency, vide: nomenon to be described. the EMCDDA does not de- Ð descriptions of the exist- The objectives of the EM- velop drug policy strategies. ing information structure on CDDA’s epidemiological Neither does it give valuing drugs in their country and work are to provide a global statements nor recommenda- their role in this context overview of the situation in tions to certain approaches in Ð details on the network of the European Union regard- the member states. institutional and non-institu- ing drugs, drug use, drug ad- tional partners co-operating diction and their conse- with them and an evaluation quences, which is objective, 2. International partners of the information needs of reliable, comparable and use- this network. ful for Policy-makers and The EMCDDA also co-op- Ð the development of com- professionals at European erates with important interna- mon definitions and linguistic level. tional organisations and co- equiavlents of the key drug ordinates projects with them terms in order to avoid duplication Ð the drafting of National 5. Activities in the field of efforts and to enhance syn- Reports, with a comparable of Demand Reduction ergy in common activities. structure, on the drug situa- These organisations are: tion. If Epidemiology focuses 1. The United Nations These characteristics are exclusively on quantitative Drug Control Programme similar to the network, which data describing the extent and 2. The Pompidou Group of also exists inside the Catholic specific features of the drug the Council of Europe Church and to the reporting phenomenon, Demand reduc- 3. The World Health Or- structure you have used dur- tion is more interested in ganisation ing this conference. The EM- qualitative information about the measures taken in the mation from decentralised or early preventive strategies member states to curb the regional sources, the lack of and messages have to include problem. accessibility to expertise in alcohol and tobacco, also in Like so many terms used in the field of demand reduc- order to beware the credibili- the drugs field, there is no tion, and differences in con- ty of the “preventionists” fac- clear definition of demand re- cepts and terminology be- ing a critical and informed duction. Read literally, “de- tween the Member States. youth. mand reduction” implies de- Our strategy therefore is The most important set- creasing the desire for and the based on the systematic col- tings for prevention interven- use of drugs. In practice, this lection and improvement of tions are: term is used to contain a di- the quality of demand reduc- 1. First childhood interven- versity of prevention, assis- tion activities. tions tance, treatment and rehabili- The focus herein lies on 2. School programmes tation interventions, the mix psycho-social aspects and the 3. Youth programmes out- varying by time and place. dynamic of drug use develop- side schools The EMCDDA has adopt- ment. Here are some areas of 4. Community programmes ed an operational concept intersection, where the First childhood interven- and includes all activities Catholic Church is very ac- tions depart from the knowl- aimed at decreasing the de- tive and where information edge that family has both the mand for drugs at an individ- exchange could be possible. I greatest influence on the for- ual or group level in its infor- will sketch them out in the mation of certain behaviours mation collection. Interven- following part: and the greatest potential to tions aimed at reducing the instil a lifestyle that promotes harmful consequences of the emotional and physical 71 drug use are also included: 6. Fields of intersection health of a child. It is also an Ð Prevention of drug use important setting, because Ð Prevention of risks and As it was pointed out by drug prevention should start harmful consequences related some participants at this con- very early and, as a first to drug use ference it is not enough to fo- phase, should give parents as- Ð Assistance to drug users cus solely on the reduction of sistance in the education of Ð Treatment of drug abuse “risk factors,” factors that fre- their children. This is a set- Ð Aftercare and rehabilita- quently can be found in the ting were the Churches can tion biography of drug users and exert substantial influence According to this concept, thus are believed to predis- and reach families and their drug demand reduction can pose for drug use. It is even children in an effective way, be seen as complementary to more important to try to de- provided that the workers in the drug supply reduction ap- termine and positively influ- this field have received pre- proach which comprises ence the “protective factors,” vention-related training. measures to reduce availabili- looking into the characteris- Youth programmes outside ty of and access to illicit tics of the majority of young school often use peer-group drugs. people not using drugs. Ex- approaches, which are pre- Demand reduction inter- amples for activities related ferred in youth organisations, ventions have a broad and to this latter approach are to featuring special youth-to- multifaceted scope, ranging promote skills in coping with youth and youth leader pro- from preventive actions aim- life, to promote changes in grammes. These activities ing at forestalling the demand behaviour towards a lifestyle have a wide scope, involving for drugs to specific opera- free of substance abuse, to cultural events, rock concerts, tions leading to an addict re- promote the ability to create a theatre, video productions, fraining from drug use or lifestyle and to create the re- exhibitions, etc. The active from especially harmful prac- sponsibility of ones own be- participation and elements of tices involved in drug use, for haviour. Also important is personal and cultural experi- example through: that drug prevention is not to ences, adventure, body ex- Ð Community-based pro- be seen as an isolated issue, pression techniques, con- jects but included in a wider con- trolles risk are main features Ð School programmes cept of health promotion and of these programmes. This is Ð Mass-media programmes the development of healthy also a field where the Church Ð Outreach work life-styles (childhood and can reach—by her existing Ð Treatment youth). It is contrary to the infrastructure and means—a Ð Prevention of infectious some statements I heard dur- big part of the target popula- diseases. ing this conference—of cru- tion for effective prevention. The role of the EMCDDA cial importance that preven- Community programmes: in this field is to collect infor- tion is not only concerned Their common characteristic mation on demand reduction with illegal drugs but take in- is a global approach, involv- interventions in Europe, to account other substances ing the whole society (school which is objective, reliable (tobacco, alcohol, pharma- / youth centre / neighbour- and comparable, but this task ceutical drugs). There is hood / city / part of a city). is not easy because of the dif- broad consensus among sci- The rationale of this strategy ficulties in collecting infor- entists and professionals that is that individuals are most susceptible to the influence of 1. It should aim toward demand reduction activities people in their immediate sur- strengthening protective fac- in Europe which could serve roundings. Activities in this tors as example or inspiration for field aim to enhance commu- 2. Like skills training must your own prevention strate- nication between adults and be a central component gies you will find in the EM- young people. The Churches 3. It includes both sub- CDDA’s Annual Report on influence and power to advo- stance-specific and sub- the state of the drugs problem cate and to mediate communi- stance-unspecific elements in the European Union. The ty programmes is consider- 4. It starts early, is long- highlights of the Annual Re- able strong and can be used term and continuous port in the eleven languages for setting up innovative de- 5. Family and peer-group of the European Union are at mand reduction programmes influence is seen as impor- your disposal. in neighbourhoods at risk. tant Evaluation research—one 6. Mass media are to be Mr. GREGOR BURKHART of our major priorities in the combined with interpersonal Officer for Issues field of demand reduction communication. of Prevention and Evaluation at the European Data Center identified some clues to good Further information about for Drugs and Substance Abuse, prevention: the content and the scope of Lisbon, Portugal

72 United for Life CONCLUSIONS OF THE INTERNATIONAL SYMPOSIUM

I thank Archbishop Lozano by drugs, and the increase in 2. What is at stake? for having given me the honor demand among young people, of concluding the sessions of we have gauged the extent of 2.1. The Search for this Colloquium of interna- the phenomenon more fully. If Sensations tional experts to prepare the we are invaded by a sense of It is important to examine drafting of a manual in the impotence in the face of such the conditions spurring a per- near future for the use of pas- a scourge, we still cannot re- son to use psychostimulant or toral workers dedicated to sign ourselves. psychosedative products. The combating drug addiction. former offer the illusion of I would like to speak on be- 1.2. Numerous Statements conferring energy whereas the half of all taking part and of Witness latter are thought to have thank the President of the Pon- We have heard numerous calming effects. There may be tifical Council for Pastoral As- statements witnessing to the a suffering in drug users which sistance to Health Care Work- involvement of local churches keeps them from living or an 73 ers and the members of his of- in prevention and the educa- inability to choose, an existen- fice for having brought us to- tional, social, and pastoral tial boredom. In others who do gether here. These valuable treatment of addicts. Many ac- not necessarily present special talks and exchanges have tions are undertaken, a proof problems, drugs are a source opened up perspectives for our that the Church has not re- of curiosity. They start taking work and encouraged us in our mained passive in the face of them for the sake of recre- service to life and to those this phenomenon. But we ation, but very soon psycho- who are addicted to drugs. ought to do more. logical and social problems I also express our gratitude By means of her members, are created. The product then to the Holy Father, who want- the Church thus works and becomes an answer for those ed to hold this Colloquium so manifests herself regarding lacking motivations for their that the Church could make the problems posed by drugs. existence and for others her contribution to the prob- For many years the Holy Fa- caught in the trap of euphoria lems raised by drug addiction. ther, John Paul II, has had oc- or relaxation of the inner ten- I propose concluding our re- casion to set forth essential sions caused by drugs. But in flections by way of three ques- ideas enabling us to orient all cases they become prison- tions: pastoral action so as to create ers of their own sensations. 1) How have our work ses- psychological, social, and Unable to receive nourishment sions been conducted? spiritual conditions which fos- from life, they consume them- 2) What is at stake here? ter personal development, ed- selves with just any substance, 3) What pastoral orienta- ucation, the growth of social which often turns into the only tions have been observed? bonds, and the quality of par- purpose of their lives: “It’s ticipation in professional life. happiness.” They take drugs to These are the tools needed to remain “hooked” on them- 1. How have our work win the battle against drug selves while losing them- sessions been conducted use. selves. In this gesture we must see a search for relationship 1.1. Becoming Aware 1.3. An Ecclesial Experience with themselves and others of the Breadth Over the course of these which, however, in this man- of the Phenomenon three days we have had an ex- ner leads to failure. Drug production and sup- perience of the Church, ply, along with demand and which, in the unity and diver- 2.2. The Search for use, pose numberless prob- sity of her members, has re- Happiness. lems. This pandemic hits all flected on human problems, In What Way? countries. We are faced with considering their structure in The question posed here the Third World War, involv- the light of Evangelium Vitae. concerns human well-being. It ing the destruction of man’s This meeting has allowed us is a question which has always spirit through the use of toxic to acquire a shared awareness. existed, but which is revived products. In considering the We must now take to our local when people are unable to ac- power of the drug traffickers, churches the fruit of our ex- cept and give meaning to their the barons of finance, the dis- changes and the message of lives. In that case they risk tribution networks, the trivial- hope by which people can provoking limitless desires ization of consumption, the shape themselves humanly and silencing them with drugs. public health problems caused and spiritually. Human desire is insatiable, to the point of negating itself metaphor of food used in an- of power and part of his self- when it becomes its own ob- tiquity (as experiencing the sufficiency and narcissism. jective. It needs to be devel- pleasures of life) to the This is needed to be in a posi- oped, oriented, and given an metaphor of sexuality in tive relationship with others, aim in order to unfold and en- Christian thought to express in a position to act and find rich it and ensure the very the dimension of conflict be- pleasure in reality. All of these consistency of the personality. tween infinite desire (which operations involve psychic However, in wanting to fulfill may cause anguish) and un- sufferings (in the sense of ef- desires as they appear, au- derstanding of what we need. fort and work directed towards tonomously and impulsively, Christianity proposes taking oneself), but also acts of re- the personality can soon be human desires into considera- nunciation. They can be car- overcome, no longer able to tion, examining them, and ried out only with a view to- know what it desires. If people seeking to satisfy them in cer- wards a life project, an ideal let themselves go in desiring tain perspectives rather than proposed by society. People in this way, they do not con- wanting to empty them encounter an objective reality struct anything. through multiple uses. limiting them, but at the same The men of antiquity, espe- time opening them to life and cially the philosophers, were 2.3. Christianity Liberates developing their inner life. able to pose the problems Work on the Meaning Turning to drugs, Freud ex- which concerned the economy of Desire plains, annuls this process. He of desire. We may summarize Desires have always dis- speaks of drugs as “using their thought as follows. turbed human awareness to something which shatters con- Ð Plato criticizes limitless the point of leading people to cern;” the person’s energy be- 74 desire which is impossible to flee them, cultivate illusions comes indolence. There is satisfy. He proposes using it to of happiness, negate them, or concern only for the substance see the truth about human life. act as if they did not exist. The keeping one from thinking Ð Aristotle affirms that psychoanalyst E. Jones intro- about oneself and reality. It is when we abandon ourselves to duces the Greek term aphani- the search for illusory plea- desires, they take us over en- sis (the act of causing disap- sure. tirely and carry us away from pearance) to designate this In effect, to develop means all reflection. need present in some people to being able to shape one’s de- Ð For Epicurus we must abolish the very function of sires, postpone their satisfac- avoid suffering over our de- desire. The idea of death thus tion, and choose objects com- sires and suppress worries. We prevails over vital functions. patible with the world. Plea- must thus appropriate objects The psychology of drug ad- sure is otherwise sought in im- so as to be immediately satis- dicts may develop in terms of mediacy so as to be heedless fied. The central concern is this problematic. The militan- and anesthetized in the face of “the styles and uses of de- cy of some politicians who apparently insurmountable sires” so as to exploit the would like to depenalize the difficulties for life. We are not boundlessness of desire. We use of drugs, particularly made for all the pleasures we find this idea again in contem- cannabis, remains imprisoned can experience to the point of porary concerns when some by the symptom and does not destroying ourselves. This is, people leave the stage of life perceive what is really at stake however, the message spread to live in an artificial universe in the crisis. Depenalization by drugs. made up of multiple sensa- would only legalize aphanisis tions. and the symbolic death of the 2.4. What are the Ð In Christianity a individual. consequences? hermeneutic of desire is initi- Christianity, then, has 1 Ð People are unable to oc- ated, a search to understand opened another dimension to cupy their inner space. It is a and interpret human desire. It reflection on human desires. crisis in resources, an inner makes man emerge from the For the ancients, desires were void, a cognitive disturbance, tragic thought in which he was a sort of anguish, and it was and a difficulty in concentrat- enclosed by Greek philosophy. preferable to keep to food, ing. It presents itself through a whereas for Christianity they 2 Ð The negation of the message of life (cf. the mys- are a source of life. In this per- body. Everything is done to tery of the Incarnation of the spective, we must be able to make the most of the body in Son of God) and invites man choose our desires and know today’s mentality. But this atti- to take possession of his hu- the kind of man we are be- tude covers over disdain of the manity rather than flee from it. coming. real body as compared to an This message of hope is a life The question, we repeat, is imaginary body which one project inviting him to shape not new. More recently, Freud seeks to experience as such his existence as a response to analyzed it in The Discontent through drugs. God’s love (the Paschal mys- of Civilization. Civilization is 3 Ð There is no more sensa- tery, with the Resurrection). a human progress forcing us to tion. The psychology of ad- Death cannot be the last word organize and give meaning to dicts expresses a paradox: nar- on life. It is worthwhile to ex- our pulsions regarding struc- cotics are sought to multiply perience and transform life. tural ideals. Man is brought to sensations, and sensations are We therefore move from the renounce his infantile feeling sought so as to become insen- sitive to the life that is in one- is not accompanied in its full family by associating parents self. unfolding in history. It does with prevention as the primary 4 Ð Temporary immaturity. not receive a faith and hope educators of children. To com- Time is reduced to immediacy, through which to discover the fort them in their role and pro- with no historical awareness. meaning of life. Individuals vide them with the means to This short time relation no must handle things on their perform it. The family is a longer sustains psychology own. source of relationships and life and leads to addictive behav- 3) Children seek words by and also a cell of the Church. ior to gain reassurance. adults. Contemporary educa- 7) To renew catechesis In view of these observa- tion does not help them with- through acceptance of life, a tions, drugs are not just a med- stand inner and outer stimuli. life willed by God. To teach ical problem to be controlled There are thus impulsive, vio- the young to measure them- by replacing with other sub- lent personalities not engaging selves by the truth of the word stances, but an anthropologi- in the work of sublimation to of God to reflect on their exis- cal and existential problem. transform the primary mani- tence and nourish it. The When millions of people are festations of human psycholo- young in particular need to no longer able to summon gy into higher functions. They discover the objective truths their psychological, social/cul- do not engage, either, in sym- on the basis of which life is tural, and spiritual/religious bolic thought or a sense of possible. It is these truths that resources, it means that in our law. This work is possible on- Jesus Christ came to reveal to societies a conception of exis- ly to the extent that young us and that his Church contin- tence is lacking on the basis of people receive ideals from the ues to bear through human which they may shape and outer world, consistent social history. deal with themselves. Seeking models and a spiritual mes- 8) To develop the spirituali- 75 to reduce existential difficul- sage (catechism). Pragmatic ty of the Incarnation. The Son ties to a mere medical ap- thought, on the contrary, dom- of God has shared the human proach shows the extent to inates spirits to the point condition to free us and open which our societies are re- where individuals no longer us to accept the Love of the gressing and are sick with a seek to comprehend and inter- Lord. He invites us to receive malaise affecting life. pret the meaning of what each this word of life so as to be in desires. Some even go so far the world without fleeing from as to affirm that we must get it. But this word is not to be 3. Educational Orientations used to living with drugs and confused with ephemeral in Pastoral Care liberalize and depenalize some modes. It has not been adapted substances, such as cannabis. to the world. When catechesis 1) The Church must be at Acting in this way would be a is confused with worldly the center of education, inas- symbolic sin contributing to frameworks, under the pretext much as education forms part locking young people and so- of pedagogy, we risk getting of her mission in conveying ciety into this pragmatism of disoriented and no longer let- humaneness by showing men immediate satisfaction, justi- ting the originality and wealth that they are called by God to fying the drug traffickers trivi- of the Word of God appear. life. In our societies, education alizing notions. This Word educates human in- has been neglected for thirty 4) The multiplication of pre- teriority. years, and children have been cautionary measures in all ar- 9) To learn to ritualize life to left to themselves under the eas of life is a sign of the fail- avoid repetition, dependence, pretext of not influencing their ure of education in general. and neglect. To learn the freedom and not making We must educate on the mean- meaning of simple gestures in choices in their place. This at- ing of life and at the same time daily life and of more solemn titude has contributed to a on the risks in life. We must be gestures through celebration break with the necessary able to say no to children and of the major moments in histo- forms of transmission which have them face the limits of ry. Many people, for example, have shaped mankind. Educa- life in order to develop their no longer know the signifi- tion begins when children can potential. cance of a family meal. Others identify with trustworthy 5) Action by Christians to no longer know the meaning adults and institutions that combat drugs and foster life of the festivities celebrated. help them to grow and become must be explicit so that the Recently some young people free by learning how to specific nature of the Church’s asked a priest, “Why do you choose. message will be seen as a life get Christmas mixed up with 2) Children are returned to project. The example of thera- religion?” For them, Christ- themselves, and what they peutic communities is un- mas is just a worldly celebra- hear from adults could often doubtedly a model to be pre- tion placing value on child- be translated as “Don’t identi- sented; it permits liberation, hood and encouraging com- fy with us; we have nothing to socialization, personal merce with the exchange of tell you!” Society, reduced to progress, and discovery of gifts. This testimony says a lot economic terms, produces life-giving words based on the about our cultural deficien- consumers who will conform Gospel as transmitted by the cies. With this ignorance of to products. But people’s Church’s tradition. the meaning of festivities and awareness is not awakened. It 6) To restore trust in the rites which structure our soci- ety, other celebrations are in- tion of the substance which fices to give them a sense of vented which lack meaning are validated with no personal their responsibilities and sanc- and tie in with earthly, pagan questioning about oneself and tion them, when necessary, to celebrations, like a tree festi- life. The distinction between avoid rendering them infan- val or a music festival. hard and soft drugs is false to tile. the extent that recourse to and The Church must react dependence on substances are prophetically to this suicidal Conclusion based on the same psychologi- climate. We must pay atten- cal structures: a lack of sup- tion to two problems. The Church’s observations port, deficient interiority, and Ð The Church is concerned on drugs cannot fail to be an- self-doubt. So many foresee- about man for the sake of the thropological and moral. The able deaths in a society which Love of God. Her message Church points to a sense of accepts the futile sacrifice of aims to educate human behav- overall education of persons its young wherever needed ior. She cannot be satisfied with respect for their dignity. acts of renunciation are re- with messages on hygiene and She must ask nations, “What fused. health which are partial and is our conception of man if cit- How can we educate and immediate. izens are forced to adopt the provide care when the law rec- Ð The Church must re- liberalization of drugs?” The ognizes the possibility of this mind nations that “drug addic- only vision of life society pro- behavior? We are faced with tion is the result of a culture vides is oriented towards an additional contradiction in emptied of many human val- health and hygiene. Society the current world, which trivi- ues which compromises the promises to accompany peo- alizes a phenomenon and then promotion of the common 76 ple to a clean, medically-su- seeks to discover how to deal good and therefore personal pervised death. There is a de- with it. Will citizens continue development” (Pontifical sire to foster prevention and to pay taxes to deal with the Council for the Family, From avoid addiction while at the health problems of those Despair to Hope). same time affirming the fol- handing themselves over to The Manual for Pastoral lowing countermessage: “You every excess? A very serious Workers on the Problems of can take drugs. There will al- social problem threatens to Drug Addiction must thus ex- ways be someone to take care present itself in the face of the press what is at stake clearly, of you, even if this costs the enormous costs for the collec- along with the pastoral orien- collectivity a fortune.” The le- tivity of prevention and care tations and pedagogy needed galization of drugs threatens for drug addicts, among oth- to be “united for life.” For no to produce effects contrary to ers. We can always appeal to one can love God without the ones desired, since we solidarity, but the essential loving man. God may be know that today it is readily problem is the education of deeply wounded if man is thought that what is legal is behavior. The liberal attitude wounded. normal and moral. Through of politicians and decision- depenalization it is not the makers is paving the way for Rev. TONY ANATRELLA substance which is liberalized; severe repression in the future. Psychoanalyst and Specialist in Social Psychiatry, rather, it is the motivations and Compassion is not indulgence. Paris behavior leading to consump- Addicts are not victims: it suf- The Sixth World Day of the Sick

Loreto, Italy February 8-11, 1998 The Sixth World Day of the Sick in Loreto

In the year devoted to spe- ference for Pastoral Care in On November 21, 1997, in cial reflection on the Holy Health; the Marches Region, Loreto, the official presenta- Spirit, as desired by the Holy with its bishops, priests, and tion of the Day’s program to Father, the Sixth World Day of religious; and in a special way the press took place in the the Sick was celebrated, with the Capuchin Friars at the small dining room, with re- the motto “The Holy Spirit Sanctuary and the personnel marks by Archbishop Comas- makes us a house of health of the universal Congrega- tri, the Most Rev. Donato and hope.” tion. Bianchi, Archbishop of The site designated for the This unified cooperation Urbino and Chairman of the principal celebration was the made possible not just a fit- Italian Bishops’ Council for Marian sanctuary in Loreto, ting preparation and celebra- the Health Ministry, Rev. José Italy. As the Holy Father re- tion of the Day, but also its Luis Redrado, Secretary of 78 called in the Message for this singular effectiveness in the Pontifical Council for Pas- Day, dated June 19, 1997 and touching the sensibilities of toral Assistance to Health published on July 3, “Loreto, numerous members of the Care Workers, Italian Health recalling the moment when faithful and religious and sec- Minister Rosy Bindi, and the the Word became flesh in the ular institutions engaged in President of the Marches Re- womb of the Virgin Mary by health care in a widening ra- gion, Vito D’Ambrosio. the work of the Holy Spirit, dius. On November 27, 28, and invites us to set our gaze up- 29, the first national meeting on the mystery of the Incar- of the directors of the dioce- nation.” The Pope’s Message Preparation of the Day san and regional health apos- for this Sixth World Day of tolate offices was held, spon- the Sick thus comments on After being announced and sored by the Italian Bishops’ this statement: “And the instituted by the Pope’s Mes- Conference. Word became flesh, by the sage, the celebration of the On the occasion of the work of the Holy Spirit, in Sixth World Day of the Sick Feast of the Translation of the the womb of the Virgin immediately became the ob- Holy House (December 9 and Mary.” ject of numerous preparatory 10), pilgrims were given a The Pope wished to add to initiatives. It should not be copy of the Pope’s Message; this ideal motivation for forgotten that over a month Cardinal Bernardino Gantin, choosing the site a personal before the publication of the Dean of the College of Cardi- recollection, writing in the Pontifical Message, Mother nals and Prefect of the Con- same Message, “In my re- Theresa of Calcutta, then ap- gregation for Bishops, took peated pilgrimages to this proaching death, had sent a part. The Loreto monthly first Sanctuary of internation- letter (May 22, 1997) to publication Il Messaggio del- al scope dedicated to the Vir- Archbishop la Santa Casa, was also pro- gin...I have always felt the precisely on the World Day of viding simple, but significant special closeness of the sick, the Sick. information, thereby becom- who come here trustingly in The Pontifical Council for ing a valuable historical great numbers.” Pastoral Assistance to Health source for the event. The outstanding character- Care Workers, by way of its On January 15, at the An- istic of the Sixth World Day President, Archbishop Javier cona Faculty of Medicine, of the Sick was the joint effort Lozano Barragán, and his through the joint organization by the Pontifical Council for staff, in unity of purpose with of this Faculty and the March- Pastoral Assistance to Health others working on this effort, es Theological Institute, a sci- Care Workers; the Health Of- effected a broad dissemina- entific meeting on “Health fice of the Italian Bishops’ tion of the Pope’s Message in- Facilities and Patients’ Conference; the Most Rev. ternationally, prepared the of- Rights” was held, with the Angelo Comastri, Archbishop ficial Manifest for the Day sponsorship of the President of Loreto and Chairman of and numerous complemen- of the Italian Republic and of the Italian Bishops’ National tary materials. Radio Maria, the Presidency of the Council Committee for the Jubilee of based in Italy, offered a valu- of Ministers and of the the Year 2000; Monsignor able service through live Marches Region. Sergio Pintor, Director of the broadcasts of the main events On January 22, during the Office and National Council connected with the celebra- prayer octave for the unity of of the Italian Bishops’ Con- tion. Christians, an ecumenical gathering took place in Lore- In the course of the press Immaculate Mary Dermo- to devoted to “The Experi- conference there was a pre- pathic Institute in Rome. ence of Pain as a Context for sentation of two stamps is- At the opening of the ses- Reconciliation.” There were sued by the Republic of San sion, Archbishop Lozano talks by Armenian Orthodox Marino’s Stamp and Coin stressed that it was absurd “to Archbishop Datev Sarkissian; Administration, and it was an- regard profit as the core of the Pastor Domenico Tomasetto, nounced that the Italian Postal healthcare system,” inasmuch President of the Italian Feder- Service had prepared a com- as “health is a good in itself” ation of Evangelical Church- memorative design for can- with which society is con- es; Rev. Oreste Benzi, celing stamps. cerned and it must thus “be founder of the John XXIII On Sunday, February 7, at guaranteed for all the earth’s Community; and Dr. Silvia the Angelus, John Paul II re- inhabitants by using resources Maragoni (Comunitˆ di minded those present of the in the best way.” The General Sant’Egidio). Three days lat- significance of observing the Secretary of the Italian Bish- er, on January 25, a meeting World Day of the Sick and ops’ Conference, Monsignor was held at the Loreto Sanc- called Loreto a “celebrated , recalled that tuary on “Control of Human icon of the mystery of the In- a large portion of the projects Procreation and Ethics,” or- carnation, an extremely suit- financed by the Conference ganized by the Catholic Med- able site in the second year of for the third world involve ical Association of Italy, with immediate preparation for the health care. remarks by the Most Rev. devoted to the In all the talks the urgent Elio Sgreccia, President of Holy Spirit.” need emerged for affirmation the Pontifical Academy for of a solidary outlook support- Life. ed by the Christian vision of 79 In the period from the 23rd The Celebration man. to the 30th of January, the Monsignor Sergio Pintor Marches dioceses organized The key events held were closed the Congress. In the three pilgrimages for the the International Scientific evening Maestro Giuseppe Di faithful, including patients Congress (February 8), the Mare presented an organ con- and others, and a triduum for Meeting with the Bishops Re- cert structured around the prayer began on February 6 sponsible for the Health theme “Jeshua: From Expec- which concluded with the Apostolate in Europe (Febru- tation to Glory,” taking up the and offering of ary 9), the Day of Prayer and life of Jesus by way of poetry suffering. Each of the three Fraternity (February 10), and linked to musical composi- days was enriched by contri- the major celebration on Feb- tions by M.E. Bossi, J.S. butions from patients and vol- ruary 11. Bach, G. Frescobaldi, D. unteers from the Marches Re- The International Congress Zipoli, F. Mendelssohn, and gion. was devoted to “The Eco- Di Mare. Gianni Alderuccio On February 5, at the Vati- nomics of Health Care: Prior- recited verse. can Press Center, a briefing ities and Equity in Resource On Sunday morning Arch- was held on The Sixth World Distribution.” It was held in bishop Comastri presided at a Day of the Sick. It was the large John Paul II Audito- Mass which was nationally marked by the presence of the rium. At the morning session broadcast, and in the evening President of the Pontifical Professor Stefano Zamagni of there was a solemn Mass cele- Council for Pastoral Assis- the University of brated by Archbishop Lozano. tance to Health Care Workers, dealt with sociological as- The meeting with the Bish- Archbishop Lozano; the pects; Dr. Fernando Anteza- ops Responsible for the Council Secretary, Rev. José gna of WHO spoke on the po- Health Apostolate in Europe Luis Redrado, O.H.; the Un- litical and economic dimen- (February 9) considered the dersecretary, Rev. Felice sion; and Archbishop Lozano, work of these prelates in rela- Ruffini, M.I.; Archbishop An- President of the Pontifical tion to the plans of the Bish- gelo Comastri; Monsignor Council, considered the pas- ops’ Conferences and the Sergio Pintor; Dr. Giampietro toral/ethical perspective. Pontifical Council. The basic Ragagna; and Marino Cesa- At the round table in the af- questions posed were how the roni, press officer of the Pon- ternoon, whose moderator European churches were re- tifical Delegation in Loreto. was the Hon. Maria Pia Gar- sponding to the field of health The moderator was Dr. Lina avaglia, Extraordinary Com- policy and care, what re- Petri. At the end of the press missioner of the Italian Red sources were being used, and conference some special ges- Cross, there were remarks by what problems had to be tures were made, such as giv- Italian Health Minister Rosy faced. The sessions began af- ing those attending silk Bindi, Albanian Health Min- ter a concelebration at which scarves to mark the event, ister Leonardo Solis, Member the Most Rev. Franco Fes- with the image of the Holy of the Ukrainian Academy of torazzi, Archbishop of An- Father and the prayer he had Science and General Director cona, presided. In addition to composed for the World Day, of the Kiev Medical Center the President of the Pontifical a copy of the letter sent by for Radiation Anatoly Roma- Council, who spoke at the Mother Theresa, a commem- nenko, and Rev. Franco De- start of the meeting, there orative card, and a rosary. caminada, President of the were remarks by the Most Rev. Georg Eder, Bishop of Cardinal Angelo Sodano, is a place for all her children. Salzburg, Austria; the Msgr. Secretary of State of His Holi- Indeed, where God dwells, Jacques de Vlieger, delegate ness and Pontifical Legate for every man finds welcome, of the Bishop of Bruges, Bel- the Sixth World Day of the comfort, and peace, especial- gium; the Most Rev. Guergui Sick, also took part in the ly in the time of trial.” Yovcev, Bishop of Plodviv, evening prayer vigil, whose An article in L’Osservatore Bulgaria; the Most Rev. Ar- theme was “Mary, the Woman Romano stated, “Loreto and mando Brambilla, Auxiliary Who Said Yes.” In addition to the Pope; Loreto and the vast Bishop for the Health Min- the President of the Pontifical multitude of the sick and pil- istry in Rome; Msgr. Riman- Council, the Most Rev. Alber- grims; Loreto and the Vatican tas Norvila, delegate of the to Ablondi, Vice President of Audience Hall: two sanctuar- Lithuanian Bishops’ Confer- the Italian Bishops’ Confer- ies, with so many souls in ence; Msgr. Czeslaw Podles- ence, also participated. prayer, on the day of the feast ki, delegate of the Polish The audience was delighted of Our Lady of Lourdes.” Bishops’ Conference; the and moved by appearances by Cardinal Sodano’s homily, Most Rev. Frantisek Vaclav the popular singers Morandi after recalling the meaning of Lobkowkicz, Bishop of Os- and Scialpi and by Scarlet, the World Day of the Sick, trava, Czech Republic; Msgr. who was left paralyzed after a dwelt upon the mystery of Joze Stupnikar, delegate of serious traffic accident. human suffering and Christ’s the Slovenian Bishops’ Con- response to the problem of ference; the Most Rev. Javier pain by way of love. Then, Osés, Bishop of Huesca, citing a passage from John Spain; and the Most Rev. Paul II’s Apostolic Letter 80 William Dèkani, Auxiliary Salvifici Doloris (“Together Bishop of Eszterg-Budapest, with Mary, the mother of Hungary. Christ, who remained by the After observing the differ- cross, let us pause alongside ences between western and all the crosses of man to- eastern Europe as regards the day”), the cardinal invited the situations faced by the sick who were present to en- churches, it was seen that the trust themselves to the sup- former are excessively influ- port coming to them from the enced by past experiences in Church and those who were the health ministry, whereas healthy to make a priority the latter, after decades of commitment to serving those communist, atheistic regimes, suffering. must organize a health apos- Insistent applause arose tolate all over again in many every time the cardinal respects, though burdened by named the Holy Father. a shortage of priests. The concluding celebra- The presence of the Pontif- At the end of the time there tion, on February 11, com- ical Legate at the Loreto was moving testimony by memoration of Our Lady of Sanctuary, along with numer- Msgr. Giuseppe Beretta, Lourdes, was both solemn ous bishops, priests, reli- brother of Blessed Gianna and well attended. There gious, and lay people from all Beretta Molla; Maria Grazia were 2500 patients, accompa- backgrounds (all of them en- Bolzoni, friend of the Servant nied by numerous volunteers circling the sick and reflect- of God Benedetta Bianchi and members of the faithful. ing on the Christian meaning Porro; Luciano Mazzini, a Pontifical Legate Angelo of suffering), offered a mov- young tetraplegic who com- Cardinal Sodano presided, ing and very realistic picture municates only by eyebrow and leading religious, civil, of the universal Church, movement; and Rev. Daniele and military authorities were which in attention and service Simonazzi, the spiritual guide present. Rev. Corrado Brida to those suffering can and of Paolo Caccone in a time of directed the hymns accompa- must find one of the deepest illness (AIDS) and return to nying the Mass. and most efficacious sources faith. The Marian songs of At 10:15 a.m., on a live of her inner unity and witness Nunzio Farsi, accompanied television link to Loreto, the in the world. on the accordion by Valentino Holy Father, John Paul II, The meeting held on May Lorenzetti, further enriched spoke from Paul VI Hall and 1, 2, and 3 in Loreto, devoted the gathering. blessed those taking part in to the theme “The Spirit The Day of Prayer and the Sixth World Day of the Comes to Our Aid in Our Fraternity (February 10) was Sick. These words in his mes- Weakness (Rm 8:26): Spiritu- celebrated in the Indoor sage were central: “In the sig- ality and Suffering,” was vir- Sports Arena, where patients nificant atmosphere of the tually a prolongation of the and young volunteers were holy place, let us receive the World Day. It was organized brought together by UNITAL- light and power of the Spirit, by the Volunteers in Suffering SI. The topic for the gathering capable of transforming Center, and Cardinal Giaco- was “To Communicate Hope man’s heart into a dwelling of mo Biffi, Archbishop of in Prayer and Service.” hope. In Mary’s house there Bologna, took part. JOHN PAUL II’S LETTER TO ANGELO CARDINAL SODANO NAMING A PONTIFICAL LEGATE FOR THE WORLD DAY OF THE SICK IN LORETO

To Our Venerable Brother, Cardinal of the firm in the Faith. Lastly, you shall convey to Holy Roman Church, Angelo Sodano, Secre- them our affection, that it may embrace all, tary of State: console them in their sufferings, and bring joy to their hearts. You know we shall follow Our Lord Jesus Christ came down to earth your mission with our prayers, in the confi- to bring us relief and assistance in our afflic- dence that your it will produce the best re- tion due to sufferings of the body and the sults for all present there. soul and to teach us the salvific value of pain. Finally, we are pleased to impart our Apos- And He taught us this, not only by words, but tolic Blessing as a most certain assurance of also by his example, bearing our pains and health and promise of divine graces for all sufferings upon Himself and becoming obe- taking part in the celebration. We particularly dient until death (Ph 2:7-8). want you to extend this Blessing to the whole 81 The Pontifical Council for Pastoral Assis- Loreto community. tance to Health Care Workers proposed that From the Vatican, December 29, 1997, the this salutary message, in the perspective of twentieth year of our Pontificate. the Jubilee in the Year 2000, be celebrated in 1998 and manifested by the world day devot- JOHN PAUL II ed to the sick. With the greatest joy we accept this proposal and indicate Loreto as the site for the celebration, at the famous Marian Shrine which is usually termed the icon of the mystery of the Incarnation. It is an illus- trious place. For centuries the faithful from The Pontifical Mission which will many parts of the world have made devout accompany Cardinal Sodano shall be pilgrimages to it to venerate the Heavenly made up of Archbishop Javier Mother and ask her for health in soul and Lozano, President of the Pontifical body. Next February 11 will be devoted to Council for Pastoral Assistance to the faithful around the world who are afflict- Health Care Workers; Rev. José L. ed by illness. This day must be celebrated Redrado, O.H., Secretary of the with special solemnity. To indicate our per- Council; Rev. Felice Ruffini, M.I., sonal spiritual presence and involvement in Undersecretary; and Monsignor Tim- this celebration and in the most fitting way othy Broglio, counselor of the Nun- stress the importance of the event, we turn to ciature. you, venerable brother, with singular confi- dence, that you may carry out this ministry. We name you our Pontifical Legate for the World Day of the Sick to be celebrated at the Holy House in Loreto, in consideration of the innumerable merits you have acquired day by day in assuming responsibility for the public affairs of the Church without sparing yourself any effort. By means of this letter and by way of you we also greet the venera- ble Bishops and all the priests, religious, and lay people who gather together there. Representing my person, you shall preside at the liturgical rites and by your words testi- fy to our filial affection for the Virgin Mother of God and set forth in accordance with our thought the importance of that event for all, especially for the sick, whom you shall con- Christ Reveals to Us the Meaning and Value of Suffering

THE HOLY FATHER’S MARIAN MEDITATION AT THE ANGELUS ON SUNDAY, FEBRUARY 8, 1998

Beloved brothers and sisters: 2. The Day of the Sick invites everyone to reflect on the meaning and value of suffer- 1. Next Wednesday, February 11, the ing in the light of the good news of Christ— Sixth World Day of the Sick will be cele- that is, of the revelation that God is not brated, placed under the spiritual patronage indifferent to the dramas and trials of of Our Lady of Lourdes, whose liturgical men, but, on the contrary, has taken them commemoration falls on that date. It will upon Himself to open the way of salvation take place in Loreto this year, at the Holy for us. House, a famous image of the mystery of During his earthly existence, Christ ap- the Incarnation, a very appropriate site in proached the suffering people with special this second year of immediate preparation love. He cured the sick, consoled the afflict- 82 for the Jubilee, dedicated to the Holy Spirit. ed, nourished the hungry, healed the deaf, For this important occasion I have named the blind, and lepers, freed those possessed the Cardinal Secretary of State, Angelo So- by the devil, and raised the dead. At the cul- dano, my Legate; he will go to Loreto to- mination of his mission, he went out to meet gether with those responsible for the Pontifi- passion and death with the awareness that, cal Council for Pastoral Assistance to Health precisely by means of the cross, He was to Care Workers. I cannot fail to recall here the arrive at the roots of evil and perform the great merits of Cardinal Angelini, who con- work of salvation. tributed to the beginning of that Council. Christ, spurred by love, suffered voluntar- ily; He suffered, though innocent, and thus demonstrated the truth of love by way of the truth of suffering, a suffering which He, as the God-Man, experienced with boundless intensity. But, precisely through that sacri- fice, He joined suffering to love once and for all and thereby redeemed it.

3. In this mystery of suffering and love, his mother Mary is, first of all, associated with Jesus. Her pain is joined to that of her Son. On Calvary she becomes the perfect model of sharing in Christ’s cross. Every man is called to suffer. Every man, imitating Mary, can cooperate in the suffer- ing of Christ and, therefore, in his redemption. This is the good news does not cease to announce, especially through the wonderful testimony of so many men and women who with faith accept and with love live through the physical and spiritual trials in life. I entrust all the people who are sick and suffer to the Blessed Virgin Mary, Salus In- firmorum. May her motherly intercession obtain for each the consoling experience of the love of God, who in the night of pain as well infuses the light of hope. Mary Is Attentive to the Needs of Every Person

“Where God dwells, every person can find Jubilee of the Year 2000, is dedicated pre- acceptance, comfort and peace, especially in cisely to the Holy Spirit. times of trial. With Mary, “Health of the I would like to make a spiritual pilgrimage Sick”, there is support for the hesitant, light to the feet of the Our Lady of Loreto, togeth- for the doubting and relief for those er with you who have gathered here today in burdened by suffering and illness. Loreto is this Paul VI Auditorium for the customary a house of solidarity and hope where one annual meeting of 11 February. In spirit, let can almost feel Mary’s maternal concern”, us join the sick in Loreto to pray in the Holy the Holy Father said at the General House, which calls to mind God’s wonderful Audience of Wednesday, 11 February, World condescension by which the Word became Day of the Sick. In his catechesis the Pope flesh and dwelt among men. spoke of this year’s celebration of the World In the evocative atmosphere of this sacred 83 Day at the Shrine of Loreto and turned his place, we receive the light and strength of the thoughts especially to the sick. Here is a Spirit, which can transform man’s heart into translation of his address, which was given a dwelling-place of hope. In Mary’s house, in Italian. there is room for all her children. In fact, where God dwells, every person 1. Today, 11 February, a day dedicated to can find acceptance, comfort and peace, es- the memory of Our Lady of Lourdes, we are pecially in times of trial. With Mary, “Health celebrating World Day of the Sick for the of the Sick,” there is support for the hesitant, sixth time. This year it takes place in the Shrine of Loreto, at the Holy House, where sick people and volunteer workers, faithful and pilgrims from Italy and from other na- tions have gathered for this special occasion. I would like to address my affectionate thoughts directly to them, linked with us by radio and televions. I first greet my represen- tative at the celebration, Cardinal Angelo So- dano, Secretary of State; Archbishop Javier Lozano Barragàn, President of the Pontifical Council for Pastoral Assistance to Health- Care Workers; and all who have promoted and organized today’s event. I greet Arch- bishop Angelo Comastri, Pontifical Delegate for the Shrine of Loreto, and the prelates who have wished to attend the prayer meeting. I greet the health-care workers and volunteers, especially the members of UNITALSI. However, my words are addressed with deep affection particularly to the sick. They are truly in the limelight on this Day, which echoes deeply and vividly in my soul. My most cordial greetings to them!

2. Loreto and the sick! How well these words to together! The renowned Marian shrine immediately recalls the mystery of the Incarnation, in which the action of the Spirit was fundamental. Indeed, 1998, the second year of immediate preparation for the Great light for the doubting and relief for those bur- longing for healing and I urge you always to dened by suffering and illness. illumine and elevate this longing with the Loreto is a house of solidarity and hope, theological virtue of hope, Christ’s gift. Mary where one can almost feel Mary’s maternal will help you give new meaning to suffering, concern. Comforted by the assurance of her making it a way of salvation, an occasion of motherly protection, we are more encouraged evangelization and redemption. Thus your to share the suffering of our brothers and sis- experience of pain and loneliness, modeled ters, tried in mind and body, to pour on their on that of Christ and enlivened by the Holy wounds, after the Good Samaritan’s exam- Spirit, will proclaim the victorious power of ple, the oil of consolation and the wine of the Resurrection. hope (cf. Roman Missal, Italian edition, May Mary obtain for you the gift of Common Preface VIII). trust and may she sustain you on your Likewise at the wedding feast at Cana, the earthly pilgrimage. Trust is more necessary Blessed Virgin is attentive to the needs of than ever today, because the experience of every man and woman and is ready to inter- moderne life is more complex and problem- cede with her Son for all. That is why it is atic. very significant that the World Days of the And you, O Blessed Virgin of Loreto, Sick, year after year, take place in Marian watch over the paths of us all. Guide us to the shrines. heavenly homeland where, with you, we will contemplate the glory of your Son, Jesus, for 84 3. Dear sick people, today is your Day. I ever. am thinking of those of you who are gathered My affectionate Blessing to all! next to the Holy House, of those who are here in this auditorium, and all the sick who To the English-speaking pilgrims and visi- have met at the feet of the Immaculate Virgin tors the Holy Father said: near the grotto in Lourdes or at other Marian I am happy to greet the students and teach- shrines throughout the world. I am thinking ers of the Olso Handelsgymnasium and the of you, still more numerous, in hospitals, in Sotra Vidaregaande Skule from Norway, your homes and in the rooms which are the as well as the students of the Junshin Uni- shrines of your patience and daily prayer. A versity of Kagoshima in Japan. I welcome special place is reserved for you in the eccle- all the English-speaking pilgrims and visi- sial community. The condition of sickness tors, especially the various groups from the and the desire to recover your health make . Upon you and your families I you privileged witnesses of faith and hope. cordially invoke the blessings of almighty I entrust to the intercession of Mary your God.

Being Close to Pain with the Gospel of Love

THE HOMILY BY CARDINAL SODANO, THE PONTIFICAL LEGATE, DURING HOLY MASS AT THE SANCTUARY OF THE HOLY HOUSE

The Cardinal Secretary of State Angelo So- This passage from the Apocalypse we have dano, Pontifical Legate, presided at the just heard shows the image of the Heavenly solemn concelebrated Mass for the Sixth Jerusalem, in which there will no longer be World Day of the Sick in the Sanctuary of the sources of pain and weeping. Holy House in Loreto, Italy, on February 11, It is moving to contemplate our heavenly 1998. We are publishing below the text of his fatherland in the shadow of this little homily at that Mass. “House,” which tradition presents to us as the place inhabited by the Son of God in his his- “This is God’s dwelling with men! He will torical existence. We may also apply the dwell among them, and they will be his peo- words of the Apocalypse to the Holy House: ple and he will be ‘God-with-them.’ And he “This is the dwelling of God with men.” But will wipe every tear from their eyes...” (Rv this obviously means the earthly dwelling, 21:3-4). where tears were not to be lacking, where Christ experienced life’s toil and in a certain ing sharpens the psychological contrast be- sense “trained” for the Cross. Here Mary said tween the condition of illness and that of her Fiat, perhaps intuiting, with her inner good health. Moreover, with the tearing of docility to the Holy Spirit, that it was also an the fabric of community, in a society which is assent to the sword which would pierce her more and more in a hurry and there is less heart (cf. Lk 2:35). and less time for others, the sick often feel Christian reflection on suffering thus more alone emotionally. And solitude is cer- draws unequaled inspiration from this Sanc- tainly more bitter in one who, by a supreme tuary in Loreto. misfortune, has also lost the gift and comfort of faith.

1. The World Day of the Sick 3. Job’s Question The subject for our reflection is offered by the celebration of the World Day of the Sick, Contemporary men continue to ask the instituted by John Paul II in 1992. The date, question in the Book of Job. Why is there February 11, gives this Day a distinctly Mari- pain? Why do even the innocent suffer? Why an imprint. The Pope in fact chose it in rela- do even children suffer? When one is in the tion to the liturgical commemoration of Our grips of illness, no rational argumentation Lady of Lourdes, thus thinking of the cele- will ever suffice to provide consolation. God brated Sanctuary in the Pyrenees, where nu- has given the answer to the question about 85 merous sick people go to place their suffer- pain with the cross of Christ! ings on Mary’s heart. In Lourdes, Loreto, and In Job’s time, a direct correlation between so many other Marian sanctuaries, it is al- illness and personal sin was assumed. It was ways the Mother herself who becomes the a mistaken opinion. But, in keeping with the consoler of the afflicted, Salus Infirmorum. biblical text, it was rightly believed that God Mary carries out her mission by obtaining had projected neither pain nor death for man; numberless graces of healing for her chil- they had entered the world as a result of sin. dren. But, even more, she becomes their The fullness of revelation is implanted into teacher, to enable them to face the problems this Old Testament message. Christ has given posed by suffering with courage and solidari- us an authentic “gospel”—that is, “good ty. It is precisely this instructive message of news”—concerning the subject of suffering, hers which the World Day of the Sick seeks too. In fact, in Him God Himself comes to to take up and disseminate. It was in fact es- meet his creature and defeat pain and tablished to “increase sensitivity in the Peo- death—indeed, to uproot them, overcoming ple of God and, consequently, in numerous sin in the Paschal mystery. Catholic healthcare institutions and civil so- ciety itself, to the need to ensure the best care for the sick and help those who are ill to val- 4. Christ’s Message ue suffering in human and, above all, super- natural terms” (John Paul II, Insegnamenti In seeking to grasp Christ’s message on XV, 1, 1992, p. 1410). suffering, it is appropriate to consider it in two stages, as if by way of two settings emerging from the Gospel narrative. 2. Illness Today The first setting involves Jesus surrounded by crowds as He announces the impending And who does not see the urgency of such Kingdom of God. He does so not only by reflection to augment sensitivity? Illness has calling men to inner conversion—“Repent always been the major thorn in humanity’s and believe in the Gospel” (Mk 1:15)—but side. It continues to be in our time, too, in also by relieving their physical sufferings. He spite of the admirable progress of medicine. does so with the paralytic, whose sins He for- Man advances in the conquest of space, but gives and to whom He says, “Take your finds it hard to master himself. The most stretcher and go home” (Mk 2:11). He does highly developed medical facilities do, of so with all the sick who turn to Him. course, make diseases more bearable physi- But there is a second setting which at first cally and allow them to be cured more readi- glance clashes with the first one. It is the set- ly. But, in a certain sense, in the face of ill- ting opening with the statements announcing ness, especially when it is serious and incur- the passion and culminating on Golgotha. Je- able, contemporary man feels more fragile sus Himself provokes this change in horizon than in the past. Indeed, widespread well-be- when, in Caesarea Philippi, He draws up a sort of balance sheet on his ministry and asks not involve a miracle of healing then, but his disciples, “Who do you say I am?” (Mk those newlyweds would have experienced 8:29). It is a crucial question. His successes discomfort and sadness if Mary had not as a wonder worker and healer have brought looked after them with an intuitive tender- Him the enthusiastic, but also ambiguous and ness which was entirely maternal. She was a superficial, support of the masses. Jesus is mediator of grace for them. And hasn’t the awaiting something quite different from his People of God always represented her this disciples! The time has come to lead them to way? Mary is the Mother! The sick who go the core of his mystery, with the revelation of to her at Lourdes and so many other Marian the Cross. And in fact, right after Peter’s sig- shrines know they can always obtain some nificant confession of Him as Messiah, He grace—if not of healing, at least of consola- announces his death. The disciples react with tion. bewilderment. Peter even rebels, deserving a But the gospels set the image of Mary’s harsh reproach by the Master (Mk 8:33). pain alongside that of Mary the Consoler. All four evangelists portray her in the icon of Golgotha: Stabat Mater dolorosa.... Mary 5. The Way of Love was at the foot of the Cross to share Jesus’ choice, on this occasion making not her In reality, the episode of the Cross does not Son’s power, but his “impotence” her own. contradict that of the healings. Indeed, on On Calvary she is no longer the advocate in 86 close examination, it reveals their profound the face of pain, as at Cana, but the Mother of meaning. The healings are manifestations of Sorrows. And she thus becomes the model God’s project: they remind us that God does for the Church, as John Paul II has written in not will pain and that it should be combated. the Apostolic Letter Salvifici Doloris: “To- But the Cross indicates the only valid way to gether with Mary, the Mother of Christ, who win this hard battle: the way of love. Christ stood by the cross, we pause alongside all the Crucified does not cease to be a “physician,” crosses of man today” (no. 31). but remains one by identifying Himself with the suffering. He goes out to meet them by placing Himself on their side and asking to 7. The Church and the Sick be encountered, served, and loved in them: “I was sick, and you visited Me” (Mt 25:36). In Mary leads us by the hand, then, on this this way He makes us co-workers and virtu- World Day of the Sick to grasp and imple- ally administrators of his salvific energy, not ment Christ’s design. The care of the sick has through the miracles of omnipotence, but always held a central place in the witness of through those of love—that is, by asking us the Christian community. It is certainly not to live out that oblational love in relation to the function of the Church to carry out our brothers and sisters which turns into at- healthcare “policies,” but it is her specific du- tention, gratuitousness, and sharing; by ask- ty to show concern for the sick in the frame- ing us to develop the inventiveness and cre- work of her concrete purposes of evangeliza- ativity of love by placing study, research, the tion and service. She thus continues Christ’s application of scientific progress, and the or- mission, making healing a sign of the King- ganization of adequate care at their service. dom of God. Moreover, Christ Himself also Prayer to obtain healing is situated within pointed to healing the sick by the laying-on this great way of love. Of course God is able of hands as one of the manifestations of to grant extraordinary graces as well to those apostolic service (cf. Mk 16:18). invoking Him with faith, but He normally The Church takes care of them in many makes use of the concrete mediation of our ways, beginning with her specific closeness love. in prayer, which is sacramentally manifested in the Anointing of the Sick. No less important is the help she offers the 6. Mary and Pain sick by spurring her children towards active solidarity and promoting health care and oth- Mary perfectly embodied this Gospel of er forms of assistance throughout the world, pain and love. It suffices to contemplate her especially in the poorest countries. in two typical “icons” of the Gospel narra- Furthermore, aware of this mission of hers, tive. the Church does not cease to appeal to civil In regard to the first one, I think of John’s society so that the problems of illness will be account of the wedding in Cana, where Mary placed at the center of culture and of a policy gave the “go-ahead” to Jesus’ miracles. It did of solidarity. The Church asks that the sick be respected May the Blessed Virgin obtain the grace in their dignity and cared for in all their di- for those suffering not only to be consoled mensions. It is a true “culture of love” that by fraternal solidarity, but also, in accep- must be embodied in the style of medical and tance of pain, to become witnesses to saving paramedical personnel, called to make their love. work not just a profession, but in a certain sense a mission. 9. Prayer to Mary

8. The Pope’s Teaching We turn to her today, thinking of all the world’s sick, with the words of the Holy Fa- But those suffering can feel themselves to ther. be not only recipients, but rather “main ac- “Our Lady of Loreto..., to your tenderness tors” in this culture of love if they develop as a mother we entrust the tears, sighs, and that prodigious capacity, typical of faith, hopes of the sick. May the beneficent balm of which is able to turn pain itself into a min- consolation and hope descend upon their istry of salvation, through union of their sac- wounds. May their pain, joined to Jesus’, be rifice with Christ’s. This is the summit of the transformed into an instrument of redemp- Gospel message concerning pain. tion. I would like to conclude by recalling “May your example guide us in making thoughts which are very dear to John Paul II, our existence continuous praise of God’s 87 who is so experienced in pain and is always love. Make us attentive to the needs of oth- able to speak to the hearts of those suffering. ers, solicitous in bringing aid to those suffer- He has written, “By working the redemption ing, capable of accompanying those who are through suffering, Christ at the same time alone, and builders of hope where human raised human suffering to the level of redemp- dramas are taking place. At every joyful or tion. Every man, then, in his suffering, can al- sad stage on our way, with motherly affection so become a sharer in the redeeming suffering show us ‘your Son, Jesus, O clement, O lov- of Christ” (Salvifici Doloris, no. 19). ing, O sweet Virgin Mary.’” To Be a Fisher of Men ARCHBISHOP LOZANO’S HOMILY

Lk 5:1-11 carnation. Man was lying in the shadow of In this Gospel text we are struck by the death, and He, the light that is Life shining confession of St. Peter, who, falling to his upon every man coming into this world, knees, says, “Withdraw from me, Lord, for I comes to give the Life which is Life and to am a sinner,” and by Jesus Christ’s attitude give Life abundantly (cf. Lk 1:79; Jn 1:4-9, on replying, “Do not fear. From now on you 8:12, 9:15). shall be a fisher of men.” As the Pope tells us, this is the horizon of Peter was an expert fisherman, and when, true health. The Incarnation of the Word is in the field in which he regarded himself as the horizon of hope for the sick. The Spirit of most competent, that of fishing, he was God, especially in this year dedicated to miraculously surpassed by Christ, he then Him, has us encounter in the Incarnate Word 88 noted the great distance separating them, for of God true hope of Life and Health. All of he was only a fisherman, far removed from our health moves towards Him. the capacity and perfection of the Lord. He The Virgin Mary, whom we venerate at therefore fell to his knees, worshipping the this Sanctuary as the Mother of the Word Lord. And on the basis of this humility, made flesh, is the model for this hope, whose which is the truth of Simon Peter, he received fulfillment She experienced on the day of her his basic future mission: to be a fisher of Assumption and coronation as the Queen of men. Heaven and Earth. She is our help and indi- We have gathered for this Sixth World Day cates to us where health is heading. From this of the Sick, with very serious study during Sanctuary She gives us the meaning and the International Congress of Health Minis- power of our Sixth World Day of the Sick. ters and Experts, devoted to the subject of We do not tell Jesus Christ to withdraw “Where Health Care Is Heading.” There have from us. We recognize we are sinners, but we been significant observations. Now, at Holy ask Him not to withdraw, but to be in us and Mass in this House of Loreto, Jesus encoun- with us, for the mission He conferred upon ters us in the Incarnation of the Word, and He St. Peter is to some extent conferred by Him truly is able to tell us precisely where health upon us, too: to be fishers of men. He now care should go today; we fall to our knees commissions us, in accordance with our vo- and proclaim He is the Lord of health and cation in the Church, to fish in the sphere of life. illness and health—an activity we can carry This is the house which Pope John Paul II out only by having the Incarnate Word with has called the “icon” of the Incarnation. Here us and in us as a remedy for illness and as we can sense where health care is going, in complete Life. Everything we have said at the knowledge that health is precisely the In- our Congress amounts to approaching this fullness. And this is the Eucharist we are celebrat- ing, which the Church Fathers called “the medicine of immortality” (cf. St. Ignatius of Antioch). In this Eucharist we are celebrating Life triumphing over death. It is the Passover of Christ: “We celebrate your death and pro- claim your resurrection. Come, Lord Jesus.” We say this after the Consecration. It is the unequivocal proclamation of Christ, the way and goal of all health. In Him, in this Eu- charist, we fully know where health is head- ing. Let us encounter one another fully in Him and entrust to Him our Sixth World Day of the Sick, that He may give us the health we are seeking. STATEMENT BY THE PRESIDENT OF THE SWISS CONFEDERATION IN CONNEC- TION WITH THE WORLD DAY OF THE SICK SUNDAY, MARCH 1, 1998

Dear Fellow Citizens: spect, and dialogue are effec- sick. In Switzerland everyone Our society has thought up tive medicines which we are has a right to the best possible many artifices to keep us from all capable of providing. This medical treatment. We have meditating on illness. But the morning I had occasion to always been firmly convinced person suffering in a hospital meet some patients at the Lo- about this. In spite of increas- bed well knows what it means carno Hospital, with whom I ing costs and undoubtedly to be ill. Those who have the had stimulating and moving necessary reforms in the good fortune to have been conversation—an experience health field, we must never ar- spared by illness readily forget always prompting deep emo- rive at a medicine based on about the sufferings, pains, tion in me. In this way I once class discrimination. Health and impediments which in- again realized that illness is an must never be linked to the deed disconcert the existence integral part of the destiny of size of one’s fortune. In a rich of the ones affected. On this the human being. It is also a country like Switzerland, ade- day our thought goes out, with unique occasion to understand quate treatment and care in the 89 deep sympathy and warmth, to the relativity and fleetingness event of illness are a basic those for whom illness has be- of our life. In the face of pain right. come a life condition. and illness, the pursuit of suc- The Day of the Sick has as Illnesses, especially when cess and wealth seems like its theme this year “The Sick they leave no hope for a rapid dramatically ridiculous vanity. Spur Our Commitment.” On cure, bring us face to face with The sick do not belong to a this scale of values, which are basic challenges. There is, on separate world, but to our life-oriented, not material val- the one hand, an aspiration to own, exactly as we belong to ues, the sick prompt us to eliminate illness and, on the theirs—this is the central mes- change our way of conceiving other, the observation that we sage reaching us from this what is important for us. I con- cannot do so, but must live Day. vey my most heartfelt and pro- with and reconcile ourselves In Switzerland we have one found appreciation to all car- to it. Those not directly affect- of the best medical systems in ing for the sick and helping ed are unable to realize all the world. We are proud of it them to recover their health. I this. An authentic living com- and want to do all we can so sincerely wish all our dear munion is thus much more im- that it will remain this way in people who are ill, wherever portant among healthy people the future. But this also means they may be, strength, pa- and sick people. Security, re- that it may be expensive to get tience, and confidence. The First Meeting of Bishops Responsible for Pastoral Care in Health in Their Respective Bishops’ Conferences Introduction

It is a great honor for me to willing, we shall celebrate it in fore celebrates the World Day be able to greet and welcome next year. of the Sick. The different vo- all the Bishops and other rep- In these celebrations, in ad- cations we have received re- resentatives of Bishops’ Con- dition to a central dedication quire varying kinds of harmo- ferences responsible for the to prayer, we have wanted to ny and balance at each stage in health ministry in your respec- maintain dialogue by the Pon- life. This is the meaning of tive nations. Welcome to tifical Council with those who health. If we can fulfill the vo- Loreto, this “icon” of the In- are our natural interlocutors, cation received, we can say we carnation. The Most Blessed the Bishops from the different are enjoying the health needed Mother of God will accompa- national Conferences, and par- at each moment. It will not be ny us at this meeting and un- ticularly with those responsi- complete health, but we do ask doubtedly show us the benev- ble for the health ministry in that it be sufficient to carry out 90 olent countenance of the Fa- each Conference. We are very what God has entrusted to us. ther in Our Lord Jesus Christ, interested in your experiences May the Lord grant all of us the way and goal of true and in fostering an occasion this health, through the inter- health. for us to listen to one another cession of Our Lady of Loreto, The Pontifical Council for and arrive at a needed ex- and may She be for us the Pastoral Assistance to Health change of pastoral initiatives. health of the sick at this first Care Workers rejoices at the At the Pontifical Council we meeting of European Bishops presence of all of you at this understand health to be not responsible for the health min- Loreto Sanctuary on the occa- just the absence of illnesses, istry in their respective Con- sion of the Sixth World Day of but a dynamic process involv- ferences. the Sick. Our wish is that this ing people’s equilibrium and I welcome you once again. event may subsequently be physical, mental, social, and May the Holy Spirit, whose held on all of the continents in spiritual harmony in accor- year we are celebrating, en- such fashion that the health dance with the different stages lighten our meeting. apostolate may truly be cele- in their lives. In this way we brated everywhere on this are incorporated into the death + JAVIER LOZANO very important occasion of the and resurrection of Christ and BARRAGËN World Day of the Sick. In past thus do not exclude illness Archbishop Emeritus years we had the opportunity from the very concept of Bishop of Zacatecas to celebrate this Day in Africa health, but, paradoxically, in- President of the Pontifical Council and America. We are now cel- clude it in the Paschal per- for Pastoral Assistance ebrating it in Europe. God spective. The Council there- to Health Care Workers The Bishop Responsible for the Health Ministry within a National Conference

1.The Persons the definitive Word of God C. The field of health and We Are Addressing and the Servant who has illness, by means of science come to give his life for and technology, has under- This reflection is addressed many. gone spectacular develop- to those Bishops who have This has given a new impe- ment in our time. Considera- received from their National tus to the health apostolate, tion for health has risen Conference this very impor- particularly in the following among citizens to very high tant mission for the episcopal areas. levels, and concern for health ministry within the Assembly is reflected increasingly in of Bishops. A. A deeper awareness overall government budgets. of the nature, being, and mis- These changes pose ques- sion of the Church has been tions and prompt responses 2.The Health Ministry gained and, more directly, by the Church. in Our Churches of the Diocesan Church and 91 in the Past and Present her bishop: “The Diocese D. The Church, under the is a portion of the People of direction of the Holy See, has The health apostolate has God that it is entrusted attentively observed these been a living, well-known, to a bishop so that he advances, with some particu- and widely experienced reali- will shepherd it with the larly decisive measures, like ty in the universal Church cooperation of his priests, the establishment by John throughout her history. It is in such fashion that, united Paul II of the Pontifical rooted in the life, work, and to its Pastor and gathered to- Council for Pastoral Assis- mission of Jesus—in what is gether by him in the Holy tance to Health Care Work- termed Christ’s Mystery of Spirit by the Gospel and the ers, as well as its journal Do- Healing. Eucharist, it may constitute a lentium Hominum and the As a constant, uninterrupt- particular Church; in it the creation of the World Day of ed tradition the Church has Church of Christ, which is the Sick. practiced this service wher- one, holy, Catholic, and apos- ever the Gospel has been an- tolic, is truly present and E. These new structures for nounced, in the awareness acts,” and he exercises there- the health ministry have had that this action is an essential in his functions of “teaching, positive repercussions on the part of the saving mystery of sanctifying, and governing” Churches distributed around Christ. And she continues to (CD, 11). the world, in both Dioceses deepen and mature it as she and Bishops’ Conferences, strives to respond to the chal- B. The importance the prompting a generous re- lenges presenting themselves particular Church (Diocese) sponse in this ministry in the experience of illness, has acquired and communion throughout the Church. pain, life, and death. among all the Churches, unit- Simply, but truly, we may This pastoral care is espe- ed in the Supreme Pontiff, state that at this time we en- cially intense today in our has had as one of its conse- counter a wealth of experi- Churches. quences the creation of ence in this pastoral care in the Bishops’ Conferences in the different Churches, even the local Churches, with if the pace, organization, pri- 3.A New, Special Time well-defined objectives: to orities, and structure of the for the Health Ministry foster communion among the health ministry may vary. different Churches or Dioce- Vatican II, in examining ses, within the dynamic of the mystery of the Church collegiality; to provide better 4.The Purpose of and her relation to the world, service to all the Diocesan This Meeting asks all Christians, who are Churches, seek to respond also members of society and more adequately to actions In view of the foregoing, I citizens of this world, to seek affecting all and calling feel it is very praiseworthy to fulfill the mission of evan- for a greater common good, for the Pontifical Council to gelization through dialogue and coordinate those which have called together the bish- and in a spirit of service, imi- go beyond the frontiers of ops responsible for the health tating God, who has brought each particular Church. ministry in the European dialogue with the world to This objective has also Bishops’ Conferences. What fullness by sending his Son, spurred the health apostolate. is the aim? I think the Holy See, wish- biguous, but extremely dan- ses, parishes, religious com- ing to promote this ministry gerous. munities, and Bishops’ Con- more and more as a true sign Ð The peremptory philoso- ferences. of an evangelizing Church phy of well-being degener- Ð The commitment which committed to a New Evange- ates into the idolatry of the Vatican II and the Apostolic lization, under the immediate body and pleasure, generat- Exhortation Christifideles responsibility of the Pontifi- ing an individualistic, hedo- Laici request from lay people cal Council, seeks the follow- nistic conception of the per- in the Church and the world ing. son. is being attained. Ð To gain direct knowledge Ð These materialistic mod- Ð New forms of care and of how we are working in els have repercussions for the action are emerging in rela- this field in each Church. so-called Third World, vic- tion to the elderly, the termi- Ð To promote exchanges timized, on account of our nally ill, and AIDS patients. among us in the light of the selfishness, by hunger and Ð Concern in our Churches Church’s ample health-relat- illnesses leading to early for the poorest also has posi- ed Magisterium. death and lives unjustly de- tive repercussions on a health Ð To reorient, stimulate, prived of their inalienable apostolate motivated by this and coordinate this ministry dignity. preferential option for the to some degree by way of in- poor, including those in the creasingly shared criteria. Third World. Ð To achieve a more au- Ð A health ministry is be- thentic health apostolate in ing forged which is quite content and objectives and in conscious of the structures 92 relation to the Pontifical created by current society for Council. health care and of the domi- nant mentality and culture, which sometimes have a very 5.The Need negative impact on the con- for Progress ception of health, pain, ill- ness, and even personhood it- I feel this time is especially self. favorable for new advances in this ministry for the fol- lowing reasons. 6. The Bishops’ Conference in the 1. The Church seeks to Health Ministry make her own the joys, hopes, and sorrows of all We start from LG, 23. men—particularly the poor- Ð These new situations The Council, after explain- est and most afflicted (GS, have become a kind of ing the meaning and content 1). And the world of the sick prophetic outcry for the con- of Collegiality, invites the fully enters into this sphere science of our Churches, and bishops and the Churches of the poor. the result is in-depth formu- they preside over to manifest lation of health, illness, well- this collegial affection and 2. As a sign of the times, being, and the meaning of union and concludes, “Simi- pastoral care of the sick is life within their pastoral larly, the Bishops’ Confer- vigorously awakening in plans. ences can now provide effec- many Churches, and aware- All of this represents a tive and fruitful assistance so ness is growing in the Christ- very positive reaction by our that collegial affection will ian People of solidarity and Churches which is contribut- lead to concrete applica- responsibility for this care. ing to the rediscovery, study, tions.” and activation of a health Let us also refer to no. 37 3. The new challenges apostolate seeking to be inte- of Christus Dominus and the arising in the dynamic of gral and to include all of the first paragraph of no. 38. progress, civilization, and dimensions involved in it. The health ministry, then, history have notably broad- Ð It wants to count on the and all it involves, is one of ened and modified the scope whole Church and all her the areas in the Church’s mis- of evangelization in this field members as the subject of sion which, in view of its and prompt our vigilance. this ministry. weight and importance, Ð There are disturbing, pro- Ð It strives to be very forces us to seek the greatest liferating signs of death—re- aware of the Church’s institu- good of the Church, for it al attacks on human life, such tions, specifically the Insti- thoroughly concerns human as abortion and euthanasia. tutes of Consecrated Life life and personal dignity, val- Ð Genetic manipulation whose charism is care of the ues which the Church must overlooks ethics and gets car- sick. care for, defend, and promote ried away by the mere logic Ð New organisms are being with all her strength, since of scientific knowledge, created to respond adequate- her mission is to announce proving to be not only am- ly to this ministry in Dioce- the fullness of life which Christ has brought us and ferences in this field. violating life and personal which also includes the life Ð The Plenary Assembly of dignity. of the person, a gift of God. Bishops is responsible for And we bishops must unite pointing out the major guide- to “perform this task in a lines and objectives for all 7.The Bishop timely and effective way.” the local Churches, to be im- Responsible for the Indeed, in all of the Bishops’ plemented, first of all, by the Health Ministry in the Conferences there is a com- Health Department of the National Conference mission or similar body deal- Bishops’ Conference and ap- ing with the health ministry. plied by each Diocese, ac- This Bishop, named by the And every bishop, in order cording to the criterion and Conference to deal particu- for this action to reach his indications of its Bishop. larly with the health ministry, whole Church, creates a cor- Ð The Plenary Assembly of must continually recall and responding diocesan body so Bishops, in taking up this revive this commitment with- that this ministry will be well project, demonstrates that the in the Conference as an effort conceived, planned, and exe- health ministry is an endeav- by each Bishop in his Church cuted. or and responsibility of the and by the Conference as a In connection with the whole Church, all the Bish- whole. Synod for America, the Pres- This stimulus should help ident of this Council made the Bishops discover new some recommendations of fields in this ministry, present great interest for those experiences in other parts of Churches which are also the world, foster greater quite applicable for us, for awareness among the Bish- 93 they directly concern what ops of this task, and assist we are saying. I shall cite them in reviewing their pas- some of them. toral action.

1. The health ministry should effectively enter into 8.The Health Ministry’s the ordinary planning of each Roots at the Core Diocese and the Bishops’ of the Apostolic Ministry Conferences. The Bishop, in his teach- 2. The Bishops’ Confer- ing, liturgical, and pastoral ences should foster the union mission, should always be of Catholic hospitals, chap- aware of the health aposto- lains, physicians, nurses, and late. pharmacists, both nationally ops, and each Bishop in his Bishops are authentic and internationally. local Church. teachers and preachers of the And the diocesan Church faith—that which should be 3. Each Diocese should must use all means so that believed (content of faith) commit itself to promoting this ministry may penetrate and that which should be ap- the culture of life as opposed the whole comm unity in- plied to customs (LG, 25). to the culture of death, with creasingly. They must announce the concrete programs crystalliz- The Health Ministry De- “Gospel of Life” and shed ing in the preferential option partment in the Bishops’ light on the most pressing for the poor and respect for Conference ought to become problems in health care and the unborn. a very valuable service for facing death and the value, Dioceses by providing study greatness, and dignity of hu- 4. We Pastors should be plans for training, examining man life, while ensuring the aware of the need for a spe- varied experiences to carry moral and doctrinal integrity cific ministry to the elderly out this ministry better in of Catholic medical attention. and the morality of palliative parishes, hospitals, and other They must denounce viola- care. environments, and helping to tions of life—attacks on prepare those working in this those still unborn, euthana- 5. Parish priests should ministry and in volunteer ser- sia, and experiments and ma- give priority to the health vice. nipulations contrary to the apostolate in all its scope. Ð There must be an effort dignity of the person and of to take this ministry into the human life—exhorting peo- 6. The health ministry spheres where vital health is- ple to do what favors life and should be taught at seminar- sues are at stake—that is, into what permits a dignified ies, insisting on the current the structures of social power death, according to the teach- ethical problems posed by where health policy is decid- ings of the Church, in aware- genetic engineering. ed, and into hospitals, by es- ness of the fact that such ac- With these orientations we tablishing and maintaining cusations are generally not can specify some of the lines ethics committees, with all made, for they are complex of action for Bishops’ Con- their impact on defending or subjects and there is fear of unpopularity. Above all, established, organized, and 9.Some however, this is one of the se- applied, with special atten- Applications rious duties of the Bishop’s tion to the ministry of chap- munus docendi. He must fo- lains. Ð To structure and organize ment discernment concerning As a Pastor, the Bishop is the Health Ministry Depart- the most difficult problems, responsible for promoting, ment carefully in each Dio- for current culture, in most stimulating, and coordinating cese. cases, prescinds from ethics. all pastoral activity, as re- Ð To promote schools for And he must constantly point gards the area of health as the health ministry to train out the dehumanization well. these pastoral workers. which is so degrading for He must exercise his au- Ð To develop training pro- personal dignity. thority over all forms of grams for parish groups and In his liturgical mission, apostolate in his Diocese, as those visiting the sick. “the Bishop, endowed with the Church’s teaching reiter- Ð To specify the mission of the fullness of the Sacrament ates (LG, 20; CD, 11; and the chaplain and religious as- of , is the admin- different canons of the Code sistance at hospitals. istrator of the grace of the of Canon Law. In a word, he Ð To prepare and celebrate supreme priesthood. He over- must coordinate healing min- the World Day of the Sick sees every legitimate celebra- istries for the sake of the with the greatest care. tion of the Eucharist and all common good. He must in- Ð To prepare lay people for the Sacraments” (LG, 26). vite religious to join forces in this apostolate as individuals Consequently, he must en- fostering the health ministry and in associations. sure that the Sacraments spe- and ensuring its Christian Ð To avoid identifying the 94 cific to illness—Anointing of and Catholic identity. Aware health ministry with religious the Sick and the Viaticum— of profound changes in the assistance at hospitals. are diligently celebrated, field of health and life, we with adequate preparation must pay attention to the Most Rev. JAVIER OSÉS and catechesis and that voice of science, assisted by Bishop of Huesca, Catholic religious assistance the ministry of theologians Responsible for the Health Ministry at hospitals is appropriately and moralists. in Spain Summary of Reflections by Groups

Those attending were di- fifty years, reflection is be- Belgium vided into two groups to ginning in this field. There is Health care is divided into study situations, opportuni- no bishop responsible for it, public and private sectors. ties, and relations among the but there is a national dele- The health ministry is more different Bishops’ Confer- gate who studied at the closely connected to the latter ences in connection with the Camillianum. and integrated into the work health ministry. The question- of Catholic Charities, which naire and replies by the study Spain has prepared a statute for groups are detailed below. There is a well-structured health workers. Special atten- national body, with a bishop tion is devoted to training. responsible for it, a national QUESTIONNAIRE coordinator, regional coordi- Austria nators, and diocesan dele- There are two sectors: a) 1. The Status of the gates. All activities for a private, with considerable in- 95 Health Ministry three-year period are nation- volvement by the Church in Your Bishops’ ally programmed, and there is through religious orders and Conference an effort to carry them out. Catholic Charities, and b) All national initiatives have public, where women reli- Ð What organism is respon- positive repercussions on dio- gious are active, but their sible for this ministry? ceses and parishes. This kind numbers are markedly de- Ð What are its activities? of organization began thirty clining. The National Confer- Ð What impact does it have years ago and is now yielding ence has named a Bishop to on the diocese? its fruits. be responsible for all pastoral care, including the health Italy field. There is a person re- 2. Opportunities The health ministry has de- sponsible for the health min- veloped on a local level, istry in every diocese. Na- Ð What possibilities exist above all, through charisms tionally, there is an associa- for coordinating and promot- of consecrated life specifical- tion for the health ministry ing this ministry in your ly related to serving the sick which is concerned with Bishops’ Conference? and the suffering, associa- health professionals. There Ð What means would have tions of health professionals are three training centers for to be employed to this end? and patients, service organ- these workers, and a meeting 3. Relations Between the isms, Catholic health facili- is organized every year in Bishops’ Conferences and the ties (a great charitable lega- Bavaria for health profes- Pontifical Council cy), and hospital chaplains, sionals. Ð What can the Confer- with their association. ences offer to the Pontifical Only later was the National Poland Council? Council for the Health Min- The organization of the Ð What do they expect istry created, presided over health ministry embraces two from it? by a bishop designated by the areas. Permanent Council of the a) One dimension, presided Italian Bishops’ Conference over by a Bishop for the pas- ANSWERS and made up of representa- toral care of the sick, is orga- tives of Regional Pastoral nized through a national sec- 1. The Status of the Health Councils and of national as- retariat and a national dele- Ministry in the Bishops’ sociations and organisms for gate. There is an apostolic Conferences the health apostolate. and spiritual association A National Office for the (about 84,000 members) for Hungary Health Ministry was recently the sick based on three com- There is no organism on a created by the Italian Bishops’ mitments: 1) acceptance of Conference level, but there is Conference, and a Director illness as God’s will, 2) un- an effort to create it. Work is was named. Similarly, there dergoing it in communion done through parishes or are efforts to establish such an with Jesus Christ, 3) offering Catholic Charities. office in every diocese. suffering for the salvation of There are various training sinners. The sick are given a Slovenia centers on a national and re- diploma with a cross and are After a hard period lasting gional level. informed by way of a bul- letin. Every year, for the feast Spain Austria of the Patron, the secretariat As presently organized, Several steps are seen as for the sick organizes a pil- this ministry is quite effec- necessary. grimage. Every week there is tive. Much progress has been Ð Preparation of a docu- a radio talk, and spiritual ex- made, and a lot of distance ment on current cultural and ercises are offered annually. has been covered. Many ethical change. b) Another dimension, groups are involved, and Ð Establishing an Ethics presided over by a Bishop for there is good programming. Institute within the university healthcare workers, is also or- Two associations, FERS and structure. ganized through a national PROSAC, are very active, as Ð Development of pastoral secretariat and a national del- may be affirmed regarding organization. egate. This area has markedly parishes, healthcare ethics, Ð Greater ecumenical effort developed since the celebra- and other areas. through cooperation with the tion of the World Day of the Evangelicals in health care. Sick in Czestokowa, with the creation of different associa- Poland tions and activity on a dioce- Ð Union of the two areas san level. and secretariats under a sin- gle Bishop. Lithuania Ð Promotion of the Associ- As a result of the previous ation of Hospital Chaplains. circumstances in the country, Ð Fostering volunteer work there is not yet real organiza- with the health professions. 96 tion of the health ministry. Ð Providing better ethical Numerous activities are training. linked to parishes and Ð Creating ethics institutes. Catholic Charities. Hospital chaplains are still lacking, but Lithuania there is pastoral care in Ð Organization of the parishes. Some steps have health ministry on a Confer- been taken by Catholic Chari- ence level, with some shared ties in collaboration with lo- orientations and cooperation cal government (e.g., diag- in activities. nostic clinics). Two facilities Ð To appoint hospital chap- serve as special “signs”: a lains. “house for birth” and a Ð To promote a culture of “house” to accompany the life after the period of intense dying. ideological conditioning within the nation.

2. Opportunities for the Coordination 3. Relations Between and Development the Bishops’ of This Ministry Conferences and in the Bishops’ the Pontifical Council Conferences a)What They Can Hungary Contribute There is gradual progress, to the Pontifical Council? especially with some groups Ð Ad Limina visits. of Catholic physicians and in Italy Ð Information every two parishes. A few courses in There should be develop- years. pastoral medicine have been ment of an ecclesial infra- Ð Attendance at congress- offered. The Bishops’ Con- structure through the creation es. ference has written a pastoral of diocesan offices where Ð Greater communication letter dealing with certain they are still lacking and by with the Council (some Con- problems and relations with naming local and parochial ferences have been remiss in the sick. Since 1990 possibili- coordinators. There is a need not responding to requests). ties for work have improved, for greater cooperation, better with the help of lay groups use of Catholic health facili- b)What They Expect and, above all, parishes. ties, and more planning. from the Council? Ð Orientations and pro- Slovenia Belgium grams not only for the Con- The need is felt for training There is a commitment to ferences, but also for individ- in this field, and work is be- better cooperation through a ual bishops. ing begun. Many resources monthly meeting of the Vic- Ð Greater awareness of the are undoubtedly lacking. ars for Catholic Charities situations they face. from every diocese. Ð More direct visits. International Conference on the Economics of Health Care: Priority and Equity in Distributing Resources, February 8, 1998 I: Sociological Aspect

In this introductory note I of development we have en- ance and the development of intend to touch upon a topic tered. more and more costly medical emerging forcefully in recent technology. In other words, it debate on health policy in both 1. All economically ad- is possible to show the exis- Italy and other developed vanced countries have for tence of a specific causal countries: how to deal with the some time been experiencing nexus between incentives for rationing of care and health a high growth rate in health scientific research—aimed at services. I shall divide the sub- expenditures, which, along- developing certain types of ject into two parts. In the first side a slowdown in overall new technology—and the role one, I shall discuss the struc- growth, has brought about a of the insurance system, on the tural factors accounting for the disturbing increase in health one hand, and between the impressive rise in the percent- costs in relation to GNP and characteristics of the insurance age of GNP devoted to health greater tension in the general system and the long-term ef- 97 expenditures over the last framework of financial bal- fects of new technology, on decades. In the second part, I ance. Together with various the other. B. Weisbrod, in par- shall deal with the ethical cri- difficulties in public finance, a ticular, has convincingly teria for determining priorities still-unresolved conflict has shown the ways the quality of in allocating healthcare re- emerged between the pursuit the health care which it is tech- sources. of the objectives proper to the nically possible to provide at a The question spontaneously health system in accordance given time and the breadth of arises as to why a problem in with welfare policies—that is, access to that care by citizens healthcare rationing is posed an increased lifespan and a have an impact on each other today. The response is imme- better quality of physical life and also on the aggregate level diate. Medical progress in the for all citizens—and ever- of health expenditures. recent past has enabled us to tighter budget restrictions for The pull of scientific “work miracles,” but the costs the public sector. progress—as an independent are so high that these advances To grasp the structural and variable causing changes in cannot be made available to not merely circumstantial na- the form and extent of insur- all who could benefit from ture of the percentage increase ance coverage and as a depen- them. Some people will die of health expenditures in rela- dent variable influenced by in- and others will suffer not be- tion to GNP in the OCSE centives working through the cause we lack methods for countries, we must pause to system of health insurance— treatment, but because we can- examine the noteworthy fact poses the need to consider the not extend those methods to that over the last forty years decisive influence of incen- them. It is thus necessary to the health systems in western tives. Specifically, it may be determine who can be treated countries have undergone rad- maintained that 1) the total of and who cannot. This is ra- ical changes without historical resources destined for medical tioning. precedents in three specific ar- research largely depends on The crisis with which the eas. Firstly, new technologies the mechanisms which are ex- health systems in our coun- have revolutionized the ways pected to be used to finance tries are struggling is rooted in health care may be practiced. the provision of health ser- specific circumstances. These It is obvious that most of the vices in the future, when the systems were created to re- current equipment for the di- results of the research process lieve the suffering and save agnosis and treatment of dis- can be commercialized; 2) the the lives of citizens, eases was still unknown forty demand for health insurance with no a priori exclusion; years ago. Secondly, the role partly depends on the state of moreover, the state of knowl- of public and private health in- technology, which, in turn, re- edge and, above all, the avail- surance has expanded impres- flects the scientific research ability of means permitted sively. Finally, personal health done in the past; and 3) it fol- only limited action, though expenditures have grown be- lows that the long-term growth substantially within reach yond all reasonable prevision, of health expenditures in a of everyone. The situation even in the light of the famous given country is a conse- has been reversed today. law of Engel. quence of the interaction be- Explicit rationing has become It can be—and has been— tween the medical research inevitable, but a way out has demonstrated that there is a process and the health insur- not been found. This is a para- very close connection between ance system being used in that dox typical of the period the expansion of health insur- country. In the light of the foregoing, dividuals have to bear to com- lem could be solved only if it we can understand why the so- pensate for reduced public ser- were possible to eliminate lution to the economic/finan- vices may prove higher than waste or increase health ex- cial problem cannot consist of the savings achieved by the penditures. There is no ques- a mere reduction in public public budget, with an overall tion that health care is a sector health expenditures. Three loss in efficiency. Finally, the characterized by large pockets specific reasons may be ad- contraction of public health of inefficiency and still exces- duced to support this affirma- resources may generate other sive expenditures. But at- tion. Firstly, we must observe inefficiencies in allocation be- tempting to solve the problem that, as regards healthcare de- cause health care is character- this way would be futile, espe- mand, it is not possible to de- ized by the presence of phe- cially because money is cer- termine a function of au- nomena which prevent the tainly not the only scarce re- tonomous demand—that is, a market, when left to itself, source in medicine. Let us function which makes the de- from functioning in a way that consider organs for trans- mand for health services de- is socially optimal. Let us con- plants—there will never be rive only from the preferences sider the monopoly power en- enough! of individuals and their budget joyed by some of the suppliers Explicit rationing is thus in- restrictions. As K. Arrow ob- of health services and the pos- evitable. How should we act in served over thirty years ago, itive external factors produced this regard? There are two rel- the relation between patients by health care (improvement evant questions: a) What ob- and doctors (and other health- in the health of each citizen jectives should decision-mak- care providers) is rendered ers pursue? b) What criteria complex by “problems of should be adopted in deter- 98 agency,” which are in turn due mining the people for whom to the existence of asymmetri- certain treatments should be cal information among the reserved? Another aspect con- parties and of specific rela- cerns the institutions and pro- tions of confidence. Indeed, cedures through which to im- patients entrust themselves to plement objectives and crite- doctors to seek to define their ria. Should we leave rationing demand for health services. decisions to the family doctor They may even confer upon or the specialist? To the mar- doctors partial or complete au- ket or to some public agency? thority for making their deci- I shall devote attention below sions. This is the meaning of only to the first of the two the well-known phenomenon troublesome areas. of demand induction, a phe- The first reply spontaneous- nomenon which is clearly des- ly coming to mind is that we tined to be reinforced precise- has a positive impact on the must use scarce resources in ly because of the hectic pace health of others, and the so- such fashion as to produce the of technological innovation in cially optimal level of care greatest good. This idea is at health care. In this kind of may thus prove superior to the root of the use of QALYS framework, the economic no- that which the market would (“quality-adjusted life years”) tion of a fully informed con- achieve spontaneously). as a unit to measure the value sumer who looks at prices Therefore, the only strategy of different types of medical when deciding the sum of to be followed must be com- treatment. As we know, health services to plex and based on sound in- QALYS are a measure of the be purchased is obviously sights, starting from clear ob- “good” produced by care, or out of place. And yet almost jectives for the quality and de- the benefit it brings about. the whole current debate on gree of universality of services Medical care can do two kinds the subject assumes the exis- and introducing a framework of things. It can prolong the tence of a well-defined de- of economic compatibilities life of some individuals and mand curve for health for identifying and selecting improve the life of others. services among citizens. the instruments and mecha- QALYS combine these two It follows that measures to nisms needed to pursue those types of benefits into a single contain health expenditures objectives. measure. One year of healthy based on decreasing the de- life equals one QALY; the mand for health services can 2. No society today can af- years spent in illness, on produce only modest effects: ford to offer all its citizens all the other hand, are adjusted the price variable loses force the health care they could ben- downwards on the basis in determining the optimum efit from. Each society must of a factor aiming to measure levels of individual consump- thus establish priorities—that the quality of life. Clearly, one tion. is, what to distribute and to arrives at making room for a Secondly, it is not clear that whom and, therefore, who is trade-off between length of a reduction in public health to remain excluded from bene- life and life conditions. expenditures entails a reduc- fits. Once the QALYS associat- tion in overall health expendi- Someone might be led to ed with a certain treatment tures, since the costs which in- think that the rationing prob- have been determined, they are compared to its costs. transplant and there is only people be treated in equal Economists in the English- one liver available. What fashion qua persons. As we speaking world have estimat- should be done? The criterion see, increased intellectual en- ed the cost per QALY of dif- adopted in countries such as ergies have to be applied, and ferent treatments. For in- Italy and Britain is urgency: the horizon of our understand- stance, a kidney transplant the patient’s status is described ing must be expanded to deal may cost about $3000 per as urgent if death will occur in with such problems. QALY, whereas a shoulder re- three days unless a transplant placement may cost about is effected. 3. What are the implications $1200 per QALY; this means Now, if the objective to be of this discussion for the that the money spent on a pursued were the greatest meaning and practical applica- shoulder replacement pro- good, urgency would not play bility of deontological codes? duces more good than that any role: the transplant would To answer, it is useful to con- spent on a kidney transplant be effected for the patient of- sider at least briefly the two and that scarce resources fering the best chances of suc- major matrices of moral phi- should thus be directed to- cess, regardless of the degree losophy in which proposals wards the former rather than of urgency. What is the ratio- for ethical codes can be situat- the latter. nale, then, for the criterion of ed: on the one hand, the neo- But, on close consideration, urgency? Is there some good contractualist matrix, associat- not a few difficulties arise reason or is it just a compro- ed with the now famous from such a methodology. As mise? names of John Rawls and J. Broome, A. Williams, and David Gauthier; on the other, others have brought out, the the matrix we can term moral first one is to set the scale of evolutionism, ascribable to the 99 factors to adjust quality for work of F. von Hayek, which different states of health. If a hails back to the intellectual certain condition has an ad- tradition of the Scottish moral- justment factor of 0.5, it ists (a tradition to which A. means that two years in such a Smith belonged). state equal one year in good The essential difference be- health. How can we decide tween the two matrices is that, which state of health deserves whereas in the neocontractual- this evaluation? This is cer- ist conception the basis for tainly a problem of primary values is the impartial agree- importance which still needs ment of rational individuals, in to be solved. the evolutionist approach the However, I wish to dwell foundation of ethical values upon the general idea that we lies in the process through are to allocate resources so as There is a good reason, and which these values are built up to produce the greatest good. it involves considerations of as virtues. In other words, in Are we sure this is the appro- equity. If the patient in urgent the neocontractualist perspec- priate objective for using need cannot obtain the trans- tive, rational individuals real- available health resources? In plant, the last chance to go on ize that it is in their interest— the aforementioned example, living will be lost. If someone whatever that interest may we ought to ration kidney else, on the other hand, in a be—to reach an agreement on transplants more severely than non-urgent situation, does not shared norms for behavior so shoulder replacements, even if obtain the transplant, there re- as to overcome the problems the former save human lives. mains hope for a future oppor- connected with the rationing Is it morally acceptable to de- tunity. It follows that by giv- of health care. According to ny someone a chance to live in ing priority to urgent cases we moral evolutionism, on the order to use resources to im- act in such fashion as to equal- other hand, the basic idea is prove the quality of life of oth- ize people’s chances of sur- that, given a certain communi- ers? When we consider alter- vival. By behaving this way, ty of people, those practices nate treatments for a single pa- we increase equity in the sys- and institutions are justified tient, it is undoubtedly right to tem. which support the develop- choose the one which will As is readily understood, ment of the virtues typical of prove more beneficial for the the objective of equity is often that community. This is the individual. In such cases the in conflict with that of the meaning of the “virtue ethic” use of QALYS does not pose greater good. The question is approach, just as A. Smith ethical problems. But the situ- posed as to whether it is to posited in The Theory of ation is different when it is a some degree possible to rec- Moral Sentiments (1759), question of distributing re- oncile the two objectives by where he brought out the need sources among different pa- balancing them. The reply is for society to create an institu- tients. not easy, for the basic reason tional framework capable of Another criterion, different that equity has nothing to do fostering virtuous behavior from QALYS, is equity. Let us with maximizing anything, among citizens. consider the case where two not even the greatest good. In- It is easy to grasp the differ- people are waiting for a liver deed, equity demands that ences observed in deontologi- cal codes on the basis of one identification of the incentives internal conditions—that is, moral context or the other. If serving to ensure “self-en- the moral constitution of we consider a code from a forcement” of the code. agents. These are the moral neocontractualist standpoint, it Now, a structure of this kind rules which, while bringing will strike us as a rational con- will produce the desired ef- great benefit to society, may dition—that is, a self-imposed fects, and the practice of self- not be to the direct advantage obligation determined by a de- regulated codes will thus be of those putting them into cision maker to achieve a cer- successful, only if one practice. These are all the tain goal; on the other hand, “macrocondition,” so to rules serving to minimize or the same code, from an evolu- speak, is met: there must be a neutralize various forms of tionist standpoint, will appear “reputation market” where opportunistic behavior, from as an instrument for the prac- good standing has a positive “free-riding” to “shirking,” tice of virtue—that is, to foster value. Observance by many which are at the root of the development of moral dis- individual organizations of processes of decay in a soci- positions. their respective deontological ety. This dichotomy poses a What is the practical signifi- codes might otherwise lead to big problem: whereas to pro- cance of this distinction? Let a perverse result. This is why duce and enforce the moral us examine the elements char- acceptance of the neocontrac- rules in the first category a co- acterizing any ethical code. tualist approach does not suf- herent system of laws is suffi- The first one concerns identi- fice to ensure the success ex- cient, when accompanied by fication of the social pact con- pected from adoption of ethi- well-oiled machinery of jus- stituting a form of organiza- cal codes by individual organi- tice and a framework of exter- tion, the pact binding the dif- zations. nal incentives in the form of 100 ferent “stakeholders” (those If we generalize for a mo- reputation capital (as accords with property rights, employ- ment, the fact is that there are with the neocontractualist ma- ees, managers, patients, two categories of moral rules: trix), to provide society with providers). The second ele- those which may be conceptu- the other kind of moral infra- ment concerns setting forth all alized in the form of human structure it is necessary to act the norms (for impartiality, eq- reputation capital (people upon people’s inner motiva- uity, resolution of conflicts, know they will be subject to tions—that is, their convinced and so on) which serve to es- major personal costs in the adherence to shared values (as tablish the behavior to be event they transgress, since sought by the virtue ethics ap- adopted by the parties every their reputation will be hard proach). time the incompleteness of the pressed by an immoral act) contract leaves gray areas. Fi- and, on the other hand, those Professor STEFANO ZAMAGNI nally, the third element is the whose execution depends on University of Bologna II:The Political and Economic Dimensions of Health Care*

I think Professor Zamagni utopia. Health is a state not against the individual, but has in clear and detailed fash- only of the absence of illness, less mention of social pollu- ion delineated the major but, rather, of complete well- tion. The globalization now problem presenting itself to- being—economically pro- bringing so many advantages day when we speak of health ductive and socially accept- and possibilities also poses and economics or finance. able, universal. We have enormous challenges for Unfortunately, in this world, mentioned universality. Is health. I shall mention some which is now described as this possible? Are our soci- of them. globalized, everything seems eties prepared to make this to be reduced to discussing description a reality? social problems in economic I shall then talk about what Investing and financial terms. I feel health for all means in the in Health Professor Zamagni has co- twenty-first century, the big gently explained and stressed challenge today for WHO, The second element I 101 an aspect which I would like though it may look like a would like to cite is of a gen- to reconsider briefly—the dream. It is a basic direction eral nature—the cost of, or, multisectorial nature of of the humanistic vision and rather, investment in health. health care. thus coincides with the With this much more utilitari- Health, as it was defined Christian vision of man’s an criterion, health services fifty years ago by those wise destiny. In this sense—today are now multiplying, and people who, after the experi- I was reading the Holy Fa- they seem to have become a ence of the second world ther’s Message for this commercial good, like so war, created the World Day—I think it coincides, as many others, to the point Health Organization, is not you will see, with the main where, if there are hotel just the absence of illness, document approved last chains, there are also multina- just as peace is not just the week by the Executive Coun- tional hospital chains where absence of war. Many years cil of WHO concerning service is gauged in terms of ago a writer, Girondel, stated, health strategies in the twen- patient comfort, without nec- “Peace has broken out.” To- ty-first century. essarily being monitored in day it seems that what were In relating health to illness, terms of medical and techni- called the “dividends of I recalled what a famous cal quality. Insofar as possi- peace,” which we intended to Spanish endocrinologist, Pro- ble, they have the most recent use and concentrate in the so- fessor Mart’n Ibá–ez, said: technology, but the question cial sector, are for the most “In studying medicine we we ask is whether the latest part being diluted in the ef- have been taught to recognize technology is the best. It may fort to keep this peace. The the symptoms and signs of virtually seem to be so, for, cost of peace-keeping thus illness, but they have not since everything is based on appears to be as great as or taught us to recognize the trends, if you do not use the greater than that of avoiding symptoms and signs of latest technology, the patient a world conflict. health. This ties in with what is not left completely satis- Professor Zamagni said about fied. In this respect, I feel the lifestyle: if we could better key point is—and I repeat a Health recognize the signs and term used by Professor Zam- and Illness symptoms of health, individ- agni—rationalization. Who ual lifestyle might perhaps be rationalizes? Who makes the I wish to touch upon three modified on this basis. We rules of the game? Public au- points in my talk. The first see the risks to which the en- thorities cannot deny their re- concerns a general vision of vironment is subjected, but sponsibility for health and, health and illness. On this the environment is not just though not the care providers, Sixth World Day of the Sick, the physical and natural do- must provide norms accord- I feel it is appropriate to recall main—it is also social. The ing to the constitution of each what health is, for all of us, at pollution of the social envi- country. a certain time in life, are ronment is as important to- I would like to refer very struck by illness, and illness day, I think, as the other kind. briefly now to the fundamen- is, to some extent, linked to In this current world on the tals of WHO around the health. The definition of move, there is a lot of talk of world. I am trying to reflect health as such, in WHO’s lan- chemical pollution, of pollu- the reality of its 191 Member guage, might thus seem like a tion in terms of aggression Nations, most of which—that is, two-thirds of the world— The Social second, equity, solidarity, and are poor and cannot gain ac- Environment ethics; and, finally, equality cess to many new technical between men and women. I achievements. People now I am increasingly surprised shall say a word on ethics. I speak of telemedicine, of the by the fact that one can watch think all the values complete- whole mechanism created by sixty, eighty, or one hundred ly coincide with the message the information highways. In television channels without of the Holy Father and the some cases, as we have stat- leaving one’s armchair. Is this principles of the Catholic ed, the highway may exist, good or not? I think we must Church. but there are no vehicles to wonder about it in many There are two points, travel on it. Reality is thus senses. On the one hand, we though, which I would like somewhat different from that promote healthy nourishment to consider more at length. vision because the means for and, especially at a certain The first is equity in health communication available to age, its importance, while we care. In this global dimen- these communities and coun- are also witnessing a major sion, we also want to see eq- tries are, unfortunately, not movement in the same pro- uity among peoples reflected, the same. portion which does not al- above all, in international ways go in the same direc- cooperation. And I do not tion—not to mention excess mean international coopera- A New Policy smoking, alcoholism, and so tion just in terms of economic of the World Health on. aid, but in terms of informa- Organization for the The matter of health for all tion, knowledge, and access Twenty-First Century is neither a WHO issue nor a to different sources enabling 102 WHO document, but a ques- decision-makers to make Why should there be a re- tion concerning the whole more intelligent decisions. newal of the health-for-all health sector around the We have seen in some cases policy? Let us point to one of world, all those involved with that cooperation is not neces- the main aspects which have health care. WHO does not sarily in keeping with the been mentioned. Though in have a monopoly—it is what priorities and benefits of the last twenty years the health ministers like us want certain populations. Coopera- world has produced the it to be. But health ministers tion must thus reflect an ele- greatest wealth in universal also depend on cooperation ment of equity between the history, it has also produced with other government minis- countries with greater re- the greatest number of poor ters and with many sectors. sources and those with fewer people. There is an asymme- NGOs and religious bodies options. try or gap here which we thus play a big role. In Africa The other aspect I wish to shall explain later when deal- there are countries where refer to is ethics. We have ing with social benefits and over 60% of medical care is spoken of technology, ser- demographic change. We all provided by the Catholic vice, and health. Ethics, in know that life expectancy has Church, and conditions are our view and that of WHO, notably increased, especially even better where there is ec- applies to the whole of life, in the industrialized coun- umenical cooperation. In from its beginning to its end. tries, but also in the develop- talking about progress in this In both curative and preven- ing ones. Today there are field, then, it is vitally impor- tive terms, then, care must be health problems and chronic tant to establish policies and governed by ethics and the illnesses which did not previ- priorities. highest respect for the human ously exist, at least in these I have already mentioned condition. proportions. In poor coun- globalization. All I can add is As regards access to health tries as well what are called that it is creating winners and services and life expectancy, nontransmissible diseases losers, and the latter, unfortu- the latter must not be under- have begun to appear, but the nately, are always the same. stood only quantitatively. The causes are different. Previ- In health care, we are trying fact that people now live until ously, the inhabitants of these to create norms for exchang- age seventy does not they live countries did not live long ing health-related goods and well. Quality of life must re- enough to contract chronic services that will permit ap- flect the means available to- diseases. Mortality affected plication of WHO principles day to every human commu- the very young. Today, with concerning equity, coopera- nity. And the same applies to the increase in life expectan- tion, and social justice. health services. Their equity cy, other problems have should relate to needs, not in- emerged, giving rise to a very dividual or community finan- different epidemiological Values of the cial capacities. I feel need profile. Epidemiology has New Policy ought to determine the use of changed in such fashion as to these services, and not neces- take on a twofold weight: not I would like to refer briefly sarily demand, as has often only transmissible diseases, to the basic values of the new occurred until the present. but also chronic ones are be- policy. It is essentially based What do we expect from coming more complex and on three aspects: first, the this new policy? Health must difficult. right to health, as you know; be at the core of develop- ment. The idea is for health to a core value will not possible. In conclusion, I would like be mentioned every time we I would initially like to say to say that WHO and I, as an speak of development, for that the health system should individual and practicing man is the heart of develop- not create unfulfillable hopes. Catholic, think there is a ment in this new conception Secondly (and here I come to communion of fundamental of health policy, for those of the supply-and-demand side, concerns in dealing with the us working at WHO and, I privatization, and everything person’s condition in the face think, for all those present we have previously men- of health and of individual here. tioned), aside from govern- and community responsibility Disease control continues, ment and some NGOs, there for health. If this does not be- of course, to be the central are not many actors con- come concrete, I feel that not concern of WHO action, but cerned about prevention and only will we fail to attain not only control as such— health promotion. The major health for all, but we will not rather, global vigilance over element is to serve health. We even build a world with a cer- what is happening in the have seen the privatization of tain tranquillity and peace, world, with a view towards health services, but we have which, in a word, we are all timely intervention and joint still not witnessed a privatiza- seeking. Thank you. action. There are not many tion of anything promoting borders today when disease is healthy life attitudes because Dr. FERNANDO ANTEZANA involved. that is apparently not prof- Deputy Director of WHO I wish to cite two factors itable. I feel, however, that for basic action. The first government and organisms concerns the idea that health like the churches and schools is at the core of development. have a basic and significant 103 The second involves the ob- duty as regards the future, for * This text is a summary of the au- servation that if there is not a they influence the shaping of thor’s oral remarks, which were record- sustainable system, health as lifestyles. ed. III: A Theological-Pastoral Approach to Economics and Health

A. THE PROBLEMATIC have a set course, time, and tation of means and responsi- order and the doctor-patient bilities for local managers. A Since the beginning of the relationship would be aban- structure is required which 1980s governments in the doned, for the customer is left permits clear differentiation western countries have been aside once the product is de- among the main actors in the deeply committed to contain- livered. Many patients for health system and recognition ing healthcare costs, bur- whom the law of supply and of their respective responsi- dened everywhere by annual demand did not function bilities. The central adminis- increases superior to national would be abandoned, as with tration would be the main economic growth. They have the terminally ill or the vic- source of finances; health done so by way of restrictive tims of incurable diseases, sectors, the buyers of service; measures and new health such as AIDS, or the elderly hospitals, varied health facili- policies, seeking to augment and handicapped, for whom ties, doctors, and pharmacies, 104 free-market factors in health psychological and spiritual the providers; and users, the care and medicine. Welfare- therapy is essential. In addi- customers. state medicine is said to have tion, patients’ family ties, de- The basic obligation of the generated inefficiency, unsus- cisive for cure, would be sev- buyer would be to obtain the tainable expenditures, corrup- ered. The concept of volun- best quality service with tion, and the plague of bu- teer work would be emptied. available resources. This in- reaucratic expansion.1 Commercial expectations ternal health market would would be the rule and not pa- produce the competitive stim- tient health, and medical fa- ulus for different units re- 1. Against the Free Market cilities would no longer have sponsible for providing ser- the recovery of the sick as vice. It was not long before some their aim, but economic gain.2 It is assumed that competi- spoke out against such deci- tion would thus be created sions. It was deemed absurd which would prompt im- to treat the domain of illness 2. In Favor of the Free provements in the quality and and health commercially be- Market cost of services and give cause health would be seen as users more room for choosing a product for a business to Far from rejecting the free among providers. The prime supply competitively by ex- market system in health care, basis for work relations be- ploiting available resources the vast majority of current tween providers and users to the utmost and reducing government health policies, would be the contract, which costs and patients would be- at least in the west, accept it would be accepted after de- come mere customers. on the basis of various mo- tailed analysis of its efficien- This rejection assumes that tives which, they feel, cy. Both the public and the a health facility does not demonstrate that the welfare- private sectors would be in- work to increase a product or state system is obsolete and volved. the supply of services, but to can no longer be maintained Awareness of personal reduce needs. It is further alongside present develop- obligation and accountability stated that in the health area ment of their countries. They for results would be incen- there is no market saturation, propose it as a model for the tives and improve the wel- and increased supply may first world and, to some ex- fare-state type of administra- thus encounter increased de- tent, with a degree of accom- tion, which now proves inad- mand. Moreover, calling modation, for the third world, equate for grasping and man- health a “product” is offen- too. aging the complexity and vol- sive to the integral concep- The improvements pro- ume of health services. The tion of health care because it posed in place of the welfare rigidity of welfare-state encompasses spheres which system, they say, never ought norms would be replaced by may not be so termed, includ- to affect the basic core of eq- flexible services, and the per- ing psychological and spiritu- uity and solidarity, with the verse primacy of bureaucracy al, as well as physical, condi- pursuit of more favorable would be avoided, with con- tions, and to call a patient a conditions for obtaining the sumers taking on their full “customer” is not appropriate combined benefits of greater role. Two key factors come because it implies an exclu- decentralization, the chance into play: economic interest sively economic perspective to apply the tools of business and freedom of choice. The in which every illness would management, and the delimi- former aims at product quali- ty; the latter, at service quali- What costs nothing is not ap- dence-based medicine,” ty. Both of them may degen- preciated.3 which consists of using the erate, it is true, but they may It is true that in strict terms most reliable medical knowl- also be factors to be taken in- the law of supply and de- edge in clinical practice. The to consideration for priority mand, when applied to success of this system has and equity in health resource health, does not work, for as been demonstrated in regard distribution. supply increases, so does de- to both better and more nu- Modern management tech- mand, and there is also an un- merous cures, with notable niques entail speeding up questionable autonomy of savings in health costs. There procedures, defining respon- health professionals, along are now “evidence-based sibilities, and delegating au- with cost inflation. But the medicine” manuals and ac- thority. Healthcare manage- advantages of the manage- cess to them on the Internet. ment must always be con- ment system can be main- It may thus be affirmed that cerned about product quality, tained in accordance with the business infrastructure and satisfying budget require- solution now applied in the diagnostic/therapeutic proto- ments, reducing costs, pro- US, called “managed care,” cols are the two orientations ductivity, the motivation and which are becoming domi- compensation of personnel, nant today in healthcare de- research and development, velopment.4 and the viability of the hospi- tal enterprise. Awareness of expenditures must be height- 3. Economy and Health ened among both users and in the Third World providers. It is true that health 105 is priceless, but it does have a In the third world, the free cost. What really character- market model is followed in- izes the bureaucratic welfare sofar as possible. system is that it poorly allo- In broad terms, let us recall cates resources, with wasteful the two recent economic expenditures. Competitive- stages which have been dom- ness would demand ongoing inant. The first model basical- training of service providers. ly involved price stabilization Continually advancing tech- of raw materials, control of nology must necessarily be agricultural markets, training incorporated into the health responsible leaders, exploit- service. The foregoing exi- ing natural resources, and de- gencies are connected with veloping infrastructures. the advantages of good man- When this model failed, agement in current health largely because of foreign care. debt, the program called In the free market system “structural adjustment” was the elderly, the chronically ill, conceived, with the freeing of the convalescent, and those supported by “evidence- prices, free exchange and a requiring palliative care based medicine.” This proce- free market, and privatization would also be attended to. dure seeks to control expen- of enterprises. There would be a market for ditures by acting on each of In this context it is believed products and services, but the the healthcare producers in that health care cannot be free people receiving such care each individual case. The and state sponsored, for the would not be regarded as the professional conduct of doc- state is not strong enough subjects of the market. tors must be standardized in economically, and care is also Health care behaves as a keeping with explicit diag- subjected to the laws of the superior good—that is, it in- nostic/therapeutic protocols. free market.5 creases at a faster pace than The novelty of managed care In the third world the per capita income. The in- lies in the economic use of poverty of health care is situ- creased cost must be limited. tools to describe the care ated in a context of socioeco- There are two ways to do so: process whose purpose is to nomic poverty understood to by general restrictive action define standard cures for each be a system of unemploy- and by circumscribing action pathology by way of the con- ment/underemployment, a to provide basic services and stituents contained in the shortage of money and mater- require that others be paid for. “black book” of clinical deci- ial goods, a low educational Users must be convinced that sions. Its limit is the extreme level, poor housing, a lack of health care is not free; aside variability of the clinical be- water, deficient sanitation, from exceptions demanded havior of different patients in malnutrition, the spread of by solidarity and equity, similar situations and the di- disease, social apathy, and a everything beyond basic ser- verse subjective attitudes of lack of will and initiative re- vice must be paid for, and physicians. garding improvement. In in- even basic service must be The cultural process main- dustrialized countries people paid for, at least symbolically. taining this protocol is “evi- spend about US $500 a year per person for health care. In B.THEOLOGICAL- and must thus be ensured for developing countries, expen- PASTORAL all the earth’s inhabitants. ditures are between $2 and $7 PROJECTION And it is necessary to study a year. In a given age group, the use of resources so as to deaths related to pregnancy in 1. The Health Ministry make health a legacy for all. developed countries reach Resources are, of course, lim- 1%, whereas in the same In the face of the major ited, and we must, then, an- group the rate is 20-45% in problems in economy and swer the question as to their developing countries.6 health which we have briefly organization in order to give In the third world there is touched upon in some re- everyone an effective right to pressing need for a health spects, we obviously need a health. Individual rights system based more on dis- health apostolate in keeping thereby take on a collective ease-prevention than cure. with the present time which dimension as a way of prac- The following indices have will continue Jesus’ healing ticing charity, and the guiding been used to measure the mission and be a sign of principle is social justice, un- health status of countries: life God’s unconditional love for derstood to be a permanent expectancy, infant and juve- disposition of the will con- nile mortality rate, overall sisting of always seeking and mortality rate, summary in- choosing and making avail- dex of fertility, overall birth able to the members of a rate, rate of population community what they need to growth, index of per capita fulfill their social functions. income, school attendance Health thus appears as one 106 rate, and daily consumption of the leading factors in de- of calories. velopment theories, as a field After carrying out statisti- for research by all the scien- cal studies, it has been found tific disciplines with an im- that in some countries that pact on health, and as a hu- basic key to these indices is man and moral reality giving school attendance by women, purpose to such research, and the variant strategies in- since health is identified with volve potable water, environ- life itself.8 mental protection, and basic health facilities. As for per capita income, mortality is in- 2. The Market Economy versely proportionate to it un- and Health til it reaches a middle range; as income further increases, We must firmly establish so does mortality. that profit may not be regard- It has been shown that un- ed as the ultimate aim of clean water may contain the health care; accordingly, in germs of over twenty infec- the case of Catholic hospitals, tious diseases. As for diseases all, particularly for the poor- shareholder-owned hospital involving diarrhea, every est and most vulnerable in the chains are not compatible year unclean water causes the third world. The main criteri- with the health ministry, for death of about six million on will certainly not be profit, their goal is exclusively gain.9 children under age five. Wa- but human needs on an indi- In the health apostolate and ter problems also cause vidual and community level. the sphere of Catholic hospi- malaria in 150 million people There clearly is a lack of tals, health care is provided a year and a million deaths. proportion between health by a community which gives 250 million are attacked by needs and national public assistance to those in need. It lymphatic filiarosis, and thir- budgets devoted to them, but is animated by the Gospel ty million, by river blindness. it must be noted that health is and guided by the Church’s It is noteworthy that more not a part of social policy—it moral tradition. It extends to people die from unclean wa- is its conditio sine qua non. children, the unborn, unmar- ter than from insufficient Man needs health policy be- ried mothers, the elderly, the calories. Infant mortality is cause of his insufficient ca- incurably ill, drug addicts, higher in arid zones than in pacity, and health must thus ethnic minorities, immi- humid ones, because of the be a collective right. Conse- grants, refugees, and the water shortage, and life ex- quently, legal norms which mentally and physically dis- pectancy is lower. Desertifi- do not devote enough atten- abled. It encompasses the cation disturbs ecological tion to equal distribution of physical, psychological, so- balance and thus weakens the health care must be reformed. cial, and spiritual dimensions systems of production and The good of health is es- of the human person. health.7 sentially one which is direct- As for the economic as- ed towards all. Health is a pect, a Catholic health orga- good in itself, and we may nization must responsibly say it is a social obligation manage available medical re- sources in accordance with We might say that other de- health is decisive in a Christ- Catholic social and moral scriptions of health have been ian vision. Subjectively, per- teaching and is required to traced out on the basis of sons receive these ends in ac- provide equal opportunities these WHO suggestions cordance with their vocation, in hiring personnel, job secu- which correct and comple- which requires self-realiza- rity, active participation, ment them, but do not sepa- tion through self-donation to salary, organizational struc- rate completely from this di- others and full union with tures, and so on.10 rection. God. Objectively, these ends In this connection, we must In this regard, we might try mean union with Christ in his explicitly pose the problem of to describe health as a dy- death and resurrection the free market economy and namic of inner and outer har- through the Holy Spirit and health care. We may not close mony of/among body, mind, thereby discovering the way our eyes to a reality that is al- spirit, social surroundings, to the Father (Rm 5:5, 6:4, ready dominant or is becom- and the physical environment 8:9-14; Jn 14:5). ing so everywhere. Undoubt- which enables human persons In this perspective, health is edly, if it is not interpreted to carry out their tasks. When not opposed to death, but en- rigidly within the coordinates compasses it as a fullness of supply and demand, unre- leading to resurrection. Con- strained competition, and sequently, health means mov- profit orientation, there is no ing towards fullness at each reason why its advantages stage in life: childhood, may not be adopted. In the youth, maturity, and old age, Gospel mentality we would in keeping with one’s tasks speak of the Christian com- and the mission received for 107 munication of goods rather each period. Integral health, than the market economy. It then, will be understood in would not involve health care terms of each phase in life, in- alone, but an exchange volving different physical sit- among doctors and patients uations, ever-greater aware- and medical facilities where- ness, identification with each by patients would give part of life stage, and self-donation to what they possess to doctors others in one’s environment, and facilities, as the latter which requires helping others would give to patients, while to live in healthy fashion. avoiding the problems of a In this perspective, the corrupt, inefficient bureau- obligation is grasped to seek cracy and a welfare-state ap- others’ health together with proach to health. one’s own, since the two terms are not separate. And the economic problem of 3. A Theological Profile health care also entails the of Health obligation to use resources in I say “of/among,” I mean the the best manner so that health Perhaps some reflections inner harmony of each com- may correspond to the de- on the nature of health will ponent and the harmony ex- mands of each stage in life. help to clarify the foregoing. isting among them. We thus see that what has The well-known WHO de- As regards the body, physi- been stated regarding health finition has been criticized cal well-being and the ab- in a free enterprise system is (“Health is a state of com- sence of illness are the not objectionable, provided plete physical, mental, and keynotes. As for the mind, we the aim is integral health and social well-being, and not are considering psychic well- not, of course, profit, which merely the absence of disease being and also the absence of becomes an absurd finality in of infection”), especially for illness; harmony means trans- this integral conception. speaking about a state of parent personal self-aware- Another consequence is complete well-being which ness. In terms of the spirit, we that the Christian integral proves utopian. It has, how- are speaking of harmony with health we are discussing does ever, opened up new horizons the total ends of human per- not exclude illness, but in- for understanding that health sons, their transcendence; this cludes it, tempering or elimi- is not just the absence of ill- involves the fulfillment of nating it according to the life ness. In addition, the WHO one’s task, the ends proper to stage one is going through. In definition is completed by each. Harmony with one’s so- this connection, health and adding that this well-being cial and physical surround- salvation are used as syn- enables the individual to car- ings involves relations with onyms. The secular meaning ry out social and productive others and the world becom- of health, as applied only to functions and specifying that ing a cosmos in each person bodily or psychological it extends beyond physical and receiving its order from health, is a partial one which well-being to the mental and the work carried out. must be integrated into the social spheres. The teleology or end of complete Christian vision. We referred to our topic as Our Lady of Loreto, continue Notes “Economics and Health: Pri- to present this Sanctuary as 1 TONELLI-GIANNINI, “L’evoluzione ority and Equity in Distribut- the house of health and hope, naturale dei sistemi sanitari,” in Panora- ing Resources.” In a fully and may this Sixth World ma della sanità 49/97, 44. Christian view, the economic Day of the Sick also serve to 2 CARDINAL FIORENZO ANGELINI, “Problematiche etiche e deontologiche,” sphere is an important part of redefine health commitments Policlinico A. Gemelli, June 2-3, 1995. health, destined for a collec- by all, with the best use of 3 Cf. FERNANDO ABRIL MARTORELL, tive beneficiary. Health care economic resources, free “Informe Abril Martorell,” Labor Hos- pitalaria (223), 1992, 42-56. need not fear a free enterprise from all selfishness and al- 4 Cf. TONELLI-GIANNINI, “L’evoluzione system, provided it is not ways giving preference to the naturale dei sistemi sanitari,” in Panora- commercialized, and the pri- poorest and neediest. ma della Sanità 48/97, 44-45. 5 Cf. RENATO DI MENNA, “La salute orities for its distribution cor- dei poveri e l’aggiustamento strutturale respond to the different stages + JAVIER LOZANO del terzo mondo,” in Dolentium Hominum 18/91, 38-40. in man’s life and the vocation BARRAGAN 6 Cf. GUIDO MIGLIETTA, “Il diritto alla and mission received by Archbishop-Emeritus salute,” in Documentazione 3/97, 24-35. each. Bishop of Zacatecas 7 Cf. RENATO DI MENNA, “Sanità e May the Holy Spirit, whose President of the Pontifical salute in Africa,” in Dolentium Council for Pastoral Assistance Hominum 23/93, 48-56. year we are celebrating, 8 Cf. JOSEPH JOBLIN, “Distribution de through the intercession of to Health Care Workers resources economiques et santé,” in Do- lentium Hominum 37/98. 9 Cf. DONALD W. WUERL, “The Non- profit Nature of Catholic Health Care in the United States,” Dolentium Hominum 36/97, 44. 10 Cf. NCCB (USA), “Ethical and Re- 108 ligious Directives for Catholic Health Services,” in Medicina e morale 2/96, 341-385. The Fourth Plenary Assembly of the Pontifical Council for Pastoral Assistance to Health Care Workers

March 9-11, 1998 St. Martha Domus Nova Vatican City Greeting, Introduction to the Sessions, and Remarks on Methodology

Your Eminences, Your Ex- topics briefly and then set our Council heading? This cellencies, forth the methodology. topic is entitled “Aims of the Members and Consultors of Pontifical Council,” and I will the Pontifical Council, have the pleasure of setting it 1. Topics forth. It is a great honor for me to Once the aims are estab- be able to greet all the Mem- In the light of its thirteen lished, we shall discuss con- bers and some of the Consul- years of experience, our Coun- crete action. As we are a Pon- tors of the Pontifical Council cil already has a history. To tifical Council, we shall obvi- for Pastoral Assistance to move into the future, we must ously act within the Church Health Care Workers, on the consolidate our roots. For this and orient ourselves according occasion of its Fourth Plenary reason, the first topic is to its three classical ministries: Assembly, my first one as “Eleven Years of the Pontifi- the Word, Sanctification, and 110 President. cal Council.” Eleven, not Communion. A little over a year ago, on twelve, inasmuch as the The topics involved here are August 20, 1996, to be exact, twelfth, as mentioned, has in- “The Council’s Action in the His Holiness John Paul II gen- volved practice and pertains to Ministry of the Word,” intro- erously named me President the period when I became duced by the Secretary, Rev. of this Council, where I took President. The first topic will José L. Redrado; “Action in office on January 19, 1997. I be set forth by a person who the Ministry of Sanctifica- feel this Plenary Assembly, lived through those eleven tion,” presented by another of- being held one year and two years and is thus highly quali- ficial, Rev. Krzystof Nykiel; months after I began work, fied: the Council Secretary, and, finally, “Action in the will be quite important for the Rev. José L. Redrado. Ministry of Communion,” development of our Council I would like to express here presented by Rev. Felice and its future activity. my deep thanks to my prede- Ruffini, the Undersecretary. The Assembly has been cessor, Cardinal Fiorenzo An- projected on a practical, func- gelini, who organized our tional basis. We have taken the Council in that period and to 2. Methodology liberty of separating our Mem- whom we owe so much. May bers and some of our Consul- the Lord and the Blessed Vir- All of these talks are just in- tors from their daily occupa- gin, Salus Infirmorum, repay troductions. The real work of tions so they can help us to re- him for the good he has done the Assembly will be conduct- design the organizational and the Church through our Coun- ed by all present, for the pur- operational framework of the cil. pose of planning our Council. Council. After taking a look at the We have, of course, already This Pontifical Council has Council’s history, we shall done planning and tested it for entered upon its thirteenth move onto planning. Th first a whole year, with good re- year of existence. It has car- topic will be “the model we sults, but everything has been ried out numerous activities. should reach.” This model is on an “experimental” basis. Now, in its new circum- offered to us by the documents The Assembly will be called stances, the time has come for which are the constitutive ba- upon to provide a statute so another kind of organization, sis for our office—that is, the that we can move from this more in keeping with current Pontifical documents and oth- first stage of experimentation needs. The proposals we shall ers tracing out the ideal we to something more substantial make have benefited from a should approach, the reason and definitive. It will not, year’s experience. It is our why it was created. This topic, then, be just a matter of ap- hope that what was done pre- “The Starting Point for the proving, but, rather, of im- viously will be confirmed and Pontifical Council,” will be proving what is already being improved. In short, we must considered by Monsignor done, correcting it, and mak- carry out some new planning Mpendawatu, our official, ing suggestions for the future. for the Council. who is well capacitated to deal We previously sent a rough In fact, our Assembly has with it. draft of our plans to all the been structured with a view Ideals remain the horizon Members and Consultors for towards this need, in terms of towards which our Council is your examination, posing both the subjects considered oriented through specific op- questions which will be dealt and the methodology to be erative goals responding to the with here, since they corre- used. I shall first mention the practical question Where is spond to each part of our Ple- nary Assembly. The first part on this result. day, when we conclude the concerns the aim of our Coun- All our attention today, sessions, or another day, cil; the second, action in the Tuesday, March 10, will be obliging us to modify our area of the Word; the third, ac- devoted to the Council’s aim schedules. tion in the area of Sanctifica- and model. There will be in- As was the case today, we tion; and, finally, the fourth, troductions, as I mentioned, shall begin each day’s sessions action in the area of Commu- and work groups. with Holy Mass, a central nion. Each specific point for The topics form a unity di- point for the Council dedicat- action represents a program to rected towards action. There ed to the health ministry, for be carried out. There are thir- are so many programs that the this celebration expresses all ty-seven programs in all, Plenary Assembly will find it that we are doing. distributed as follows: nine hard to deal with all of them. Since we are now in the for the Word, five for Sanctifi- Tomorrow, Wednesday, year of the Holy Spirit in cation, and twenty-three March 11, will be devoted to preparation for the 2000 Ju- for Communion. These num- concrete programs. The ses- bilee, we entrust our Assem- bers are obviously not final, sion will be a bit lengthy be- bly to the Spirit, who will illu- but may be increased or cause it must deal with three minate and lead us so that our decreased, according to the areas: the Word, Sanctifica- office may accomplish the Assembly’s judgment, for tion, and Communion. mission assigned to us by the the sake of greater effective- The Assembly will thus be Holy Father—to promote, ori- ness. divided into two main parts: ent, and coordinate the health Consequently, the most im- the first day, model and aim, apostolate in the whole portant part of the Plenary As- and the second day, specific Catholic Church. sembly will be dialogue, ex- action. The third day will We place our work under 111 changes among Members. For mark the close, with our Con- the protection of Our Lady, this reason stress has been clusions. Salus Infirmorum. May She placed on study groups and The conclusions we shall intercede for us, that there plenary meetings. arrive at ought to serve as im- may be a new stage for our This very morning we shall peratives for the future of our Council which will be more begin with the work groups to Council—hence the impor- effective and better organized, enrich the model we are given tance of continuous atten- for the good of the whole as the Council’s objective; this dance and commitment by all Church. afternoon other work groups present. will examine ways to attain As mentioned in the As- + JAVIER LOZANO the specific goal we are pursu- sembly Program, the Prefec- BARRAGAN ing; and then at the general ture of the Pontifical House- Archbishop-Emeritus session the Assembly’s hold will in due course advise Bishop of Zacatecas thought on key points will be us as to the Audience with the President of the Pontifical Council summarized. All the future ac- Holy Father. We do not yet for Pastoral Assistance tion of our office will depend know if it will be on Wednes- to Health Care Workers Christ Suffers in Our Sick Brothers and Sisters WORDS OF GREETING BY ARCHBISHOP JAVIER LOZANO BARRAGAN, PRESIDENT OF THE PONTIFICAL COUNCIL FOR PASTORAL ASSISTANCE TO HEALTH CARE WORKERS

Holy Father, Starting from the Word of God, we shall examine programs on the meaning of suf- For three days the Pontifical Council for fering, medical schools, publications of the Pastoral Assistance to Health Care Workers Pontifical Council, reproductive health, will be meeting in its Plenary Assembly, in- drafting a manual for the pastoral care of cluding its Members and some Consultors, drug addicts, various conferences, con- to reflect and maintain dialogue on the gresses, research, documentation, and cen- model, aim, and action of the Council, so as ters for training in the health apostolate. to respond more effectively to the mission As regards sanctification in the health entrusted to it by Your Holiness and be of ministry, we shall study emergency Bap- assistance to your lofty Petrine Ministry in tism, the Anointing of the Sick, the World 112 the specific field of the health apostolate. Day of the Sick, prayer by the infirm, and Our attention will be directed to the Word the Prayer Apostolate. of God concerning the gospel of illness and In connection with communion to meet health, the sanctifying presence of the Lord needs and take initiatives in the health min- in the health ministry, particularly through istry, we shall consider the Catholic interna- the sacraments for the sick, and essential tional associations of doctors, nurses, and communion regarding needs and initiatives pharmacists; chaplains; women religious in the realm of health care workers. devoted to health care; Catholic hospitals; the Bishops responsible for the health apos- tolate; the universal right to health care; new diseases; patients’ associations; the Christian communication of goods in med- ical attention; economic aid by the Pontifi- cal Council; the exchange of health person- nel; Christian volunteers; centers for health- care ethics; improving our office’s informa- tion systems; the plenary assembly; pastoral trips; ad limina visits; ongoing attention to different continents; interdepartmental rela- tions; relations with the Nunciatures; ad- ministrative programs; and the Council’s personnel. We turn our gaze towards Christ, who is suffering in our sick brothers and sisters, in the awareness that his suffering is the source and cause of joy in the living fullness of health which Christ Himself offers us in his death and resurrection, which are always present in his Church. In this year dedicated to the Holy Spirit, in preparation for the great Jubilee of the In- carnation, through the lofty intercession of our Mother, the Blessed Virgin Mary, Salus Infirmorum, we particularly ask for light from the Paraclete. On our first day of work, filled with re- spect and veneration, we implore the bless- ing of Your Holiness and eagerly listen to the words of your Magisterium, which al- ways guides us. Your Mission: To Serve Health and Life

THE POPE ADDRESSES THE PONTIFICAL COUNCIL FOR PASTORAL ASSISTANCE TO HEALTH CARE WORKERS, MARCH 9, 1998

On Monday, March 9, 1998, the Holy Fa- myself created it in 1985, entrusting it to the ther met the members, consultors, officials enterprise of Cardinal Fiorenzo Angelini, and staff of the Pontifical Council for Pas- whose intense activity I again wish to recall toral Assistance to Health-Care Workers, with appreciation and gratitude. who were holding their Fourth Plenary As- sembly in Rome. Here is a translation of his 3. In receiving and continuing this pre- address to them, which was given in Italian. cious legacy, you have taken charge, with a sense of responsibility and love, of the tasks 1. I am pleased with this meeting which which the document creating this dicastery takes place during the fourth plenary assem- assigned to it. You therefore carefully follow bly of the Pontifical Council for Pastoral As- the difficult problems of health care, helping sistance to Health Care Workers. I greet your those who dedicate themselves to the service 113 President, Archbishop Javier Lozano Bar- of the sick and suffering, so that their work ragán, and thank him for his cordial words may ever more closely meet the emerging expressing, together with the sentiments of needs in this delicate area. You are particu- affection you share, the vitality and commit- larly concerned to collaborate with the local ment of your young dicastery. Churches to ensure that health care workers I also greet you all, dear members, offi- are provided with appropriate spiritual assis- cials and consultors of the Pontifical Council tance as well as with the opportunity to ac- who are attending this Audience. Through quire a thorough knowledge of the Church’s you my greeting is extended with grateful appreciation to all the priests, religious, doc- tors, scientists, researchers and those who, with their human and ecclesial sensitivity, and according to their respective specialties, are involved in the complex world of health. 2. You intend to discuss demanding topics during these days of study, in which you will attentively examine the problems and chal- lenges that the vast field of health care raises for the pastoral care of health.

2. These first 13 years of activity have wit- nessed the dicastery’s zealous and dynamic commitment in a sensitive, frequently trou- bled area, and have confirmed the urgent need for the ecclesial service it carries out. I look with gratitude at the many things it has been possible to achieve because of your constant concern to support the admirable, sometimes heroic, willingness of doctors, sisters and chaplains to serve the sick. The health care apostolate, born of the Church’s charity and eminently witnessed to by many saints, among whom St. John of God and St. Camillus de Lellis are outstanding, flour- ished extraordinarily over the centuries due to the activity of the religious orders and in- stitutes dedicated to serving the sick. Today it is coordinated and promoted by the institu- tion to which, in various ways, you belong. I teaching on the moral aspects of illness and structures or in the simple structures of devel- the meaning of human pain. Your dicastery oping countries, if done with a spirit of faith is also attentively following the theoretical and fraternal sensitivity, becomes in a very re- and practical problems of medicine, as well al sense a religious act. as legislative developments in the area of Care of the sick, if carried out in a context health care law, with the intention of safe- of respect for the person, is not limited to guarding respect for the dignity of the person medical treatment or surgery, but aims at in every situation. healing the whole man, restoring his interior Unfortunately the beneficial action of pro- harmony, the zest for life, the joy of love and tecting and defending health not only encoun- communion. ters obstacles in the many pathogenic factors, This is also the aim of your dicastery’s ac- both old and new, which threaten life on tivities in the complex and varied world of earth, but sometimes also in the mentality and holiness, and in collaboration with similar conduct of individuals. Oppression, violence, pastoral centres of the local Churches, which war, drugs, kidnapping, the marginalization co-ordinate the service of the chaplains and of immigrants, abortion and euthanasia are all nursing sisters with the generous service of threats to life that result from human initia- volunteer workers. The common goal is re- tive. The totalitarian ideologies that have de- spect for the life of every individual who, graded man by making him an object, tram- even if functionally or organically impaired, pling upon or evading basic human rights, preserves, whole and entire the human digni- 114 find a worrying counterpart in certain ex- ty that is his. ploitations of biotechnology that manipulate life in the name of an inordinate ambition for 6. I keenly hope that in your work over the domination which distorts aspirations and next few days, you will succeed in formulat- hopes and increases anxiety and suffering. ing appropriate practical guidelines. This is the way to achieve the original goals of the 4. “I came that they may have life, and Pontifical Council, which will not fail to play have it abundantly” (Jn 10:10): the Church, its own particular role in the period of prepa- which preserves and spreads the message of ration for the Great Jubilee of the Year 2000. salvation, takes Jesus’ vivid and inspiring af- You will thus help the faithful to become firmation as her programme. Defending hu- aware that “in suffering there is concealed a man health, which is your programme, re- particular power that draws a person interior- flects this mission. ly close to Christ” (Apostolic Letter Salvifici The concept of health cannot be limited to Doloris, n. 26). Human suffering, thus trans- the mere absence of illness or of temporary formed into the mystery of the Redeemer’s organic dysfunctions. Health involves the suffering, becomes “the irreplaceable media- well-being of the whole person, his biophysi- tor and author of the good things which are cal, phychological and spiritual state. There- indispensable for the world’s salvation” fore, in some way it also embraces his adapta- (ibid., no. 27). tion to the environment in which he lives and Continue to offer your expert service to the works. national Episcopal Conferences and all the “I came that they may have life, and have it organizations involved in the health-care abundantly” (Jn 10:10). The objectives you ministry, and the Holy Spirit, who “by his pursue—such as the defence of the person’s own power and by the interior union of the dignity in his physical and spiritual life; the members... produces and stimulates love promotion of study and research in the field among the faithful” (Dogmatic Constitution of health care; the encouragement of ade- Lumen Gentium, no. 7), will continue to show quate healcht-care policies; the guidance of himself to the Church at the beginning of the hospital ministry—are the reflection on an third millennium as “the principal agent of operative level of the task wich Jesus trans- the new evangelization” (Apostolic Letter mitted to his Church: to serve life! I can only Tertio Millennio Adveniente, no. 45). urge you to fulfil this duty. As I entrust these wishes to the Blessed Virgin, who after the Annunciation of the an- 5. The Incarnation of the Word healed all gel expressed her immediate willingness to our weaknesses and ennobled human nature, serve life for her cousin Elizabeth, who was raising it to supernatural dignity and making soon to give birth, I cordially impart my af- the people of Redemption one body and one fectionate Blessing to you and willingly ex- mind through the action of the Holy Spirit. tend it to those who work with you to make Precisely for this reason, every act of helping the service to persons tried by illness ever the sick, whether in the fore-most health-care more effective and human. Proposals of the Fourth Plenary Assembly for Current Planning of the Pontifical Council for Pastoral Assistance to Health Care Workers*

The Members, Consultors, and ennobled human nature, 8. To improve the Council’s and Experts of the Pontifical is, if carried out in a spirit of annual International Confer- Council for Pastoral Assis- faith and fraternal sensitivity, ence. tance to Health Care Work- care directed at Christ Him- ers, meeting at the Vatican, self; and 9. To provide researchers in March 9-11, 1998, for the Ð care of the sick is called our field with adequate docu- Fourth Plenary Assembly of to heal man integrally, restor- mentation. the Council, recalling and ing the harmony of inner bal- continuing the rich legacy of ance, a taste for life, and the 10. To support centers for its first thirteen years of activ- joy of love and communion. the health ministry. ity and considering the aims Aware of their specific role and tasks which the Motu in preparing for the Great Ju- Proprio Dolentium Hominum bilee in the Year 2000, they In the Ministry (no. 6) and the Apostolic make the following recom- of Sanctification 115 Constitution Pastor Bonus mendations for the current (nos. 152 and 153) assign to programming of the Council. 1. To devote attention to the Council, are convinced emergency baptisms at hospi- that tals for both children and – the Church’s mission to In the Ministry of the Word adults, in the context of the announce the Gospel of Life, parish community. Suffering, and Salvation is re- 1. To shed light on the flected “in defending health;” meaning of life and suffering, 2. To provide orientation – modern man’s disequilib- nature, ecology, man’s condi- on other sacraments received rium, malaise, and illness tion as a creature, disease pre- in the healthcare environ- point to a different notion of vention, and patients’ rights. ment. health, more integral and comprehensive, and also an 2. To unite Catholic med- 3. To promote correct re- anthropological diagnosis ical schools, exert an influ- ception of the Anointing of which will arrive at patients ence on secular medical edu- the Sick and prayers and and uncover the root of their cation, insist on basic Christ- blessings which lay people malady beyond the mecha- ian training for doctors, may use with the sick. nisms and spectrum of the promote the creation of de- physical and psychological; partments of healthcare 4. To prepare a manual on Ð the concept of health ethics, and foster training in the health ministry, especially must not be limited to signify- the health ministry at semi- on administering sacraments ing only the absence of illness naries. for the sick. or momentary organic dys- functions, but affects the 3. To update and improve 5. To intensify the celebra- well-being of the whole per- the Council’s publications. tion of the World Day of the son, including biological, Sick. psychic, and spiritual states 4. To cooperate with WHO and adaptation to the environ- programs while maintaining a 6. To promote prayer by ment in which people live and critical approach to threats to both the sick and health work in order to fulfill the life. workers and prepare the “in- mission entrusted to them; tention” for the Prayer Apos- Ð service to life, the task Je- 5. To complete the manual tolate which is requested sus gave the Church, compre- on the pastoral care of drug from the Council each year. hends protection of the digni- addicts. ty of persons in their physical and spiritual life, promotion 6. To prepare methodologi- In the Ministry of study and research in the cal guidelines on how to con- of Communion field of health, and providing duct the health apostolate in a a stimulus for adequate health secularized society. 1. To foster the coordina- policies and for pastoral care tion and orientation of in health; 7. To continue with the con- Catholic doctors, nurses, and Ð care of the sick, thanks to ferences, research, papers, pharmacists. the Incarnation of the Word, and studies which the Council who has healed our weakness is asked to prepare. 2. To promote the union of Catholic chaplains at health 12. To stimulate apostolic nent Observatory for each facilities. associations of the sick. continent in connection with the health ministry. 3. To promote the union of 13. To maintain contact Catholic hospitals. with centers for healthcare 21. To take part in interde- ethics, promote them within partmental meetings for the 4. To promote the union of the Bishops’ Conferences, and sake of greater internal coordi- the bishops responsible for the encourage them to develop nation of our work. health ministry in different this field and disseminate it. Bishops’ Conferences. 22. To intensify communi- 14. To update the Index of cation with the Nunciatures 5. To promote the union of Catholic health facilities, dis- regarding the health ministry. women religious in health tinguishing between Catholic care. hospitals and those which are 23. To continue the Coun- not, though they may have cil’s observation of new dis- 6. To support the union of Catholic chaplains or women eases. Catholic obstetricians and gy- religious. necologists. 24. To modernize and in- 15. To improve the Coun- crease the efficiency of the 7. To cooperate in increas- cil’s computer systems and Council’s administration and ing awareness of the universal continually update its Internet secretariat. right to health. site. 25. To expand the Council’s 116 8. To promote the Christian 16. To intensify the Coun- staff to deal more effectively communication of goods in cil’s links with Vatican Radio. with the challenges it faces. the economic structure of Catholic health facilities. 17. To promote local church Vatican City, March 18, celebrations of the World Day 1998. 9. To act as a bridge be- of the Sick. tween the churches possessing + JAVIER LOZANO economic resources for health 18. To foster direct contact BARRAGAN care and those lacking them. with local churches to make Rev. JOSÉ L. REDRADO, the Council more effective in O.H. 10. To coordinate offers by the health ministry. health workers. 19. To communicate with 11. To promote Christian the Bishops’ Conferences volunteer work, beginning making their ad limina visits * This is a summary of proposals by the with the family, and associa- to the See of Peter. Fourth Plenary Assembly. The Pontifi- cal Council studied them with a view to- tions for the relatives of the wards internal organization and pub- sick. 20. To maintain a Perma- lished a booklet entitled Piano di lavoro.