DOLENTIUM HOMINUM No. 82 – year XXVIII – No. 2, 2013

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

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

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

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

Published three times a year. Subscription rate: 32 € postage included Printed by Editrice VELAR, Gorle (BG) Cover: Glass window Rev. Costantino Ruggeri Poste Italiane s.p.a. Spedizione in Abbonamento Postale - D.L. 353/2003 (conv. In L. 27/02/2004 nº 46) art. 1, comma 2, DCB Roma

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Contents

Twenty-First World Day of the Sick 17 Topics 11 February 2013 18 Pain-Pleasure-Joy: from the Soma 4 Message of the Holy Father Benedict Xvi to the Pneuma. An Integrated on the Occasion of the Medical-Theological Vision of Man Twenty-First World Day of the Sick Prof. Pierluigi Zucchi, S.O. 11 February 2013 Prof. Bonifacio Honings, O.C.D. “Go and do likewise” (Lk 10:37) 35 The New Horizons of Pastoral Care 6 Letter of the Holy Father Benedict XVI in Health in : from Cinderella to H.E. Msgr. Zimowski to Queen? Fr. Leonardo Nunzio Di Taranto 7 A Chronicle of the Twenty-First World Day of the Sick 39 Care for the Sick and the Treatment Altötting, 11 February 2013 of Infectious Diseases in the History Msgr. Dariusz Giers of the Church Rev. Fidel González Fernández, MCCJ 9 Homily: As Mary did, do Good to the Suffering H.E. Msgr. Zygmunt Zimowski 53 Testimonies

12 The Solemn Handing Over of the Relic 54 The Mission of the Catholic Physician of the Blessed John Paul II Today in Altötting Msgr. Jean-Marie Mupendawatu H.E. Msgr. Zygmunt Zimowski 60 50 Years of Medicus Mundi 13 international Meeting Organised by Internationalis, MMI the Catholic University of Eichstätt, on: Dr. Edgar Widmer ‘Do Good to those who Suffer’ 7-8 February 2013 63 international Symposium on Bioethics and African Realities 13 1. Summary of the Results cotonou, Benin, 10-14 June 2013 of the Meeting and Prospects Prof. Christoph von Ritter, Md, PhD 63 1. Recommendations Prof. Jean Soubrier 16 2. The Deliberations of the International Conference Organised by 64 2. Speech by the Pontifical Council the Catholic University of Eichstätt: for Health Care Workers Reflections and Recommendations Fr. Pierre Jean Welsch Dr. Rosa Merola

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the Twenty-first World Day of the Sick

Altötting, Germany 11 February 2013

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MESSAGE OF THE HOLY FATHER BENEDICT XVI ON THE OCCASION OF THE Twenty-first WORLD DAY OF THE SICK 11 FEBRUARY 2013

“Go and do likewise” (Lk 10:37)

Dear Brothers and Sisters,

1. On 11 February 2013, the liturgical memorial of Our Lady of Lourdes, the Twenty-first World Day of the Sick will be solemnly celebrated at the Marian Shrine of Altötting. This day represents for the sick, for health care workers, for the faithful and for all people of goodwill “a privileged time of prayer, of sharing, of offering one’s sufferings for the good of the Church, and a call for all to recognize in the features of their suffering brothers and sisters the Holy Face of Christ, who, by suffering, dying and rising has brought about the salvation of mankind” (John Paul II, Letter for the Institution of the World Day of the Sick, 13 May 1992, 3). On this occasion I feel especially close to you, dear friends, who in health care centres or at home, are undergoing a time of trial due to illness and suffering. May all of you be sustained by the comforting words of the Fathers of the Second Vatican Council: “You are not alone, separated, abandoned or useless. You have been called by Christ and are his living and transparent image” (Message to the Poor, the Sick and the Suffering).

2. So as to keep you company on the spiritual pilgrimage that leads us from Lourdes, a place which symbolizes hope and grace, to the Shrine of Altötting, I would like to propose for your re- flection the exemplary figure of the Good Samaritan (cf. Lk 10:25-37). The Gospel parable re- counted by Luke is part of a series of scenes and events taken from daily life by which Jesus helps us to understand the deep love of God for every human being, especially those afflicted by sickness or pain. With the concluding words of the parable of the Good Samaritan, “Go and do likewise” (Lk 10:37), the Lord also indicates the attitude that each of his disciples should have to- wards others, especially those in need. We need to draw from the infinite love of God, through an intense relationship with him in prayer, the strength to live day by day with concrete concern, like that of the Good Samaritan, for those suffering in body and spirit who ask for our help, whether or not we know them and however poor they may be. This is true, not only for pastoral or health care workers, but for everyone, even for the sick themselves, who can experience this condition from a perspective of faith: “It is not by sidestepping or fleeing from suffering that we are healed, but rather by our capacity for accepting it, maturing through it and finding meaning through union with Christ, who suffered with infinite love” (Spe Salvi, 37).

3. Various Fathers of the Church saw Jesus himself in the Good Samaritan; and in the man who fell among thieves they saw , our very humanity wounded and disoriented on account of its sins (cf. Origen, Homily on the Gospel of Luke XXXIV,1-9; , Commentary on the Gospel of Saint Luke, 71-84; Augustine, Sermon 171). Jesus is the Son of God, the one who makes present the Father’s love, a love which is faithful, eternal and without boundaries. But Jesus is also the one who sheds the garment of his divinity, who leaves his divine condition to assume the likeness of men (cf. Phil 2:6-8), drawing near to human suffering, even to the point of descending into hell, as

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we recite in the Creed, in order to bring hope and light. He does not jealously guard his equality with God (cf. Phil 2:6) but, filled with compassion, he looks into the abyss of human suffering so as to pour out the oil of consolation and the wine of hope.

4. The Year of Faith which we are celebrating is a fitting occasion for intensifying the service of charity in our ecclesial communities, so that each one of us can be a good Samaritan for others, for those close to us. Here I would like to recall the innumerable figures in the history of the Church who helped the sick to appreciate the human and spiritual value of their suffering, so that they might serve as an example and an encouragement. Saint Thérèse of the Child Jesus and the Holy Face, “an expert in the scientia amoris” (Novo Millennio Ineunte, 42), was able to experience “in deep union with the Passion of Jesus” the illness that brought her “to death through great suffer- ing” (Address at General Audience, 6 April 2011). Luigi Novarese, who still lives in the memory of many, throughout his ministry realized the special importance of praying for and with the sick and suffering, and he would often accompany them to Marian shrines, especially to the Grotto of Lourdes. Raoul Follereau, moved by love of neighbour, dedicated his life to caring for people afflicted by Hansen’s disease, even at the world’s farthest reaches, promoting, among other initiatives, World Leprosy Day. Blessed Teresa of Calcutta would always begin her day with an encounter with Jesus in the Eucharist and then she would go out into the streets, rosary in hand, to find and serve the Lord in the sick, especially in those “unwanted, unloved, uncared for”. Saint Anna Schäffer of Mindelstetten, too, was able to unite in an exemplary way her sufferings to those of Christ: “her sick-bed became her cloister cell and her suffering a missionary service. Strength- ened by daily communion, she became an untiring intercessor in prayer and a mirror of God’s love for the many who sought her counsel” ( Homily, 21 October 2012). In the Gospel the Blessed Mary stands out as one who follows her suffering Son to the supreme sacrifice on Golgotha. She does not lose hope in God’s victory over evil, pain and death, and she knows how to accept in one embrace of faith and love, the Son of God who was born in the stable of Bethle- hem and died on the Cross. Her steadfast trust in the power of God was illuminated by Christ’s resurrection, which offers hope to the suffering and renews the certainty of the Lord’s closeness and consolation.

5. Lastly, I would like to offer a word of warm gratitude and encouragement to Catholic health care institutions and to civil society, to Dioceses and Christian communities, to religious congrega- tions engaged in the pastoral care of the sick, to health care workers’ associations and to volunteers. May all realize ever more fully that “the Church today lives a fundamental aspect of her mission in lovingly and generously accepting every human being, especially those who are weak and sick” (Christifideles Laici, 38).

I entrust this Twenty-first World Day of the Sick to the intercession of Our Lady of Graces, ven- erated at Altötting, that she may always accompany those who suffer in their search for comfort and firm hope. May she assist all who are involved in the apostolate of mercy, so that they may become good Samaritans to their brothers and sisters afflicted by illness and suffering. To all I im- part most willingly my Apostolic Blessing.

From the Vatican, 2 January 2013

BENEDICTUS PP. XVI

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Letter of the Holy Father Benedict XVI to H.E. Msgr. Zimowski

To Our venerable brother Zygmunt Zimowski Archbishop-bishop emeritus of Radom PRESIDENT of the Pontifical Council for HEalth Care Workers The Church has always brought comfort to the sick and will never cease to seek to attend to their needs. Indeed, she remembers the numerous recommendations with which the Divine Master sent out the Apostles to evangelise, amongst which there is: ‘cure the sick in it [the town] and say to them, ‘The kingdom of God is at hand for you.’’ (Lk 10:9). Indeed, he himself, before teaching, used to heal the sick (cf. Mt 8:6; 12:15; 14:14). This authentic commitment to the health of souls obliges all of the faithful to unite themselves more closely to the Lord Jesus in their suffering and to have a more solicitous and constant care for the sick. Thus, every time that We can engage in Our pastoral responsibility towards those who suffer We do so willingly, so that they may feel strengthened and so that those who care for them may carry out their mission more faithfully. With joy, therefore, We grant your petition, Venerable Brother, by which you humbly asked us to send a legate to Altötting in Germany so that during the celebrations for the World Day of the Sick, Our presence will be seen as being nearer. In granting this respectful request of yours, We think of you, Venerable Brother, specifically because We think that you, as the President of the Pontifical Council for Health Care Workers, will be able, in an important way, to make those taking part in this event aware of the great charity with which We love the sick and of the solicitude with which We raise up prayers for them and those who care for them. Thus by this letter We appoint you Our Special Envoy for the celebration of the twenty-first World Day of the Sick which will be held on 11 February next. We thus exhort you to proclaim to all the participants the light of the gospel truth, and the only way of salvation, that is, Jesus Christ. In addition, on this occasion you will speak about the very sweet bond of love by which We are united to them. In also celebrating happily the Year of Faith, announced by us in St. Peter’s Square, you will be able to invite them to profess faith in God with renewed hope, because in ‘believing’ the sick are also more strongly ‘defended’ (St. Augustine, De Utilitate Credendi,1, 2). Christian faith leads us to proclaim, without doubt, the Gospel to all the peo- ples of the earth (cf. Mt 28:19) and to bear witness to the true meaning of pain and suffering. Indeed, through the tribulations of this life each person is led to true freedom and to a sincere self-giving. You, Venerable Brother, will bring this message of Ours and you will invite the participants to strengthen the faith with which, in the fullest freedom, they entrust themselves to God and answer the commandment of love taught by His son. You will bring Our greetings to all those who are pre- sent, in particular to the Apostolic Administrator of the Diocese of Passau and to the other bishops, to the presbyters, to the men and women religious and to all the lay faithful. In addition, We wish you to extend the words of Our benevolence to the civil authorities and to all the participants as well. Lastly, Venerable Brother, We accompany you in the carrying out of your mission with prayers and We entrust you to the Blessed Immaculate Virgin Mary, Mediator of all the graces, bestowing upon you most willingly Our Apostolic Blessing, and we wish you to transmit it to all the partici- pants at the celebrations. Given in , at St. Peter’s, on the tenth day of the month of January, in the year 2013, the eighth year of Our Pontificate. BENEDICTUS PP. XVI

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A Chronicle of the Twenty-First World Day of the Sick Eichstätt-München-Altötting, 7-11 February 2013

Mons. Dariusz Giers and one that was liturgical, with care workers and patients of this Official of the Pontifical Council its culminating point being the health-care centre. After making for Health Care Workers, solemn celebration of the Eucha- a speech of greetings, Archbish- the Holy See rist on 11 February in Altötting. op Zimowski went to the chapel inside the clinic where he prayed together with bishops, , re- he Twenty-First World Day of The Blessing of the Holy Father ligious, lay people and workers in- Tthe Sick was celebrated in a volved in pastoral care in health. solemn way on 11 February of this On the occasion of the general The visit to the patients in the hos- year, the liturgical memorial of the audience of 6 February 2013, the pital wards ended the first strong Blessed Virgin of Lourdes, at the President of the Pontifical Coun- moment of the first day of the Vati- Marian Sanctuary of Altötting in cil for Health Care Workers, Arch- can delegation to Bavaria. Bavaria, the region where the Ho- bishop Zygmunt Zimowski, had a In the afternoon, at the Catholic ly Father Benedict XVI was born. short meeting with the Holy Fa- University of Eichstätt, the inter- ther, and received a special bless- national conference on medicine ing which was to be extended to all and pastoral theology entitled ‘Do The Announcement the events belonging to, and all the good to those who suffer’ (Salvi- of the Event people taking part in, the World fici doloris, n. 30) was begun. The Day of the Sick in Germany. Special Envoy of the Holy Father The World Day of the Sick was welcomed by the local Ordi- 2013 was accompanied and illu- nary, H.E. Msgr. Gregor Maria mined, as regards its meaning and The Letter of Appointment Hanke OSB; by the Rector of the contents, by the Message of the university, Prof. Richard Schenk; Pope which was entitled ‘Go and In the Letter appointing the head and by the Secretary of the Depart- do likewise’ (Lk 10:37). of the Pontifical Council for Health ment of Health, Dr. Thomas Ilka, The press conference present- Care Workers the Special Envoy who had come specifically for the ing the Message was held at the for the celebrations of the Twen- occasion from Berlin. press room of the Holy See on ty-First World Day of the Sick, the About two hundred people at- Tuesday 29 January and wit- Holy Father, amongst other things, tended the conference, amongst nessed the participation of H.E. wrote: ‘We exhort you to proclaim whom were thirty-two speakers of Msgr. Zygmunt Zimowski, the to all those present the light of the various disciplines: theology, pas- President of the Pontifical Coun- gospel truth and the only way of toral care in health, anthropology, cil for Health Care Workers; Ms- salvation, Jesus our Christ…You, spirituality, medical psychology, gr. Jean-Marie Mupendawatu, the venerable brother, will take this health-care policy, epidemiolo- Secretary of the Pontifical Coun- message of ours and you will in- gy, public health care, and hospi- cil; Rev. Fr. Augusto Chendi, vite those taking part to confirm tal economics and management. M.I., the Under-Secretary of the their faith and more than freely A first summary of the princi- Pontifical Council; Msgr. Lud- to entrust themselves to God and pal questions and observations to wig Limbrunner, the Rector of enact the precept of love given by emerge from the conference was the Sanctuary of St. Mary of the His Son’. made by Prof. Christoph Von Rit- Graces of Altötting; and Rev. ter, a Consultor of the Pontifical Prof. Dr. Janusz Surżykiewicz, a Council, who emphasised that the lecturer at the Catholic University The First Moment – the figure of the ‘Good Samaritan’ will of Eichstätt-Ingolstadt. Cultural Aspect (7-8 February) always remain a valuable example At the press conference the pro- which health-care workers should gramme of the celebrations en- The first moment of the World refer to and base themselves on. visaged in Bavaria was presented Day of the Sick in Germany took The final paper was entrusted and, following the approach of the place in the diocese of Eichstätt- to His Eminence Cardinal Rein- previous solemn editions of this Ingolstadt on Thursday and Friday hard Marx, the Archbishop of Mu- World Day, it was to have three 7-8 February. The Special Envoy nich and Freising and the Grand principal moments: one that was of the Holy Father received a warm Chancellor of the university, who, cultural, with a conference at the welcome in the university clinic of in citing the apostolic letter Salv- Catholic University of Eichstätt- Eichstätt from representatives of ifici doloris of the Blessed John Ingolstadt; one that was pastoral, the federal and local authorities, Paul II, emphasised the need for a with visits to places of health care; and from the managers, health- new evangelisation, especially in

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the field of pastoral care in health institutions in Europe. The Special The administration of the sacra- which should be able to accompa- Envoy of the Holy Father, with ment of the anointing of the sick ny sick or suffering people in per- his entourage, visited the modern was a strong and moving moment. ceiving their need for spirituality, Interdisciplinary Centre for Pal- This sacrament was administered on a pathway of faith that opens liative Care where the ‘Spiritual by Cardinal Marx, Archbishop Zi- hearts to hope in Christ. Care’ service is provided. This is mowski, Archbishop Périsset and The conference was a valuable directed by Fr. Eckhard Frick, S.J., Bishop Schraml to those elderly opportunity to reflect, with an in- the first person to hold a chair in and sick people who had gathered terdisciplinary approach, on the this discipline in Germany. The together at the foot of the altar. figure of the health-care worker second visit was to the clinic of After the post-communio who is called today to be a ‘Good Schwabing where the Special En- prayer, the Special Envoy of the Samaritan’ for his or her suffering voy of the Pope presided over the Pope presented the subjects of the brethren, following the example of celebration of the Sunday Holy next World Days of the Sick, an- our Lord Jesus Christ, the physi- Mass in the hospital chapel which nouncing that the solemn edition cian of bodies and souls. is also a parish church. of 11 February 2016 would take place in Nazareth. H.E. Msgr. Gi- acinto-Boulos Marcuzzo, the Aux- The Second Moment – The Third Moment – iliary Bishop of Jerusalem of the the Pastoral Aspect the Liturgical Aspect Latins, who had come to Altötting (9-10 February) (10-11 February) as a representative of His Beati- tude the Fouad Twal, ex- The second moment took place In the afternoon of Sunday 10 pressed his gratitude for this hap- in Munich in Bavaria and began in February, the Special Envoy of py announcement and extended to St. ’s Church in which are the Pope, with his entourage, went those who were present a cordial kept the relics of two who to Altötting, the heart of Bavaria invitation to the Holy Land. were physicians: Cosma and Da- (‘Herz Bayerns’), to take part in At the end of the Holy Mass the mian. The Holy Mass was presided the prayer vigil presided over by Special envoy of the Holy Father over by Cardinal Marx and concel- the Bishop Emeritus of Passau, gave to the sanctuary a relic of the ebrated by Archbishop Zimowski, H.E. Msgr. Wilhelm Schraml. The blood of the Blessed John Paul II the Apostolic Nuncio to Germany, same prelate then led the subse- as a sign of gratitude for the insti- Archbishop Jean-Claude Périsset, quent torchlight procession, car- tution of the World Day of the Sick Monsignor Mupendawatu, Mon- rying in his hands the miraculous which had had its twenty-first cel- signor Krzysztof Nykiel, the Re- statue of Our Lady. After placing it ebration in Germany. This relic, gent of the Apostolic Penitentiary in the Chapel of Graces, where it is which was received with emotion and numerous prelates and priests. normally kept, Bishop Shraml, in by the keepers of the sanctuary, A large number of health-care, so- front of the altar of Our Lady, in- was placed in the Chapel of Our cial and pastoral workers also took vited the faithful who were present Lady of Graces next to the golden part in the service, as well as pa- to say a Marian prayer that he had rose given by Pope Benedict XVI tients and volunteers. written for the occasion. during his pilgrimage to Bavaria A meeting took place in Munich The solemn concelebration of in 2006. This fact, explained H.E. between the Special Envoy of the the Eucharist, on the occasion of Msgr. Zimowski, could be inter- Pope and a number of bishops and the Twenty-First World Day of the preted ‘almost as a symbol of that delegates responsible for pastoral Sick, began at 10.00, 11 Febru- Marian devotion that unites the care in health who came from Eu- ary, at the great church behind the memory of Pope Wojtyła to the rope, the Holy Land and Africa. To- Chapel of our Lady of Graces. A magisterium of Benedict XVI who gether with the priests of the Vati- large number of German and for- in this chapel matured and nour- can delegation, they were received eign bishops and priests concele- ished full awareness of his voca- at the Archbishop’s palace by Car- brated with Archbishop Zimowski. tion to service to the Church of dinal Marx and those who work The Apostolic Nuncio read the Christ’. closely with him. The second part pontifical letter appointing H.E. of the meeting, which this time was Msgr. Zygmunt Zimowski his open to the public, which sought Special envoy for this event. Conclusion to draw up recommendations to be During the course of the cele- proposed to the Holy Father as re- bration the Special Envoy of the The solemn celebration of the gards pastoral care in health, took Holy Father, after referring in his World Day of the Sick 2013, simi- place the next day at the religious homily to the principal features of lar to the previous ones as regards house of the Carmelites. the papal Message for the World its three fundamental aspects, was, Once again in the Bavarian Day, called attention to the spiritu- however, exceptional because, capital, other visits took place to al links of Benedict XVI ‘with the as the Special Envoy of the Pope health-care institutions. The first sanctuary of his youth’, assuring said, ‘we have been in the foot- was to the health centre of Gros- those present of his nearness and steps of Benedict XVI, of his spir- shadern which has the clinic of his spiritual union with his fellow ituality, of his Marian dimension, the University of Munich (LMU) citizens and the faithful taking part because he always entrusts him- and is one of the largest hospital in the event. self to the Most Holy Mary’.

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As Mary did, do Good to the Suffering Homily of H.E. Msgr. Zygmunt Zimowski, president of the Pontifical Council for health care workers, Special Envoy at the Marian Sanctuary of Altötting, at the End of the Twenty-First World Day of the Sick, 11 February 2013

our Eminences, Your Excel- to the specialisation of paramed- to her, “Do not be afraid, Mary, Ylencies, Most Reverend Nun- ical and nursing staff, and to as- for you have found favour with cio, dear brothers in the priestly sistance to afflicted families, but God. Behold, you will conceive service and in the deaconate, all also to people of good will who in your womb and bear a son, and members of the monastic commu- live and work with the sick and you shall name him Jesus’ (Lk nities and the institutes of bless- the suffering and attend to them 1:26-31). This Biblical scene has ed life, dear personnel involved in various capacities. been well known to us ever since in health care, medicine and as- The Holy Father, Benedict our childhoods. This is the mys- sistance, and above all, dear sick XVI, in his message for this tery that we are told about by the people and people tested by suf- World Day of the Sick referred fine venerating Bavarian tradi- fering! to the words of his predecessor tion of the prayer ‘Der Engel des when he wrote: ‘This day repre- Herrn’ (‘The Angel of the Lord’) sents for the sick, for health care which the Pope says in the Vati- 1. Introduction to the Twenty- workers, for the faithful and for can, as well, every Sunday togeth- First World Day of the Sick all people of goodwill “a privi- er with pilgrims. How many times leged time of prayer, of sharing, have we tried to penetrate this Today the whole Catholic of offering one’s sufferings for mystery of the call to the Mother Church is celebrating the Twen- the good of the Church, and a call of God, Mary, in the prayer of the ty-First World Day of the Sick. for all to recognize in the features rosary, in pilgrimages to sanctuar- Following the wishes of our Ho- of their suffering brothers and sis- ies, in the Masses of the Advent ly Father, Benedict XVI, we are ters the Holy Face of Christ, who, or in Marian devotions? There- doing this here in Altötting, in his by suffering, dying and rising has fore, what is the deepest mean- beloved sanctuary of the Mother brought about the salvation of ing of the Announcement? It is, of God, Our Black Lady of Ba- mankind” (John Paul II, Letter for therefore, a kind of divine call varia. Today we look at the figure the Institution of the World Day for a special mission. She who and the person of the Mother of of the Sick, 13 May 1992, 3)’. was called was therefore aware of God, ‘a woman, whose dress was the fact that her role and her hon- the sun and who had the moon un- our were rooted in God. To this der her feet and a crown of twelve 2. The Announcement call Mary and many other people stars on her head’ (Ap 12:1). of Mary’s Call called by God replied with a gen- However, today we also sing: erous ‘Yes – fiat!’ ‘Tota pulchra est Maria’. Let us return to the tablet of To the mysterious call of God The World Day of the Sick was the divine word, above all to the the Virgin replied: ‘May it be instituted by Pope John Paul II in Gospel which portrayed for us done to me according to your 1993 to remember all people af- the scene of the announcement, word’ (Lk 1:38). This courageous flicted by illness. It is celebrated recalling Mary’s call. To carry answer from Nazareth would every year on 11 February, the out His plans of salvation, God have many consequences. After day when Our Lady of Lourdes is chooses completely practical peo- the announcement, Mary went to commemorated. The Blessed John ple and sends them out. Mary, too, her cousin Elizabeth to serve. The Paul II wanted this special day to was called to carry out a special final consequence was the great remind the whole of the people of mission in the history of salva- suffering of a mother at the feet of God of the absolute need to im- tion: ‘In the sixth month, the an- the cross of her son. prove treatment and care for the gel was sent from God to Thus the Holy Father in his sick and the suffering, the phys- a town of Galilee called Nazareth, message for this World Day ical but also the supernatural di- to a virgin betrothed to a man writes as follows: ‘In the Gospel mension of suffering, so that this named , of the house of the Blessed Virgin Mary stands World Day would provide an im- , and the virgin’s name was out as one who follows her suffer- pulse both to care for souls in Mary. And coming to her, he said, ing Son to the supreme sacrifice health-care services in dioceses, “Hail, favoured one! The Lord on Golgotha. She does not lose in parishes, in monastic commu- is with you.” But she was great- hope in God’s victory over evil, nities and in institutes of blessed ly troubled at what was said and pain and death, and she knows life throughout the world, and to pondered what sort of greeting how to accept in one embrace of the promotion of voluntary work, this might be. Then the angel said faith and love, the Son of God

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who was born in the stable of Today, how can the interdisci- experience this condition from a Bethlehem and died on the Cross. plinary task of treatment and care perspective of faith’. Her steadfast trust in the power of succeed in the face of illness and Our Pope in his Message al- God was illuminated by Christ’s suffering? so reacts to the contemporary resurrection, which offers hope to What importance do religious problems of society in which the suffering and renews the cer- faith and personal spirituality an increasing number of people tainty of the Lord’s closeness and have in the process of healing? believe that they can help the suf- consolation’. Is such an overall care fund- fering by procuring for them an The serving approach of the able and sustainable from and artificial end to their lives. He re- Mother of God did not stop af- economic-organisational point of minds of his first encyclical when ter her assumption into heaven: view? he writes: ‘It is not by sidestep- it is still real today. Now, as well, Following the central theme of ping or fleeing from suffering that and here in Altötting, Mary gives the World Day of the Sick, the we are healed, but rather by our us her smile: ‘In the smile of the Biblical image of the Good Sa- capacity for accepting it, matur- most extraordinary of creatures, maritan, scientists have been con- ing through it and finding mean- which is addressed to us, is re- cerned to obtain answers about the ing through union with Christ, flected our dignity as children of ways in which it is possible to as- who suffered with infinite love’ God, that dignity that not even a sure the best care possible to sick (Spe Salvi, n. 37). sick person ever loses. This smile, people in the real circumstances ‘Go and do likewise’ – this is a true reflection of the kindness of of our system of welfare. On the a task for all of us: to give our God, is the source of an invincible one hand the person as a subject hands, our feet, our ears, our hope…Who could be nearer and in anxiety, hope and trust, and on eyes and our mouths to Jesus so more intimate than Christ and his the other the person who helps as that the Lord makes us Good Sa- holy mother, the Immaculate Con- a subject of technical and human maritans and continues to work ception? They are capable more action, must not disappear from through us caring for the sick and than any others of understanding the scene of the Church and soci- the suffering. each other and understanding the ety. A dynamic dialogue must be harshness of the fight against evil installed between reason and faith and suffering’. (Fides et Ratio), between science 4. The Year of Faith – and practice, so as to give space a Good Opportunity to the various disciplines that can to be a Good Samaritan 3. The Figure of the Good illumine the contemporary data Samaritan provided by research and by oper- Today’s World Day of the Sick ational fields, as well as the deep- is celebrated during a special pe- In order to highlight the special est, indeed spiritual needs, of man riod for the Church. Exactly four spiritual meaning and the theo- in an exchange of reflection, so as months ago the Holy Father in- logical contents of the great feast to be able to open up new paths augurated the Year of Faith, ex- of today in this wonderful sanctu- that can be followed. horting all of us to rediscover the ary, the Holy Father invites us to Benedict XVI in his current approach of the Good Samari- engage in an in-depth reflection Message, after a brief exeget- tan. We, too, must learn what it on the emblematic figure of the ic reflection on the person of the means: ‘looking with love at he Good Samaritan as portrayed in a Samaritan, emphasises the last who needs love and care’. The very striking way by the Evange- phrase spoken by Jesus which, on Year of Faith constitutes, there- list Luke. the one hand, involves an chal- fore, a unique opportunity to re- Naturally, this is a gospel par- lenging answer to the question flect upon faith and to deepen it, able which specifically today ‘What, then, must I do today’, but, but also to live it in an active way, demonstrates its contemporary on the other, constitutes a kind of transforming it into one’s own relevance and above-temporal call for all of us, that is to say: ‘Go deaconate of love. character both in the life of the and do likewise!’ (Lk 10:37). On this pathway of renewal and Church, which is undergoing This process only succeeds if disclosure of faith, an in-depth transformation, and in modern so- we stay near to the source of this analysis and a reflection on the ciety, in particular in the field of action: ‘We need to draw from the lives of true witnesses to faith the promotion of care, but also infinite love of God, through an who have placed their lives at the those who are directly involved: intense relationship with him in service of the sick and the suffer- the sick and the suffering. prayer, the strength to live day by ing may be of use to us. Specifically on the occasion of day with concrete concern, like The Pope mentions some of the inauguration of the Twenty- that of the Good Samaritan, for them: Saint Thérèse of the Child First World Day of the Sick at the those suffering in body and spirit Jesus, the Lui- Catholic University of Eichstätt who ask for our help, whether or gi Novarese, who will be beati- we pose very serious questions to not we know them and however fied in three month’s time, Raoul which we should give questions poor they may be. This is true, not Follereau, the Blessed Teresa of that are valid for the future: ‘How only for pastoral or health care Calcutta and naturally also a great can we do good to those who suf- workers, but for everyone, even woman saint of Bavaria, Anna fer’? (Salvici doloris n. 30). for the sick themselves, who can Schäffer of Mindelstetten. Bene-

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dict XVI spoke with sincere emo- trust in the power of God, which he would pray for us. The Ho- tion about her, the daughter of this is stronger than sin and death, ly Father also thanked us for our land, pointing to her as an exam- was chosen by the Holy Father prayers, our commitment, and the ple of the union of one’s suffer- to end his Message, where he en- suffering that we sacrifice for his ing with the suffering of Jesus trusts everyone to the intercession wishes and also for the Church. Christ: ‘So her sick-bed became to Our beloved Lady of Altötting Allow me, if you will, at this her cloister cell and her suffering ‘that she may always accompany point to thank once again all the a missionary service. She strug- those who suffer in their search for organisers of the Twenty-First gled for a time to accept her fate, comfort and firm hope. May she World Day of the Sick, in par- but then understood her situation assist all who are involved in the ticular the ordinary of the dio- as a loving call from the crucified apostolate of mercy, so that they cese of Passavia, the apostolic One to follow him. Strengthened may become good Samaritans to administrator, Bishop Wilhelm by daily communion, she became their brothers and sisters afflicted Schramml, as well as those who an untiring intercessor in prayer by illness and suffering!’ work with him, for having invit- and a mirror of God’s love for the ed us with open hearts, and with many who sought her counsel. a solicitous readiness to help, to May her apostolate of prayer and 5. Conclusion Altötting, attending to us in an ex- suffering, of sacrifice and expia- emplary way as his guests. May tion, be a shining example for be- Dear brothers and sisters in God reward him! lievers in her homeland, and may Christ! I would like to end this long her intercession strengthen the Last Wednesday, during the au- homily with a prayer of St. Igna- Christian hospice movement in dience, I was able to speak to the tius of Loyola in which he inter- its beneficial activity’ (Homily for Holy Father and to present to him cedes in a special way for the sick the Canonisation of the Blesseds, once again the rich programme and the suffering. Above all you, 21 October 2012). of the Twenty-First World Day dear sick people, feel the near- Mary, the Mother of God, is the of the Sick, and I asked him for ness of the loving heart of Jesus most important witness to faith his blessing. I can assure you that and draw faith and joy from this and love. Mary, who with courage our beloved Pope Benedict XVI source by praying: ‘Water of the followed her own suffering son on bestowed his apostolic blessing rib of Christ, wash me! Suffering the way that led him to the sacrifice with great joy on all of us. He al- of Christ, strengthen me! Good Je- on the cross and experienced the so asked me to communicate to sus, hear my prayers! Protect me great joy of his resurrection. This you his keenly-felt personal com- in your wounds!’ Amen (Prayer magnificent approach of Mary, her mendations and promised that of St. Ignatius of Loyola).

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The Solemn Handing Over of the Relic of the Blessed Pope John Paul II in Altötting

H.E. Msgr. and mindful of the afflictions of As is customary, men come on Zygmunt Zimowski the last terrible war, which in- a pilgrimage here to Altötting to President of the flicted such deep wounds, above pray, to praise God, to be recon- Pontifical Council all on the peoples of Europe, I en- ciled with Him, and after the pil- for Health Care Workers, trust to you the peace of the world. grimage they once again go back the Holy See May a new order be born amongst to their homes. these peoples that is based upon This great Pope – the Blessed full respect for the rights of every John Paul II – wants to remain ear pilgrims, those taking individual nation and of every in- near to you for always to plead, Dpart in the twenty-first World dividual man in his nation, an or- at the feet of Mary the Mother of Day of the Sick! der that is truly moral, in which Good in the Chapel of Graces of It is an old tradition of the Church the peoples live together like a Altötting, the cause of all of us, that Christians meet together at the family through the due balance of and in particular of the sick, the tombs of saints and martyrs and justice and freedom! This prayer suffering and the desperate. celebrate the Holy Mass there. I address to you, Queen of Peace Thus now, as the Special Envoy This tradition has been kept in par- and mirror of justice, I John Paul of the Holy Father, I would like to ticular in Rome with prayers in un- II, Bishop of Rome and successor hand over in a solemn act to the derground catacombs in front of to St. Peter, and I bequeath it to Most Reverend Apostolic Ad- the bones of heroes of the Church. your sanctuary of Altötting in per- ministrator of the diocese of Pas- I would now like to connect with ennial memory. Amen’. sau, Bishop Wilhelm Schraml, this venerable tradition by offering He was a fervent venerator of the relic of the blood of a special you a surprising pilgrim. the mother of God – above all of pilgrim and Pope – the Blessed Certainly you know him very the Black Madonna, the one here John Paul II. It was entrusted to well because of the fact that he in Altötting, and also of that in his me in Rome by the of came here personally to Altötting homeland, in Poland, in the sanc- the process of sanctification, the on a pilgrimage, to be exact in tuary of Czestochowa. He entrust- prelate Oder, to be handed over the year 1980, and at that time he ed the whole of his life to Mary: here in Altötting. spoke as follows: ‘To you, moth- TOTUS TUUS MARIA! Your Excellency, into your er, I entrust the future of faith in Today he returns again to Altöt- hands I now entrust the relic of this ancient Christian country; ting, as an eternal pilgrim. the apostolic Pilgrim.

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International Meeting organised by the Catholic University of Eichstätt on: ‘Do Good to those who Suffer’ (Salvifici Doloris, 30) on the Occasion of theTwenty-First World Day of the Sick Eichstätt, Germany, 7-8 February 2013

1. Summary of the Results of the Meeting and Prospects

Prof. Christoph era it becomes ‘patient/medical care for health-care workers, or- von Ritter, Md, PhD doctor/institution’, linked togeth- ganises its activities by involving Director of the ‘RoMed Klinik er, as in this parable, by scrupu- international organisations such Prien am Chiemsee’, Germany. lous and loving care and by the as the World Health Organisation Consultor of the Pontifical shouldering of responsibilities. (WHO), health-care and politi- Council for Health Care Through this important parallel, cal institutions, hospital institu- Workers during this meeting the words of tions, and support organisations: this parable stimulated a series of in short, innkeepers! All of them reflections. can, and must, contribute to striv- his international meeting was Prof. Montgomery, the Presi- ing, each according to their own Theld under the title ‘Do Good dent of the National Order of specific role, to helping people to those who Suffer’, a phrase Medical Doctors of Germany, who suffer. taken from the encyclical letter carrying on the metaphor, saw in Under the guidance of its Pres- Salvifici Doloris of the Blessed the figure of the innkeeper a tak- ident, Archbishop Zimowski, the Pope John Paul II. ing of responsibility for, and the Pontifical Council for Health Care In practical terms this meet- stewardship of, a suffering per- Workers, amongst other impor- ing had to give answers to the son, in order to restore and main- tant initiatives is responsible for following complex questions: 1. tain good general conditions of the World Day of the Sick, which in the face of illness and suffer- health. He also observed that this year has been celebrated at ing how should the interdiscipli- health-care and paramedical staff Eichstätt, at Munich and at Al- nary task of treatment and care need professional, financial and tötting, and every day in Novem- be performed today? 2. What is institutional resources in order to ber this Pontifical Council organ- the importance of religious faith be able to employ all of the ener- ises an international conference and personal spirituality in the gy that is needed to achieve suit- at which all kinds of health-care process of healing? 3. Is a holis- able care for sick people. workers meet to engage in a pro- tic approach to care fundable and The Blessed John Paul II had ductive dialogue with representa- sustainable from an economic-or- already highlighted the connec- tives of public institutions of the ganisational point of view? tions between general conditions health-care sector in order to then The parable of the Good Samar- of an economic-political kind and identify and implement effective itan, proposed as a point of depar- good care for sick people when he initiatives and operational strat- ture for the discussion, demon- instituted the Pontifical council egies. This is an important and strated its extraordinary efficacy for Health Care Workers twenty- wonderful message: everyone can in presenting the relationship of seven years ago. take part in care for sick people, ‘in need of care/carer/the place of This Pontifical Council of the being concerned to ensure that care’: transposed onto the modern Roman Curia, through pastoral sick people are well looked after

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and that suitable instruments are tering human life through assist- people and the unborn are killed available for this. Everyone can ed procreation, PID or selection, out of ‘compassion’. Since suf- take part in the great task of doing through the abortion of individu- fering is no longer borne, suffer- good to those who suffer. als with handicaps even before ing people are eliminated, allow- Here is another important ele- they were born, and through pre- ing thereby the dominance of the ment that emerged: in many of venting the coming into the world culture of death, as John Paul II the papers that were given at the of disabled people destined only rightly expressed himself. meeting the following question, to suffer infinitely and to cause Our society suffers! It lies ex- which weighs on consciences, notable costs to society! ploited and naked at the side of was predominant: how can we, For a society that often ob- the road, deprived of its values, in the future as well, do good to serves, analyses and acts with divested of its dignity, without those who suffer in a society that cynicism and superficiality, doing hope, without a future, searching is subjected to economic limita- good to those who suffer – leav- for meaning! Our society suffers, tions and which obeys the rigor- ing aside the question of costs – is it has fallen and hopes for help! ous rules of profit? a superseded romantic idea; a so- To do good to those who suf- In the parable of the Good Sa- ciety of this kind comes to seek an fer means, as Good Samaritans, maritan, because of the severe end to suffering and organises it- to help this suffering society to do rules that are imposed, the self to this end! Two years ago the good to itself, making it become passes by on the other side of the European Parliament called for aware that a society of this kind, road from the suffering man. How the ‘eradication of genetic diseas- which witnesses its materialis- is it possible to help the suffer- es. We have the techniques to do tic goals end up in emptiness, is ing in a society in which there is this. For example through the new a hopeless society which, given a chronic penury of time, where prenatal test LifeCodex we have the lack of meaning of its mate- assistance has to be measured the possibility of detecting in the rial ideas and the evident failure in minutes, and where the con- blood of the mother trisomy 21 of its positivistic trust, falls prey straints imposed by pre-estab- and other genetic mutations that to panic. This society is suffering lished rules predominate? These are present in the unborn child from collective burn out. constraints are what, in the par- and indeed we have managed to We live in a society that looks able of the Good Samaritan, also eliminate trisomy 21 almost total- only for utility inasmuch as it oblige the Levite, the servant of ly through abortion on the basis of thinks in a utilitarian way. Con- the temple, to pass by in an uncar- the indication of an embryopathy! cerns relate to the material as- ing way when faced with the sick By this step we do not even pect of things, the market, busi- man! Will the future not perhaps have to do good: we simply elimi- ness, but not man. These nexuses inevitably make us perform the nate suffering! can be understood by reading the roles of being that priest and that All of this is distressing: Pope wonderful book ‘Capital’ by Car- Levite? Benedict XVI is very concerned dinal Reinhard Marx. One asks how one can do good about this. In his message to our However we can and we must to those who suffer given the de- World Day of the Sick, taken do good to this suffering society. mographic transformations that from his second encyclical Spe How? Very simply! This society are now forecast, the increase in salvi, he quotes the following pas- longs to have values and mean- old age, the increasing number sage: ‘It is not by sidestepping or ing. Exactly like the Scribe who of people in need of assistance fleeing from suffering that we are at the beginning of the episode of and treatment, and the increasing healed, but rather by our capacity the Good Samaritan asks Jesus number of people with function- for accepting it’. what the way is to achieve eter- al disturbances of their minds? But our society thinks in a posi- nal life, specifically in the same How will it be possible in the fu- tivistic way: it lives in the belief way this society asks about the ture to sustain the costs of care that everything can be organised, meaning of life, the way to happi- for the sick given problems which that it is self-determined, indeed ness. We must give it the answers are on such a grand scale? Even that it creates itself on its own, be- to its insistent questions through less would it be possible to have ing itself its own creator. It does the parable of the Good Samari- priorities which would involve, not know the influence of natural tan. The answer is simple, as in paradoxically, choosing young law. It does not want to know the the Gospel: ‘Go and do likewise!’ people and the able who offer an ecology of man, as Pope Bene- (Lk 10:37). Solidarity rather than active contribution to society and dict XVI expressed himself in his greed, helping rather than exploit- pay taxes rather than old people speech in Berlin. ing, having compassion rather who create only costs! One would In this society, there are very than killing! Simply: ‘love your come thereby to promote active many people who see the fact of neighbour!’ help for death or at least assisted accepting suffering as mistak- The parable of the Good Sa- suicide in order to spare people en or at least superseded; indeed maritan points out the way, as it from suffering in old age and at compassion corresponds to a lack did two thousand years ago. This the same time remove the enor- of empathy, it is seen as cynicism. is the message of love and of mous costs caused to society by A society that no longer knows kindness for the human being: for the last years of life! Moreover, compassion only wants suffer- the elderly, the sick, the disadvan- one would impede suffering en- ing to cease rapidly. Thus elderly taged, the naked; for the little, not

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standing out, unborn child; and like the Good Samaritan is a priv- ty, as was demonstrated to us, in for the depressed and the mental- ilege. The parable of the Good their respective papers, by Prof. ly ill. Kindness for all of us, the Samaritan shows us that activity Frick and Prof. Büssing, on the creatures of God, with all our de- involving service to the sick is a basis of their clinical studies. fects! wonderful pathway towards eter- I imagine the Good Samaritan This Christian message is not nal happiness. Is there, perhaps, as a man who was happy to live: an arid list of prohibitions, al- a more beautiful profession than he rejoices at doing good to those though it is often seen as such, but this? We have an opportunity to who suffer, he does not give up the key to an active, free and hap- help people who are in need, we hope in the face of suffering be- py life. One need only observe the have available to us the means by cause he sees in suffering an op- joy of young people at the World which to do good to those who portunity to do good, to provide a Youth Days: they are not people suffer. good account of himself. He em- who suffer from prohibitions that But there is more: we experi- ploys all the instruments he pos- are imposed on them: in an aware ence suffering. Often it is not easy, sesses to mitigate suffering and and happy way they open up to often it is a heavy burden; howev- this is something that gratifies themselves a pathway through er, above all else it is a privilege. him. One could almost say that he life. And there is also, alas, the We can learn from our patients is enriched through his own gen- very much discussed field of sex- how to accept illness and suffer- erosity and receives gratification uality! Let us help suffering soci- ing, we can learn about how they from his love for his neighbour. ety with the wonderful theology attribute meaning to their suffer- Prof. Mang in his paper empha- of the body: this is the good news ing, ‘freeing the salvific force of sised that no accounting system of how sexuality enriches us; how suffering’, as we can read in the of modern health care manages this wonderful force of sexuality encyclical letter Salvifici Doloris to be the same as this spiritual re- leads us to marriage, to the fam- of the Blessed John Paul II. And ward. ily, to union between a man and a Prof. Frick observed in a wonder- We should also mention a fi- woman, to a union that makes us ful way that the wounds of the nal aspect that was discussed by happy, transmitting to us divine healer, the burdens to which the one of the six workshops during faculties, that is to say the ability Good Samaritan is exposed, free a lively discussion: the Good Sa- to conceive children. This is the salvific forces. maritan is not a health-care pro- good news that impedes this won- It is in this sense that we are fessional. He helps in a totally derful gift of sexuality, this great privileged and thus even more non-professional way, he cleans force, from giving rise to an ob- strongly called upon. ‘Hospitals the man’s wounds with wine and tuse frenzy, to an arid instinctu- as Settings for a New Evange- oil. He does not have a diploma al addiction, and to pornography lisation’: this was the title cho- as a manager of wounds; he has without interest in, and despising, sen by Archbishop Zimowski for other tasks and then he goes on humanity. the international conference of his way. This means that every We should, as was said in the the Pontifical Council for Health person has an opportunity to be- wonderful prayer of Bishop Sch- Care Workers which took place in come happy through good deeds raml for the World Day of the Rome in November 2012. We, en- for his or her neighbour; every Sick: ‘be ourselves a light for suf- gaged in service to the sick, have person has an opportunity to re- fering people and irradiate help’. the task of setting an example to ceive gratification by addressing Doing good to those who suf- suffering society, with service to his or her neighbour in a loving fer: this is not only our task but the ‘sick Lord’, as the Order of way. Such is our Good News. We also our mission and a great privi- Malta asked nine hundred years launch this message of this meet- lege for us. We who are active in ago of the members of the Order. ing on the occasion of the twenty- service to the sick, we should not Today, in service to the sick, lov- first World Day of the Sick in a complain! We are highly privi- ing service, recognising spiritual world without hope, thereby giv- leged. Our vocation to be active needs, must regain a new validi- ing it hope!

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2. The Deliberations of the International Conference Organised by the Catholic University of Eichstätt: Reflections and Recommendations Eichstätt, Germany, 7-8 February 2013

Dr. Rosa Merola Care Workers, provided a sum- ception of people’s need for spir- Psychologist, Psychotherapist, mary of the conference which ituality. Consultor to the Pontifical was then magisterially ended by 7. The implementation of the Council for Health Care Workers the speech of Cardinal R. Marx, service of spiritual assistance as who, quoting the encyclical Salv- an important integrative element ifici Dolorisof the Blessed John of health care. he celebration of the Twenty- Paul II, emphasised the need for a 8. A commitment to mediating TFirst World Day of the Sick in new evangelisation, especially in pastoral care in health with the Altötting (Germany) which drew the field of pastoral care in health, responsibility of political powers inspiration from the parable of the which would be able to accompa- towards social justice as a form of Good Samaritan, ‘Go then, and do ny sick or suffering people in per- charity and as a foundation for the you likewise’, refers humanity to ceiving their need for spirituality, building up of a society of peace the mystery of suffering: ‘to rec- on a journey of faith that opens and supportive love. ognise in the face of a sick brother hearts to hope in Christ. 9. The creation of help servic- the Holy Face of Christ who, in From an attentive reflection on es to provide hospitality to family suffering, dying and rising again, the deliberations of the confer- relatives who are in need and far achieved the salvation of humani- ence, the following possible rec- from their homes and have to care ty’ (John Paul II, Letter for the In- ommendations emerge: for their suffering relatives. stitution of the World Day of the 1. The connection in a network 10. A specific and targeted for- Sick, 13 May 1992, n. 3). of workers involved in pastoral mation for spiritual workers who The solemn liturgical celebra- care in health; of central and out- are to be assigned to the service tions of the Eucharist, on this oc- lying organisations in local areas. of pastoral care in health and who casion concelebrated by Cardi- 2. The creation of an interdis- are to selected, in addition to their nals and bishops responsible for ciplinary network of pastoral theological training, also accord- pastoral care in health and pre- workers and health-care work- ing to their disposition, motiva- sided over by H.E. Msgr. Zyg- ers, including those working in tion, capacity-ability as regards munt Zimowski, the President of administration, at an institutional relationships, and resilience; the Pontifical Council for Health level, and in Catholic and secu- counselling for the prevention of Care Workers, and which took lar voluntary work, applying the burn-out; and a rotation of jobs place in the Marian sanctuary Al- principles of solidarity and sub- in the various health-care institu- tötting, were moments of vibrant sidiarity, of the centrality of the tions so as to avoid environmental prayer for all those who attended. sick or suffering person, and of crystallisation. Equally significant were the the defence of his or her dignity. The principle objective of an important pastoral, cultural and 3. A reassessment of the role evangelisation of renewed pas- scientific initiatives promoted by and the organisation of local-area toral care in health is to sensitise the Catholic University of Eich- agencies (parishes – associations consciences to the love of Christ stätt which organised an inter- of volunteers) to provide more so that in people there is set in national conference in harmony capillary and efficient assistance motion a process of inner change with the theme of the World Day to people in need. which leads, without prejudices, of the Sick of 2013, ‘Do good to 4. An increase and revitalisa- to respect between people in a those who suffer’ (Salvifici Dolo- tion, in places of care and suffer- mutual self-giving, and to love for ris, n. 30). This international con- ing, including prisons, in and of one’s neighbour which becomes ference was directed towards the groups of spiritual assistants for service or relief for the suffering identification of concrete respons- catechesis and of priests for litur- of the other. es to the need to assure to all sick gical celebrations and assistance A journey of spiritual renewal people respect for their dignity as with the sacraments. which makes man able to know well as integrated care in the field 5. The reorganisation and spir- how to listen with his heart and, of contemporary national health- itual renewal of Orders at the ser- like the Good Samaritan, able to care systems, which all too often vice of suffering people. be charitable and merciful to- have failings because of a short- 6. A re-launching and spread of wards those most in need, to those age of public financial resources. the consoling function of prayer who ask for help, and to those who Prof. von Ritter, a consultor of in the acceptance of suffering and suffer in body and spirit. To evan- the Pontifical Council for Health people’s human limits; in the per- gelise is not to speak, it is to do.

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Topics

Pain-Pleasure-Joy: from the Soma to the Pneuma. An Integrated Medical-Theological Vision of Man

The New Horizons of Pastoral Care in Health in Italy: from Cinderella to Queen?

Care for the Sick and the Treatment of Infectious Diseases in the History of the Church

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Pain-Pleasure-Joy: from the Soma to the Pneuma. An Integrated Medical-Theological Vision of Man

Prof. Pierluigi Zucchi, SO Another interesting and new to a transcendent moral and spir- Lecturer in Physiatric illnesses aspect that emerges from this re- itual value’ and that ‘sexuality… of the locomotive apparatus search is that, as with receptors and becomes personal and truly human at the Faculty of Medicine and synapsis, the peripheral and central when it is integrated into the rela- Surgery of the University of pathways of the communication of tionship of one person to another, Florence and lecturer in the the sensation of pain-pleasure that in the complete and lifelong mutu- physiopathology and treatment is shared, and, according to the al gift of a man and a woman’ of pain and headaches at the stimulus, painful or pleasurable, It is stressed that as a funda- the Università Campus give rise to the final nociceptive mental premiss for combating the Bio-Medico of Rome event (pain) or anti-nociceptive vices, for example the sin of glut- event (pleasure). tony, and maintaining the virtues, Prof. Bonifacio The authors describe in two for example chastity, one should Honings, OCD very illustrative graphs (fig. 4 and exercise the cardinal moral virtue Emeritus Professor of Moral fig. 6) the various types of nocic- of fortitude. In the text, indeed, Theology at the Pontifical eption (pain) and anti-nociception it is emphasised that ‘to achieve Lateran University, Rome. (pleasure) (fig. 4) and the clinical- the moderating transformation of Consultor to the Pontifical theological paradigm of the devel- chastity in relation to the attraction Council for Health Care opment of the concept of the en- of sexual pleasures, and to achieve Workers, the Holy See. tities of pain and of pleasure (fig. the restorative transformation of Ordinary Member ad vitam of 6) from an immanent parameter to temperance in relation to the pleas- the Pontifical Academy for Life, a transcendent value, with the cor- ures of food, one needs a strong the Holy See responding neuro-anatomical sub- spirit. In a few words, one needs strata. the appropriate cardinal moral vir- A medical-theological definition tue of fortitude…which refers us and interpretation of empathetic back to confidence in being able to Preface pain and pleasure is engaged in. take part in the paschal victory of In this work there also emerges Christ, that is to say in the trans- I have most willingly written an original definition of the ca- formation of pain and pleasure into this preface to the work ‘Pain – ress effect and an embryiological the moral and spiritual transcend- Pleasure – Joy: from the Soma to explanation of the close relation- ent values of paschal joy. Indeed, the Pneuma. An Integrated Medi- ship that exists between the skin the paschal mystery transformed cal-Theological Vision of Man’ by and the brain which are defined in pain and death on the Cross into Zucchi and Honings for the review a very appropriate way as ectoder- the victory of the Resurrection and Dolentium Hominum. In this essay mic twins. the joy of the Ascension to heaven, there emerge new contributions, Another aspect of great contem- so as to sit at the right hand of the above all for scholars who exam- porary relevance that is explored Father’. ine the medical-theological litera- as an extreme and mistaken form As a scholar and a researcher I ture on this subject. of pleasure is immoderate alimen- find that this work offers not only From the medical point of view, tation which can lead to the fre- original medical data from a physi- a new concept emerges of algo- quent pathology of obesity. In this opathological point of view but al- antalgical synapsis as a ‘mediat- context, the sin of gluttony is ex- so points to a medical-theological ing fulcrum of every sensation of amined from a moral point of view, hermeneutic vision of man that is pain and pleasure’. In this way, with its obvious clinical conse- truly integrated, in defence of the the authors argue that for pain and quences. quality of life but above all of its pleasure there is a single receptor A truly integrated medical-theo- sacredness, transforming pain and unity of departure with properties logical vision of man in this work pleasure from immanent param- that modulate pain or pleasure ac- emerges through an examination eters into transcendent values, be- cording to the intensity of the ini- of the aspect of chastity in relation cause, as St. Augustine says, ‘God tial stimulus, independently of the to the moral value of the pleasure is happy, God wants us to be hap- anatomical-functional morphology of sexuality. py, God makes us happy’. of the individual receptors (Meiss- Here a concept present in the ner’s corpuscle: touch; Pacini’s Catechism of the Prof. Don corpuscle: pressure; Ruffini’s cor- (CCC) is emphasised which de- Stefano Tarocchi puscle: heat; Krause’s corpuscle: clares that ‘chastity becomes the Dean of the Faculty of cold; free terminations: pain). virtue that transforms sexuality in- Theology of Central Italy

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Introduction of the effects of medical products, derstands that pain possesses and the improvement of man’s three important components: Pain and pleasure are two en- health in toto. 1) the sense and objective com- tities that are closely connected To summarise, in the Order of ponent constituted by the damage and – present and impelling in the Redemption of Christ, the or- (trauma, fracture, illness: algos the human organism – they play der of the creation of Adam rais- physical pain, which in English is a fundamental and irreplaceable es man to his highest level. This expressed by the term ‘disease’. role in our daily lives. The pur- approach of ours established the 2) The affective, subjective pose of this work is: a) from a original physiognomy of our an- and personal component consti- theological point of view, to ex- thropological and medical-theo- tuted by meaning (internalisation plain the development of the con- logical studies in harmony with of physical pain in moral suffer- cept of the entities of pain and of the CCC which at n. 374 affirms ing: pathos, which in English is pleasure from an immanent pa- that: ‘The first man was not only expressed by the word ‘illness’) rameter to a transcendent value, created good, but was also estab- attributed to this unpleasant event with their corresponding neu- lished in friendship with his Crea- which is interpreted and experi- ro-anatomical substrata. To this tor and in harmony with himself enced differently according to in- end, the authors offer a clinical- and with the creation around him, dividual cultural and religious ap- theological paradigm (fig. 6); b) in a state that would surpassed on- proaches. from a medical point of view, to ly by the glory of the new creation 3) The extrapersonal compo- explain and emphasise the new in Christ’ (Redemption). nent as a social sensitisation and acquisition in the neurophysi- perception of a new form of cus- ological field of: a single recep- tom (ethos, which in English is tor; algo-antalgical synapsis; and expressed by the word ‘sickness’) shared pathways for both pain The Definition of Pain which leads to the establishment and pleasure. and Pleasure of differing rules in society (no- This study, like our previous mos, for example the law in Italy ones, stands out because in the As regards definitions of pain on opiate painkillers of 15 March medical-theological field it ap- that appear in the international lit- 2010). plies an anthropology that ex- erature, scholars usually refer to plains the order of the Creation in those of the International Associ- The theological definition of pain close connection with the order of ation for the Study of Pain (I. A. Pain is a value entity in whose the Redemption. S. P., 1979, 1982) and to that of physiognomy jointly penetrate, The Ordo Creationis establish- the algological school of Florence both in the Order of the Creation es that man in his nature unites (Algologia, 1983). and in the Order of Redemption, the material world (the body) with of necessity, the constitutive ele- the spiritual world (soul-pneuma). The clinical definition of pain ments of man: soma (body), psy- Because of this unity of his being, Pain is an unpleasant sensorial che (soul), and pneuma (spirit). man is capable of a transcendent and emotional experience associ- relationship with his God-Cre- ated with a real or potential injury The clinical definition of pleasure ator. Indeed, after creating him to tissue or described with terms Pleasure is a perception deter- good, God established man, male that refer to such injury (1979, mined by extremely appreciated and female, immediately in a re- 1982). This definition separates conditions or following the over- lationship of friendship with Him. off from the Sherrington approach coming of painful or unpleasant Adam and Eve were established and emphasises that an organic le- physical or mental conditions. in a state of original holiness and sion or even a harmful stimulus justice. God placed them in para- need not be perceivable for the in- The theological-anthropological dise. dividual to perceive pain. definition of pleasure L’Ordo Redemptionis estab- True pleasure is that sensorial- lishes not only the restoration of The anthropological definition moral entity that is experienced the transcendent relationship of of pain by the individual as the cultural man with God, which was lost The algological-internist school or religious result of self-giving because of sin, but the new crea- of Florence proposes a broader which gratuitously fulfils the be- tion in Christ which goes beyond definition and states that pain can ing that is given. it. In the place of the grace of Ad- be defined as a psychophysical From these definitions of pleas- am, man participates in the capitis entity with universal meanings ure one deduces that this entity is grace of Christ (the new Adam). (because experienced by every- not only a sensation which is ex- Thus the order of the redemption one) in the perception of which perienced or to felt. Indeed, when raises the order of the creation to are at work different individual, it is looked for exclusively for its its highest level. cultural and religious factors, in own sake, it generates dissatisfac- Thus when sick and suffer- whose analysis take part not only tion and impoverishment, giving ing man has – through faith and the branches of medicine and bi- rise to a person folding in on him- prayer – this relationship with ology but also the human sciences self or herself. God, a raising of the threshold of (Algologia, 1983). Pleasure, on the other hand, is pain is achieved, a strengthening From these definitions one un- an entity that also creates relation-

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ships between living beings, bear- ing in mind that God, Absolute SOUL - BODY Happiness, is the Being in a rela- (CORPOREAL) - (ANIMATED) tionship. From the relationship of man with God, Absolute Happi- ness, is actuated in man the rela- -SUFFERING PLEASURE-JOY-HAPPINESS tionship with other men and with (Algia Algos Pathos) (Edoné Agape Caritas-Felicitas) the other beings of the Creation (empathetic pleasure). Fig. 1. Ontological nexus between pain-pleasure and the (corporeal) soul-(animated) body, as a dual-unitary-transcendent entity.

Pain and Pleasure: A small local pain (algia) can be what is lacking in Christ’s afflic- Historical and transformed into a wider physical tions for the sake of his body, that Theological Aspects pain (algos) which can become in- is, the Church”’.1 To understand ternalised (pathos). In pleasure, as the ontological root of the connec- The history of philosophy pre- well, an analogous development tion between the feeling of pleas- announced these concepts, prefig- takes place. The edonè, pure sen- ure and joy, St. uring by centuries the discoveries sorial pleasure, is transformed into teaches: ‘the reason why one looks of modern neurophysiology. Plato agape to then rise to caritas and to for good is identical to the reason in Phaedo describes relief from its absolute form which is identi- why one looks for pleasure and pain when the chains are removed fied with the felicitas of God. This joy, these being nothing else but from Socrates. Socrates tells his is why in an integrated medical- the placating of tending in good, friends that first he felt pain and theological anthropological vision just as it is because of the same afterwards pleasure, so that the pain and pleasure can become au- natural force that the grave tends two sensations ‘seem to have ori- thentic moral values. downwards and lies on the earth’2. gin in the same place, even though Pain and pleasure, in these moves An abbot saint explained this con- there are two of them’. Pain can, that have just been described, con- nection in a truly masterful way: therefore, follow pleasure, but an stitute the (corporeal) soul and the ‘If man wants to love himself with unpleasant sensation can also co- (animated) body as a dual-unitary- an authentic love he should not al- exist with a pleasant one. As re- transcendent entity (fig.1). low himself to be corrupted by any gards the explanation for this last pleasure of the flesh. So as not to condition, we are helped once succumb to concupiscence of the again by Plato who in his Dia- Pain, Pleasure, Paschal Joy: flesh, he should address all of his logue described that when an in- Theological Aspects affection to the sweetness of the dividual engages in a very natural bread of the Eucharist. In addition, act such as drinking, because he Pain and pleasure acquire value in order to rest more perfectly and is thirsty, he at one and the same as the transcendent entity of joy gently in the joy of fraternal char- time feels both pleasure and pain. solely in the passion of the Cross ity, he should embrace with true Pain because the individual expe- of Christ. The Cross, indeed, is the love his enemies as well. So that riences the sensation of thirst and demonstration not of the force of this divine fire does not become pleasure because when he drinks the power of God but of the force tepid in the face of injustices, he the lack caused by thirst is rem- of the love and pain of God. The should always look with the eyes edied. Cross, therefore, does not repre- of his mind at the patience and The historical period when man sent the love of force but the force the serenity of his beloved Lord began to think in a different way of love and the acceptance of pain and Saviour’.3 The Cross, there- as regards his assessment of pain by Christ, for love of the Father fore, represents the synthesis of and pleasure, and the beholding and , therefore, to please the Fa- the Pain and the love of Christ as of the lyrical values of nature and ther (Zucchi, Honings, 2001; Zuc- the highest form of omnipotence the close relationship that exists chi, 2002). This concept is very and the capacity of God to make between these components, goes present in St. Augustine who ob- himself powerlessness. Obviously back to the birth of Christianity. served: ‘Fortitudo Christi te creav- enough, the meaning of this mys- Christianity introduced into the it, infirmitas Christi te recreavit’, tery can be shared only in faith. In- world a radical change and thus a that is to say the divine power of deed, it is not God crucifying man lifestyle that was different from Christ created you, the weakness but God Crucified for man so that the one that had existed hither- of the passion of Christ recreated man can overcome pain and pleas- to, identifying pain and pleasure you, and in Luke (24-26) who says ure and live for ever in love–joy. entities perceived by the body in ‘Per crucem ad lucem’, where the Pain and pleasure acquire trans- close union with the soul (fig. 1). meaning of the cross of supreme cendent meaning when pain (al- These two types of perception powerlessness constitutes the ob- gos) is transformed into a con- constituted a new form of know- ligatory road to supreme life. John suffering (pathos) of the Crucified ing, not without anxieties. Chris- Paul II wrote: ‘Declaring the pow- Christ and, equally, the pleasure of tianity directed pain and pleasure er of salvific suffering, the Apostle the senses (edonè) is transformed towards joy. Paul says: “In my flesh I complete into a joyous con-resurrection

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(amor benevolentiae ➝ agape atomical circuit that characterises ence of pain and pleasure without ➝ Caritas-Felicitas) of the Kyri- both the nociception and the anti- attributing to each of them a per- os. We could after a certain fash- nociception (fig. 2). sonal meaning. As regards pain, ion say: ‘Patior, ergo cum Christo Herodotus observed: ‘ta pathema- sum’, in a parallelism with ‘Amo, Specifically for this reason, pain ta mathemata’, that is to say trans- ergo cum Christo sum’. Thus our and pleasure characterise the pa- forming troubles into teachings, interest relates both to pain, with rameters of the connatural because and, we may add, about love. And its appropriate treatment, and the they belong to the body, creating, in Ecclesiastes we read ‘Qui auget equilibrium of pleasure, because when they are in equilibrium, an scientiam, auget et dolorem’, that of their connection with the pas- authentic cinestesia, which is ob- is to say, ‘whoever increases his chal joy, transforming them into ligatory for experiential growth level of knowledge also increases joyous moral-spiritual transcend- and wellbeing. Pain and pleasure his suffering’. However, to have ent values. are fundamental elements in man’s a better understanding of the on- acting and precisely because they togenesis and the phylogenesis of are connatural with his very exist- pain-pleasure unity as a single pa- The Anthropological Sciences ence constitute components which rameter, which does not belongs and the Neurosciences in are needed for his completeness. only to the physical nature of the Dialogue They contribute to the harmoni- body, we are helped by the evolu- ous and integral development of tionary philum of these two clinical Pain and pleasure constitute an- the human being and constitute a entities, which belong not only to thropological categories examined reason for reciprocal integration. the body but also to the soul. In this not only by philosophy and theol- It is specifically the condition of sense, pain-pleasure unity creates ogy but also by the neurosciences. unpleasantness or pleasantness, an interpretation of the biological Here, amongst the definitions of indeed, that creates a level of the parameter that places it in harmony pain and of pleasure which have knowledge of his or her body by with the epistemological parame- appeared in the literature, those an individual that allows a clinical ter. Pain and pleasure as language proposed by us take into account researcher to interpret the physio- of the body constitute fundamental the needs of the person-man, on pathological mechanisms which and obligatory perceptions which the basis of contemporary cultur- thereby lead to a therapy that is place man in conditions that are al- al questions as well, as required certainly appropriate from a medi- ways new, for which it advisable within the field of medical science cal point of view. The perception to implement therapeutic herme- and theology. Pain and pleasure of pain and pleasure, which is in- neutics which, although diversi- are two specific physiological enti- herent in the nature of man, is so fied, tend to the single good of the ties and constitute the result of the subjective that that it constitutes person. It is only in the utility of projection of an external stimulus the epiphany of the psycho-so- this particular language, and thus which is transformed into an in- matic individuality of the person. in the conditions of similar pho- ternal input on a single neuro-an- Nobody can address the experi- netic expressions, that in pain and

PERCEption-INTEGRAtion CORTEX SOMATOSENSITIVE FIDES (Soul-Mind)

RATIO III order neuron modulation Thalamus Limbic Nucleus Accumbens II order neuron I order reception neuron traNsmission Algogenous stimulus Receptors Spinal cord Pleasurable stimulus Algo-antalgical synapsis

Fig. 2. Graph of the anatomical stations followed by pain stimulus (nociception) and pleasure stimulus (anti-nociception).

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pleasure that synthesis takes place all else for muscular pain; seroto- an opiate nature (endogenous opi- in which each man is placed in the nin; bradykinin; histamine; prosta- oids), with an action equivalent physiognomy of a true person. It is glandins (of series E); leukotriene; to that of administered medical precisely because of the character- prostacyclin; oxygen free radicals; products, for example morphine istic of perceptive uniqueness that nitric oxide, which takes part in (exogenous opioids). Knowledge pain and pleasure impress in each primary hyperalgesia; calcitonin about certain substances found in individual that doctors and health- gene related peptide (CGRP), a nature that have an opiate effect care workers should not be con- powerful vasodilator; and the sub- goes back 6,000 years, as emerges cerned so much about what kind of stances released by the fibres of from archaeological discoveries pain or pleasure are felt in that man the sympathetic nervous system. of the civilisation of the Sumer- but, rather, and above all else, what These algogenic substances can ians, the Babylonians and the kind of man feels that specific pain be released at an interstitial level Egyptians. Other chemical media- or pleasure. following an exogenous stimulus tors of the antalgical transduction Pain and pleasure are so closely (trauma) or an endogenous input are exogenous substances such connected with each other that the (lowering of the pain threshold, as, for example, cortisone deriva- verification of such an intimate for example for mental illness, as tives, which were extracted from connection is highlighted above depression can be), reducing the the adrenal cortex during the first all else in the medical field in pH and contributing to the main- years of the twentieth century and the assessment of a grave illness tenance and strengthening of the widely employed from the 1920s where a surgical operation is nec- pain (nociceptive) charge. The onwards. Local anaesthetics and essary. Obviously enough, a sur- antalgical substances are released, non-steroidal anti-inflammatory gical operation constitutes a con- in all likelihood, in the same sites drugs (NSAIDS) are substances dition of pain and of concern but where the algogenic substances with an exclusively exogenous through this therapeutic condition are released. The diversity of the antalgical action, that is to say the individual recovers a pleasure, release of the substance is inher- introduced from the outside be- that is to say healing. ent in the nature of the stimulus, cause they are not to be found whether algogenic or antalgical, physiologically in our organism. on the pre-synaptic receiving cell. It is advisable to remember that 1) Neurophysiological Aspects the founder of NSAIDS was as- pirin (acetylsalicylic acid), which Synapsis. Pain-pleasure was produced at the beginning of pathways the twentieth century; 2) some NSAIDS (paracetamol and meta- In the neuro-physiological mizole) are active on nitric oxide sphere synapsis, with the recep- (NO), whereas others (ketorolac) tors and neuro-chemical media- inhibit both nitric oxide and the tors released at an inter-synaptic prostaglandins. level, constitutes the fulcrum of Pleasurable conditions, such as every sensation relatable to pain listening to music that is liked, ad- or pleasure. We thus posit a sin- miring a fine work of art or a land- gle modulating unity of pain and scape (Zucchi, P. L., Honings, B., pleasure according to the initial Voegelin, M. R., 2005), or spiritu- stimulus. This unity has been de- al conditions, such as those made fined by us as the algo-antalgical up of a reflected-upon reading of synapsis (algogenic-antalgical) a passage from the gospel (Zuc- (fig. 3), even though the process chi, P. L., Honings, B., Voegelin, of nociceptive and anti-nocice- Fig. 3. Hypothesis of algo- M. R., 2001; 2003; 2008), tend ptive transduction at the level of antalgical (algogenic- to lower the tone of the sympa- the nociceptor remains the subject antalgical) synapis: 1) thetic nervous system in favour of study. However, it is impossible algogenic or antalgical input; 2) of an activation of the parasym- to exclude the presence of a pre- pre-synaptic receiving cell; 3) pathetic nervous system, leading synaptic receiving cell that is not inter-synaptic space; 4) release to the release of substances such in harmony with a post-synaptic of algogenic or antalgical as endorphins or dopamine. The receptive cell, as conceived by us. substances at the level of the endorphins or dopamine, which inter-synaptic space; 5) post- are also defined as pleasure sub- synaptic receiving cell. stances, are neurotransmitters that The chemical substances of activate receptor sites of an area pain and pleasure of the brain known as the nucle- The chemical mediators of the us accumbens which plays a basic The chemical mediators of the antalgical transduction (pleas- role in the transmission and mod- nociceptive transduction (pain) ure) are made up fundamentally ulation of the perception of pleas- are: lactic acid, hydrogen ions of the family of encephalins, en- ure and pain, as is also argued by (H+) and potassium (K+), all three dogenous substances, that is to other researchers (Zubieta, 2007). of which are responsible above say secreted by the organism, of

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Pathways of pain-pleasure gical substances that stimulate the It is therefore advisable to unity apparatus of reception (peripheral stress that the organs of transmis- nociception or anti-nociception) sion (receptors, synapsis, spinal From a neurophysiological point which transforms the stimulus in- pathways, sub-cortical and corti- of view, pain, like pleasure, are to a painful or pleasurable input cal centres) must be seen, above due to the activation of receptors, which, through the first-order or- all, as instruments of the neuro- of algo-antalgical synapsis and of der neuron reaches the spinal cord modulation of the final percep- shared peripheral and central af- (reflex nociception or anti-nocice- tion, made up of pain and pleas- ferent pathways which constitute, ption); at this level the first-order ure, which constitutes the most according to the stimulus, whether neuron enters into synapsis with important sensations of our lives. painful or pleasurable, nociception the second-order neuron which Precisely because it is a sensa- (pain) or anti-nociception (pleas- informs the thalamus (uncon- tion experienced by the body, the ure) (fig. 2). scious nociception or anti-noci- physiological experience of pain and pleasure belong to medicine both as a physiopathological in- Neuro-anatomical Substratum Clinical Substratum terpretation and as a therapeutic finality of illness and therefore Soul = Mind Conscious Nociception of state of health. However, giv- Fides Cortical-Mental- en that the soul is one with the = Spiritual pain soul, pain and pleasure, when per- ceived by the body, can rise to the conscious Anti-Nociception transcendent entity of the paschal Ratio Cortical-Mental- joy, creating an ontological nex- Cortex Spiritual Pleasure us, that is truly inseparable, be- tween them. In this medical-theo- logical integrated anthropological Limbic system interpretation the two corpore- Unconscious Nociception al physiological entities create a Nucleus Accumbens Emotional-Sub-Cortical Pain new clinical, moral and spiritual Brian Stem = Unconscious Anti-Nociception acquisition in the field of the neu- Emotional-Sub-Cortical Thalamus Pleasure rosciences and moral theology. and Hypothalamus To deny this new value entity of pain and pleasure because of their close connection with the soul, for man in a state of grace, Reflex Nociception Referred-Visceral-Parietal would truly be a grave deviation Pain of a moral and spiritual character. Spinal column = Reflex Anti-Nociception Referred-Visceral-Parietal From the Ordo Creationis Pleasure to the Ordo Redemptionis: the Theological-Moral Aspect

Moral discourse on pain and Peripheral Nociception Peripheral Receptors Peripheral-Receptor Pain pleasure begins with the concept = that they can be compared to the Peripheral Anti-Nociception passions. They belong, like the Algo-Antalgical Synapsis Peripheral-Receptor passions, to the human and Chris- Pleasure tian inheritance; they are natural components of the human psychic life and are a link and assure the Fig. 4. Different kinds of nociception (pain) and anti-nociception connection between the life of the (pleasure) with the corresponding neuro-anatomical substratum. senses and the life of the spirit. They are emotions or movements A receptor is a structure that is ception). From the thalamus the of the senses that lead to act or not transformed into an electric phe- third-order neuron projects the to act in view of what is felt or im- nomenon, that is to say a sequence painful or pleasurable input to the agined as being good or bad.4 But, of action potentials, thermal ener- somatosensory cortex (conscious and this is what interests us, like gy, mechanical energy, chemical nociception or anti-nociception) the passions, the perceptions of energy and light energy. The algo where the synapsis is actuated be- pain and pleasure in themselves or antalgical stimulation creates tween the mind and the soul in a are neither good nor bad. They re- at the level of the organism an an- harmonious and reciprocal lan- ceive a moral qualification to the atomical condition of tissues with guage, for man in gratia, between extent that really depend on rea- the release of algogenic or antal- ratio et fides (Fig. 2-4). son and the will. However great

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may be the feelings of pain and agony and passion. In Christ hu- ‘fill your minds with those things pleasure, it is not they that decide man feelings are able to reach that are good and deserve praise: morality and even less the holi- their consummation in charity things that are true, noble, right, ness of people who suffer and who and divine beatitude’.5 This moral pure, lovely and honourable’ (Phil enjoy. Pain and pleasure are mor- perfection, and this is determin- 4:8). Indeed, the subject of analy- ally good when they contribute to ing, lies in the fact that man is not sis is following the itinerary of the a good action and are spiritually induced to good only by his will transformation of pain and pleas- sanctifying, when they participate but also by his sense appetite, ac- ure from immanent meanings into in the paschal mystery. They be- cording to the words of the psalm: transcendent spiritual and moral come moral values when they are ‘My heart and flesh sing for joy to values. Being morally neutral en- a part of the behaviour and spir- the living God’ (Ps 84,2).6 In our tities, the point of departure is the itual of a Christian life be- integrated medical-theological concept of virtue which, indeed, cause in that case pleasure is in anthropological vision these two has a moralising function. Indeed, harmony with a prudent temper- physiological entities are, from a ‘A virtue is an habitual and firm ance and pain is in harmony with moral point of view, neutral per- disposition to do the good. It al- a prudent fortitude and both take ceptions. lows the person not only to per- part, through love, in the paschal Thus, so that these entities can form good acts, but to give the joy. In this way, pain and pleas- take part in the joy of the paschal best of himself. the virtuous per- ure constitute not only an entity of mystery and become transcendent son tends toward the good with all moral values and spiritual growth value entities of the moral order his sensory and spiritual powers; but are also valuable therapeutic and the spiritual level, we propose he pursues the good and chooses it supports for health and the har- the medical-theological passage in concrete actions’.11 One of the mony of the body-soul unity of described in figure 6. great Greek Fathers, St. Gregory the human being. of Nyssa, dared to state: ‘The end The unpleasant or pleasant in- of a virtuous life lies in becoming put of the periphery reaches the Pain and Pleasure: from similar to God’.12 However, for nucleus accumbens and the lim- (Physiological) Immanent the moment we will dwell upon bic system where a first integra- Meanings to (Spiritual) the human virtues whose function tion is worked through above all Transcendent Values at an individual level is to restore else by the hypothalamus (the intra-personal harmony and at a most important part of the limbic To approach at its roots this social level to restore inter-per- system). Indeed, in the hypothal- passage of values we must bear sonal harmony. Indeed, ‘Human amus the perception of pain and in mind that ‘God ‘willed that virtues are firm attitudes, stable pleasure, according to the intensi- man should be left in the hand of dispositions, habitual perfections ty of the initial stimulus, is trans- his own counsel’ (Sir. 15:14), so of intellect and will that govern lated into an activation either of that he might of his own accord our actions, order our passions, the parasympathetic nervous sys- seek his creator and freely attain and guide our conduct according tem (designed to recover energy) his full and blessed perfection by to reason and faith. They make or of the sympathetic nervous sys- cleaving to him’.7 Free action be- possible ease, self-mastery, and tem (designed to activate energy). longs to man as a man8 and makes joy in leading a morally good life. From the hypothalamus the input him a moral individual. Chosen the virtuous man is he who free- reaches the cortex already modi- on the basis of a judgement of ly practices the good. The moral fied and there the final integration conscience, the free acts of man virtues are acquired by human ef- is actuated, which gives rise to are morally definable: they are fort. They are the fruit and seed of the definitive sensation of pain or good or they are bad.9 God gave morally good acts; they dispose of pleasure, perceived by the in- man this power to act or not to act all the powers of the human be- dividual, which becomes, for the and to engage in his own free ac- ing for communion with divine believer, an internalised entity ef- tion so as to adhere to Him and love’.13 Of the virtues, four are fected by the soul (fig. 2). When reach blessed perfection. The called ‘cardinal’ virtues because algos, pathos, amor amicitiae CCC observes: ‘The human per- all the other virtues are grouped (philia) and felicitas are fused in a son is ordered to beatitude by his around them. They are: prudence, virtuous lifestyle, pain and pleas- deliberate acts: the passions or justice, fortitude and temperance. ure can no longer deviate, either feelings he experiences can dis- Now, given that it is the task per eccessum or per defectum be- pose him to it and contribute to of these virtues to transform the cause these two physiological en- it’.10 Thus, and this is what it is physiological entities of pleasure tities by now form a part of an or- interesting to observe, the physi- and pain into transcendent mor- der of transcendent spirituality. ological perceptions of pain and al values we will dwell first up- The CCC confirms this paschal pleasure can not only dispose and on temperance for pleasure and approach when it teaches us that: contribute but do really dispose then upon fortitude for pain. It ‘In the Christian life, the Holy and contribute to adhering to God should also be observed, because Spirit himself accomplishes his and to reaching, through free acts, this is very important, that both work by mobilizing the whole be- blessed perfection. We feel our- these virtues require, to be moral ing, with all its sorrows, fears and selves moved more than ever be- virtues, their form, which is pru- sadness, as is visible in the Lord’s fore by the warning of the apostle: dence.

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The Cardinal Moral Virtue of the Sermon on the Mount he gave sexuality into a transcendent spir- Temperance and Pleasure a rigorous interpretation of the itual value and sexual pleasure projects of God: ‘You have heard into a transcendent moral value. A classical dictum proclaims in that it was said, ‘Do not commit The CCC teaches that under the medio scientiae stat definitio, that adultery’. But now I tell you, an- influence of chastity, sexuality is to say, he who understands the yone who looks at a woman and appears a school of giving of the description of the subject already wants to possess her is guilty of person. Self-mastery is ordered possess what he can or wants to committing adultery with her in to self-giving. Chastity makes he know. For this reason, this is the his heart’ (Mt 5:27). Man should who practises it a witness, to his definition of temperance: ‘the not separate what God has put neighbour, of the faithfulness and moral virtue that moderates the together (cf. Mk 19:6). Now, the tenderness of God.22 The virtue of attraction of pleasures and pro- tradition of the Church, follow- chastity indicates to the vides balance in the use of cre- ing the interpretation of Jesus of how to follow and imitate he who ated goods. It ensures the will’s the seventh commandment, and chose us as his friends (Jn 15:15), mastery over instincts and keeps here we enter in medias res, has who gave himself totally to us desires within the limits of what seen the whole of human sexual- and makes us participants in his is honourable. The temperate per- ity and thus also the physiological divine condition. Then arranged son directs the sensitive appetites entity of sexual pleasure as incor- and cultivated as true friendship toward what is good and main- porating.17 Chastity thus becomes both between people of the same tains a healthy discretion: “Do the virtue that transforms sexual- sex and between people of differ- not follow your inclination and ity into a transcendent moral and ent sexes, chastity constitutes a strength, walking according to the spiritual value. ‘Chastity means great good for everyone because desires of your heart.” (Sir 5:2)’.14 the successful integration of sex- it leads to spiritual communion. 23 Here we have clearly expressed uality within the person and thus We now introduce a moral re- the moral value of the virtue of the inner unity of man in his bod- flection on sobriety and the pleas- temperance as regards the value ily and spiritual being’.18 ‘The ure of food. It is therefore very of pleasure. As a physiological chaste person maintains the in- important to dwell, first, upon a entity, pleasure is not, therefore, tegrity of the powers of life and medical-dietary reflection on ali- to be avoided or even less to be love placed in him. This integrity mentation. prohibited but, rather, it should ensures the unity of the person; it be transformed into a moral value is opposed to any behaviour that with a uniquely immanent value. would impair it. It tolerates nei- Pleasure, Pain and In moderating the use of good, ther a double life nor duplicity in Alimentation. Medical Aspects created pleasure, physiological speech’.19 To remove any misun- pleasure, becomes a moral val- derstandings, two aspects should Diet enrichment with certain ue because it is ordered to good. be made clear. The first to indi- substances, for example chocolate Thus the virtue of temperance as- cate that chastity marks out peo- containing high does of cocoa, sures temperate man the enjoy- ple in their different states of life. sweets, spicy foods containing ment of the goods created in an Some profess virginity or conse- pepper (capsaicin) and recently honest and licit way from a moral crated celibacy, an eminent way water as well,24 provoke pleas- point of view. Temperance is of- of giving themselves more easily ure and create the conditions for ten praised in the Old Testament: to God alone with an undivided the release of antalgical substanc- ‘Do not follow your passions, heart. Others live in the way pre- es and therefore the formation of place a check on your desires’ (Sir scribed for all by the moral law, physical-chemical energy which 18:30).15 In the Old Testament it is whether they are married or sin- promotes the raising of the physi- called ‘moderation’ or ‘sobriety’. gle. Married people are called cal threshold (algos) and mental We ought ‘to live sober, upright, to live conjugal chastity; others threshold (pathos) of pain. It is and godly lives in this world’ (Ti practise chastity in continence.20 advisable to emphasise that cocoa 2:12). Examining sexual pleas- The second aspect that should be is the food with the highest con- ures, we introduce the virtue of made clear is to remove the preju- tents of flavonoids and polyphe- chastity, as an instrument of the dice of a certain phobia, and em- nols (a class of anti-oxidant sub- moral value transformation of phasises that sexuality, in which stances against pain) and the more pleasure itself. Chastity, indeed, is expressed man’s belonging to chocolate is bitter the higher is its is closely dependent on temper- the material and biological world, concentration of cocoa. At an ex- ance which seeks to govern the becomes personal and truly hu- perimental level it has been seen passions and the appetites of the man when it is integrated into that these foods, acting on the ra- human senses by reason.16 the relationship of a person with phe magnus which is located in a person, in the total and lifelong the brain stem, once the pain path- mutual gift of a man and a wom- way has been defined, reduce the Chastity and the Moral Value an. Thus the virtue of chastity in- response of a mouse to a hot stim- of the Pleasure of Sexuality volves the integrity of the person ulus. It has also been observed and the integrality of the gift.21 that in chronic migraine pain a di- Jesus came to restore the crea- To summarise: chastity empow- et based on maize, and thus one tion to the purity of its origins. In ers the sexed person to transform poor in an antalgical substance,

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tryptophan, lowers the threshold gral part of his organism; and the briety. ‘Directed towards the pas- of the perception of pain, whereas humours of which this is made up chal joy following the footsteps a single injection of L-tryptophan are transformations of the foods of Christ the Lord we follow the can eliminate pain hypersensitivi- and drinks that have been ingest- austere journey of Holy Lent… ty, returning to a condition of nor- ed’. Here, one can point to au- may the table be spare and frugal mality and thus also of pleasure. thentic dietary rules and habits of and speech and the heart sober’.25 The cerebral levels of tryptophan life with an antalgical therapeu- This text from the liturgy of Lent, depend on the quantity of trypto- tic function that lead to a condi- and this is what now interests us, phan present in the blood which tion of satisfaction and pleasure. proposes to us a lifestyle that is derives from the metabolism of They are: 1. the taking of carbo- able to transform the antalgical the proteins of our diet. How- hydrates as 60% of total calories; therapeutic value of dietary rules ever, for a feedback mechanism, 2. the limited taking of proteins and habits of life into moral val- after the abundant taking of pro- (15% of total calories); 3. the tak- ues. tein substances there is a decrease ing of fruit, vegetables, brown in tryptophan at a cerebral level. bread and cereals rich in fibre; 4. This phenomenon is explained by an increase in the consumption of Sobriety as a Moralising the presence in a diet with a high liquids (2-4 litres of water a day); Lifestyle and Immoderate protein content of other amino ac- 5. a low consumption of carbo- Pleasure in Eating: Theological ids (tyrosine, phenylalanine, leu- hydrates before going to sleep; 6. Aspects cine, isoleucine, valine) that enter controlling calorie intake so as to into competition at the level of the obtain the ideal body weight; 7. a ‘Thus a great deal of education- cerebral receptors with the trypto- limited consumption of caffeine; al and cultural work is urgently phan. After a meal, however, with 8. the taking of pluri-vitamin needed, including the education a high carbohydrate content, the compounds and mineral salts; 9. of consumers in the responsible levels of tryptophan at the cer- the taking of supplements based use of their power of choice, the ebral level are high because the on: tyrosine, lecithin, choline, d- formation of a strong sense of re- insulin, secreted by the pancreas, phenylalanine, d-leucine, cyano- sponsibility among producers and in response to the carbohydrates, cobalamin, pyridoxine, ascorbic among people in the mass media lowers the levels of the other ami- acid, folic acid, carnitine; 10. the in particular, as well as the nec- no acids compared to the trypto- taking of 1 gr. of L-tryptophan be- essary intervention by public au- phan. It should also be empha- fore sleeping; and 11. the taking thorities…the decision to invest sised that eating pleasing foods of 60-100 mg. of vitamin C every in one place rather than another, stimulates the release of beta-en- day. in one productive sector rather dorphins which improve mood These rules are optimal for the than another, is always a moral and create pleasure. On the other organism so long as the regulation and cultural choice’.26 When ad- hand, conditions such as smoking, of the production of leptin by the dressing the great planetary prob- drinking excessive doses of alco- adipose cell takes place normally. lems of globalisation – develop- hol, being exposed excessively to Indeed, as one can read in the well ment, peace, hunger – Pope Karol polluting agents or the sun, taking organised work by Carlo Manfre- Wojtyla laid stress upon the ur- excessive doses of food contain- di which appeared in the review gent need to construct appropri- ing tyramine (fermented cheese, Toscana Medica (2010), leptin, ate lifestyles at a personal and tomato sauces, smoked or pick- which is produced by the adipo- social level. We will confine our- led fish, yeast, sausages, liver, cyte in response to an increase in selves to the sobriety of pleasure caviar, avocado pear, raspberries, the fat mass in individuals with a and eating, proposing a lifestyle beer), or taking excessive doses normal weight, has an anorexi- according to the virtue of sobri- of foods that release histamines genic role inasmuch, in acting in ety which we believe to be the (strawberries, peaches, tomatoes, the mesencephalic ventral teg- most appropriate. Sobriety cer- eggs), provoke in our organism mental area, it causes an increase tainly has an economic meaning a notable release of free radicals in dopamine in the nucleus ac- but first of all, and above all else, which are the principal elements cumbens and a consequent reduc- it is has a marked anthropologi- responsible for the processes of tion in the feeling of hunger. In an cal value. Indeed, in this virtue is ageing, above all of the skin, for obese individual, unfortunately, expressed a concern for the other the establishment of cardiovascu- there is a disorder in the produc- because a ‘self’ that is conscious- lar disease, for painful illnesses tion of leptin which involves a re- ly sober wants to ‘share’, refusing and even for cancer. From these duction of the level of dopamine the inebriation of consumption, observations one can understand in the nucleus accumbens with a accumulation and possession. A how important a correct lifestyle consequent increase in the feeling sober man is thus a ‘self’ respect- is for the good health of the body of hunger. Beyond these aspects ful of the limits of the pleasurable and the soul. Mens sana in cor- of an organic nature of a quin- created goods of eating, drinking, pore sano, Hippocrates rightly tessentially dysendocrinal char- clothes and entertainment. A so- said, and he also stated that ‘the acter, in eating one should, how- ber lifestyle thus involves impor- cosmos penetrates man with air, ever, adopt a lifestyle that brings tant anthropological dimensions with drinks and with foods, all us back to the virtue of temper- that are human, moral, cultural, substances that become an inte- ance and more specifically to so- economic and political. This is

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why a Christian and every man Scientific Reflections on the because of the absence of pain re- of good will cannot abandon the Relationship between Pain and ceivers (nociceptors). However, ethical foundation of living at a Pleasure there is no animal species, from personal and social level.27 In this the protozoa to man, that does not sense, sobriety restores intra-per- Scientific research has tried to have a system of a signalling of sonal harmony and thus also inter- highlight the relationship between harmful conditions and in which personal and cosmic harmony. In- pain and pleasure through studies there is not also present a system deed. A sober person is a balanced on animals. In our view, however, for the inhibition of pain. In man and harmonic ‘self’ because in it should be emphasised that the the origin of the pathway of pain his or her choices of pleasurable experiments carried out on ani- is constituted in classic terms by goods he or she is ordered to true mals in the neurophysiological, the nociceptor and the nerve fi- moral good. Sobriety does not neuropharmacological or neuro- bres of a small diameter, A-delta condemn, therefore, the moder- surgical fields cannot be related mylins and C amylins, which can ate use of alcohol but, rather, its directly to man without falling be countered by A fibres which abuse. Alcoholism creates addic- into errors of quantitative and have a large diameter. It is from tion, obfuscates the conscience, qualitative analysis, even taking the balance that is established be- and at a chronic stage produces into account, as an obligation, the tween the fibres with a small di- grave injury to the organism and difference between man and ani- ameter and those with a large di- the mind.28 The same applies to mals. ameter in favour of the last that tobacco because ‘the ethical un- the pain stimulus does not man- lawfulness is not in its use but in 1. Clinical-Experimental Aspects age to proceed beyond the spinal its abuse. At the present time it is cord and reach the higher centres, established that excessive smok- In animals, behavioural stud- as is highlighted in the gate con- ing damages the health and caus- ies are important because they are trol theory of Melzack and Wall es dependency, This leads to a op- more relatable to man. Indeed, (1965) (fig. 5). pressive lowering of the threshold from the theory of conditioned re- The representation of nocic- of abuse’.29 The virtue of sobrie- flexes of Pavlov one deduces that eption and anti-nociception, in a ty also forms a ‘self’ attentive to in the realm of animals pleasure more modern vision (figs. 2, 4) the needs of the other, very con- coincides with the positive forms can be identified in a single sys- cerned about his or her material, of behaviour linked to reward and tem which modulates perception moral and spiritual needs. And in man with the results that are of pain and pleasure and which even more important, the virtue of obtained linked to a strong mo- we could define as the algo-anta- sobriety does not construct only a tivation, whereas pain is linked lgical system. We have posited in lifestyle that shapes the identity to negative forms of behaviour a clinical-theological paradigm and the otherness of a person but with injury sustained during the the development of the concept of also constructs a lifestyle respect- course of the experiment. Pain the entities of pain and pleasure ful of the cosmos, of nature, in or- for all animals constitutes a phy- in their different typologies and der to cooperate in promoting a logenetic defence in the absence with their corresponding anatom- sustainable world able to promote of which each individual and the ical-clinical equivalents, which the common good, that is to say species as a whole would be des- best contextualises not only pleas- that set of conditions of social life tined for extinction, as occurs in ure but also and above all else the that allow the achievement of true congenital analgothymia where close relationship between this en- integral progress, that is to say of the individual dies at a young age tity and the entity of pain (fig. 6). every man, of the whole man and of all men.30 However, to choose such a lifestyle marked by sobrie- central control ty, the life of every person should be structurally linked to the so- cial system that he or she would like to change. 31 For that matter, gate control system this lifestyle corresponds to the full to the design of the Creator: L ‘In God’s plan man and woman have the vocation of “subduing” action GS the earth as stewards of God. This gate T system sovereignty is not to be an arbi- trary and destructive domination. God calls man and woman, made in the image of the Creator “who S loves everything that exists”, to share in his providence toward other creatures; hence their re- sponsibility for the world God has entrusted to them’.32 Fig. 5. Gate control theory of Melzack and Wall (1965).

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Neuroanatomical Sub-Stratum Clinical-Theological Sub-Stratum

ordo redemptionis

i p p caritas-felicitas pathos n e n Transcendent Love Transcendent Pain t r e e c u Modulating g e Somatosensitive m Pathema Agape r p a Modulating Cortex Love a t Pain t i amor AMOR benevolentiae AMICITIAE i o SUN-Patheia EN-Patheia Shared (Philia) o n Shared Entrance Love Interdialogic n Suffering into the pain Mental Love of another

ordo creationis

M Limbic System p Emotional Pleasure Emotional Pain O Nucleus Accumbens s (Sub-Cortical) (Sub-cortical) D Y U c L Brain Stem h SUN A e amor AMOR algos Patheia T concupiscientiae BENEVOLENTIAE I Thalamus Physical Shared O Physical Shared Pain Suffering N Love Love Hypothalamus

T s Perceptive Pleasure Perceptive PAIN R o (Physical Sense) (Physical Sense) A m N a Amor S Spinal Column M eros concupiscientiae Agon Algos I S Sense Physical Sense Physical S Love Love pain pain I O N VOLUPTAS POENA

r s Peripheral Pleasure Peripheral pain e a (Receptor) (Receptor) c r e Peripheral x p Receptor t edoné VOLUPTAS algia poena i Pleasurable Pleasurable Painful Painful o (Pain-Pleasure) n Physical Functional Physical Functional Perception Perception Perception Perception

Anti-Nociception Nociception (Pleasure) (Pain) Fig. 6. Development of the concept of the entities of pain and pleasure from an immanent parameter to a transcendent value. A clinical-theological paradigm (read in an ascending vertical sense).

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On can, indeed, observe that at modulating pain (pathema) leads old of total, physical, mental and the level of the peripheral receptor to transcendent pain (pathos). spiritual pain. (reception) is gathered the pleas- From a clinical point of view, In Christ in the Garden of Geth- urable (edonè) physical percep- sun-patheia and en-patheia can semane, through a (direct) im- tion (sarx) which is transformed be identified with the burn-out mediate empathetic relationship into a pleasurable functional per- syndrome, which is so frequent with God the Father and in, high- ception (voluptas). On the other amongst health-care workers. ly suffering, everyman, through hand, the same receptor can func- Pain and pleasure can be identi- prayer (indirect-mediated empa- tion in an algic way, transforming fied as value entities in the phe- thy) were created the conditions the painful physical perception nomenon of empathy. for the assimilation of God in the (algia) into a painful functional pain of His son man-Christ and in perception (poena). Passing from Empathetic Pain and the pain of everyman. Just as in this first receptor level, represent- Pleasure: Theological the dying Christ were created the ed by the reception of a pleasura- Aspects conditions for a more serene pas- ble or unpleasant stimulus (recep- sage to the Father, so in everyman tion), one comes to a second level Empathetic Pain of the the conditions were created for which is the ascendant pathways Man-God the more dignified bearing of pain of the spinal cord (transmission). The term ‘empathy’ comes from above all when this entity takes These nerve clusters transport the Greek empatheia (en=inside; place at the end of life. the pleasurable impulse consti- pathos=suffering, feeling) as an tuted by the conditions that are expression of the assimilation of The Empathetic installed in sensorial love (eros) the suffering of others without, Pleasure (Joy-Happiness) which is transformed into physi- however, experiencing it in the of the God-Man cal love (amor concupiscientiae), first person. The capacity of the creature to and in the case of pain they trans- From a theological point of empathise with the happiness of port the nociceptive impulse con- view, we can state that God, who his own Creator stituted by the conditions that are became a man like us, made Him- God, through current grace, installed in sensorial pain (agon), self capable of empathy in Jesus transforms sense pleasure in man in physical pain (algos), at the of Nazareth in and each man. into spiritual joy, and man be- level of the body (soma). From a clinical point of view, comes a creature capable of em- The third level (psyche) is the this empathetic relationship in pathy with the happiness of his modulation of the pain and pleas- Christ-man, the praying-suffering own creator, like Jesus in the Fa- ure input which is actuated at the man and God creates the condi- ther on the day of the Resurrec- level of the hypothalamus, the tions for the raising of the thresh- tion-Ascension. thalamus, the brain stem, the nu- cleus accumbens and the limbic system. In these anatomical lo- god cations is actuated (sub-cortical) immediate mediated empathy emotional pleasure and pain which empathy by prayer for pleasure are made up of physi- (direct) cal love (amor concupiscientiae) which can become benevolent Equivalence of Pain love (amor benevolentiae) and for pain is made up of physical pain Pain Pain (algos) which can become shared of Christ-man of every man suffering (sun-patheia). The fourth level (pneuma) is Fig. 7. Interpretation of the empathetic pain of God-man. made up of the integration-per- Capacity for empathy of God in the pain of Christ-man and the ception of pain and pleasure which pain of everyman. is actuated in the most noble ar- ea of the central nervous system made of the somatic-sense cortex. GOD (Creator) At this level is actuated for pleas- ure the internalisation of shared Current grace Capacity for empathy physical love (amor benevolenti- ae) which is transformed into in- ter-dialogical mental love (amor amicitiae-philia) which through modulating love (agape) leads sense pleasure SPIRITUAL JOY to transcendent love (caritas- of man of man (creature) felicitas).­ For pain, shared suffer- ing (sun-patheia) is transformed Fig. 8. Interpretation of the empathetic pleasure of God-man. into assimilation of the pain of the The capacity for empathy of the joy of the creature with the other (en-patheia) which through happiness of his Creator.

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2. Neurological Aspects which contribute, therefore, the carry out a good action is an ethi- cerebral, cortical and sub-cortical cal act for the person who engag- From a neurochemical point structures. es in it and a therapeutic one for of view, the release of endoge- the person who receives it. Indeed, nous opioids (endorphins) joint- 3. Integrated Clinical-Theological every time that we caress someone ly works to neutralise pain. The Aspects who is ill we obtain for him or her link between these substances and relief from physical pain and mor- their receptors constitutes the neu- ‘Endowed with a spiritual soul, al suffering. Contact with the oth- rochemical basis for the specific with intellect and with free will, er and good action not only has a sensation that we define as pleas- the human person is from his very moral value but can also constitute ure, identified by us neuroanatom- conception ordered to God and an interpretation of the ontogenet- ically in the antalgical synapsis. destined for eternal beatitude. He ic meaning of our being. Embryol- The opioids, indeed, are substanc- pursues his perfect in ‘seeking and ogy, on this point, comes to our aid es endowed with a euphoria-in- loving what is true and good’.33 To in explaining the physiopathologi- ducing effect and possess an anal- gesic effect, that is to say one that Cingulate gyrus blocks painful sensations. Mor- phine, which comes from opium, Fornix is known for its powerful analge- Septum sic effect, for its anxiolytic proper- ties and for generating sensations of pleasure. As a remonstrance as regards these ‘pleasurable’ condi- tions there is a weighty population of morphine addicts, people who Prefrontal abuse it. The endorphins produced cortex by the cerebral neurons or secret- ed by certain endocrinal glands have the specific function of being Nucleus the chemical neurotransmitters of accumbens pleasure, automatically raising the pain threshold of pain and there- Olfactory fore creating a close relationship bulb between the two sensations of Hypothalamus pain and pleasure. The limbic sys- tem is important for the pleasur- Amygdala Mamillary able or unpleasant emotions. This Hippocampus system is localised in the antero- bodies medial face of the telencephalon made up, on the medial part of Fig. 9 . The anatomical structures that make up the limbic system. the temporal, parietal and frontal lobe, areas that form a continuous Exteroceptive centres strip of the cortex in a circle (lim- bic means circular) of grey and white structures that constitute the internal part of the cerebral hemi- spheres located around the corpus callosum and the third ventricle; the gyrus of the corpus callosum; the hippocampus; the parahip- pocampal gyrus; the amygdala; the nuclei of the septum; the nu- cleus accumbens; the basal nuclei of the proencephalon and of the hippothalamus; the anterior tha- lamic nuclei; and the back-medi- al nuclei of the thalamus. Of all these structures the hypothala- mus, the hippocampus, the amyg- dala, the nucleus accumbens and the prefrontal cortex have a fun- damental role in the limbic system Fig. 10. Schematic portrayal of the spinal cord and more in particular (fig. 9) in the perception of sensa- of the head of the posterior horn, the seat of the exteroceptive centres tions such as pain and pleasure, to where the painful or pleasurable inputs, collected by the skin, arrive.

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cal mechanism of the phenomenon able event. This condition should cilitates growth. As proof of this, defined by us as the ‘caress effect’. not in the least be underestimated indeed, the skin or the epidermis The caress effect is the result of because it constitutes, for exam- which covers the whole of the hu- a psycho-physical positive reac- ple, in the paediatric-clinical field, man body does not only have the tion that each individual has when when a neonate is underweight, a function of external microbiologi- he or she encounters a pleasur- neuro-sensorial stimulus that fa- cal defence but also constitutes a nerve interface between the exter- nal part and the internal part of the body itself. To have a better under- standing of this physiological con- cept, one has to refer to an ontoge- netic concept, emphasising that in an embryological sense the skin derives from the same little sheet of the embryo called the ectoderm, just like the structures of the cen-

Meissner’s corpuscle tral nervous system and the pe- Touch ripheral nervous system. Here we would like to make a clarification. The skin is made up of two strata: the epidermis and the derma. The stimuli gathered by the Pacini’s corpuscle Pressure skin reach a particular area of the spinal cord (fig. 10), and more specifically the head of the pos- terior horn, the centre of the spi- nal cord as regards exteroceptive

Ruffini’s corpuscle stimuli of the skin, to then arrive heat at the highest stations of the cen- tral nervous system (the hypothal- amus and cortex, fig. 11).

Some neurobiologists, on the krause’s corpuscle cold basis of electro-physiological studies, tend to emphasise the re- lationship between the various layers of the skin and some areas of the nervous system. The skin, or epidermis, can be, therefore, Free terminations Pain/pleasure (nociceptors) (needle) (caress) made up of 1) the horn layer and 2) Algo-antalgical synapsis Receptors Stimuli granular layer correlated with the cortex; 3) the spinal layer correlat- Fig. 11. Anatomical portrayal of the stimuli, the receptors, the pathway ed with the limbic system; and 4) and the modulating centres of the perception of pain-pleasure. the basic layer correlated with the encephalic trunk. In this last lay- er, above all else, are located the Corneal layer CORTEX polymodal receptors (which are sensitive to the various levels of Granular layer CORTEx pressure and temperature: Pacini’s epidermis corpuscles: pressure: Ruffini’s (Ectoderm) Spinous layer LIMBIC system corpuscles and Krause’s corpus- cles: temperature +/-; Meissner’s corpuscles: touch) and the recep- Basal layer brain stem skin tors that modulate the perception (polymodal receptors) of pain/pleasure (fig. 10-11).

The other layer, made up of the skin underneath the epidermis, is derma Corresponds to the sub-cutaneous tissue the derma, which in embryologi- (Mesoderm) containing: (Mesoderm) sweat glands, cal terms has a mesodermic origin, sebaceum, minuscule hair erectors, made up of sub-cutaneous tissue Adipose cells which contains the sweat glands, the miniscule erectile muscles of Fig. 12. Schematic portrayal of the constituents of the skin. hairs (fig. 12).

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The function of the skin can be chastity in relation to the attrac- moves to rest and through death compared to that of the eyes and tion of the sexual pleasures, and one obtains life, given that he the ears. Indeed, just as the eyes to achieve the restorative trans- took upon himself the weakness- and the ears transport the visual or formation of temperance in rela- es of our condition, and we, too, hearing inputs from the outside to tion to the pleasures of food, one if we persevere in profession and the inside of the encephalon in or- needs a strong spirit. However, love of him will attain the same der to be integrated at the various to overcome aggressive resist- victory and achieve the prize that cortical and sub-cortical levels, ance to pain we also need, and is promised. Thus both to ob- so the skin transports the sensa- even more, a strong spirit. In a serve the commandments and to tions of the external world to in- few words, we need the appropri- bear troubles, may there always side the encephalon. The skin, or ate cardinal moral virtue of for- ring out in our ears the voice of epidermis, with the layers that are titude. This is because ‘Fortitude the Father who says: ‘This is present within it, constitutes an us the moral virtue that ensures my own dear son, with whom I accessory nervous structure con- firmness in difficulties and con- am pleased. Listen to him’ (Mt nected to the various levels of the stancy in the pursuit of the good. 17:5).35 But what does this tell central nervous system, above all It strengthens the resolve to resist us? All of the riches of my life of the cortex, with which it shares temptations and to overcome ob- are destined to every man and the same embryological origin stacles in the moral life. The vir- constitute the possession of eve- (ectoderm) (fig. 12). On the basis tue of fortitude enables one to ryone. I have not lived for myself of what has been said hitherto, we conquer fear, even fear of death, but from the Incarnation for you can define the skin and the brain and to face trials and persecu- men and your salvation, and un- as two ectodermic twins. tions. It disposes one even to re- to my death for your sins (cf. 1 From a clinical point of view it nounce and sacrifice one’s life in Cor 13:5); I rose again for you to is right to point out that a pleas- defence of a just cause. ‘The Lord put right with God (cf. Rm 4:25). urable tactile sensation, like that is my strength and my song.’ (Ps And also now I am your advocate produced by a caress, a pleasura- 118:14). ‘In the world you have with the Father (cf. 1 Jn 2:1) ‘be- ble stimulus through hearing, like tribulation, but be of good cheer, ing always living to intercede’ on that produced by listening to mu- I have overcome the world’ (Jn your behalf (Heb 7:25). With eve- sic that is liked, or a visual stim- 16:33)’.34 It is true that this def- rything that I have lived and suf- ulus that is equally pleasurable, inition brings out how the trans- fered for you once and for all, I like that produced by appreciat- forming function of the virtue of remain always ‘on your behalf in ing a fine work of art, whether a fortitude can lead us to the high- the presence of God’ (Heb 9:24). painting or a sculpture, or a spir- est level. And yet, and this is pre- 36 This is why, and this is the ba- itual stimulus, represented by the cisely what interests us, the virtue sic reason for the transformation dialogical relationship between of fortitude refers us back to con- of the medical meaning of pain God and man, through prayer, fidence in being able to take part and pleasure into transcendent raises the threshold of physical in the paschal victory of Christ, moral and spiritual values, all the pain (algos) and mental pain (pa- that is to say in the transforma- members must strive to conform thos), producing a condition of tion of pain and pleasure into the to him so that in them ‘Christ’s the perception of pleasure (Ratz- moral and spiritual transcendent nature is formed’ (Gal. 4:19). inger, J., Bertone, T., 2000; Zuc- values of paschal joy. Indeed, the To achieve this likeness, we are chi, P. L., Honings, B., Voegelin, paschal mystery transformed pain taken up his suffering and suffer M. R., 2001, 2005). In opposite and death on the Cross into the with him so as to be glorified with conditions, whether physical or victory of the Resurrection and him’.37 mental, caused by an unpleas- the joy of the Ascension to heav- ant stimulus, they will create a en, so as to sit at the right hand of perception of pain, because of a the Father. The Prophet Nehemi- Conclusion threshold notably lowered in an ah proclaims: ‘This day is holy to algical sense. the Lord your God, so you are not In our integrated medical-theo- to mourn or cry…Today is holy logical anthropological vision we to our Lord, so don’t be sad. The started from the clinical fact that The Virtue of Fortitude and joy that the Lord gives you will pain and pleasure are two entities the Relationship of Pain and make you strong’ (Nem 8:9,10). that are closely connected. Pre- Pleasure And St. Leo the Great says in one sent and impelling in the human of his discourses: ‘The proclaim- organism, they play a fundamen- The ethical aspect of the close ing of the Gospel should thus tal role in our daily lives. Pain is relationship between pleasure and reinforce the faith of all of you a psychophysical entity with uni- pain leads us to place in harmony and nobody should be ashamed versal meanings and pleasure is the virtue of temperance with the of the cross of Christ, by which a perception experienced by the cardinal moral virtue of fortitude. the world was redeemed. Nobody body (physical) and by the soul Let us address the explanation should hesitate to suffer for jus- (mental) caused by extremely of the nexus that exists between tice, nobody should doubt that appreciated conditions or con- these two entities. To achieve the they will receive the promised re- sequent upon the overcoming moderating transformation of ward. Because through work one of painful or unpleasant mental

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or physical conditions. Pain and be directed towards the paschal was made flesh – the son of man pleasure are two physiological joy of Christ. He, indeed, was – so that man in Him, and He in entities in the perception of which born for us, lived for us, suffered man, could understand all imma- various religious, cultural and in- for us and died for us, rose again nent human values, even in the dividual factors come into play. In for us, and sits at the right hand of most daily meanings of pain and their contextualisation take part the Father for us. And all of this pleasure, transformed into trans- not only the branches of medi- so that man can participate in his cendent values of the moral and cine and biology but also those heavenly glory. The Son of God spiritual order. of the human sciences and moral wishes for a certain participation The cross, therefore, and pain theology. From this last point of and also an extension and contin- are closely connected and directed view, pain and pleasure are com- uation in us of his salvific mys- towards pathos and felicitas be- parable to the classic passions of teries through the graces that he cause, as St. Augustine observed, concupiscence and ire. Thus pain wants to communicate to us and ‘God is happy; God wants us hap- and pleasure are also morally wants to complete in us. Thus we py; God makes us happy’. This neutral entities, that is to say in must constantly develop and last- is why pain and pleasure consti- themselves they are neither good ly complete within ourselves the tute moments of a perfect osmosis nor bad. For this reason they can, states and the mysteries of Jesus. with paschal joy. Because, direct- like the passions, through specific We must pray to him that he him- ed towards giving love and guid- moral virtues, become transcend- self completes them in us.38 This ed by prudence, they can fuse in ent moral and spiritual values. In- is why John makes clear: ‘God a harmonious synthesis with the deed, as regards pleasure, there gave the Law through , but mystery of the death and resur- are two virtues which are strictly grace and truth came through Je- rection of Christ. Our study thus dependent on the cardinal moral sus Christ (Jn 1:17). In him were highlights the physiological entity virtue of temperance, which have fulfilled the promises of the pro- of the painful pathologies of the this moralising function. The vir- phetic figures and the meaning of body and that of the pleasurable tue of chastity transforms the the precepts of the law was actu- perceptions of the senses but also pleasure of sexuality into a mor- ated; his presence demonstrates their connection with the trans- al value of conjugal, virginal or the prophecies and grace makes cendent entity of the joyous expe- celibate love because it expresses possible the observing of the riences of the Christian life. Pain, the positive integration of sexu- commandments. To follow his pleasure and joy are thus three en- ality within the person and, as a commandments is true joy.39 If tities, having the same ontological consequence, the inner unity of your law had not been the source root in man, redeemed by Christ. the man in his bodily and spirit- of my joy, I would have died from This is because those who accept ual being. The virtue of sobriety my sufferings. I will never ne- their pain as a completion of the transforms within man the pleas- glect your instructions, because sufferings of Christ make it sub- ures of food into moral values of by them you have kept me alive’ lime and render it salvific. intra-personal, inter-personal and (Ps 119 [118], 92). Let us pray cosmic harmony because it cre- with David: ‘Create a pure heart ates the capacity for self-mastery in me, O God, and put a new and and self-giving. What is needed, loyal spirit in me’ (Ps 51:12) and Bibliography as is the case with the other mor- let us try to put into practice what al virtues, is always prudence as the Apostle wrote to the Thessa- Gensini, G. F., Conti, A.A., ‘Antioxidant practical reason of the ‘right mid- lonians: ‘Our brothers and sis- strategy for cardiovascular disease’, Lancet, 357 (2001), 1704. dle way’, but more specifically ters you learnt from us how you International Association for the Study of the cardinal moral virtue of for- should live in order to please Pain (I. A. S. P.), ‘Pain terms. A list with titude. This is because not only God. Now we beg and urge you in definitions and notes on usage’, Pain, 6 (1979), 249; 14 (1982), 205. the appeal at the level of concu- the name of the Lord Jesus to do Manfredi, C., ‘Il piacere e la ricompen- piscence of pleasures and above even more… This is, of course, sa’, Toscana Medica, 6 (2010), 24-25. all those of sexuality, of alcohol how you have been living. God Mason, P., Foo, H., ‘Comfort food: choc- olate, water reduce pain response to heat’, and of tobacco, but also irasci- did not call us to live in immoral- Journal of Neuroscience, 4 (2009). ble aggression of resistance to ity, but in holiness’ (1 Thes 4:1.7) Melzack, R., Wall, P. D., ‘On the nature the evil of pains, require the help to hear the voice of the Lord who of cutaneous sensory mechanisms’, Brain, of the virtue of fortitude. In ad- says: ‘Come on in and share my Pain, 85 (1962), 331-356. Melzack, R., Wall, P. D., ‘Pain mecha- dition, last but not least, in the happiness’ (Mt 25:21). With these nisms: a new theory’, Science, 150 (1965), salvific plan of God all the be- words the Lord wanted to imply 971-979. Pavlov, I. P., I riflessi condizionati (Bor- ing and acting of man is ordered mystically that this eternal joy inghieri, Turin, 1994). to participation in the paschal joy is not only in our hearts but also Platone, Dialogo (Delphi, Turin, 1976). of Christ and thus to the works surrounds us and absorbs us eve- Platone, Fedone (La Scuola, Brescia, of his redemptive love. Thus to rywhere and submerges us like 1982). 40 Ratzinger, J., Bertone, T., Istruzione obtain the utmost moral osmosis an infinite abyss. On the basis circa le preghiere per ottenere da Dio la and sexual pleasures, and for the of what has been expounded as guarigione, (CDF) (Libreria Editrice Vati- restoring transformation of tem- regards this profound beatifying cana, 2000). S. Agostino, Le Confessioni (Città Nuo- perance in relation to pleasures, joy, we believe that our study has va, Rome, 1975). pain and pleasure, as well, must highlighted that the Word of God Sherrington, W., The integrative action

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of the nervous system, 2nd ed. (Yale Univer- Zucchi, P. L., ‘Il Volto dolente di Cristo. 18 CCC, n. 2337 sity Press; New Haven, 1947). Algos e Pathos nel Gethsemani’, Il Volto dei 19 CCC, n. 2338. S. Tommaso d’Aquino, Summa Theologi- Volti, 2 (2002), 46-55. 20 Cf. CCC, n. 2349. ca (Salani Editore, Florence, 1949). Zucchi, P. L., Honings, B., Voegelin, M. 21 CCC, n. 2337. Schönborn, C., ‘La felicità delle piccole R., ‘Pain, Music, Prayer’, Dolentium Hom- 22 Cf. CCC, n. 2346. cose’, Vita e Pensiero, 6 (2003), 74-79. inum, 60 (2005), 14-30. 23 Cf. CCC, n. 2347. Serafini, M., Bugianesi, R., Maiani, G., 24 Cf. the study published in the Journal Valtuena, S., De Santis, S., Crozier, A., of Neuroscience by two researchers, Paggy ‘Plasma antioxidants from chocolate’, Na- Mason and Hayley Foo, of the University of ture, 424 (2003), 1009-1013. Chicago. Sgreccia, E., Bioetica (Vita e Pensiero, Notes 25 From the early morning lauds during Milan, 1986). Lent. Wagener, T. D., Scott, D. J., Zubieta, J. 1 John Paul II, Apostolic Letter on the 26 John Paul II, Centesimus Annus, n. 36. K., ‘Placebo effects on human mu-opioid Christian meaning of human suffering, 27 Cf. Benedict XVI, Caritas in veritate. activity during pain’, Neuron, 55 (325-336), Salvifici doloris, Introduction, 1. 28 Cf. Charter for Health Care Workers 2007. 2 Summa Theologica, I-II, q. 2, a. 6. (Vatican City, 1995) n. 97. Zucchi, P.L., Vivaldi Forti, C., Milan- 3 From ‘Mirror of Charity’ by St. Alred, 29 Charter, n. 99. esi, E., Obletter, G., ‘Definizione del ter- abott. Lib.3,5: PL, 195, 582 30 Cf. GS, n. 26. mine dolore. In: Test di personalità proi- 4 Cf. The Catechism of the Catholic 31 Cf. Antonio Nanni, La sobrietà come ettivi (Rorschach, T.A.T.) e non proiettivi Church (CCC), nn. 1763-1764. stile di vita, www. Vicariatus urbis, orb, p. (M.M.P.I.) nella cefalea psicogena e nella 5 CCC, n. 1769. 8. I have based myself on this thoughtful es- cefalea da tensione muscolare. Indirizzi ter- 6 CCC, n. 1770. say on a number of occasions. apeutici’ Algologia, 1 (1983), 41-82. 7 CCC, n. 1743. 32 CCC, n. 373. Zucchi, P. L., Honings, B., ‘Dolore fisico 8 Cf. CCC, nn. 1744-1745. 33 CCC, n. 1711. e sofferenza morale di Gesù nel Gethsem- 9 Cf. CCC, nn. 1749. 34 CCC, n. 1808. ani: il fenomeno della ematoidrosi. Aspetti 10 CCC, n. 1762. 35 From the Discourse,51, 4 of St. Leo the clinici e teologici’, Dolentium Hominum, 47 11 CCC, n. 1803. Great, Pope: PL 54, 212, (2001), 24-33. 12 St. , Orationes de 36 Cf. CCC, n. 519. Zucchi, P. L., Honings, B., Voegelin, M. beatitudinibus, 1: PG 44, 1200D. 37 CCC, n. 793. R., ‘Pain Faith Prayer. Therapeutic effect of 13 CCC, n. 1804. 38 Cf. CCC, n. 521. Faith and Prayer on subjects with painful 14 CCC, n. 1809. 39 Liturgy of lauds, Monday, third week pathologies. Blind study on a group of 1104 15 Cf. Sir 37, 27-31. of Lent, Brevier, II, p. 203. patients’, Compendium of Pain Semantics, 16 Cf. CCC, n. 2341. 40 Cf. St. Bernardino, Discourse 2 on St. 11 (2001), 1-384. 17 Cf. CCC, 2336 and 1614. Joseph, Opera 7, p. 37.

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The New Horizons of Pastoral Care in Health in Italy: from Cinderella to Queen?

Fr. Leonardo Nunzio Operational Goals that For this reason, we should have Di Taranto have already been Identified a new look at the new operation- Capuchin, al areas which require urgent and Chaplain at the ‘Policlinico A specific index of the impor- creative answers from the whole Consorziale’ of Bari, tance achieved by pastoral care in of the Christian community. I have Director of the Diocesan Office health over recent decades lies in identified ten which I call paths or for Pastoral Care in Health, the large number of goals identi- ‘pathways’, because one is dealing Bari, Italy fied by the first pastoral Note of here with outlining new pathways, 1989,2 which can be divided into some of which are absolutely un- three great areas: precedented: ‘when walking, a 1) the sick and their family rela- pathway opens up’. tives (taking care of the sick, sup- The Goals Achieved by porting the disabled and the handi- Pastoral Care in Health, Today capped, being near to the families 1. The centrality of the sick of sick people, and caring for sick person as a pastoral subject In its second pastoral Note, the people who are neglected by soci- Episcopal Commission for the Ser- ety); John Paul II in his post-synodal vice of Charity and Health, when 2) culture and politics (sensitis- apostolic letter on the vocation and looking at recent decades, ob- ing local areas, promoting a cul- mission of the laity in the church served: ‘the journey taken in Ita- ture of life, working with public and the world saw in the sick per- ly by pastoral care in health since and private bodies that provide son a ‘worker sent into the vine- health-care services and train pro- yard of the Lord’ for the evange- the Second Vatican Council has 6 been notable. Ecclesial sensitiv- fessionals, and influencing the po- lising mission of the Church. The ity towards the problems of health litical realities that bear upon leg- first pastoral Note also saw in the care have grown, leading to a more islation in the health-care sphere); sick person the second subject of effective involvement of all the 3) humanisation and evangelisa- pastoral care in health after the members of the community in ser- tion (fostering the professionalism subject of the Christian commu- vice to those who suffer and in in- of health-care workers, contribut- nity, and also offered practical rec- itiatives directed towards the pro- ing to humanisation, preparing cat- ommendations: participation in motion of health. The literature in echesis projects, and illuminating Church bodies, the defence of the the problems of the world of health rights of sick people, involvement this field has undergone a signifi- 3 cant development and centres for care with faith). in knowledge about the situation of the formation of pastoral workers The second pastoral Note of one’s own illness and the treatment 2006, for its part, had the merit of provided, and the non-marginalisa- have increased in number. Dia- 7 logue with bodies and institutions emphasising other objectives in tion of the family and society. which at a social and political lev- various parts of this document: the For its part, the National Office el are involved in care for the sick conjoining of care for the sick with dedicated the Fourteenth World and the promotion of health has the promotion of health; the spe- Day of the Sick (11 February 2006) become more open and construc- cific responsibility of parishes; the to the subject ‘At the School of the tive’.1 explicit appreciation of deacons Sick’, and prepared useful support The wonder, the joy and the sat- and women; the important role of material in which, amongst other isfaction of the Italian Church, extraordinary ministers of holy things, it was emphasised that the communion and the importance sick bear witness, educate, and therefore, spring from three specif- 8 ic positive events which have led acquired by the World Day of the ask. The journals and the bibliog- to a growth in our pastoral care in Sick; the updating of bodies in- raphy of this field have constant- health: the sensitivity and the in- volved in communion and anima- ly returned to the sick person as tion; the challenges of the world of an active subject of the Christian volvement of the whole commu- 4 9 nity to and in the world of health health care… community. The voice of Bene- care; an increase in opportunities dict XVI has not been absent and at the level of formation accom- in his encyclical on hope he used panied by an increase in the bib- The Ten New Horizons: ‘When very severe words, saying that a liography of this sector; and an Walking, a Pathway Opens up’ society was ‘cruel and inhuman’ improved sensitivity in the rela- if it did not manage to accept suf- tionship with health-care institu- Satisfaction, however, should fering people and was not able to tions and bodies. not lead to a halt or to laziness, as contribute through compassion to indeed John Paul II observed at the ensuring that suffering was shared beginning of the new millennium.5 and born internally as well.10

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Over coming years the attention en, first and foremost by entrust- twentieth century stressed in its of our Church should be focused ing them with managerial tasks documents and which still awaits on pastoral projects that indicate and tasks involving responsibil- to be understood more inwardly the tasks of sick people in parishes ity’. The world of health is a field and given practical expression in and hospitals, on the promotion of where the characteristics of wom- forms of life. We then went on to ecclesial associations of sick peo- en can be generative in a practical the cooperation and integration of ple and not only associations of and creative way. various charisms and ministries in sick people,11 and on the ‘rights’ order to achieve the shared goal and ‘duties’ of suffering people of evangelisation and witness to in communities. One could begin 3. The identity of new pastoral charity. Then for a few years great- with reflection on the five faces workers er reference was made to ‘joint re- acquired by the sick person over sponsibility’, that is to say shared recent decades: he who is helped; By tradition, pastoral action in responsibility in planning and in he who helps with prayer and the hospitals was always engaged in individual pastoral programmes. offering up of suffering; he who exclusively by hospital chaplains This revolutionary meaning, in evangelises; he who teaches from who for the most part belonged to a its serene simplicity, seems to be the teaching chair of the Cross; and religious family. Sisters who were that to be found in the statement he who helps another sick person.12 nurses and heads of wards often of the Italian bishops (2005): ‘to became their valuable co-workers move charisms from cooperation and prepared patients for the re- to joint responsibility, from fig- 2. The role of women, a Marian ceiving of spiritual service and in ures which lend a hand to pres- presence in the health-care particular the receiving of the three ences that think together and walk world sacraments of the time of illness. in a shared pastoral project’.17 And With the development and re- after the fourth national ecclesial In the history of the charity of newal of pastoral care in health, conference the profound meaning the Church women have played a which began above all with Salvif- of the integration of the three ‘Cs’ role of primary importance in ser- ici doloris (1984), the action of the was specified: ‘joint responsibility vice to the sick, both in hospital Christian community for sick peo- is an experience which gives con- institutions and in homes. Their ple was extended to deacons, sis- crete shape to communion through spirit of sacrifice, their maternal ters, and lay men and women both a readiness to share choices that feelings, their compassionate char- in hospital chaplaincies and pasto- involve everyone…The choral ity, their visceral devotion to those ral councils. The reintroduction of and overall participation of all the who are sick have been expressed the extraordinary minister of holy members of the people of God is in an admirable way specifically communion witnessed lay people, not only an objective: it is the way at the side of the suffering.13 John above all women, take on this min- by which to achieve the goal of an Paul II did not spare words and istry, which is bringing advantages evangelically transparent and in- writings to exalt the ‘genius’ of to sick people in their homes. cisive presence’.18 Pastoral care in women and to call for new spaces Over the next few years it will health needs to follow these three of presence and action for women be necessary to examine, both the- paths in order to become more fe- both in society and in the Christian ologically and pastorally, the iden- cund and to achieve its large num- community.14 The second pastoral tity of these new pastoral workers ber of goals. Note dedicated a special section to so that they can find specific -ar the original contribution of women eas and tasks for their ministerial in the field of health care and suf- action: the originality of each of 5. The promotion of health in fering.15 them can enrich both the pastoral parishes and hospitals In bodies of communion and body that brings them together and joint responsibility of the health- their evangelising mission. Thus After going beyond the belief care world such as pastoral coun- they are not only helpers of a par- that pastoral care in health is to be cils and chaplaincies, both married ish priest or a chaplain but authen- identified solely with pastoral care women and consecrated women tic pastoral workers, co-workers for the sick, one is now dealing, find a specific place where they who are jointly responsible. after restating the importance of can make their female and mater- service for those who suffer, with nal roles and their original contri- exploring the possibility of parish- bution bear fruit.16 In national, re- 4. Growth in communion, es and chaplaincies becoming the gional and diocesan agencies and cooperation and joint promoters of the value of ‘health’ councils many women already of- responsibility during the various stages of life. fer their cooperation to the anima- The second pastoral Note repeat- tion and planning of pastoral activ- The three ‘Cs’, which define the edly states the need to conjoin care ity, indeed in some dioceses that identity and the life of a Christian for the sick with the promotion of have also been called to the re- community of our times, have ma- health, but it does not indicate, nor sponsibility of heading agencies. tured slowly in the life of the Italian can it indicate, the concrete path- But some people add with a certain Church, and this took place above ways by which to achieve this malice: ‘Enough of flower-giving. all after the Second Vatican Coun- goal. For this reason, one of the We should increase trust in wom- cil. We began with the ‘koinonia’ tasks of this year and the years to which the ecclesial event of the come of the ecclesial community

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will be to look for, and to experi- achieving a reawakening of atten- el of pastoral care in health this is ment with, projects to promote the tion being paid to, and the provi- not in the least perceived as a socio- health of young people, of adults sion of care to, people in pain. The political and religious reality. Few and of elderly people, identifying Italian Church, and pastoral care in people perceive the urgent need to first its personalist overall meaning health in particular, will discover engage in dialogue with other Eu- and then exploring the contents of in coming years how important it ropean communities in our field the Gospel of health. The draft has is for people after a loss to retrieve of pastoral care. And yet there al- already been drawn up: helping the meaning of life and the ability ready exists a movement for coop- young people to achieve a healthy to reinvest their physical, mental, eration and dialogue amongst the human and spiritual development, familial, spiritual and pastoral re- different nations. However, Italy accompanying adults in overcom- sources for themselves and their has remained practically outside ing in a balanced way the crisis of communities.21 this: there is an inability to under- their age, and offering elderly peo- stand the benefits that could spring ple resources which help them to from dialogue and the sharing of live through old age with seren- 7. The development of the experiences. ity.19 ecumenical pathway and I am convinced that the time The choice of paying attention inter-religious dialogue has come for national and region- to education which was made by al bodies (agencies and councils) the Italian Church through ‘Pas- Suffering and illness are univer- to begin to form relationships with toral Directions’ for the new dec- sal experiences: they belong to hu- this movement, to take part in Eu- ade of the twenty-first century will manity, they are almost co-exist- ropean conferences, and to belong help pastors and pastoral workers ent with human life. The process to a pathway that will be increas- to discover and appreciate the ed- of globalisation affects everyone ingly indispensable. The Italian ucational importance of pastoral and leads to the encounter and the Association for Pastoral Care in care in health in the welcoming co-existence of races and religious Health (AIPaS), which in the past and defence of life, in the promo- traditions brought about by migra- paid concrete attention to pasto- tion of health, in the appreciation tory flows. There is an increase in ral care in other European nations of the salvific dimension of ill- experiences involving the encoun- (France, Spain, Germany, Eng- ness-suffering, and in the reading ter of values and needs of people land, the countries of Eastern Eu- of death in the light of the paschal who ‘come from faraway’ and who rope…), could move in this direc- mystery.20 await pastoral responses from the tion by taking cultural initiatives Church. The ecumenical pathway and initiatives involving forma- and inter-religious dialogue are ad- tion. 6. The growth in pastoral care vancing in pastoral care in health Enriched by its long history, for people in mourning as well and this leads pastors and l’AIPaS could offer a very valu- other people with leading positions able service to the Italian Church, The multiplicity of ways of dy- to become actively involved in this opening up increasingly large ar- ing today, above all those that are field of pastoral care. eas of knowledge, of enrichment sudden or violent (heart attacks The challenge of the years to and of growth in the formation of or road accidents, neo-plastic ill- come, but a challenge that is al- priests and other pastoral workers nesses or murders), make the in- ready with us, will be the specif- within the European horizon. dividuals involved in these events ic formation of pastoral workers, increasingly defenceless and un- the acquisition of the spirit of di- prepared. People suffer not only alogue, knowledge about other 9. Pastoral care for migrants because of the loss of a loved one ways of ‘saying God’, the need who are sick – they are also ‘traumatised’ by the for constructive dialogue, and the way in which that person died. The overcoming of the syndrome of In 2010 the regional council for consequence is that an increas- the single faith and a single reli- pastoral care in health of Puglia22 ing number of individuals do not gion. Little or nothing exists on and the AIPaS23 addressed the rich manage to experience loss in an this in the ecclesial magisterium: subject of pastoral care for mi- ordinary period of time and in or- this increases the urgent need for grants during a period of illness dinary ways. Instead, psychologi- a theological and pastoral analysis and there was no lack of stimulat- cal mechanisms are set in motion that leads to pastoral policies that ing contributions in the papers and which block the growth of life and are coherent with the Gospel and the study groups. I myself sought a return to the previous ordinary with the spirit of the Second Vati- to hold up possible paths as re- life. can Council. gards the pastoral care provided by For over ten years in Italy there health-care institutions and by lo- has been renewed attention paid to cal areas.24 But it is of urgent im- mourning through the coordination 8. Openness to the European portance to deepen personal and of self-help groups for the working dimension of pastoral care in communal reflection in this area through of loss and through the health because the political and social ‘Children of Heaven’ Association. events of recent years and months In their diversity and complemen- Although at a political and eco- which are still undergoing devel- tariness they are a help and stim- nomic level Europe has achieved a opment do not allow of delays or ulus for Christian communities in unity of intent and work, at the lev- examples of negligence.

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The arrival in Italy of immi- is already taking place both at the bilee of the year 2000, , 6 January 2001, n. 15. grants, whose numbers will stead- Camillianum of Rome and at the 6 Cf. John Paul II, post-synodal apostolic ily increase, stimulates us to draw A. Gemelli Centre for Bioethics of exhortation Christifideles laici on the voca- up response strategies and projects the Faculty of Medicine and Sur- tion and mission of the laity in the Church and the world, Rome 30 December 1988, nn. by hospital chaplains and parish gery of Rome) and to prepare sup- 53-54, hereafter CfL. priests. The event of illness in all port materials to help patients, their 7 Cf. PSCI, nn. 26-32. the latitudes and longitudes of the family relatives and the workers of 8 Cf. UFFICIO E CONSULTA NAZION- world deeply marks the inner and hospital communities to know the ALE CEI PER LA PASTORALE DELLA SALUTE, 14a Giornata mondiale del mala- spiritual balance of individuals answers of the Church, which are to 11 febbraio 2006 Alla scuola del malato and requires that charity of works illuminated by the Gospel.28 (Camilliane, Turin, 2005). which can spring only from a civ- 9 By way of example I may cite: Dolen- tium Hominum, Camillianum, Insieme per il conscience and the force of the servire, L’Ancora della salute, … For the Spirit. The New Horizons: Stimulus bibliography one may consult those bibliog- and Creativity raphies of books that address the questions and issues of this field or consult the bibliog- raphy of the Camillianum of Rome. 10. The answers of bioethics to As is evident from this list, the 10 Cf. Benedict XVI, encyclical letter Spe new questions new horizons of pastoral care in salvi on Christian hope, Rome 30 November 2007, n. 38. health for individuals involved in 11 For example the Centro Volontari della Bioethics, even though it is pastoral care ‘constitute a stimulus Sofferenza (CVS) which, fundamentally, is young in terms of its name and as to keep strong the wish to engage made up of the mentally and physically ill. a separate discipline in the world in further steps, reinvigorating the 12 Cf. Di Taranto L. N., Fare pastorale della salute in Italia, oggi, p. 38-45. of theology and philosophy, in the spiritual and apostolic impetus 13 Cf. Messina R., Storia della Carità cu- space of a few decades has ob- and refining pastoral methods and ore della Chiesa (Camilliane, Turin, 2001). tained a qualified position in the strategies, always keeping one’s 14 Cf. John Paul II, apostolic letter Muli- eris dignitatem on the dignity and voca- world of formation and culture of gaze on Jesus Christ, the Good Sa- tion of women on the occasion of the Mar- our days. And this has taken place maritan, in the awareness that the ian Year, 15 August 1988; IDEM, Letter To both at a lay level and at an eccle- commitment to the promotion of Women, 29 June 1995. 15 Cf. PVCM, n. 58. sial religious level. health and loving care for the sick 16 Cf. PSCI, n. 79-80; PVCM, n. 66. Since the end of the 1980s, pas- truly contributes to the achieve- 17 CONFERENZA EPISCOPALE ITAL- toral care in health has paid atten- ment of the kingdom of God’.29 IANA, Nota pastorale, Il volto missionario delle parrocchie in un mondo che cambia, tion to bioethics and has proposed Parish priests and chaplains Rome 30 May 2004, n. 12. it as one of its principal objectives. above all else, together with their 18 CONFERENZA EPISCOPALE ITAL- The pastoral Note of 1989, in the respective communities, will know IANA, Nota pastorale “Rigenerati per list of its objectives, ranked it at una speranza viva” (1Pt 1,3): testimoni how to grasp these ‘signs of the del grande “sì” di Dio all’uomo dopo il IV the top because it had the task of times’ which the Spirit sends to his Convegno ecclesiale nazionale, Rome 29-6- ‘illuminating the problems of the Church and also to find the right 2007, n. 24. world of health care that underlie answers to the just needs of the hu- 19 Cf. PVCM, n. 51. 20 Cf. CONFERENZA EPISCOPALE research, scientific advance and man heart. ITALIANA, Orientamenti pastorali, Edu- techniques of intervention, and in We do not know if over the com- care alla vita buona del Vangelo per il de- which are involved the nature and ing years pastoral care in health cennio 2010-2020, Rome 4 October 2010. 21 The bibliography in this field is con- dignity of the human person, with will stop being a Cinderella and stantly growing. I refer, amongst many oth- 25 faith’, and it emphasised the ‘rel- will become a queen: the title is ers, to: Pangrazzi A., Il lutto: un viaggio evance of moral problems’ raised not important, but what is of im- dentro la vita (Camilliane, Turin, 1991); Pe- by ‘the scientific and technical ad- ruggia L., L’abbraccio del mantello (Monti, portance is that it enters as an or- Saronno (VA), 2002); Pangrazzi A., Aiu- vances which have taken place in dinary dimension of ‘integrated tami a dire addio. Come sostenere chi è in the world of health care’.26 pastoral care’ into the life of the lutto (Erickson, Trento, 2002); Scaramuzzi O., Dall’isola all’arcipelago. Il gruppo per In its turn, the pastoral Note of Christian community. l’aiuto psicorelazionale nel lutto (Camilli- 2006, returning to the subject of ane, Turin, 2004). bioethics, observed that the ‘weak- 22 Urso F. (ed.), Migranti e salute, Atti ening of ethical emphases and the del convegno della Consulta regionale pug- Notes liese di pastorale della sanità svoltosi presso subjectivism of consciences, to- l’ospedale “Miulli” di Acquaviva delle Fonti gether with cultural, ethical and 1 COMMISSIONE EPISCOPALE CEI (BA), 12 giugno 2010 (Servi della Sofferen- religious pluralism, easily lead to PER IL SERVIZIO DELLA CARITà E LA za, S. Giorgio Jonico (TA), 2010). SALUTE, Nota pastorale “Predicate il van- 23 INSIEME PER SERVIRE, Rivis- a relativising of values and thus to gelo e curate i malati”. La comunità cristi- ta dell’Associazione Italiana di Pasto- the risk of no longer being able to ana e la pastorale della salute, 4 June 2006, rale della salute (AIPaS), n. 86 – 2010, refer to a shared ethics, especial- n. 68, hereafter PVCM. Atti del Convegno nazionale “Il bacio del 2 Cf. CONSULTA NAZIONALE CEI lebbroso. Evangelizzazione e pastorale ly as regards the great questions PER LA PASTORALE DELLA SANITà, dell’accoglienza”, Porziuncola/Assisi (PG), of existence, which are connected Nota pastorale La pastorale della salute nel- 11 – 14 October 2010, pp. 9-60. with the meaning of being born, of la chiesa italiana. Linee di pastorale sani- 24 Di Taranto L. N., ‘La comunità cris- living and of dying’.27 taria, 30 March 1989, n. 20, hereafter PSCI. tiana e la cura pastorale degli immigrati nel 3 Cf. Di Taranto L. N., Fare pastorale tempo della malattia’, in URSO F. (ed.), Mi- Pastoral care in health can start della salute in Italia, oggi, CVS, Roma 2010, granti e salute, pp. 69-105. afresh from this basis both in order pp. 73-83. 25 PSCI, n. 20. to assure that health-care and pas- 4 Cf. PVCM, nn. 2. 48-67, 58, 65, 66, 26 Ibidem, n. 21. 5-18,… 27 PVCM, n. 16. 28 toral workers have suitable forma- 5 Cf. John Paul I, apostolic letter Novo Ibidem. tion in the bioethical field (and this millennio ineunte at the end of the Great Ju- 29 Ibidem, n. 68.

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Care for the Sick and the Treatment of Infectious Diseases in the History of the Church

Rev. Fidel González which is his sacrament in space that a Christian immediately rais- Fernández, MCCJ and time. Indeed, the life of Christ es is whether illness and death are Lecturer in Ecclesiastical as it is described to us in the gos- a person event or pure perishing.4 History, pels unfolds in a continuous re- ‘What finishes is what is inelucta- The Pontifical Urbanian lationship with the sick, with the ble in life: suffering that is wide- University, pain of man, and he offers himself spread everywhere, the suffering The Pontifical Gregorian as a response to this human drama of the defenceless and the weak; University, with a precise action of mercy and the suffering of animals or un- Consultor of the Congregation compassion: healing the sick and speaking creatures…the fact one for the Causes of Saints, relieving every kind of human cannot change anything, that one Consultor of the Congregation pain; forgiving sinners and giving cannot remove this. It is like this for the Evangelisation of salvation. Most of his miracles and it will be like this. And here is Peoples, are specifically a response to this the gravity of the matter’.5 Emeritus Rector of the Urban human drama which could not be As Scola well observes,6 in to- College of Propaganda Fide marginal in the life of Christ, just day’s cultural climate two answers as it has not been marginal in the to the problem of death and there- history of his Church. fore of illness and suffering are in- The encounter of Christ with tertwined. The first is captured in I. Man Faced with the sick is one of the most hu- a verse by Rainer Maria Rilke: ‘O Illness and Death man aspects that we find in the Lord, give to each his death. The gospels. This encounter is for the death that flowered from that life, 1. “If you want to, you can heal overall salvation of the person when each person loved, thought, me” (Mk 1:40) and not only to give him or her suffered’. That is to say, this poet health alone, to overcome physi- ‘invokes’ the gift of a ‘personal’ “If you want to, you can heal cal illness and thus to avoid ‘cov- death, the seal of an authentically me” (Mk 1:40): this was the cry ering himself up in the impossi- personal life. The I must die, no- of a man afflicted by an incura- ble goal of definitively defeating body can deduce their deaths from ble illness who drew near to Je- death’.2 The encounter of Christ the deaths of others, which, how- sus of Nazareth. ‘What was really with the sick in the gospels is to ever, remain unpredictable. And in play in his imperious request achieve a healing of the person in so it is that as Levinas observes: for healing?’ Faced with an ill- his or her entirety. Clinical heal- ‘in death I am exposed to absolute ness which leads inexorably to ing will always be temporary be- violence, to murder in the night’.7 death is it possible to ask for the cause a person has a meta-histor- This terrifying experience is cer- impossible, that is to say healing, ical destiny which passes by way tainly something that all men have without leading somebody into of death: the outcome of a defini- in common. the ‘dead end street of delirium of tive handing over into the arms of The other response, which to- omnipotence’? What does heal- the Father, the location of the de- day is more widespread, is that ing mean? Can one always real- finitive salvation of the person. In expressed well by the words of ly heal?1 These questions become this sense ‘healing’ is not a utopia Adorno which were ‘critically increasingly dramatic in the case but a reality.3 very hostile’ to the position adopt- of illnesses that are considered ed by Rilke: ‘The biological de- ‘dangerous’, such as infectious struction which takes place with diseases, which are often seen as 2. Health, illness, healing and death is made specifically by an incurable and which have often salvation aware social will. A humanity for been the cause of inhuman dis- whom death has become no less crimination. Indeed, the subjects of health, indifferent to its members can im- Faced with these existential illness and healing cannot be sep- part it by an administrative path and essential questions, what arated from the subject of salva- to an unlimited number of hu- did Christ reply and how has the tion which represents the centre man beings. The famous prayer Church replied down the centu- of gravity of everything. The life of Rilke is a miserable deception ries? Christ, who wanted to be of man should be seen in the light by which an attempt is made to similar to us in everything with of its birth and its meaning and conceal the fact that men by now the exception of sin could not ig- one cannot understand it with- croak and nothing else’.8 nore this human situation and the out the perspective of inevitable In the gospels Jesus appears as same may be said of the Church, physical death. But the question being constantly involved with

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men and women who are marked turally linked to infinite time and understand death without birth. by illness, by death, by afflictions to the finitude expressed by ill- Both, however, have a meta-his- of the body and the soul. He gives ness and death. torical meaning. For this reason, an answer to the fundamental The question that a person who the tandem of health and salva- need of man: that of overall sal- is sick and near to death – espe- tion is indissoluble. Thus the deep vation, without eliminating any cially in such dramatic cases as meaning of the mandate of Jesus factor of their lives and dramas. If epidemics and illnesses which are when he sends out his disciples: the Church is the living body of seen as having no human exit – “heal the sick in that town, and Christ in spatial-temporal history, asks a doctor, friend and God is say to the people there, ‘The king- it follows from this that in the mis- always the same “make me live!”. dom of God has come near to you’ sion of the Church is actualised I would like to quote a passage (Lk 10:9). Thus during its history the Event of Jesus Christ in its to- from The Plague by Camus, when the Church has obeyed this man- tality: the mission of the Church in Oran, faced with the spread of date of Jesus as an integral part is not that of being invited from the epidemic, Dr. Rieux ‘knew of its mission; and it has done the outside into spheres of the dai- well that his task was to diagnose: this above all through its works ly existence of men. It is a mis- to discover, to see, to describe, to of charity and its saints. The his- sion that belongs to the internal record, to order isolation. Wives tory of Christianity, that of holi- totality of the lives of men with took him by the wrist and cried: ness and Christian charity, that of all their existential and concrete “Doctor give him life”. But he miracles, are verifiable proof of daily problems. Every Christian was not there to give life…what each one its pages. This kind of thus becomes an ‘Event’ of Christ then was the use of the hatred that mission has nothing to do with ac- in reality, with all his or her per- he read on their faces? ‘You have tions of pure philanthropy, magi- son, an operative sign – through no heart”, they had said to him cal initiatives outside reality or of grace – of his Presence.9 one day. But yes, he had a heart; any other form of ambiguous re- In this sense, a Christian can- it helped him to bear the twenty ligiosity. ‘If it does not begin with not be indifferent to the drama of hours a day when he saw men die reality, mission does not have illness of the pain of men and re- who were made to live; it helped suitable reasons for lasting’.11 fer them to the spiritual sphere. him to begin afresh every day. The Church, from the outset, He or she is called to listen to the By now, he had heart enough for has taken on the mission in the cry that the prophet attrib- this; and how could it have been contexts in which it has lived, with utes to King when he was enough to give life?’.10 men and women who in a varie- dying: “heal me, and let me live” Is what is really to be found in gated way have had the grace, the (Is 38:16). Or in other words: “let this question not the need for sal- gift or the ministry of this specif- me go on!; save me, heal me…!” vation affirmed by the religious ic concern; but already beginning What do sick people ask for if not sense of every man and every with baptism a Christian is called for health? And what is meant by people? There is no human ges- to this task. And this for an obvi- health if not happiness and full- ture that is not permeated by this ous reason: ‘to what destiny would ness of life? desire for total salvation. Every the company of God be reduced This is what Jesus was asked gesture of friendship or affection if it did not solve the unbear- by the sick people whom he met expresses the meaning of the infi- able contradiction that traverses on the roads of Palestine and what nite, which is God Himself: this is the whole of reality and which in the Church, ever since the time the request or salvation. For Bib- man – who is forced to die even of the apostles, has been clearly lical man and thus for Christians though he knows that he is immor- and strongly aware of. “I have no this desire begins from knowl- tal – achieves its most acute point? money at all, but I give you what edge of their own history of sin Either Christianity resolves this I have, in the name of Jesus Christ and limits, of the wounds that radical contradiction or it resolves of Nazareth I order you to get up they bear within them and which nothing’.12 To live in Christ (‘en and walk’ (Acts 3:6) Peter said to we call ‘original sin’ (cf. Rom. Christoi’) means for us to bear the lame man who asked for alms 5-7), that wood worm that man witness, from the first individual at the doors of the temple of Je- alone is unable to remove or rip act or moment of life, that faith rusalem. from his heart: salvation comes hope and charity are never bro- Thus down its long history the from Another. The request for ken in any circumstances, even the Church has constantly found itself health is therefore always a sign most dramatic ones such as illness, faced with the drama of life, of ill- of a situation that requires a re- the most traumatic pain or death. ness and of death. This drama has quest for lasting, of radical salva- We will now see how man and become even more dramatic dur- tion from finitude itself; it means, medicine, on the one hand, have ing certain periods and certain in definitive terms, the request to experienced this reality, and how situations in history, above all at be saved from death itself. the faith of the Church has ex- moments when plagues, wars and Are this desire and this request perienced it down its history, on major epidemics have caused au- pure illusions? The Christian ex- the other. With regard to the first thentic massacres and ‘butcher- perience and the faith that ex- subject, a survey will be made ies’. In those circumstances, per- presses it tells us that they are not; but I will do this confining my- haps more than ever, people see indeed, that they correspond to a self to the world of Western cul- themselves as deeply and struc- more genuine reality. One cannot ture, not least because at a certain

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time it had a special relationship ic, in the same way as the relation- of illness as well. He has always with the history of Christianity. ship between man and illness in looked for remedies to defeat evil With regard to the second sub- every culture has been dramatic.14 or the effects of evil in his body, ject, I will confine myself to mak- ‘Illness, prior to being a subject of to overcome death, to go on liv- ing references both to the way in research, was a threat experienced ing. Often he has looked for this which Christians have seen and for centuries and centuries given origin in preternatural causes or treated sick people and to how the that one could no little or noth- in the world of ‘mystery’. The Church has applied in practice the ing about it. Its description had means by which to overcome it he gospel mandate ‘to heal the sick’. first and foremost the aim of iden- has thus identified or looked for tifying it early on and of avoid- in the same sphere. But in essen- ing it’.15 In all peoples an attempt tial terms his research has always has been made to give an expla- depended on his anthropological II. How Western Man nation of the origins of illnesses and religious vision of reality. has Addressed which have often been seen as Thus the history of Western Illness an unnatural phenomenon linked medicine is linked to Hippocrates to matters concerning the break- and his school (fifth to sixth cen- 1. The history of medicine as ing of a taboo, religious phenom- turies BC) which tried to discov- an anthropological response ena, curses and situations that er through careful observation the to the meaning of man were in contrast with the peaceful dysfunctions of the human organ- growth of man. As a result, heal- ism so as to be able to achieve a The history of medicine consti- ers were connected with the world suitable cure. Health was under- tutes a fact that demonstrates the of religion (priests) and of magic stood as balance (eucrisia) and constant question of man about (soothsayers, wizards etc…). This illness as an imbalance (discra- the meaning of life and the search vision still persists in many re- sia) between the four liquids or for an answer to the concrete need gions where ancient cultural and humours contained in the body to live in health. But the history religious visions continue to live (blood, phlegm, light bile, dark of medicine has not always been in the hearts of people. bile). From this was born the the- an answer to the overall need of With the passing of time, and in ory of humours regarding patho- man; very often partial answers the Western world above all else, genic processes. To be well, a bal- have been given, answers de- the principal concern was to de- ance between the four humours pendent on an underlying anthro- scribe illness with the aim of iden- was needed and a prevalence of pological vision; sometimes med- tifying it and avoiding it. Thus one or the lack of another caused icine has also been reductive as preventive care (avoiding illness) the pathology or character traits regards man; on other occasions was logically and chronologically of the person. it has looked in an ‘esoteric’ way prior to treatment, above all in the Another leading school of for the answer to the request for face of the great epidemics and Western medicine was that of Ga- health; and lastly it has tried to plagues – dramatic, periodic and len of Pergam who also worked in embrace man in his totality, there- chronic episodes of which have Rome in the second century be- by including the religious dimen- filled history, until today as well. fore Christ. He added to the Hip- sion as an essential part of him. In antiquity the sick, above pocratic doctrines a conception of In this sense, the Christian expe- all those who suffered from cer- the anatomical-physiological sys- rience has made a fundamental tain illnesses (one need only re- tem that put together a theory of contribution. The reason for this member leprosy and the various (natural, vital, animal) spirits with is clear: the Christian experience plagues) were distanced because observations derived from experi- is concerned with the human as a they were seen as being danger- ences of an anatomical-compara- whole and not only with an partial ous, the bearers of death and var- tive nature as well. He introduced part of the human question, such ious forms of misfortune. A sick a sort of experimental method in- as the religious ritual dimension, person was seen as an afflicted to medical inquiry; despite this the soul, or the world beyond this person, as a cursed person. A cer- aspect which was a rather impor- one. If one is interested in the tain vision along these lines still tant aspect in the history of med- whole of the person, one must be continues today even in contexts icine, Galen was the victim of a interested in every person who that are considered to be evolved, biting anatomical-comparative tries to understand the meaning of with resort often being made to criticism of a medical school with suffering, that is to say the nex- magical practices that seek to agnostic bases which accused him us between his or her life and the achieve healing and the spread of of played a biological-theological destiny for which he or she feels superstition. role which had injurious influ- made. ‘Illness is a sign of this de- ences until the time of the Renais- finitive meaning of things, and if sance. This criticism specifically it exists it is larger than we are. 2. Illness, medicine and health came from those trends that de- Illness is an appeal, the final and in the ancient Greco-Roman humanised the activities of phy- most terrible appeal, to look for world sicians. ‘The work of a man, in that meaning’.13 fact, cannot be separated from the The history of knowledge about Man has always tried to iden- approach that animates and pro- illnesses has always been dramat- tify the origin of evil and thus duces it but must be seen first of

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all in the light of this hypothesis The medical school of Saler- Spirit in Sassia, which developed of departure. Religiosity, which no comes from this medieval pe- out of an institution to take in certainly can be full of errors, is riod and legend has it that it was Anglo-Saxon pilgrims. This hos- nonetheless the only rational ac- founded by a Jew, an Arab and a pital has lasted until today. The tor which, in admitting an order Latin, a testimony to the ecumen- Rules of the Order established of things that corresponds to the ism and universality of medical that care for the sick and the poor self, invites man to discover it science.17 was the first task of its members. without abandoning the facts of This work developed throughout human experience’.16 Western Europe where hospitals connected with the Roman hos- III. The Birth of pital were created and which fol- 3. Down the Middle Ages Hospitals was a lowed the same Rules as those Christian Fact to be found in Rome. Another of After the collapse of classical these paradigmatic hospitals was civilisation, it was the Christian The real new fact of the medi- that the Hospital of St. John in tradition that supported the re- eval period, however, was the cre- the Lateran, a model and point of construction of a world where the ation of hospitals.18 These were reference for many hospitals in best values of the ancient Greco- created first of all as a response Spain and later in Spanish Amer- Roman world were saved, and to a need: the mobility of popula- ica. These hospitals had well- this was also the case in the sci- tions along the streets of a young aired rooms and operations were entific field. For many centuries Europe that was being born, and even carried out on nerves and the monasteries first and friaries which connected the great cen- the cranium, which is something subsequently were the privileged tres of pilgrimage. These hospi- that creates amazement today. places for the practice of medi- tals arise next to churches and They involved identifying cer- cine, for the conservation of the monasteries in order to take in tain illnesses such as those of ve- Hippocratic-Galenic tradition, for sick pilgrims. Their name, ‘hospi- nereal origins and infra-red rays the collecting of medical sourc- tales’, specifically expresses this were even used to treat smallpox. es, for the study of pharmacology meaning of taking in the pilgrim These hospitals, architectonically (the pharmacies in the monaster- guests as ‘Christ who passes by’. as well, were conceived as holy ies and convents were authentic These ‘hospitales’ also arose as a places, as large churches. They forges of pharmacological medi- response to the drama of a large were always dominated by a large cine), and for exchanges with the number of pestilences and thus to central altar in the halls with the knowledge that had come from the the need to take in and care for in- presence of tapestries or paint- East through the Byzantine Em- curables, infectious sick people ings that emphasised the Myster- pire and the empire of the Muslim such as lepers etc… They were ies of the Life of Christ, especial- caliphates. In a few words, these places for taking in the poor, trav- ly his relationship with pain and were places where an attempt was ellers far from their homes. In the the sick. made to know man so as to heal monasteries there existed the so- A large number of brotherhoods him of his spiritual and physical called ‘hospites’ where monastic for providing care to the sick and maladies. and canonical rules required that support for hospitals almost eve- From the point of view of medi- these people were taken in indis- rywhere were also created.20 For cine, during the medieval period criminately. At times they arose in the first time in human history the these monastic schools developed unthinkable places, in mountain sick were not men and women to this branch of knowledge on the passes, next to very small church- keep at a distance but men and basis of herbs and plants with a es, including rural ones, often situ- women to welcome, to love, and medicinal purpose. Their obser- ated at crossroads, in the country- to help. It was certainly the case vations and proposals were trans- side. They also often arose thanks that on certain occasions care for mitted orally and also in written to charitable bequests left by the sick constituted a heroic ges- form, first by the monks and then Christian priests or secular peo- ture of charity inasmuch as the in- by friars and other Christian writ- ple, where it was thought through fections and contagious diseases ers with tracts that brought to- suitable rules how take in these did not have remedies. Those who gether the medical tradition and people in need: from the water to cared for these sick people knew experiences of Egypt, of the Jew- be given to them, to hot soup, to that they were putting their own ish world, of Assyria, of Phoeni- the wood to keep them warm…19 lives at risk but they accepted this cia, of Greece and of other eastern In the twelfth century Guy de risk with full Christian awareness, cultures. The monastic herbalist Montpellier created the Hospital knowing that death, as an ancient approach continued into the mod- Order of the Holy Spirit which Spanish hymn has it, ‘no era la ern age and developed with the was specifically consecrated to palabra final’, is not the last word European geographical discov- care for the sick. This Order was on existence. Despite the very eries that began in the fifteenth approved in 1198 by Innocent III harsh conditions of life, Chris- century. Today, after a period of who supported it; it then already tians lived a greater hope which being sidelined, it has been re- had ten houses in France and its made human life more liveable in discovered and appreciated once central headquarters in Rome, relationships, even though it was again. namely the Hospital of the Holy meagre and without resources.

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IV. When Man Wants epoch was the physician, natural- strengthening of the senses, a crit- to Become the ist and philosopher of the Uni- ical capacity and the invention of ‘Measure of all versity of Basle, Theophrast von all instruments that could help in Things’ Hohemheim, also known as Par- this task entered the picture. The acelsus (1493-1541). He suffered appeal to experience was not an 1. The Renaissance utopia and because of sharp contrasts with appeal to passivity but an appeal its collapse his colleagues and with pharma- to an active process: ‘able to ex- cists by whom he was expelled amine reality and to find in it cor- During the Renaissance there from this university. Despite eve- respondences and relationships… arose a new interest in the human rything, Paracelsus made a nota- Experience requires as the ba- body from the anatomical, artis- ble contribution to the develop- sis of the scientific procedure the tic (beauty and harmony) and hu- ment of medicine, even though he recognition of a cosmic order that manistic point of view, not least was accused of witchcraft. Para- should be explored and assessed because man became increasingly celsus accused doctors of a lack by a criterion that experience it- the ‘measure of all things’. The of love for mankind and attacked self exercises at the moment when work on anatomy by Andrea Ve- with especial force the medical it takes place, as an indispensa- sal, a Fleming, who was a profes- schools of his time which dimin- ble premiss for reflection’.24 This sor at the University of Padua, De ished the importance of obser- is why science also works with humani corporis fabrica libri sep- vation and thought that medical the hypotheses than can also be tem (Basle 1543), expressed this science had by then reached its shown to be mistaken with new interest in anatomy which began summit.21 Paracelsus had an ar- tests and because the scientific with the rediscovery of classical cane-mysterious approach to ill- method requires the possibility culture in its various dimensions. ness connected with magical that experiments can be repeated. But this interest led to the sick and astronomical ideas. The as- Galileo’s method is a fundamen- being neglected, almost to defec- tral bodies, he thought, were the tally mathematical method which tive bodies being despised, to origin of all natural phenomena: is different from the philosophi- wanting to conceal – in some cases ‘thus, whereas in traditional scho- cal and theological method; the even to prohibit – begging and in a lastic medicine, which had car- first always supplies theories ‘of utopian way almost to wanting to ried on the Hippocratic-Galenic a provisional and limited charac- ‘hide’ poverty as disturbers of that tradition, balance was restored ter…related and subjected to ex- dreamt-of harmony. The artistic through the therapy of contraries, perimental exploration’. works of the time emphasise the according to Paracelsus therapy The method of Galileo is to be beauty and the harmony of bod- had to be based upon the reinte- found at the basis of the whole of ies, not their defects or their de- gration of identical elements to be the modern scientific mentality formations. The artistic and liter- indentified in minerals or plants and of much of the distrust of an- ary works of the Renaissance are a which experienced or expressed cient philosophy or theology. But hymn to harmony and enjoyment the same astral influences. Hence reality, as we known, does not end in contrast to the painful and of- his provocation to pharmacists with the kind of experimentation ten traumatic reality of the society through the new and suspicious proposed by this method, specifi- of the time. Many hospitals were procedure of producing drugs and cally beginning with the same ex- neglected and not looked after, es- medicines through techniques for perience invoked by it. Man is not pecially in places where the Re- the transformation through al- only made up of organic parts, of naissance mentality had imposed chemy of natural substances’.22 limbs that be examined separate- itself in a strong way. A certain These positions contributed to his ly. He forms a complex that we collapse in this mentality – which having the dark fame of being a call precisely ‘man’ or ‘woman’ is reflected in the paintings of Mi- poisoner. where numerous indissoluble el- chelangelo in the Sistine Chapel – ements enter into an inseparable was the sacking of Rome by the unity. Lansquenets in 1526. This was ak- 3. The experimental method in to a sign of the end of a utopian and unreal set of ideals. Despite But the great innovation for 4. The great technical advances the subsequent mannerism, the medical science was the estab- of medicine faced with the tragic European history of a cen- lishment of the experimental perennial problem of man tury furrowed by armies and wars method introduced by Galileo23 left its deep and painful marks and against the so-called Peripatetics Beginning with Galileo, medi- also explained the subsequent age (Aristotelians and Scholastics) cine achieved great technical ad- of the Baroque, in art as well. who believed that they had noth- vances, as is attested to by the ing to learn from the observation history of modern medicine. Ill- of phenomena. He stressed the nesses began to have points of 2. The emblematic case need to ‘place experience before departure, causes, processes, out- of Paracelsus any discourse’ and thus the ele- comes…Anatomy also achieved ments of his method of knowl- notable steps forward and the di- Another personality who was edge were ‘sense experiences and agnosis of illnesses became in- representative of the Renaissance certain demonstrations’: here the creasingly precise. Gradually, be-

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ginning with the Enlightenment, the ultimate problems and ques- and healing people who had all the medicine of work was born tions of man: ‘men…cannot elim- kind of disease and sickness. The (Bernardino Ramazzini da Carpi) inate limit, the authentic condition news about him spread through- and psychiatry came into exist- of dependence that nature impos- out the whole country of Syria, ence (Chiarugi and Philippe Pi- es on them. The possibility of a so that people brought to him all nel) which freed the mentally ill quantitative improvement and ex- those who were sick, suffering from chains. Discoveries such as tension of life do not appear to be from all kinds of diseases and dis- vaccination (E. Jenner) moved in infinite’.26 The human organism, orders: people with demons, and the direction of preventive med- at a certain point, seems to col- epileptics and paralytics – and icine; public health and hygiene lapse, it can at times be helped to Jesus healed them all’ (Mt 4:23- also began (J.P. Frank); the caus- recover a certain level of rehabili- 24). ‘Jesus went round visiting all es of death began to be studied; tation or health but there is always the towns and villages. He taught and schools of health care were an ineluctable end, death, which in the synagogues, preached the created to promote health care dramatically manifests that we Good News about the kingdom, and hygiene, of a public character are creatures of the human con- and healed people with every kind as well, as a primary right of citi- dition. And this ineluctable fact of disease and sickness’ (Mt 9:35). zens (to be found in revolution- calls us to personal awareness of These miracles of healing are ary France in 1794). Health thus our being and our destiny. often narrated in the gospels with became a fact of public responsi- details that are notably human and bility. moving. St. Mark offers us a de- An authentic revolution in the scription of these miracles per- field of health and health care, V. The Church Faced formed by Jesus: ‘As they left the however, took place beginning with Illness27 boat, people recognised Jesus at with the nineteenth century when once. So that they ran throughout medicine came to be a part of the 1. Beginning with Christ the whole region, and wherever life of public health. But the real himself they heard he was, they brought turning point only took place in to him sick people lying on their the middle of the century with A Christian is a man or a wom- mats. And everywhere Jesus went, the study of cellular pathology an gripped by the grace of Christ to villages, towns, or farms, peo- thanks to microscopic techniques in baptism. For this reason, Chris- ple would take those who were ill and the introduction of experi- tians are interested in the whole of to the market places and beg him mental medicine.25 The study of the human and not only in a par- to let them at least touch the edge germs and microbiology intro- tial part of the human question, of his cloak, and all who touched duced an authentic revolution in- such as that of the religious ritual it were made well’ (Mk 6:54-56). to the field of health and medicine dimension, the soul or the world In his introduction to the Ser- (Sememelweis, Wendell, Pasteur, beyond this one. Thus, if they mon on the Mount Luke offers us Koch, Hansen, Neisser, Fraen- are interested in everything, they in the passage concerned a simi- kel, Klebs, Nocolaier, Yersin, Ki- must also be interested in peo- lar description: ‘When Jesus had tasato, Bruce, Schaudinn, Rick- ple ‘who look for the meaning of come down from the hill with the etts…). Medicine had discovered their suffering, that is to say the apostles, he stood on a level plane the causes of a large number of nexus between their lives and the with a large number of his disci- infectious diseases and remedies destiny for which they feel they ples. A large crowd of people was for them by gradual steps and are made’. ‘Illness is a sign of this there from all over Judea and from the entrance into medicine dur- definitive meaning of things, and Jerusalem and from the coastal ing the twentieth century of a if [this meaning] exists it is larger cities of Tyre and Sidon; they had greater strengthening of instru- than we are. Illness is an appeal, come to hear him and to be healed ments for diagnosis and therapy the final and most terrible appeal, of their diseases. Those who were (Riva Rocci, Rontgen…) then to look for that meaning’.28 troubled by evil spirits also came followed. ‘The senses on which This concern has been pre- and were healed. All the people Galileo founded the possibility sent since the early beginnings tried to touch him, for power was of experience are today involved of Christianity and beginning going out from him and healing in perceiving not only something with Jesus Christ himself. One them all’ (Lk 6:17-19). but also the particulars of images need only observe the life of Je- The ministry to implement this that are artificially derived from sus as it is described to us by the mercy towards all suffering peo- this body’. gospels to understand the impor- ple formed a part of the mission But despite this progress, man tance that healing and care for the that Jesus entrusted to his disci- continues to pose himself the eter- sick, the suffering and every per- ples. This can be seen with clar- nal questions, at times to solve son who needs mercy, has in his ity in the classic text in Matthew: enigmas that reason alone per- life. The Evangelist St. Matthew ‘Jesus called twelve disciples to- ceives but which reason on its provides us with a brief descrip- gether and gave them authority to own it is not able to provide an- tion of his activity in this area: ‘Je- drive out evil spirits and to heal swers to. This means that there sus went all over Galilee, teaching every disease…Heal the sick, still remain the eternal deep un- in the synagogues, preaching the bring the dead back to life, heal knowns, their contradictions and Good News about the Kingdom, those who suffer from dreaded

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skin diseases, and drive out de- ings (Mk 1:40-5). Leprosy was passage of scripture has come mons. You have received with- a highly contagious disease and true today, as you heard it being out paying, so give without being was seen as a sign of divine mal- read’(cf. Lk4:18-21). paid’ (Mt 10:1-8 ; cf. Mk 3:13-19; ediction. In addition, it was the 6:7-11; 9:1-5; 10: 3-12). In the subject of severe discriminatory text of Mark one reads that: ‘He laws. Afterwards we find narrat- 2. The Apostles and their called the twelve disciples togeth- ed another series of healings of immediate successors obeyed er and sent them out two by two. the maladies of people afflicted the mandate of the Lord He gave them authority over the by physical and social handicaps evil spirits…So they went out and such as the case of the paralytics The apostles worked their heal- preached that people should turn (cf. Mk 2:1-12), blind men (cf. ing by anointing with oil (cf. Mk away from their sins. They drove Mk 8:22-26; 10:46-52), the deaf 6:13). Perhaps here is prefigured out many demons, and rubbed ol- and dumb (cf. Mk 7:31-36), peo- and has its foundation the sacra- ive oil on many sick people and ple afflicted by various diseases ment of the anointing of the sick, healed them (Mk 6:7, 12-13). such as those who were called or as understood by the Council of Luke, for his part, narrates: ‘Je- seen as possessed by demons and Trent, as we shall see. The Coun- sus called the twelve disciples to- expelled from the community (cf. cil sought to found this reality of gether and gave them power and the case of the possessed man of being a sacrament specifically on authority to drive out all demons Gerasa in Mk 5:1-20; 7:24-30), the concrete data of Scripture. and to cure diseases. Then he sent epileptics (cf. Mk 9:14-27), peo- The text of Mark 6: 7-13 provides them out to preach the Kingdom ple with illnesses that were with- a list of the activities of the Apos- of God and to heal the sick… out doubt seen socially as being tles sent out by Jesus on a mission: The disciples left and travelled ‘shameful’, such as the case of to preach penitence, to cast out through all the villages, preach- the woman with an issue of blood demons, anointing with oil and ing the Good News and healing (cf. Mk 5:34), even the raising of the healing of the sick. Anointing people everywhere’ (Lk 9:1-2, people from the dead, always as with oil was in use amongst the 6). And later Jesus adds his order: signs of his status as the Messi- Jews as a purely medicinal pro- ‘Whenever you go into a town and ah and his mercy (cf. the daugh- cedure. It was to symbolise the are made welcome…heal the sick ter of Jairus, Mk 5:35-43; the son power over illnesses transmitted in that town, and say to the people of a widow in Naim in Lk 7:11- by Christ to the Apostles. A ref- there: The Kingdom of God has 17; and of Lazarus in Jn 11:1-44). erence to anointing with scented come near you’(Lk 10:8-9). Everywhere he went the people oil is also to be seen in the anoint- There was no situation of hu- ‘wherever they heard he was, they ing that Christ allowed to be done man pain that Jesus encountered brought to him sick people lying to him by a woman at Bethany, on his travels that he did not touch on their mats’ (Mk 6:53-56; ). in the home of Simon the leper, with his mercy. This was a part of Thus from the beginning of before his death (Mk 14:3-9; Mt his mission and a sign of his au- his public life: ‘Jesus went all 26:6-13; Jn 12:1-8; cf. Lk 7:36- thenticity of being sent by the over Galilee, teaching in the syn- 50). Many author have seen in Father. To confine ourselves to agogues, preaching the Good this gesture a prefiguring of the the Gospel According to Mark, News about the Kingdom, and sacrament of the sick. we already find from the begin- healing people who had all kind The Acts of the Apostles show ning of his mission the almost of disease and sickness. The news how the Apostles and the whole continuous narration of a series about him spread throughout the of the Church were immediately of miracles involving the healing whole country of Syria, so that aware of the meaning of this man- of illnesses which for that mat- people brought to him all those date of Jesus. Its concern for the ter were then socially discrimi- who were sick, suffering from all suffering of every infirmity and natory and without a way out. kinds of diseases and disorders: of every human suffering, thus of Thus Jesus taught at Capernaum people with demons, and epilep- sick people as well, on a par with and healed a possessed man (Mk tics and paralytics – and Jesus the whole of its action of salva- 1:21). This was followed by the healed them all’ (Mt 4:23-24). tion, was seen and implemented healing of the mother-in-law of Jesus healed the sick but one as a continuation of the mission of Simon (Mk 1:29-31) and many could say that according to the Christ himself. His large number other healings: ‘After the sun accounts of the gospels he had of miracles and healings, beyond had set and evening had come, special care and tenderness for all momentary individual help, were people brought to Jesus all the of those situations of discrimina- signs of the new and definitive era sick and those who had demons. tion and illnesses that were then (escaton) of salvation that he ini- All the people of the town gath- socially discriminatory and ‘in- tiated, will receive in the parusia ered in front of the house. Jesus fectious’, such as leprosy. He its ultimate completion, a perfect healed many who were sick with himself observed the meaning of form that that will no longer ex- all kinds of diseases and drove out all these healings and his mean- perience illness and death. Con- many demons’(Mk 1:39). ing in the light of his messianic ferring on the Apostles the man- This is followed by the heal- mission in the synagogue of Naz- date to ‘heal the sick’, ‘to heal ing of a leper which would be the areth when quoting the proph- every disease and every illness’, first of a long series of such heal- et Isaiah. Christ declared: ‘This belongs therefore to his mission

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(cf. Mt 10:1; 7: 9-11; Mk 6:7-13; exercise the ministry of ‘healers’. the others engage in the anoint- Lk 9:1s.). Indeed, the healing of Each time that he speaks he em- ing with oil. They must do this in the sick constitutes an element of ploys the phrase charismata iam- the name of the Lord. This formu- the mandate with which Christ in- aton which means ‘charisms of la may mean that the action goes vited the Apostles to go out into healings’. Some think that the use back to an order of Christ or al- the world and preach the Gospel of the plural of the term means so (something that is more prob- to every creature (Mk 16:15 s.; that Paul sees a specific charism able) that prayer and anointing Acts 3:1-16; 9:32 ss.; 14:8 ss.; in each healing. F. Sullivan SJ take place in virtue of Christ and 28: 8 s.). In this context he said writes as follows: ‘ L’emploi ré- thus the salvific virtue of Christ to them: ‘Believers will be given pété de cette expression donne à is present and acts in the act of the power to perform miracles, penser que Paul voit en chaque the church elders. The salvation they will drive out demons in my guérison un charisme, ou don de of the sick person and his getting name, they will speak in strange la grâce. Mais sa déclaration à well through the Lord are indi- tongues, if they pick up snakes un autre les dons de guérisons et cated as the outcome. Here one or drink any poison, they will not sa question tous ont-ils des dons asks whether one is dealing with be harmed, they will place their de guérison? laissent supposer a corporeal or a spiritual salvation hands on sick people, who will qu’en pariant de ceux qui ont des and cure. The forgiveness of sins get well’(Mk 16:17 s.). dons de guérison, Paul ne pense is mentioned only as a hypothet- In the Acts Luke describes in pas à ceux qui sont guéris mais ical consequence of prayer and the first part the activity of Peter à ceux qui sont d’une manière anointing. Even if the sick man who performs numerous healings ou d’une autre impliqués dans has committed no sins, the church as an integral part of his apostol- la guérison des autres. La façon elders must prayer over him and ic mission (cf. Acts 3:6-7 ; 5:15- dont il en parle donne à entendre anoint him. This fact testifies that 16; the raising from the dead of a qu’il ne voit pas là un « don de the passage aims first of all at cor- woman: 9:40); in the second part, guérison » permanent; cependant poreal healing. the history of the apostolic mis- ses propos suggèrent que certains If one interprets this passage sion revolves around Paul. There individus servent, avec quelque from James within the horizon could not fail to be the miracles régularité, de canaux ou d’instru- of the New Testament, that is say performed by the Apostle of peo- ments aux guérisons qui se pro- of the whole of the thought of Je- ples as a part of his apostolic au- duisent. Si c’est bien là le cas, il sus borne witness to by the writ- thority: the paralytic of Lystra semblerait alors légitime de dire ings of the New Testament, one (Acts 14:9-10; at times by simple de ces personnes qu’elles ont un has to say that Jesus always wants contact:19:1 1; or the raising from ministère de dons de guérison to give overall salvation to man the dead of a young man who pour les autres’30. and not only physical health. The had fallen from a window (Acts In reality this kind of ministry physical healings performed by 20:10). constitutes an important part of Christ were never disconnected We also see the other Apostles the ministry of Jesus and thus also from spiritual healing. They were and Disciples perform miracles of his disciples. always in a living relationship of healing. For example it is said with forgiveness of sins, inas- that Stephen, ‘a man richly bless- much as the healing of illness was ed by God and full of power, per- 4. The testimony of James the point of departure for, or the formed great miracles and won- confirmation of, the forgiveness ders amongst the people (Acts However, the clearest testimo- of sins. In our text as well salva- 6:8). The same is said of Philip as ny of the concern of the Church tion and relief must be understood regards his ministry in Samaria: for the salvation of the sick is of- as the total salvation of man, how- ‘The crowds paid close attention fered by James (5:14 ss.). The ever much physical healing is in to what Philip said, as they lis- text reads as follows: ‘Are any the forefront. Evidently, physical tened to him and saw the miracles of you ill? You should send for health and spiritual health have that he performed. Evil spirits the church elders, who will pray an indissoluble relationship. For came out from many people with for them and will rub olive oil the former it can mean return to a loud cry, and many paralysed on them in the name of the Lord. life; for the latter death calls. The and lame people were healed. So This prayer made in faith will true good is the coming of the there was great joy in that city’ heal the sick; the Lord will restore Lord, the possession of the king- (Acts 8:6-8). them to health, and the sins they dom of God. If the achievement have committed will be forgiv- of this good requires the dilation en. So then, confess your sins to of death, this will be deferred by 3. Doctrine in the Apostle Paul one another and pray for one an- God. If it requires the acceleration other, so that you will be healed. of death, this will be hastened by Paul, for his part, lists healings The prayer of a good person has a God. Prayer and anointing with amongst the charisms produced powerful effect’ (Jm 5:14-16). oil do not produce, therefore, on- by the Spirit (I Cor. 12: 9, 28, The ‘church elders’ to which ly the health of the body but also 30).29 The Apostle speaks explic- reference is made are the lead- the salvation of the whole of man itly of a ‘gift of healings’ (vers- ers of the community. They must united to Christ. es 9, 28, 30) and of people who pray over the sick person whilst

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5. Church prayer, the anointing situation whose meaning, solely that took place within the Church. of the sick and care for the with the forces of nature, he or The early Church, basing itself sick in the early Church she would never be able to un- after a certain fashion on the ex- derstand. God, who watches over pectations of salvation of Jewish In the writings of some Fathers the sick individual, does not want apocalyptic thinking and also de- of the Church there are referenc- him or her to be lost, He wants fending itself against spells for es to health and illness as part of his or her salvation and accord- the sick which were widespread ‘indifferent’ things which are not ing to the good of his or her soul in the pagan world, often used in themselves good or bad but, ac- always gives the best good (thus consecrated oil against illnesses.34 cording to the disposition of each also physical health) as regards Traditio Apostolica by Hippoly- person, can be useful for good salvation to those who ask for it tus (c. 215) also refers to prayer or an opportunity for evil, even in faith. Hence the importance of for the consecration of oil for the though health corresponds to the the patience of a sick person and sick. A prayer for such consecra- original state of created man. Ill- of prayer. tion handed down by Serapion of ness is seen as an evil inasmuch To this context also belongs the Thmius goes back to the fourth as it appears as a consequence of sacramental action of the Church century. It reads as follows: ‘We original sin and thus as something in favour of the sick, its prayers invoke you, who possess all force opposed to the good wanted by for them, the request for overall and power, saviour of all men, fa- God. But this evil is always seen healing, always with a view to the ther of our Lord and Saviour Je- at the level of the physical nature total salvation of man. Syri- sus Christ, and pray that you send of man. As a result, at times ill- us wrote: ‘prayer is the strongest from heaven to this oil the health- ness can constitute, paradoxically, help there is for illness’. In prayer, giving virtue of the Only Begot- a good as regards salvation (Basil and above all in that prayer en- ten, so that it may serve those who of Caesarea, John Cassian, John gaged in by the Church through are anointed by it, or receive these Chrysostom, Gregory of Nazian- sacraments, man unites himself to gifts of your creation to drive out zus…). This is the same approach God and opens himself to grace; every evil and sickness, as an an- suggested by St. Ignatius of Loy- he receives from God every form tidote against every demon, for ola in his spiritual exercises in the of help and every form of good. the throwing out of every impure face of every earthly reality and For this reason many of the an- spirit, for the repression of every situation.31 cient Fathers of the Church (like malign spirit, for the elimination Thus illness can also have a Doroteus of Gaza) were con- of every heat of fever and every positive meaning. But this posi- cerned with whether a sick person coldness and weakness, for good tivity is recognised by a person if should pray or adopt an approach grace and the forgiveness of sins, he or she has a sense of transcend- of gratitude. However, if a sick as remedy for life and health, for ence, otherwise it will always be person lived in a situation of pain the health and integrity of the soul, seen in a negative and despairing or powerlessness then a prayer in of the body and of the spirit, for way. An approach of this kind not the usual sense was difficult; he or perfect restoration of health. May only does not give relief to the she thus only had the possibility be feared, O Lord, every Satanic body but also increases the pain of living silently in the presence force, every demon, every attack and the hopelessness of the soul of the Lord and entrusting him- of the adversary, every suffering, and become ‘lost pain’ (Chrysos- self or herself to the prayer of the every blow or attack or injurious tom). For this reason the Fathers Church which prayed for the sick shadow, before your holy name, of the Church laid emphasis on person, helped him or her and im- which we now invoke and before the search for the meaning of ill- plored total healing according to the name of the Only Begotten. ness in order to live a painful sit- the will of God. That they withdraw from the soul uation in a salvific sense (Maxi- In his Adversus haereses St. and body of these your servants, mus the Confessor, Gregory of (second century) point- so that the name of he who for us Nazianzus): ‘Hacer filosofía de la ed out that one of the signs by was crucified and rose again may propia enfermedad y del propio which to identify a heretic was be glorified, Jess Christ, who took sufrimiento consiste en primer that he was unable to perform upon himself our illnesses and our lugar para el hombre en consid- the miracles of healing carried weakness (Mt 8:17) and who will erar lo que se le está revelando out by Christians because he did come to judge the living and the sobre su condición’32. Thus ill- not have the power of God. He dead (2 Tim 4, I). Indeed through ness can constitute for a Chris- showed how the subject of heal- him is yours, honour and power tian an opportunityfor conversion ing the sick was a fundamental in the Holy Spirit now and for all and sanctification (Chrysostom, concern in the life of the Church centuries. Amen’.35 John Climac and numerous an- from its beginnings in a varie- For his part, Origen (second cient oriental ascetic and mystical gated way: ‘Others heal the sick century), in his Contra Celsum, writers). In this sense, illness is a by a laying on of hands and they refers to Christians who ‘cast manifestation of Providence and recover their health’.33 From this out bad spirits and perform many an opportunity for spiritual pro- text condemning emerging here- healings’. He explains the effects gress. The sick person should for sies one can deduce not only the of prayer by Christians said in the this reason constantly supplicate concern of the Church for the sick name of Jesus: ‘the name of Jesus the grace of God so as to live that but also the ‘miraculous’ healings can still eliminate the disturbanc-

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es of the minds of men, cast out tion of their relics and to pilgrim- manity with God, the purpose of demons, and distance illnesses’: ages to Christological or Marian the life of man. In this sense, mir- ‘because in this way we have seen sanctuaries or to the sanctuar- acles for him were eschatological many people freed from terrible ies of saints, to places of special ‘signs’. Prayers of intercession sufferings, mental disturbances, Christian relevance, and to plac- addressed to martyrs and saints, madness and innumerable other es of apparitions recognised by and which were encouraged by illnesses’.36 the Church, does not exclusively Aquinas and the Pope, became a During the fifth century St. Au- concern them alone. It is not my common denominator of Church gustine stated that there were still task here to provide an analysis of history of healing during the High healings of an extraordinary char- the subject of illness and care for Medieval period, an age that was acter as a response to prayer. In the sick in the Church of the ear- typically convinced that mira- some of his works of the first part ly centuries. What is of interest is cles were the clearest signs pos- of his life as a convert he express- to emphasise that the Church saw sible of canonised saintliness. In es his opinion on the fact, that in care for the sick as an integral part this context should one also read his view, the age of miracles was of its mission, in obedience to the the importance given in the West already over. But it appears that mandate of Christ. ‘Anointing of to the anointing of the sick, in a he corrected this opinion follow- the sick’ was a clear form of how sacramental sense as well, often ing his Episcopal ministry in Hip- since the times of the Apostles joined to the practice of penitence po where, he asserted, in a period this concern was expressed. and viaticum towards eternal life. of just two years and in his own Perhaps of influence here was al- diocese there were about seven- so the belief that at the moment of ty-two well documented miracu- 6. Testimony during the death was concentrated the final lous healings.37 In his Confessions medieval period until the decision about eternal destiny and Augustine describes the interven- Council of Trent thus the act of death had to be pro- tions of God in his life and how tected through its own sacrament. he used every glorious or painful During the medieval period St. Thomas Aquinas addressed the situation as an opportunity to give one should make a distinction be- question of the healing of the sick His grace. tween initiatives in the field of and thus of miracles of healing in Other Fathers of the Early illness and care for the sick and the third part of his Summa The- Church and the Fathers of the the action of the Church at vari- ologica. For St. Thomas, mira- Desert (monks, ascetics…) often ous levels. First of all, the ancient cles were a proof of gospel truths, spoke about illness, about the ap- traditions of the Fathers of the proof of Christ and his teaching, proach of Christians to it, and laid Church of thinking of illness with and it was in practice in this sense stress above all else on the aspect reference to man as a whole, of that he understood the miracles of a ‘conversion’ through prayer man who fell and was redeemed of the Gospel. The miracles of all and the imploration of divine by Christ, and thus by his salvific ages should be seen in this salv- grace for total salvation.38 Many value, was continued. Emphasis ific perspective, as he himself ob- of the Fathers, especially those was laid upon illness as an oppor- served: ‘the soul is more impor- of the Desert (ascetics, specially tunity for ‘conversion’ and being tant than the body… When the during the fourth to sixth centu- raised up to God; sick people were soul has a value that is greater ries) and also women who with- prayed for and it was stressed that than the body, equally the forgive- drew to this style of life to coeno- these should live their illness as ness of sins is a greater work than bia and convents in the deserts of an opportunity for greater un- the healing of the body; however, Egypt and the Middle East have ion with God and emphasis was because the first is invisible [God] handed down to us a complete de- placed on the need for grace to carries out a less important and scription of prayer to ask for the live their painful situations; the more evident act with the aim of grace of inner healing.39 sick were cared for – and in this demonstrating that which is great- The Christian experience of sense the specific history of hos- er and more invisible’.40 healing the sick following prayer pitals began, a history of specific It is interesting to observe that has been a constant in the life of charity whose direct goal was care an approach similar to that of St. the Church as is borne witness for the sick of all kinds. But at- Thomas is to be found in certain to by sanctuaries, pilgrimages tempts were also made to treat the figures of the Reformation such and the testimony of miracles re- sick through liturgical (anointing as Luther and Calvin who be- quired for canonised holiness. of the sick) prayer involving both lieved that miracles had taken This is sufficient to remind us that a request for total healing and in place in the early centuries in or- God, in response to prayer, al- relation to passing over into eter- der to strengthen the preaching ways grants special graces which nal life (viaticum). Emphasis was of the gospel but subsequently are often true miraculous heal- also placed on personal prayer more stress had been placed on ings in the technical and theolog- to ask God for the miracle of the the teaching of men to achieve ical sense of the term. This fact, healing of a sick person. In this their conversion, as a result of even though often in the history sense, Pope St. Gregory the Great which these figures of the Refor- of the Church it has been con- (590-604) saw miracles of heal- mation had a radical Providential- nected with devotion to saints and ing as an anticipation of heaven ist vision of every event and re- their intercession, to the venera- and as a sign of the union of hu- ality of history and thus also of

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illness. Everything that happened against, were contagious and thus Christ there is a particularly inci- in the life of a person was willed abandoned by everyone. These sive aspect: a saint intercedes for by God and was a sign of election saints consecrated themselves a man or woman who is in need or rejection (predestination), as a personally to these sick people of mercy, of forgiveness, of phys- result of which this vision could whom they saw as being Christ ical and spiritual help; his charity nourish resignation in the face himself and miraculous healings becomes a work of mercy and of of illness which was seen as the often took place through their in- human promotion; often a saint outcome of the will of God. Thus tercession, while they were alive literally works miracles of heal- it was difficult for a person who as well. Thus the practice of con- ing. In this sense, the history of was convinced of this theological secration to service to the sick, canonised saintliness demon- vision to fight against illness or also imploring their healing and strates the overall importance of ask for a miracle. As regards the obtaining treatment for them the whole person and his or her Catholic Church, the need was through prayer and every kind of care. This is why, also in the study then seen to make clear the whole charitable and active action, was of the subject ‘care for sick peo- of theology as regards the sacra- never forgotten. Charity was co- ple who are discriminated against ments and the value of prayers of essential in the very nature of the and afflicted by illnesses that are intercession, the meaning of mira- Church.42 considered infectious in the his- cles and the value of works: at a tory of the Church’, one cannot practical level the value of Chris- depart from the study of the work tian charity. One thus arrived at of saints who have consecrated dogmatic definitions and the dis- VI. The History of the themselves to these sick people, ciplinary measures of the Council Church in Relation have founded works to help them of Trent in this field.41 to the Sick and and often have performed real With respect to ecclesial prac- the Discriminated miracles, in the theological sense, tice in the life of the Church af- Against to their benefit. I will refer to cer- ter the Council of Trent, theologi- tain cases and moments in history. cal analysis of the sacraments was 1. Charity was worked continued and there was greater in the history of the Church focus on the doctrine of mira- above all by the saints 2. Monasticism and works cles, applied above all else to the of mercy causes for canonisation, on the Down the history of the Church, one hand. On the other, the great Christians have been concerned The history of the Church is full saints of the time because effec- to follow in the footsteps of Jesus of facts that illustrate initiatives tive instruments for the renewal Christ as regards the needs of peo- within the Church in favour of the of Church life and at a practical ple; amongst these one encounters sick and the discriminated against level also authentic healers in vi- care for the poor, for orphans, for of various kinds starting with the ta et post mortem. Some, like St. widows and for all those in need. early Church. The same may be John of God, St. Filippo Neri, St. This care is already to be found in said of the history of charity car- Camillus di Lellis, St. Vincent de the recommendations of the Acts ried out by saints for the poor, es- Paul, etc…stood out in the life of the Apostles when reference is pecially the most discriminated of the Church as instruments of made to the creation of deacons, against of the sick such as lep- God in the Church and in soci- to certain miracles performed ers. Stories, such as those of St. ety to meet the social dramas of by the Apostles themselves and Martin of Tours who in Amiens the time in the field of health and to the collecting of alms to help while still a soldier gave his cloak health care, especially in the face those members of the Christian to a poor man (who subsequent- of illnesses which society of the community who were in a state ly Christ identified as himself),45 time did not bother about or was of need. The same concern is to are very well known. Episodes of discriminatory towards. A whole be found in the letters of St. Paul this kind are repeated often in the history of canonised saintliness and in the rest of the letters of the history of saints, for example St. began beginning with the mod- Apostles with collections made , St. Camillus de ern epoch and especially of wom- to help the poor, especially in the Lellis, etc. an who were consecrated to car- Church of Jerusalem and in the But very soon, in the history ing for the sick, with a preference, letter of James (cf. James 2). Care of the Church, other institutions which was rather specific and spe- for the sick and all those in need, were born that were consecrated cial, for the most desperate cases therefore, was a part of the chari- to charity towards those most in and the cases most segregated table activity of the Church from need. In the early Church we find from society. These saints were its earliest beginnings.43 the creation of such works by bish- involved in the ministry of care One location where one sees ops to help orphans, widows, pil- for the sick and created hospi- in action the work of the Holy grims, poor sick people, the home- tal works, founded companies of Spirit in the concrete history of less and all kinds of poor people. brothers and sisters and religious the Church is the lives of saints, The history of monasticism is also orders that were totally consecrat- an unfolding in space and time of the history of operative charity. ed to care for the sick, especial- the Mystery of Christ.44 Well, in One need only remember here the ly those who were discriminated this unfolding of the presence of history of Western monasticism as

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developed by St. Benedict. It was ly marginalised from a health care ers, who were accommodated in not only of determining impor- point of view; in this, the practice hospitals or special houses, such tance in the missionary spread of of works of mercy were a privi- as the Order that was near to St. medieval Christianity, it was also leged part of their monastic lives. John of Acre (1190) which with of crucial importance in the crea- time was transformed into an Or- tion of a new home for peoples: der with the approval of Clement European Christendom. Welcom- 3. Orders, brotherhoods III (1191) and was organised un- ing monks both from the Roman and hospital congregations der Innocent III (1199) ‘juxta mo- populations and from the Ger- during the medieval period48 dum Templi in clericis et militibus manic peoples, Benedictine mo- et ad exemplum Hospitaliorum in nasticism embodied the dialogue With the passage of time were pauperibus et infirmis’49. Another between two worlds which was born within the Church religious Order that was also dedicated to made possible within a Christian orders, groups of Christians, service to the sick and sick pil- vision. It thus performed an edu- gathered together in the name of grims was the Spanish Order of cational function for the new Eu- Christ, to help all those who were St. James of the twelfth century. ropean peoples, thereby actuating in particular situations of need. It was specifically during the internally a true unification of the Whereas during the early centu- twelfth century that there was West and establishing a real ba- ries in small communities ample a flourishing of works of mer- sis for European unity. But there space was given to care for those cy promoted by the movement was another fundamental aspect who were in need, down the cen- of canonical apostolic life in in- of this experience. The monks turies, especially during the me- habited centres and along routes through their labour cleared and dieval period, we can witness the of pilgrimage and trade, for the drained vast uncultivated areas birth of the phenomenon of reli- provision of spiritual and mate- and transformed them into fertile gious Orders, some of a monastic rial care to the sick.50 These con- fields; they taught the new peoples character and some canonical and secrated people sought to respond to love the land and to cultivate it. later we encounter Orders that to all the needs, including mate- Rustics moved towards the mon- arose from the chivalric Orders, rial ones, of these sick people and asteries ‘attracted by their protec- those concerned with the free- these pilgrims who when travel- tion and by the example of those ing of Christian slaves (the Trin- ling far from their own country unusual pioneers of an industrious itarians and the Mercenaries…), found themselves in a sea of trou- and reparative civilisation’.46 hospital Orders, mendicant Or- bles. There were thus created spe- The monasteries also per- ders and so forth. The activities of cial houses, structures of accom- formed a social function not so these Orders was supported by lay modation were created for those much as centres for arts and crafts brotherhoods of men and women who fell ill on their travels, and but more the provision of hos- near to them which founded hos- even bridges were built in places pitality and care and accommo- pitals, rest homes for the sick, where people passed by. One very dation for the sick, in particular leper refuges and places to take well known case is connected through the foundation of special in all those who were in situa- with the city in Castillia (Spain) homes, refuge homes and the first tions of difficulty, experienced of Santo Domingo de la Calzada. hospitals in history. In this sense social discrimination or were af- St. Jacinto was a humble boatman the monasteries became the prin- flicted by illnesses that were seen who when ferrying some pilgrims cipal custodians of culture, of as infectious, often in places that also served the leprous Christ charity and of responses to needs, were on the frontiers of religious, who took him with him to eternal in the health-care field as well, cultural and political life. We find life after he had kissed leprosy. of the Western world. One need them flourishing from the elev- It was a ‘social’ necessity on the only remember their role in the enth century onwards. The reli- development of Christendom to history of medicine and pharma- gious orientation of these Orders build the domus leprosorum, the cology with the creation in every (of men and of women) meant the hospitalia pauperum, to assure monastery of pharmacies and au- exercise of works of mercy, car- security on the roads of commu- thentic places of study and care in ried out together with men and nication, to provide an economic this field. During the High Middle women, for sick people, pilgrims basis for hospitals and the lives of Ages the monks for this reason, and the freeing of slaves. For ex- their servants. The reform of hos- especially during the harshest of ample, the Order of St. Lazarus pitals was one of the points of the times, were a sign of humanity should be remembered which ad- reform carried out by Innocent and contemplative prayer placed ministered a hospital for lepers III and his legates at the councils within a violent society, magiste- in Jerusalem and which after the that preceded the Fourth General rially integrating their motto ‘ora second crusade was transformed Lateran Council. This reform was et labora’.47 They were an appeal into a military Order (1142). A carried out under the banner of a to the people of their time to the similar case is the Order of the motto: the sick, the poor, lepers memory of Christ. Gradually the Holy Sepulchre or the Order of are ‘the lords of hospitals and as monasteries became, in a society the Teutonic Knights (1198). In a consequence the workers in a that was in turmoil and violent, fact with the crusades various Or- hospital are their servants’.51 The true ‘cities’ of peace and encoun- ders arose that were consecrated organisation of the hospitals took ter, also for those who were total- to service to the sick, such as lep- place at a local level under the

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leadership of the local bishop or the bad policies of his nephews Bishop of Grosetto and Rector of the Pontif- ical Lateran University) addresses the sub- at a universal level under the pa- and to save babies thrown into the ject of illness and the wish written into the pacy. The workers in the hospitals waves of the Tiber, still exists to- heart of the man who feels that illness and (men and women) could be reli- day. death are something against his very nature and thus against the wish for eternity. gious or devout members of the At that epoch, which was by 2 A. Scola, ibidem, p. 5. laity. then in the throes of the social 3 Cf. John Paul ii, Apostolic letter on the In this way numerous brother- transformations of Europe, we Christian meaning of human suffering , Salvifici Doloris, 11 February 1984,and that hoods, religious Orders and other encounter in the thirteenth cen- of the congregation for the doctrine of congregations dedicated to care tury a notable array of women the Faith, Instruction on Prayers for Heal- for the sick spread their range. who consecrated themselves to ing, 14 September 2000. 4 A. Scola, op. cit., p. 7. For example, the so-called ‘grey total service to Christ in the poor, 5 R. Guardini, Ritratto della malinconia sisters’, who were consecrated in the sick, in the plague-strick- (Brescia, 1990), p. 37; quoted in Scola, op. to care for the sick, multiplied in en, in lepers…One may remem- cit., p. 7. 6 Ibid., pp. 8-10. number. We may remember, for ber, amongst many, Isabella of 7 E. Levinas, Totalità e infinito. Saggio example, the Crucifers or Cru- Hungary, Margaret, daughter of sull’esteriorità (Milan, 1980), p. 238, quot- cigers, the Brothers of the Holy Bela IV, Edvige, Anna of Sile- ed in scola, op. cit., p. 9. 8 T. W. Adorno, Minima moralia (Turin, Cross in Bologna (1169), the So- sia, Salome of Galicia, Cune- 1988), p. 264, quoted in scola, op. cit., p. 9. rores of St. Isabella of Turingia gonda of Poland, Agnes of Bohe- 9 These elements are dwelt upon in the (+1231) in Marbourg. ‘A fine wish mia, Isabella of Töis, Isabella of documents of the Magisterium that have been referred to: cf. Salvifici Doloris, chap. has been sent down to those who Aragon, all queens or aristocrats, III; Instruction of the Congregation of the care for lepers: ‘health, peace and often directed by the new mendi- Faith, nn. 1-2. patience to you who bend down cant Orders (Dominicans, Fran- 10 A. Camus, Opere. La peste (Milan, 1988), pp. 520-521, quoted in scola, op. cit., over the leprous Christ, that is ciscans…) who spent their lives p. 11. to say over the sick’. Those who in charity in hospitals, above all 11 Scola, op. cit. , p.14. dedicate themselves to service to amongst those most discrimi- 12 Scola, op.cit,, pp. 14-15. 13 G. Cesana, Il “Ministero” della salute. the sick, to the sick Christ, must nated against. There also arose Note introduttive alla medicina (Studio Ed- lead a life worthy of the work that new brotherhoods of groups that itoriale Fiorentino, Florence, 2000), p. 8. I they carry out…A hospital is a pi- worked together in similar activi- follow this author as regards the fundamen- ous place and its workers must be ties but in the name of Christ and tal facts of the history of medicine and its in- 52 terpretation. I am bound to him by a friend- directed to piety’. The medie- with a profound sense of brother- ship which I here leave evident. val councils were concerned with hood. They often were responsi- 14 Cf. B. Zanobbio and G. Armoncida, Storia della medicina (Masson, Milan, care for the sick and with hospi- ble for hospitals and for all those 1997). tals. One may recall here how em- works of charity that responded 15 G. Cesana, op.cit., p. 13. phasis was placed on the work of to the new emerging situations 16 G. Cesana, p. 17. 17 Il Flos Medicinae Salerni, a short po- charity of these hospital Orders; of European social life. By now em in leonine verses from the eleventh to their teacher saw himself as a hospital activity was very intense twelfth centuries containing the fundamen- servus pauperum Christi and all throughout Christendom, animat- tal precepts of Regola Sanitaria Salerni- his brothers ad servitium paupe- ed by the mendicants and by other tana, express its Christian roots; cf. the edi- tion in Italian by F. gherli, Roma (Tascabili rum venientes, making themselves movements for Christian renewal. economici Newton, 1993); the introductions servants to their sick ‘lords’.53 New hospitals were created on the by C. gatto Trocchi and r. M. Suozzi, pro- Within hospitals were received model of that in Rome, the Hospi- vide a totally ahistorical ‘secularist’ read- 55 ing; cf.; cfr. cesana, op. cit., 29-30, note 10. men, women, and lepers, and cler- tal of the Holy Spirit in Sassia. 18 Cf. H. Wolter, ‘L’ospedale in Occi- ics and members of the laity, men Side by side with these hospitals dente durante l’alto Medioevo’, in Storia and women, and good physicians then arose new brotherhoods and della Chiesa. La civitas medievale, edited by h. jedin, (Jaca Book, Milan) vol. VI/1, pp. all placed themselves at their ser- also new works for the freeing of 260-266. vice. There were also ‘sisters’ slaves held by Muslims. We are 19 As established by specific rules for a who cared for the sick, above all now at the sunset of the medieval hospital created by a French medieval pil- grim on his way to Santiago, in Sauceda women, as in Jerusalem and then period and thus we come to the (Soto) de Aller (my valley) where a church in Valencia in Spain. Thus the beginnings of what is called mo- was created dedicated to St. Martin of hospital Orders grew. This or- dernity or the modern epoch. New Tours; consecrated to St. Anne, he himself remained to serve in that place and he was ganisation at the service of pub- and grave problems are raised joined by other priests and members of the lic health care was compact and for European society. From the laity who went there. based upon fiscal exemptions and health-care point of view, authen- 20 I cannot forget that in my home val- ley of Aller on the mountains of Cordillera a solid economic base. The hos- tic tragedies occurred, such as the Astur-Cantabra (Asturias, Spain) there were pitallars of St. John were the first great plagues and pandemics that founded at this time, at least to my knowl- institute to place religious life ex struck the western world. edge, two hospitals by lay people and priests, with brotherhoods, and their own rules, of- professo at the service of hos- ten to take in incurables and sick people with pitals. Other similar institutions infectious diseases. I have seen some of the were to be found in Rome. Such above-mentioned elements in these rules. Notes 21 Paracelso, Contro i falsi medici: sette was the history of the Hospital of autodifese, edited by m. l. bianchi (Laterza, the Holy Spirit in Sassia, which 1 This is also the title of an essay by an- Rome-Bari, 1995). gelo scola, “Se vuoi, puoi guarirmi”. La 22 Cesana, op. cit., pp. 20-21. was joined to that in Montpellier 23 54 salute tra speranza e eutopia (Siena, Can- L. Geymonat, ‘Problemi di epistemo- (1170-1180). This hospital, re- tagalli, 2001), 134 pp. The author, the Car- logia e di metodo’, in Galileo Galilei (Ein- built by Innocent III, to counter dinal Patriarch of Venice (he was previously audi, Turin, 1980).

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24 Cesana, op. cit., p. 21. spiritual works (SC 92); Gregory the Nan- 42 Francis A. Sullivan SJ, Charismes et 25 (cf. here the work by Claude Bernard, zianzene in his theological discourses on renouveau charismatique. Une étude bib- Introduction a l’etude de la medecine exper- various subjects (cf. in SC and in PDF 61); lique et théologique, pp. 257-258. imentale (1865). Gregory Palama (1296-1359) in his homilies 43 Cf. Benedict xvi, Deus caritas est, en- 26 Ceana, op. cit., p. 28. (Homelies, French edition: Ymca-Press/Oe- cyclical letter of 25.12.2005 dedicates the 27 From the point of view of the history of il, 1987); Isaac the Syrian (seventh century) second part to reflections on the exercise of theology see the various tracts on the sac- in his spiritual tracts (Oeuvres spirituelles, love by the Church as a ‘community of love’ rament of the anointing of the sick, in par- DDB, 1981) which were of great influence (nn. 19-42) with concrete references to the ticular that to be found in m. schamus, Dog- in the Orient; John Cassian (360-435), an various historical stages and the forms of matica Cattolica, Italian edition edited by oriental monk who arrived in the West and such intervention. Natale Bussi, Marietti: 1966,vol. IV/1, pp. was of a great influence in monastic life in 44 On the historical aspect of processes 636-661. his Conferences (SC 42, 54, 64) and his In- of canonisation cf. Giovanni Papa, Le Cause 28 G. Cesana, Il “Ministero” della salute. stitutions; (fourth century) di Canonizzazione nel primo periodo della Note introduttive alla medicina (Studio Edi- in his Homilies on the Providence of God Congregazione dei Riti (1588-1634) (Ur- toriale Fiorentino, Florence, 2000), p. 8. I (SC 79) and Comments on the Pauline letters baniana University Press, Rome, 2001; P. follow this author as regards the fundamen- (PDF 35-36); John Climac (c. 579-654), an Delooz, Sociologie et . La tal facts of the history of medicine and its anchorite and monk, in his Spiritual ladder sélection des Saints (Faculté de Droit, Liège interpretation. (Ed. Monte Casino, 1990) which had a very - Matinus Nijhoff, La Haye, 1969). 29 Cf. for a complete exposition on the great influence on oriental monasteries; John 45 Cf. Sulpicio Severo, Vita Sancti Marti- subject: Francis A. Sullivan, s.j., Cha- Damascene (c. 650-750), a monk in Mar Aca, ni, 3, 1-3, SCh 133, pp. 256-258, quoted also rismes etrenouveau charismatique. Une near to Jerusalem, a defender of the cult of in benedict XVI, Deus caritas est, n. 40. étude biblique et théologique. Préface du the images at the time of iconoclasticism and 46 L. Stefanini, La Chiesa Cattolica cardinal Léon Joseph Suenens (Éditions who wrote a summary on the Greek Fathers; (Morcelliana, Brescia, 1952). du Lion de Juda, Collection Chemin Neuf Marcarius of Egypt (c. 300-390), a monk and 47 J. Lequercq, La spiritualità del Medio- Pneumathèque, 1988); original English ver- anchorite in the Egyptian desert of Escetea evo (VI-XII secolo). Da S. Gregorio a Sa. sion: Servant Book, Anna Arbor, Michigan who left behind for us his Apotegmata of the Bernardo (EDB, Bologna, 1986). 48107, 1982. Fathers (SC 387); 48 Atti del secondo congresso italiano di 30 F. Sullivan, s.j., ibid., pp. 249-250. (c. 580-662), the last Greek Father and a de- storia ospedaliera. S. Vincent 1961 (Turin, 31 Cf. Jean-Claude Larchet, Théolo- fender of the two wills of Christ in his Cen- 1962). gie de la maladie (Éditions du Cerf, Paris, turies of charity (SC 9) and in Meditations 49 E. Joachim and W. Hubastsch, Reges- 1994) (second edition); idem, ‘Del buen uso on the agony of Christ; Nicetas Stetatos (c. ta ordinis Sanctae Mariae Theutonicorum de la enfermedad seg ún los Padres de la Ig- 1005-1079), a disciple of the mystic Simon (Göttingen, 1948-1950). lesia. La ambivalencia de la enfermedad’, in the New Theologian, who wrote his life and 50 Guerra, De locis piis, de hospitalibus, Communio (Revista Católica Internacional, other spiritual tracts (SC 81); Poemen (fifth I, pp. 237-253; a. agustin, Epitome Iuris 19, July-August, (1997), 279-288. century), a monk in the desert of Escetea Pontificii, pars II, lib. 2 De monasteriis, et 32 Larchet, in ‘Communio’,, 281. and author of Apothegms (SC 387); Simon xenodochiis, sive hospitalibus et aliis locis, 33 I follow in this general picture the sum- the New Theologian (949.1022), a Byzan- Lucae 1771, 6, pp. 25-40 on spiritual care mary offered by Schamus, Dogmatica Cat- tine monk and mystic, in his Catechesis and for the sick. tolica. Hymns (SC 156, 174, 196); Sincletica (who 51 E. Sastre Santos, La vita religiosa nel- 34 Cf. Didachè 10, 7. died c. 400), a woman anchorite in the desert la storia della Chiesa e della società (An- 35 Funk, Didasc. et Const. Apost., 2, p. of Egypt, the author of Apothegms (cf. J.-C. cora, Milan, 1997), p. 370. 190. Guy, Paroles des anciens, Paris: Ed. Seuil, 52 Ibid., p. 370. 36 Quoted in Bridget Mary Meehan, Il Point-Sagesses, 1976). SC = Sources Chréti- 53 Cf. ibid., p. 371. Sastre remembers the potere di guarigione della preghiera (Grib- ennes, Paris: Ed. du Cerf; PDF = Pères dans story of Saladin who was struck by the char- audi, Milan, 2001), p. 32. la Foi, Ed. Migne, diffusion Brepols. ity of the hospitallars. Disguised as a poor 37 Retractationes, 12, 7; 13, 5, cfr. anche 39 Many passages along the same lines sick person he knocked at the door of the in De Civitate Dei, 22, 8. have been brought together for varying rea- hospital of Jerusalem, He was welcomed 38 A reference has already been made to sons by modern authors such as the famous and cared for, and as ‘lord of the hospital’ he this above. Here I will list certain names in P. Alonso Rodriguez, S.J., Ejercicio de per- ordered a soup made out of camel meat of a alphabetical order and works following the fección cristiana; cf. barbara bowe et al., camel that belonged to the person in charge. list proposed by Jean-Claude Larchet, in Silent Voices, Sacred Lives (Paulist Press, The hospitallars sacrificed the camel of the Communio, op. cit., pp. 287-288: St. Barsa- 1992). head man in order to satisfy the tastes of a nufio and John of Gaza (sixth century) Cor- 40 III.44.3, ad 1 and 3. poor Muslim patient (op. cit, p. 389, note respondance, Edicions de Solesmes, 1971; 41 Sess. XIV: introduction and chap.. I; 83). (330-379), above all in Denz. 1694-1695; cf. Denz. 794 (833); pp. 54 The union of the two hospitals was in- his work On the Holy Spirit and on the sub- 860, 1259, 1310, 1324, 1601, 1694, 1695- dicated in the Magna Carta of hospital ac- ject that God is not the author of maladies; 1700, 1716ss, 1718, 1864, 2536, 3448 and tivity, Inter opera pietatis, 19 June 1204, of Carthage (third century) in his also the CIC of 1917, can. 937-947; CIC of potthast, 2248; petra, II, 134-139, quoted tracts on the virtue of patience (SC 291); 1983, can. 998-1007. The Italian translation in e. sastre santos, op. cit., p. 389, note 86. Diadoc of Fotica (fifth century) in his cen- of the Tridentine text cited here is that from 55 Cf. G.G. merlo (ed.), Esperienze religi- turies of spiritual perfection (SC 5bis; PDF the Italian edition of Dogmatica Cattolica ose e opere assistenziali nel secoli XII e XIII 41); Doroteus of Gaza (sixth century) in his by Schmaus, IV/1, pp. 636-637. (Turin, 1987).

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Testimonies

The Mission of the Catholic Physician Today

50 Years of Medicus Mundi International, MMI

International Symposium Bioethics and African Realities: 1. Recommendations 2. Speech by the Pontifical Council for Health Care Workers

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XV Congress of the Asian Federation of Catholic Medical Associations Bali, Indonesia, October 18-21, 2012

The Mission of the Catholic Physician Today

Msgr. Jean-Marie have six centuries (four more than cian, like the priest, had God as a Mupendawatu our western Europe) of history of witness and guarantor of the rec- Secretary of the Pontifical the art of medicine may appear titude of his professional activ- Council for Health Care presumptuous. I will thus confine ity. One need only think of the Workers myself to presenting some out- art of medicine of China, of an- the Holy See lines which will deserve greater cient Mesopotamia, of Egypt, of exploration during the dialogue Greece and of Rome. Everything over the next days. was surrounded by a sacred auro- ra, as a result of which the physi- cian was seen as a priest. Introduction 1. The Mission of the Physician The Hippocratic Oath has been and Changes in the Art of rightly seen as the paradigm of It is a great joy and honour for Medicine the art of medicine as a mission. me to represent the Pontifical By taking this oath a young doc- Council for Health Care Workers tor would pledge to respect a cer- at this 15th Congress of the Asian -The Sacredness of the Art of tain set of rules and regulations. Federation of Catholic Medical Medicine – the Hippocratic Oath These “norms include an under- Associations. I bring to you the Let us ask ourselves, first of all, taking to avoid causing harm, to greetings and blessings of the if there still exists what is called act to the greatest benefit of the President, Archbishop Zygmunt the mission of the physician. The patient, to practice the profession Zimowski, who asked me to con- history of medical ethics clearly in a pure and holy fashion, to be vey his apologies for not being shows us that the art of medicine faithful to the principle of pro- able to be with us today, since he was considered a special form of fessional secrecy, to refrain from is currently attending the Synod service, both of a religious and inducing abortions, and so forth. of Bishops on New Evangelisa- a secular type. The practice of By means of the public declara- tion in Rome. He however prom- medicine is rightly referred to as tion of this oath the novice was ised his prayers for all of you and a profession and an examination able to enter the category of those wishes you fruitful deliberations. of the word profession can help who “professed,” or to put it an- I thank the organizers of this us grasp the message it ought to other way, of professional practi- Congress for the invitation ex- convey. The word profession has tioners.”2 tended to me to participate in a religious origin and comes from This tradition, handed down these days of reflection, sharing the Latin word profiteor, to pro- the centuries, has been received and learning, particularly discuss- fess. Traditionally, this was used and appreciated in the history of ing the Challenges of Catholic to describe the public profession Christianity until our times. We Doctors in the changing world. of faith or religious consecration. cannot outline here the whole of My sincere gratitude goes to our Thus a professed person was one the history of health assistance. host country, Indonesia, and par- who was consecrated to a minis- I will only cite the names of St. ticularly the beautiful city of Bali try or confessed this fact in pub- Benedict, St. Camillus. St. Ric- for the wonderful hospitality and lic. Therefore, a medical doctor, cardo Pampuri, St. Giuseppe organization. like the priest was a person con- Moscati, the Blessed Damian and The subject that has been as- secrated to a form of ministry and the Blessed Teresa of Calcutta. signed to me is not an easy one. this fact was publicly recognized. Other interpreters of the history of One can speak about the mission Hence, the practice of signing a health assistance belong to other, of the Catholic physician today in pact or taking an oath and thus more ‘secular’ traditions, figures a general way or by inventing at promising to exercise his profes- such as Galen, Percival, Nightin- a desk prescriptions that will not sion in a correct and upright way. gale and Dunant, but whatever the satisfy anyone. To speak today In this sense, one could certainly case they have defended a certain about this subject to people who talk about a mission.1 The physi- image of ‘service’.

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- Medical Paternalism patient, with consequences that a standard of altruism. Yet med- The position of Hippocrates are in front of everyone’s eyes. icine is typically a moral enter- was for a long time labelled ‘med- Today almost every principle prise; it requires a vulnerable per- ical paternalism’. In truth, Hip- of the traditional ethical standard son to trust in the competence and pocrates in his writings outlined is being questioned. Some inter- goodwill of someone who pro- a physiognomy of the physician pret the relationship of a physi- fesses to help. It involves a rela- as an ally of the patient and re- cian and a patient as a legal con- tionship grounded in the needs of spectful of his teacher and his col- tract instead of moral covenant, wounded humanity. leagues. others prefer to think of it as a Paternalism goes back to the commodity transaction or an ex- 1.1. The causes of this nineteenth century with Thomas ercise in applied biology. Abor- transformation Percival (1740–1804) who, in his tions are legal in many countries, book Medical Ethics, portrayed confidentiality can be violated in The causes of this transforma- the medical doctor as a gentle- certain circumstances, patient au- tion can be led back to three fac- man, a ‘minister of the sick’ in the tonomy overrides the physician’s tors: the democratic management secular sense, upholding for him autonomy, physician self-interest of power (benign authoritarian- all decisional power as regards is exploited to limit costs in man- ism no longer acceptable); public treatment and care for the patient. aged health systems, according education (demystifies the pro- Central to this tradition was the to some psychiatrists sexual re- fessions – the triumphs and fail- ideal of the medical profession as lations with patients can be part ings of the professional life are a body of people primarily dedi- of a therapeutic regimen, while revealed in novels, television pro- cated to the service of others rath- others defend assisted suicide, as grams, printed media, soap ope- er than to self-interest. This was a well as direct and indirect eutha- ras); and moral pluralism (di- vision that influenced all of medi- nasia. lemmas of modern medical care cal ethics in the United States of “Most significant in all this is and growth of a moral diversity, America and the West until the the challenge to the ideal of a pro- the homogeneous value system middle of the last century. It goes fession as a group in society dedi- (based on Judeo-Christian ethi- without saying that some physi- cated to a special way of life – a cus) is challenged – doctors and cians would fail to live up to this life of service in which self-in- patients cannot assume consensus ethic. However, when this hap- terest yields to altruism. To prac- of fundamental question about pened they were recognized as tice medicine was tantamount to a human life, its meaning, purpose, morally delinquent and their ac- vocation in the religious sense.”3 and worth – hence moral indi- tion were never legitimated or de- There is a growing tendency to vidualism).4 Doctors and patients fended as morally acceptable al- look at the medical profession as increasingly resolve moral dis- ternatives. any other occupation. Medicine putes in court. Patient autonomy as a career (means of livelihood, replaces beneficence as the dom- - The Secular Vision of Medicine prestige, power, and advance- inant principle in medical ethics. and the Autonomy of the Patient ment) was secondary to medicine The profession is divided in sev- Today this vision is opposed as a calling and a vocation. eral issues: specific moral issues by the autonomy or rather the For many such ideals are un- of abortion, voluntary euthanasia, self-determination of the patient, tenable in contemporary socio- reproductive technologies and the with an associated overturning of cultural milieu. We are experienc- nature of the physician-patient medical ethics. The overturning ing an erosion of moral standards relationship. To this should be of medical ethics goes back to in various spheres of public life, added at this point a fourth fac- the end of the 1960s. A reading of in business, politics and govern- tor, which is the transformation of this change has been engaged in ment, such that for an increas- hospitals and nursing homes into by Edmund Pellegrino and David ing number of people this seems companies that have to be ‘man- Thomasma in their book Helping an acceptable reality. Many have aged’. and Healing, which has also been abandoned the idea of medicine Bearing these factors in mind, translated into Spanish and Ital- as profession and a vocation. medical ethics cannot be under- ian. Over the last thirty years (to- There has been a progressive de- stood in the same way as it was day we can say fifty), write these scent from vocation to career in understood until the 1960s. Be- authors, more changes have tak- medicine. Pellegrino and Thom- yond the fact that many problems en place in medical ethics than asma observe that the common that were a matter of medical eth- was the case in the history of the devotion to an ideal is being re- ics are today claimed by bioeth- previous twenty-five centuries. placed by confusion, doubt, dis- ics, the very relationship between From the famous Hippocratic sent and depression. Moreover the doctor and the patient, which Oath, which upheld the sacred- the future of medical ethics is in is central in the approach of medi- ness of the art of medicine, and, doubt as a consequence. There is cal ethics, is no longer to be un- from a certain late reading, from a growing conviction that old pro- derstood in the traditional way. so-called medical paternalism, fessions like medicine or ministry There is need to rethink the con- there was a move towards a secu- are not essentially different from cept of profession and the moral lar vision of medicine and a strong business or its occupations, and obligations that flow from it. emphasis on the autonomy of the therefore why should it be held to

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1.2. Benefit in trust as a solution al character of medicine as a pro- sion implies its own internal mo- to the conflict between the fession is based, following the rality, for the Catholic physician autonomy of the patient thought of E. Pellegrino and D. this is an authentic mission. The and the duty of the medical Thomasma, are: idea of profession bears a sense of doctor the nature of the human needs special commitment. One of the addressed (health, wisdom, salva- characteristics of learned profes- The conflict between the auton- tion, justice); sions is to pursue something be- omy of the patient and the duty of the state of vulnerability of those yond self-interest. Religious be- the physician can be solved only it serves (the relationship between lief on the other hand transforms in a relationship of mutual trust. the medical doctor and the patient a profession into a vocation, dis- ‘Benefit in trust’ is the formula is not one of parity: the power to tancing them from a career. Now used by Pellegrino and Thomasma help or otherwise the patient is in a vocation is a call to a way of life to express this relationship. the hands of the professional); and as such cannot be defined on- But because of the changes men- the expectations of trust that it ly by the activities that constitute tioned above, this relationship is generates (these are based upon a career. Catholic Physician have no longer confined to the medical the profession itself of the med- a vocation to the Christian Life. doctor and the patient. The family, ical doctor, on his or her will to The later entails the transforma- other professional figures of health help the sick person and make tion of their activity to the level of care, the managerial system of the available his or her own profes- a grace, a way of giving witness local health-care company, and sional knowledge); to the gospel message. health-care policies, are all factors and the social contract that is The Charter for Health Care that have entered the stage. As a re- involved (or in line with the An- Workers offers us a good pathway sult of which, to simplify, one may glo-Saxon phrase, drawn from the by which to outline the mission of say that medical ethics concerns Biblical image, the covenant or the Catholic physician. at least three components: the pa- alliance/pact, that is established For a summary I will use a tient, the medical doctor and other between the medical doctor and presentation by L. Cantoni.7 The professional figures, and society, the patient).5 Here is indicated introduction, which has the signif- in an order of importance that is the framework within which the icant title ‘Ministers of Life’ (nn. inverted compared to the past. We art of medicine can find its lus- 1-10, pp. 7-18), sees in service will see below some connotations tre, defeating nostalgic tempta- to life the nature of the activity of this relationship. tions, on the one hand, and atti- of health-care workers. It consti- Faced with these changes, the tudes involving abandonment, on tutes a form of Christian witness: temptation would be to declare the other. ‘The principal and symbolic ex- medical ethics dead because of In dwelling for a moment on the pression of “taking care” is their choices to do with careers and/or characteristics mentioned above, vigilant and caring presence at remuneration. one should say that if the nature the sickbed. It is here that medi- For those who do not have a re- of man invokes health, wisdom, cal and nursing activity expresses ligious vision of life, observe, in- salvation and justice, these needs its lofty, human and Christian val- stead, Pellegrino and Thomasma, it become even more acute in a state ue’ (n. 1). The activity of a heath- is at least possible to bear in mind of suffering or illness. A medical care worker is based upon an in- a morality that arises from within doctor, or more in general a health- terpersonal relationship: ‘The the medical or health-care (as one care worker, cannot abuse his or health-care worker is the good prefers) profession itself. her ‘superiority’ but, instead, is Samaritan of the parable, who In our epoch, which is marked by called to make up for the vulner- stops beside the wounded person, moral pluralism and thus by a re- ability of the patient, who places becoming his “neighbour in char- jection of a single moral approach, his or trust in the medical doctor, ity” (cf. Lk 10:29-37)’ (n. 3). It which in the Western tradition of and this can be revoked only at is then emphasised that ‘Service medical ethics is the Judeo-Chris- the moment of death or when this to life is such only if it is faithful tian approach, unless one wants to trust comes to be absent on either to the moral law, which express- reduce medicine to what for more side. The relationship between the es exigently its value and tasks than a few it is already, namely a health-care worker and the patient (n. 6). The health-care worker source of gain and a pretext for a is not of a commercial kind but, ‘draws his behavioural directives career, there is still the possibility rather, acquires the characteristic from that field of normative ethics of looking at what in the profes- that one of the highest exponents which nowadays is called bioeth- sion of health care distinguishes it of modern bioethics does not hesi- ics. Here, with vigilant and care- from other professions. tate to compare to the covenant be- ful attention, the magisterium of tween God and the chosen people.6 the Church has intervened, with 1.3. The four phenomenological This brings us to the second step. reference to questions and dis- characteristics on which is putes arising from the biomedi- based the moral character of cal advances and from the chang- medicine as a profession 2. The Mission of the Catholic ing cultural ethos. This bioethical Physician magisterium is for the health care The four phenomenological worker, Catholic or otherwise, a characteristics on which the mor- Whereas for everyone a profes- source of principles and norms

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of conduct which enlighten his is organised into twenty sub-sec- alised, or an attempt is made to conscience and direct him – espe- tions addressing the many ques- make death belong to events that cially in the complexity of mod- tions connected with preven- are determined technically, pro- ern biotechnical possibilities – in tion, treatment and rehabilitation. ducing them: such is the case with his choices, always respecting life This is an area that does not al- euthanasia or postponing death: and its dignity’ (n. 6). low a summarising approach but such is the case with exaggerated The first chapter, ‘Procreation’ which finds its unifying moments treatment; ‘For the doctors and (nn. 11-34, pp. 19-33), analyses in the declaration that ‘From the their assistants it is not a question by sub-sections ‘Genetic Manipu- time that the ovum is fertilised, a of deciding the life or death of an lation’ (nn. 12-14), ‘Fertility Con- life is begun which is neither that individual. It is simply a question trol’ (nn. 15-20) and ‘Artificial of the father nor of the mother; of being a doctor, that is, of pos- Procreation’ (nn. 21-34). it is rather the life of a new hu- ing the question and then decid- As regards the subject of genet- man being with its own growth. ing according to one’s expertise ic manipulation, a clear distinction It would never be made human and one’s conscience regarding a is made between interventions if it were not human already’ (n. respectful care of the living and that are truly and directly cura- 35), and in the observation that the dying of the patient entrusted tive, and morally licit, and those ‘every intervention on the hu- to him’ (n. 121). that alter the genetic patrimony, man body “touches not only the In particular, ‘Death…must be which ‘are contrary to the person- tissues, the organs and their func- evangelized: the Gospel must be al dignity of the human being, to tions, but involves also at various announced to the dying person’. his integrity and to his identity’ (n. levels the person himself”. Health ‘The announcement of the Gos- 13). After referring to the criteria care must never lose sight of the pel to the dying finds especially for a moral assessment of the reg- “profound unity of the human be- expressive and effective forms ulation of fertility, and in particu- ing, in the obvious interaction of in charity, prayer and the sacra- lar the, at the same time, insepara- all his corporal functions, but also ments’ (n. 131). bly unitive and procreative nature in the unity of his corporal, affec- If, as has been my aim, the mis- of the conjugal act, the document tive, intellectual and spiritual di- sion of the Catholic physician has states that ‘while it is lawful, for mensions. One cannot isolate “the been outlined at the level of its grave reasons, to take advantage technical problems posed by the principal and basic aspects, one of the woman’s fertility and forgo treatment of a particular illness should, lastly, ask oneself how it the use of marriage in the fertile from the care that should be given provides an answer to contempo- periods, recourse to contracep- to the person of the patient in all rary challenges. tive practice is illicit’ (n. 17). The his dimensions. It is well to bear In this presentation of the problem is not that of a ‘distinc- this in mind, particularly at a time Charter for Health Care Workers tion simply of techniques or meth- when medical science is tending I have already referred to certain ods, where the decisive element towards specialisation in every requirements. I wish to explore would be the artificial or natural discipline”’ (n. 40). here other aspects which seem to character of the procedure’; ‘the The third and last chapter, me to be very important. ultimate reason for every natural ‘Death’ (nn. 114-150), argues It is to be remembered that the method is not just its effective- forcefully that ‘For the health care Charter for Health Care Work- ness or biological reliability, but worker, serving life means assist- ers was published in 1995, since its consistency with the Christian ing it right up to its natural com- then there have been several pro- vision of sexuality as expressive pletion. Life is in God’s hands: nouncement of the teaching of- of married love’ (n. 18). He is the Lord, He alone decides fice of the Church concerning As regards artificial procrea- the final moment. Every faithful the developments in the scientific tion, the Charter emphasises that servant guards this fulfilment of field, their application in medical ‘The desire for a child, sincere God’s will in the life of every per- science and the regulations that and intense though it ought to son entrusted to his care. He does ought to guide the research and be, by the spouses, does not le- not consider himself the arbiter of application. gitimise recourse to techniques death, just as and because he does As the Pontifical Council ex- which are contrary to the truth not consider himself the arbiter of plains: ‘In the Charter of 1994, of human procreation and to the anyone’s life’ (n. 114). the Magisterium of John Paul II as dignity of the new human being’ This is a subject – that of assis- regards Evangelium Vitae was not (n. 25). In particular, the only ‘ar- tance for the dying – that requires envisaged, with the whole ques- tificial means’ that are exclusive- renewed and constant attention: tion of the role of Catholics in pol- ly morally licit are those ‘whose the cultural context described itics. We know, in fact, that today function is merely to facilitate above, indeed, tends to reject amongst the most urgent ques- the natural act, or to ensure that death and the dying because they tions there is also justice in the al- a normally performed act reaches pose to medicine and health-care location of financial resources for its proper end’ (n. 23): such is the workers questions which they – if the common good and social jus- case with homologous artificial they are only technicians of health tice, according to the two princi- insemination. – do not know how to answer. A ples of solidarity and subsidiarity. ‘Life’ is the subject of the sec- dying person is thus misled about We may think of the questions of ond chapter (nn. 35-113) which his or her condition, or margin- the end of life and the answers that

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in 2007 the Congregation for the ticular the relationship between solatio, “consolation”, expresses Doctrine of the Faith gave as re- the Love of God and human suf- this beautifully. It suggests being gards Nutrition and hydration. We fering, within the framework of a with the other in his solitude, so may think, lastly, of the Instruc- design which does not, however, that it ceases to be solitude. Fur- tion Dignitas Personae which eliminate, mystery. I will quote in thermore, the capacity to accept addresses some of fundamental particular n. 4 of SD: ‘Human suf- suffering for the sake of goodness, questions above all in the appli- fering evokes compassion; it also truth and justice is an essential cri- cation of biotechnologies at the evokes respect, and in its own terion of humanity, because if my beginning of life: stem cells, the way it intimidates. For in suffer- own well-being and safety are ul- reduction of embryos…indeed, ing is contained the greatness of timately more important than truth these major questions were not a specific mystery. This special and justice, then the power of the in the Charter of 1994 and thus it respect for every form of human stronger prevails, then violence is advisable, indeed necessary, to suffering must be set at the begin- and untruth reign supreme. Truth update this new Charter. ning of what will be expressed and justice must stand above my Beyond health-care workers, here later by the deepest need of comfort and physical well-being, the new reference points are in the heart, and also by the deep im- or else my life itself becomes a lie. my view politicians. Precisely be- perative of faith. About the theme In the end, even the “yes” to love cause, as we also recently heard of suffering these two reasons is a source of suffering, because during the visit of Benedict XVI seem to draw particularly close to love always requires expropria- to Africa, social justice, the allo- each other and to become one: the tions of my “I”, in which I allow cation – in line with justice – of fi- need of the heart commands us to myself to be pruned and wounded. nancial resources, is an emerging overcome fear, and the impera- Love simply cannot exist without question, above all in the old con- tive of faith – formulated, for ex- this painful renunciation of my- tinent where financial problems ample, in the words of Saint Paul self, for otherwise it becomes pure are also beginning to have an in- quoted at the beginning – pro- selfishness and thereby ceases to fluence on the management of the vides the content, in the name of be love’.11 common good in essential servic- which and by virtue of which we Thus the Magisterium of Ben- es in countries which are called dare to touch what appears in eve- edict XVI constantly helps us to the ‘richest’ countries’.8 ry man so intangible: for man, in reflect that our experience is not a These observations appear to his suffering, remains an intangi- memory of the past but, rather, re- me to be valuable for the geo- ble mystery’.10 quires the contemporary impera- graphical context in which we Spe Salvi by Benedict XVI de- tive of the Christian Event.12 find ourselves as well. scribes in a masterful way other It also leads us to overcome aspects of this vision, in particu- spiritualism, on the one hand, and lar ministerial cooperation with moralism, on the other, perceiv- 3. The Anthropological Vision the love of God and compassion: ing clearly that that the action of a ‘The true measure of humanity is Christian cannot be reduced to the But although, on the one hand, essentially determined in relation- mere action of some social agen- we may refer to the urgent need ship to suffering and to the suf- cy13 but is a sign of the charity of for judgement and a moral prac- ferer. This holds true both for the Christ in the world. tice in harmony with the Magis- individual and for society. A soci- Thus the figure of the Good terium of the Catholic Church, on ety unable to accept its suffering Samaritan remains the emblem the other, it should be said clear- members and incapable of help- of the Catholic physician today. ly that the mission of a Catholic ing to share their suffering and to It is his image, we could say his physician today is not confined to bear it inwardly through “com- identity, that remains, despite the the ethical aspect. The anthropo- passion” is a cruel and inhuman changes of history. This, far from logical vision should always be society. Yet society cannot accept stopping our action, leads us to borne in mind. its suffering members and support look for ever new forms14 of being The challenge of today is the them in their trials unless individ- protagonists. This requires a kind overcoming of a positivistic vi- uals are capable of doing so them- of integrating encounter between sion which today still defines selves; moreover, the individual profession, vocation and mission. medicine. cannot accept another’s suffering Beyond technical-professional A suffering man cannot be seen unless he personally is able to expertise, ethical responsibility as an agglomerate of organs and find meaning in suffering, a path is required; it is self-evident that tissues. He should be seen, rather, of purification and growth in ma- technical-professional expertise in his wholeness as a living being, turity, a journey of hope. Indeed, is not sufficient, ethical respon- on the one hand, and in his myste- to accept the “other” who suffers, sibility is needed. In particular, riousness, on the other. means that I take up his suffer- ethical-religious professional for- Salvifici doloris (SD) by John ing in such a way that it becomes mation for all health-care profes- Paul II appears to me to be the mine also. Because it has now be- sionals is needed, in particular ‘Magna Carta’ of this vision (cf. come a shared suffering, though, for Catholic health-care workers. Introduction, chaps, I, II, II).9 In it in which another person is present, The presence of ethical commit- we see outlined the whole of the this suffering is penetrated by the tees appears to be no less impor- history of salvation and in par- light of love. The Latin word con- tant for the taking of the right de-

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cisions which are not only of a 4. By Way of a Conclusion Notes procedural character but should 1 Diego G. Guillen, “The Hippocratic be based upon a solid moral foun- All of this leads us to say that Oath in the Development of Medicine,” in dation. Lastly, we should take into our presence is as valuable as ev- Dolentium Hominum 31 (1996) 22-23. account the changes that have tak- er, both in public institutions and 2 Diego G. Guillen, “The Hippocratic en place in the health-care field, in charitable ones, and shows Oath in the Development of Medicine,” p. 24. “…As regards the care of the sick, I will without forgetting about the pro- that there is ample space for ac- prescribe the most appropriate regimen, ac- pium of the Christian dimension. tion that offers suffering man cording to my judgment and knowledge and I believe that as regards the welcome, concern and care in his will defend the sick from all harm and dis- turbance. Neither will any request avail to changes that have taken place in largest and deepest dimension. induce me to administer poison to anyone, the field of health care, we can One the other hand, by now for nor will I ever so advise. Similarly, I will in summarising fashion say the some time, on the part of the lead- not operate on women for the purpose of im- peding conception and procuring abortion. same as the Supreme Pontiff did ers of public health care there has And, in truth, I will keep my life upright and in his first encyclical: ‘Love – been the perception that there is a my art immaculate. Nor will I perform op- caritas – will always prove nec- need to ‘humanise’ hospitals.16 erations to remove stones from those suffer- ing therefrom, but will let surgeons expert in essary, even in the most just so- The great increase in the num- this art do so. I will enter any house solely ciety. There is no ordering of the ber of conferences and seminars to bring aid to the sick and will refrain from State so just that it can eliminate on various aspects of care and every unjust action and immorality, as well as from all impure contact. And, in practic- the need for a service of love. in particular of ‘caring’: do they ing my profession, I will keep silent, unless Whoever wants to eliminate love not document, perhaps, a nostal- given permission, about all that I see and is preparing to eliminate man as gia for that charity of our Saviour hear in the common life of men, even if in- dependent of the medical art. If I unalter- such. There will always be suffer- and of those who have followed ably keep faith with this oath and am able ing which cries out for consola- him? To perceive this cry of soci- to observe it loyally, may I be granted every tion and help. There will always ety, even though it is a submerged satisfaction in life and in the art, and may I always enjoy a well-deserved good repu- be loneliness. There will always cry, I believe, is our task. tation among men. But if I should not keep be situations of material need It is no accident that after the re- my oath or should swear falsely, may just where help in the form of con- ligious Orders and Brotherhoods, the opposite befall me...” The Hipprocratic Oath, in Dolentium Hominum 31 (1996) 9. crete love of neighbour is indis- new Institutes were born, such as 3 Edmund D. Pellegrino and David C. pensable. The State which would the Sisters of Charity of Mother Thomasma, Helping and Healing: Religious provide everything, absorbing Teresa of Calcutta. It is sufficient Commitment in Health Care, Georgetown University Press, Washington D.C. 1997, p. everything into itself, would ul- to be attentive to the signs and the 87. timately become a mere bureau- circumstances, as Francis of Assi- 4 Edmund D. Pellegrino and David C. cracy incapable of guaranteeing si was with the leper encountered Thomasma, Helping and Healing: Religious Commitment in Health Care, pp. 88-90. For the very thing which the suffering in the countryside of Assisi or as the Italian version see E.D. Pellegrino and person – every person – needs: was with the poor D.C. Thomasma, Medicina per vocazione namely, loving personal concern. man abandoned at Calcutta sta- (Dehoniane, Rome, 1994), pp. 111-114. 5 Edmund D. Pellegrino and David C. We do not need a State which reg- tion. Thomasma, Helping and Healing, p. 91-94. ulates and controls everything, In this we are helped by John 6 Ramsey, P., The Patient as a Person but a State which, in accordance Paul II who, when writing his (Yale, 1971). 7 Cantoni, L., ‘La “Carta degli Opera- with the principle of subsidiari- post-synodal apostolic exhorta- tori sanitari”. Una presentazione’, Cristi- ty, generously acknowledges and tion on the laity, which has al- anità n. 239 (1995). supports initiatives arising from ready been mentioned, spoke, 8 R. Gisotti, Interview with Fr. Chendi, , 29.11.2011. the different social forces and when referring to the possibil- 9 John Paul II, apostolic letter Salvifici combines spontaneity with close- ity of the mission of sick people doloris (LEV, Vatican City, 1985). ness to those in need. The Church and the suffering, about a ‘new 10 Ibid., n. 4. is one of those living forces: she and even more valuable man- 11 Benedict XVI, encyclical letter Spe 17 salvi (LEV, Vatican City, 2006), n. 38. is alive with the love enkindled by ner’ and, in his apostolic exhor- 12 Benedict XVI, encyclical letter Deus the Spirit of Christ. This love does tation for the new millennium, caritas est (LEV, Vatican City, 2005), n. 1. not simply offer people material he exhorted Christians to ‘stake 13 Ibid., nn. 28-29. 14 John Paul II, post-synodal apostolic help, but refreshment and care for everything on charity’ and stated exhortation, Christifideles laici (Vatican their souls, something which of- that ‘Now is the time for a new City), n. 53. 18 15 Benedict XVI, Deus caritas est, n. 28. ten is even more necessary than “creativity” of charity’. There 16 One work that everyone should read: material support. In the end, the is ample space in hospital institu- Brusco A., Umanità per gli Ospedali (Sal- claim that just social structures tions, in nursing homes, in nurs- com, Brezzo di Bedero, 1983). 17 John Paul II, Post-synodal apostolic would make works of charity su- ing and medical schools, in pri- exhortation Christifideles laici, n. 53. perfluous masks a materialist con- vate homes, in special refuges for 18 John Paul II, apostolic exortation Novo ception of man: the mistaken no- the sick, everywhere, for our con- millennio ineunte, nn. 49, 50. tribution, remembering that ‘the 19 Giussani. L., Qui e ora (1984-1985) tion that man can live “by bread (Biblioteca Universale Rizzoli, Milan, alone” (Mt 4:4; cf. Dt 8:3)—a forces that move history are the 2009), p. 45. conviction that demeans man and same as those that make the heart ultimately disregards all that is of man happy’.19 specifically human’.15 Thank you for your attention.

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50 Years of Medicus Mundi Internationalis, MMI

dr. edgar widmer table actions to prevention, train- cures. As many lives as possible Vice-President ing auxiliaries, and mother and should be saved at a low cost. of Medicus Mundi Switzerland, child health. For instance simple growth con- Former President of Medicus In July 1962 when the Inter- trol, oral hydration, breastfeed- Mundi International national Federation of Catho- ing and immunisation (GOBI) lic Doctors in London discussed were a means to save children ‘the Catholic Physician in Soci- in poor regions. As for breast- 2013 is a special year for the eties in Evolution’. Misereor’s feeding, the MMI participated Medicus Mundi International medical consultant, Dr. Jentgens, in 1981 in the promotion of the Network. We are celebrating the spoke about ‘the role expatriate International Code of Marketing fiftieth anniversary of its founda- doctors should play in develop- Breast-Milk Substitutes. tion. As one of the former pres- ing countries’. Professor Jans- Tools for implementing PHC idents and having been active sens from Antwerp and Professor were developed. Thus in 1977 within the network myself for Oomen from Amsterdam, both the MMI became involved in the forty-five years, I was given the directors of Institutes of Tropi- definition and introduction of the opportunity at the Jubilee Meet- cal Medicine in their respective WHO Model List of Essential ing held in Barcelona on 9 June cities, submitted a ‘report con- Drugs. 2013 of looking back and look- cerning hospitals in third world The links to European training ing ahead. countries’. Out of the meeting institutions for tropical medicine Mgr. Jean Marie Mpentawa- the idea was born to found an or- have existed since the MMI’s tu, the Secretary of the Pontifi- ganisation for international med- beginnings (Basle, Tübingen, cal Council for Health, asked me ical cooperation. Amsterdam, Antwerp, Brescia, to summarise a part of my per- The idea led to the first inter- Heidelberg, Tübingen and Bar- sonal view of the history of the national meeting of the organi- celona). Some of the MMI ex- MMI. In short, here are some of sation-to-be, hosted by Misereor perts in charge of Tropical In- the facts. in Aachen on 8 December 1962. stitutes added to the classical The beginning goes back to the A few months later, in 1963, the lessons on tropical diseases end of the colonial context when founders of the organisation for- such complementary modules the Bandung Conference (Asian- mally registered Medicus Mundi as: public health, PHC teaching, African Conference) 1955, with International (MMI) as a corpo- health education, environmental its representatives from twenty- rate body according to German health, mother and child health, one non-aligned governments, law. health service management, and discussed peace and the role of The founders’ vision was pro- district-health care development. the Third World to achieve po- fessional assistance, rather than Since 1980 Official relations litical self-determination, mutual financial and material assistance; with WHO have been decisive in respect for sovereignty, non-ag- their aim was to promote and determining our strategies. gression, non-interference in in- maintain health, seeing the com- Dialogue with politicians and ternal affairs, equality and new munity as a patient and maintain- ministers of health became very relationships between foreign ing the option for the poor. important. From 1974 to 1984 assistants and local profession- The MMI-strategy, logically, the MMI organised weekend als. was Primary Health Care (PHC), meetings at the different Euro- In 1957 several Dutch doc- which was based on the Human pean seats of its branches dur- tors who worked as post-colo- Rights Charter (1948), the Alma ing the occasion of the World nial technical assistants in Indo- Ata Health for All Declaration Health Assembly (WHA). Min- nesia came together in order to (1979) and later, as well, on the isters of health from countries talk about their experiences and Selective PHC Concept, as de- in which MMI doctors worked about their future. All reached the fined by the Rockefeller Foun- were invited. The outcome of same conclusion: the few NGOs dation, the World Bank, USAID this dialogue was summarised or missionary hospitals scattered and UNICEF at the Bellagio in 1985 in a booklet published across the island had had little Conference in Italy (1979). The in Paris (North-South Dialogue influence on the health condi- selection was based on a rank- and Health, Medicus Mundi, 25 tions of the surrounding popula- ing of the major infectious dis- Years in the Field, KARTHALA, tions. They proposed that from eases of the South, according to Paris, 1985) which was translat- then on the emphasis should be prevalence, mortality, morbidity ed into five languages. shifted from curative and chari- and the effectiveness of available Dialogue with Church leaders

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became important as well. In the the creation of a specific health rapid changing circumstances in 1980s the MMI had about 200 dicastery which finally came in- which they had to be provided. MMI doctors cooperating with to being in the year 1985 with The Kampala Statement con- more than fifty Church hospitals. the Motu Proprio ‘Dolentium tains a number of resolutions that We hoped to help in building up Hominum’ of Pope John Paul II. were adopted by the delegates of networks among Church health Right from its beginning, rep- the participating Episcopal Con- institutions, promoting the inte- resentatives of the MMI were ferences. To mention but a few: gration of Church health institu- able to work with this Pontifi- to foster stewardship, to install tions into district health systems, cal Council for Health. We were professional coordinating bodies fostering stewardship, installing convinced that by the fact that to develop institutional capacity, professional coordinating bod- as so many of our own doctors to engage in partnerships partic- ies, promoting institutional ca- worked in faith-based health in- ularly with governments, and to pacity, propagating Church part- stitutions it was useful to have a seek participation in debates on nerships with governments, and voice at this top level, not as a health policies at a national and encouraging Church participa- confessional organisation but as international level. tion in debates on health policies medical professionals. An important possibility to ad- at a national and international Dialogue within WHO at its vocate the contracting modality level. thirty-eighth WHA 1985 on ‘The was MMI’s participation in ‘A Dialogue with the Church in Importance of International Not Contribution of Catholic Health the field started in 1981 togeth- for Profit NGOs for Health’, in- Care Institutions to Reconcilia- er with our 35 Medicus Mundi cluding faith-based health insti- tion Through Health Care’ which doctors working in the Came- tutions, was a highlight. I quote was to be presented to the Sec- roon, the Federation of the Prot- here Halfdan Mahler, the Direc- ond Synod of African Bishops estant Churches in Cameroon tor General of WHO. He said: and contained suggestions for and the Foundation Ad Lucem. ‘NGOs’ prime importance is a public/private partnership by 240 health workers from about subsidiary one and governments contractual agreements. 100 private health centres gath- ought to be partners joined in a ered during 5 days of work in the marriage which the WHO would Centre Jean XXIII in the capi- like to bless’. tal Yaoundé. The Alma Ata PHC From 1999 until 2003 dip- Challenges in a Globalised concept and its importance was lomatic lobbying within WHO World explained, so that the partici- reached an important result pants were convinced that a re- when the representatives of Since the definition of the Unit- orientation was necessary. about 190 nations adopted the ed Nations Millennium Goals, Another important occasion WHA resolution 56,25 on con- extra funds such as those of the for dialogue with the Church tracting, with the title ‘The role Bill and Melinda Gates Founda- was the Dodoma Churches Con- of contractual arrangements in tion (1999), of the Global Alli- sultation on PHC in 1985. 24 improving health systems’ per- ance for Vaccines and Immuni- of our MMI doctors working in formance’. sation, GAVI (2000), and of the Tanzania took part. All Church Even though the Holy See had Global Funds to Fight Aids, Tu- hospitals were represented by given its support to the promo- berculosis and Malaria, GFATM their doctors in charge, by their tion of this resolution, the MMI (2002) have been available. But administrators, by many Church found it necessary to organise more funds are not sufficient to leaders, by owners of Church in the years 2004-2010 a series offer more and better care. The health institutions, and by gov- of Working Conferences with Human Resources for Health ernment representatives. African Associations of Bish- (HRH), the human resources’ In 1983 the MMI had the op- ops Conferences. The aim was factor, remains a main pillar in portunity to cooperate with the awareness-building for the pub- the health system. Therefore Church at its highest level when lic/private partnership approach. HRH has become a priority in the Pontifical Council Cor Unum At the same time, we sought to the MMI’s working plan. With- invited some personalities to dis- stress the strategic reorientation in the framework of the Global cuss the question: ‘Does a Pasto- of Church health institutions in Health Workforce Alliance, the ral Care for Health Exists?’ The order to face the facts of globali- MMI contributed to the imple- MMI was a part of the workshop. sation. mentation of the ‘WHO code of The way the question was for- As an example, I would like practice on the international re- mulated indicated that the organ- to mention the Uganda working cruitment of health personnel’ isers were aware that after Alma conference to which in March and was selected by the Global Ata an important paradigm shift 2004 nine Anglophone African Health Workforce Alliance to had taken place. The sick or ill- Episcopal Conferences sent their host the secretariat of the Health ness were not the centre of inter- delegates. The conference dis- Workforce Advocacy Initiative est, but health, the promotion of cussed the viability and sustain- (HWAI). It submitted to the Eu- health and the human right for ability of Catholic health ser- ropean Community in 2013 an health. This workshop proposed vices and took due notice of the Agenda for Global Action called

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‘Health Workers for All and All executives of the MMI’s pro- able to become a platform for for Health Workers’ because grammes. Now a strong secre- civil society movements and acute shortages of health work- tariat will try to involve mem- eventually become their voice ers in most countries, both rich ber organisations more in the and advocate in our dialogue and poor, have undermined ad- MMI’s policy plans. The MMI with makers in the world of vances that have already been has changed from being an um- health policy. made in improving health. brella-organisation to becoming Operational changes within a strong network. The MMI has the MMI have recently aimed at started formulating multiannu- Cf: references in the full text on Internet strengthening our activities. For- al policy plans. The future will under the title: Edgar Widmer: 50 years of merly, board members were the show whether the MMI will be Medicus Mundi Internationalis.

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International Symposium on Bioethics and African Realities Cotonou, Benin, 10-14 June 2013

1. Recommendations

prof. Jean Soubrier CD4 doses in cases of HIV/AIDS logical Commission of 2009 and Founding President infection because of a lack of fi- the Charter for Health Care Work- of the Political Institute nancial resources, even though the ers could help to clarify the prin- “Leon Harmel”, equipment and the medical prod- ciples that constitute the founda- Paris, France ucts exist. Access to health care as tion of the mission of health-care an important element in the digni- workers and their relationships ty of the person must find a way with sick or disabled people. of being improved, in particular First of all, it is very much to through the choice of health-care be hoped that ethics and research Preface policies, amongst which we may committees could promote a code refer to projects to support elder- for patients which would guaran- This first symposium in Co- ly people and the terminally ill tee the dignity of the person at the tonou on ‘Bioethics and African through palliative care units. level of care and treatment and Realities’ introduced a stage of The telemedicine project, which of research. By way of example, reflection and coordination with could respond to the problems ex- practices such as chaining up psy- those people who work in the perienced by the organisation of chiatric patients should be prohib- health-care field in order to try consultation offices (the lack of ited and punished by law. to respond in the best way possi- specialists), seems to be, because Secondly, the deontological ble to the health-care needs of the of the sums that are allocated to it, code, whose composition goes citizens of Benin. This event was disproportionate compared to the back to the second part of the twen- an opportunity for encounter and potential for fundamental activity tieth century, deserves an updating intercultural and religious dia- that could be offered to many citi- in order to adapt it to contempo- logue. Given its utility, it could be zens of Benin. rary needs and scientific advance. repeated every year, in different A more modest pilot project, A special chapter could include forms. The symposium’s organ- tested over a period of some traditional medicines which in fact isers and participants thus want years, would allow a reallocation would be recognised and whose to call the attention of the health- of funds to a health-care policy practices would be defined. The care institutions and the profes- centred anew around sick people same thing could be achieved as sionals of Benin who work in this (HIV, tuberculosis, malaria…) regards ethics committees. field to five recommendations and vulnerable people (children, Thirdly, because of the vari- which are of differing natures and expectant women, the disabled). ous religions that are practised importance. in Benin, a parliamentary Bill is required so that authentic consci- 2. Developing the Juridical entious objection could be estab- 1. Centring Health Policy and Ethical Deontological lished in relation to norms that at- Around Care for the Person Corpus tack life and which would be for Once Again all health-care workers, indepen- Three recommendations were dently of their roles. Even though numerous efforts made in this field regarding the have been made to create new rights and obligations of health- health-care institutions, it appears care workers and patients. In 3. Creating a system for the that malfunctions are occurring this sense, natural law, for exam- Circulation of Regulated in the health-care field. Access to ple that expressed in the Univer- Medical Products care and treatment, indeed, is not sal Declaration of Human Rights the same for everyone given the (1947) and in the Declaration of A more severe regulation of the financial resources that citizens Human Rights and Medicine of circulation of medical products in have available. By way of exam- UNESCO, could constitute the Benin could steadily eliminate the ple we may observe that some- basis of universal ethics; the doc- use of health products that are not times it is impossible to provide ument of the International Theo- controlled.

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4. Engaging in Specific verifying good practice in medi- health-care activities in which nu- Training for Care and cal activity but of verifying its merous religious communities are Treatment, Health Ethics meaning and justice. For this rea- involved in a special way. Parish and Research son, it appears that the health-care initiatives also exist. Lastly, asso- workers of faculties of medicine ciations such as that of St. Camil- This section deals with three and pharmacy, and obstetric and lus have taken responsibility for proposals regarding the training nursing schools, should receive the mentally ill while institutions of workers in the field of health. training in the ethics of the per- such as the John Paul II Institute First of all, the dialogue that is son throughout their studies. This assure teaching and education as required between traditional med- training should not be confused regards the family. icine and classic medicine could with a simple orthopraxis that Pastoral care in health could be find mutual recognition through regulates simple good practices. based upon a dynamic of an inter- the creation of a specialised uni- In this sense, the programme of diocesan synod which establishes versity area for traditional medi- the meeting, in its diversity, could directions in this field. cal doctors which would be as- serve as a basis for a minimal pro- Parishes are the places where sociated with an interdisciplinary gramme. the life of a community is writ- research programme. In addition, everything that ten and solidarity between fami- Secondly, within the frame- contributes to the creation and lies in particular can be practised. work of civic training in primary the role of universities and aca- It is in the family that education and secondary classes, health edu- demic institutions should be en- in life and health must be experi- cation would be directed towards couraged. The Church wants to enced and transmitted in a simple enlightening intelligences and al- make its own contribution here as and integral way. lowing them to be discerning as is recommended by the apostolic Thus this educational solidarity regards a medical supply which is exhortation Africae Munus which can be developed within a frame- constantly diversifying: Western was signed and promulgated in work of family pastoral care: medicine, traditional medicine or Cotonou in 2011. meetings for the accompanying of alternative medicines. motherhood, listening to relation- Thirdly, scientific advance and al difficulties (sources of affective the complexity of its relation- 5. Creating an Ecclesial difficulties), and the dissemination ship with treatment is placing an Dynamic for Pastoral Care in and learning of natural methods, increasing responsibility on the Health as already exists in some countries shoulders of health-care work- of Central Africa (the Democratic ers. This it is no longer a matter of The Church is present in many Republic of the Congo).

2. Speech by the Pontifical Council for Health Care Workers

Fr. Pierre jean Welsch ways paid great attention to situa- dination to offer increasingly suit- Ecclesiastical Assistant tions of suffering, imitating in this able help, in specific situations of the F.I.P.C., International her teacher Jesus of Nazareth who and contexts, for suffering people Federation of Catholic spent a third of his ministerial life so that they, also, could advance Pharmacists, amongst the sick – and the nu- in their personal development and Belgium merous works of mercy produced along the path of holiness. This during her twenty centuries of ex- wish was expressed specifically istence are a demonstration of this at a time when the sector of health he Pontifical Council for – the very idea of creating a Pon- and health care was experiencing THealth Care Workers is es- tifical Council, side by side with notable transformations through- pecially happy to take part in the the other dicasteries of the Roman out the world, in the field of the deliberations of this important Curia, we owe to the concrete ex- understanding of illness as well, meeting which addresses, from perience of suffering of a Supreme in the field of the organisation of an ethical perspective, the great Pontiff, following the assassina- therapeutic strategies, and in the problems of the health sector in tion attempt of 13 May 1981. His field of the expectations of popu- the continent of Africa. Although basic motivation was to have an lations. it is a fact that the Church has al- instrument of reflection and coor- The Pontifical Council, there-

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fore, wants to offer its contribu- nents of the world; and, lastly, the was also a medical doctor: ‘At the tion to the common effort. To be World Day of the Sick which was beginning of the war (1940) and precise, we should connect the first held in Lourdes on 11 Feb- while the early fighting was un- needs that have been expressed in ruary 1993. We may add the two derway eleven wounded soldiers the field of health in the continent encyclicals Sollicitudo rei social- were brought in. This was my first of Africa with the concerns of the is of 1983 and Centesimus annus contact with men who had come Church from the moment of the of 1991. These were followed by directly from the battle field. On historic decision of John XXIII to the preparations for the Great Ju- their faces one could still see the call an Ecumenical Council. This bilee of the year 2000: the convo- fear, the terror. I said to myself that allowed the whole of the People of cation in April 1994 of a special I had to do for them – for each one God to be associated with this, a assembly for Africa of the Synod of them – everything that was in people that was already in move- of Bishops, a synod created by the my power and as soon as possible, ment after the decisions of the Second Vatican Council in order so that those who followed would Second Vatican Council. In our to give practical expression to the not have wait for too long… I acted field, which is that of health and collegiality of the bishops. This without wasting a minute, sending health care, which is complete- was followed by the post-synodal them into the ward for sick peo- ly traditional in the history of the apostolic exhortation Africae Mu- ple. Then during my round I dis- Church, as I observed at the begin- nus of 19 November 2011 which covered that I could not recognise ning of this paper, there were ex- was signed specifically here in Co- any of them: I had examined chest pressed concrete concerns both as tonou. As regards Pope Benedict wounds, leg wounds, stomach regards the world in general and XVI, I would add the encyclical wounds and shoulder wounds but with respect to Africa in particular. letter Caritas in veritate of 29 June I had not seen their faces, not least Indeed, the Second Vatican Coun- 2009 on integral human develop- because none of them had been cil gave us a document that was ment in charity and truth, without wounded in the face. They were not envisaged in the preparatory forgetting the encyclical on hope, all lying down, in a state of shock outlines, that is to say the Con- Spe Salvi, of 30 November 2007. that they were unable to overcome. stitution Gaudium et Spes (The I have said all of this to observe Much impressed by this first ex- Church in the Modern World) that we have in front of us some- perience, when the second wave which makes clear the relation- thing that is very considerable, of- of wounded men arrived I decid- ships hoped-for by the Church and fered to the reflection of the whole ed, without stopping working with the aspirations and the responsi- of the Church, publicly, in order to my hands, to have a conversation bilities that were expressed in the nurture a creativity of action, inas- with them (one can do many things world. The two Supreme Pontiffs much as keeping oneself in good with one’s hands while continuing of the Second Vatican Council health requires commitment. to speak with a man and looking at thought that it was useful for each Your wish to place the human him). I looked at each one of them of them to give us an encyclical on person – and not only the illness – and asked some questions, and then these questions: John XXIII with at the centre of reflection, and ac- looking at their hands and their Pacem in terris of 11 April 1963 tion is especially valuable, and this wounds, I did what was necessary. (a few weeks before his death) for various reasons. I asked them: what is your name? and Paul VI with Populorum Pro- First of all, it leads us to have a Where have you been wounded? gressio of 26 March 1967 on the broad conception of the notion of Were you very frightened? These development of peoples (the de- life which defines its tasks: with- were very simple questions but of liberations on this document go out doubt the protection of life, but such a kind that a wounded man, back to the fourth session of the more in general assuring that it can managed, during the time that I Second Vatican Council and were evolve and develop in existence was attending to him, to offload entrusted to Fr. Lebret, who, how- as a whole. This approach appre- the anxiety and the horror. When ever, would not live to see the con- ciates the importance of a medi- I then visited the ward I recog- clusions of his work). John Paul cine that places at the centre of its nised first of all the faces of all II continued with this endeavour. mechanism the human person in those wounded men and then I dis- First of all, with initiatives directly his or her responsibility. The pa- covered that the shock had passed linked to his situation as a conva- tient to whom we dedicate our care because during our short conver- lescent following the assassination and our research ‘is not an anony- sations they had had the time to attempt: the apostolic letter Salvi- mous individual but a responsible externalise their feelings’ (Metro- ficis doloris of 11 February 1984 person’, as John Paul II said at the polita Antoine Bloom de Souroge, on questions raised by human suf- world congress of Catholic medi- La vie, la maladie, la mort, Paris, fering; the Motu proprio Dolen- cal doctors on 3 October 1982, that Cerf, 2012, p. 71). tium Hominum of 11 February by is to say just after he had recovered This having consideration for which he established the Pontifical from the assassination attempt. the person is not only more re- Council for Pastoral Assistance to I would like to provide an illus- spectful of the dignity of the liv- Health Care Workers which eve- tration of this with two examples, ing human being but also increas- ry year organises, in the month of The first is the testimony of the Or- es the efficacy of the therapeutic November, an international con- thodox Metropolitan responsible measure that is implemented, inas- ference on a specific subject stud- for the Russian community in Lon- much, overall, it is the sick person ied at the level of the five conti- don, Msgr. Antoine Bloom, who himself or herself, a unity of body,

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mind and spirit, who will mobilise ter the assassination attempt. Then The Concerns of Pastoral Care in the first person that multiform there was the viral infection which in Health help that we have given him or her. he got over very well. After this, John Paul II went as far as to hope the second operation cured him… This centrality of the person is that the suffering person would be of the illness that we had obtained important for another reason: tak- ‘able to ‘personally choose and for him: colostomy. Seven days af- ing into account the spiritual di- not be subjected to the decisions ter the operation we took out the mension of the human in order to and the choices of other people’. stitches and we said to him: “Your honour the integral reality of the We can here remember the discus- Holiness is cured and can leave to- human being in his or her specific sion that he wanted to have with morrow”. He left the hospital on features. And this applies both to a the college of medical doctors the fourteenth (from Non abbiate patient and to those who care for who were looking after him at the paura! André Frossard dialoga him. Gemelli hospital immediately af- con Giovanni Paolo II). Man ‘is neither an angel nor a ter the assassination attempt: ‘Was We can be happy at the fact that beast, he is an embodied spirit, that it necessary to operate immediate- this awareness was taken up seri- is to say a limited or finite synthe- ly despite the recent infection of ously in the profession, as is borne sis of the material world and the cytomegalovirus from which he out by various recent publica- spiritual world’, as was observed had just recovered? Knowing that tions: whether one is dealing with by Rafael Gambra in his study a sick man in this state is not in the the American notion of ‘care’ – published in Spain in 1968 enti- best condition, and that the risk which can be developed into a re- tled El silencio de Dios. This work that the infection would reappear al philosophy (Michel Dupuis, Le has been available in French since was great, they said to him, think- soin, une philosophie. Choisir et last year (Le silence de Dieu) pub- ing, I confess the point, of gain- vivre des pratiques de reconnais- lished by Artege. ing time: “Your Holiness can go sance reciproque, Paris, Seli Ar- My intention will be to present back right away to the Vatican”. It slan, 2013) – or the day of study the kind of help that we can expect was evident that the danger would of the European parliament (Ber- of the Pontifical Council for Health have decreased. But he did not nard ARS (dir), Fragilité, dis-nous Care Workers which wants to en- in the least see things that way. ta grandeur!, Paris, Cerf, 2013), courage at the level of the Univer- He wanted to leave hospital only or the two years of study within sal Church authentic pastoral care when he had gone back to where the framework of the University in the special field of health and he had been previously as regards of Fribourg, Switzerland (Fran- health care, both from the point his state of health. He did not want cois-Xavier Putallaz and Bernard of view of services – and thus of to leave us before the second oper- N. Schumacher (dir), L’humain et health-care workers, who continue ation. So the day that we met to fix la personne, Paris, Cerf, 2008), to to grow in numbers – and that of the date, he intervened unexpect- give only a few examples from the the suffering person. This clarifica- edly to tell us, substantially: “Do Francophone world and the geo- tion immediately requires a com- not forget that if you are medical graphical area of Europe. We can ment: the task is not limited, there- doctors I am the patient and I have also cite the meeting that was held fore, to stimulating a bishop to to make you participants in my in Germany at the Catholic Uni- ensure the presence of a chaplain problems as a patient, above all versity of Eichstätt-Ingolstadt on near to sick people in his diocese. of this: I would like to go back to 7-8 February last within the con- Before entering into the spirit the Vatican only when I am com- text of the World Day of the Sick that guides its work, let us list the pletely healed; I do not know what 2013 held in Altotting on the place concrete initiatives of the Pontifi- you think, but I for my part feel of the need for spirituality in thera- cal Council and the activities that very well, even though the analy- peutic accompanying. are offered by it every year: eve- ses say the opposite. I absolutely This encourages us to locate ry 11 February – the World Day feel able to endure another opera- medical action within specific di- of the Sick; every November – an tion”. In the final analysis, he tried mensions of existence: time, si- international conference on a spe- to convince us that in the relation- lence, touching (hands) and speech cial subject (this year, 21-23 No- ship between a medical doctor and (conversation). vember 2013, on degenerative ill- a patient, the former should not A patient needs technical inter- nesses); publication of the review be an oracle who drops his deci- vention and presence. Indeed, his Dolentium hominum; for the Year sions from on high – such deci- or her ordinary situation leads him of Faith, a pilgrimage to the Holy sions must be taken in common. or her, first of all, to fold in on him- Land, 22-28 October 2013, for its Although, on the one hand, there self or herself, in an approach of four federations (of men and wom- is the knowledge of medicine, on self-conservation, inspired by fear, en nurses, medical doctors, phar- the other there is what the person by fright and by anxiety. Then, he macists and hospital administra- knows about himself or herself. or she has to open himself or her- tors). We know this but sometimes we self once again in order to receive The Pontifical Council naturally forget it. The warning was useful. the help that is offered to him or engages in many other initiatives – The Pope got better on 14 August her. It is then that one needs ‘to for that matter I expect to speak to of that year. There was no com- know how to make a gift of one’s you tomorrow about that of 19 No- plication. I would say that he was own presence’, as Msgr. Bloom vember of last year which needs an ‘surgically’ healed eight days af- very well observes. aware and persevering mobilisa-

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tion to succeed in the long term – (she fell into a bath of boiling lye and the snow star. They open – and but those that I have just referred to in the depths of winter) nailed her die – without any human eye ever express equal concern and points to her bed. But she wanted to live seeing them, only the eye of God. of interest: the place of sick peo- this trial in an aware way follow- Just as flowers are many in num- ple in the Church and the world; ing Christ – not any Christ but the ber, so virtues are also numerous’. the need to reflect together, in the Christ of Gethsemane – accept- Anna was thus an ‘early invalid’ five continents of the world, on the ing her suffering and entering in- who needed daily care (the replac- great problems of health and health to communion with him and with ing of bandages for wounds that care; concern with ongoing forma- he who revealed to us ‘God alone never closed). She learnt to accept tion; and occasions to strengthen is enough!’ Thanks to her read- the state of her illness and discov- one’s own inner life, listening to ing and her daily encounters with ered a place in which she could ob- the Lord. Christ, she was able to shape her tain the strength for each day – in What are the pathways we could own inner life, in a life hidden her daily encounter with the Eu- go down together at the end of our from the eyes of the world, while charistic Christ. For her, life with deliberations? awaiting her return to the house of illness was a personal exploration the Lord. which obtained for her so much I will begin with the pilgrim- In 1999, when he was still Car- serenity as to make her ready to age in order to allow us to speak dinal Ratzinger, Pope Benedict comfort the crowds of people who about this dimension which adds XVI gave a luminous homily on came to visit her or wrote to her. other needs which are the mental- this life on the eve of her beatifica- She developed a correspondence biological and psychological (con- tion. ‘Naturally, we must do every- on a huge scale. She thus fulfilled scious and unconscious) substra- thing possible to alleviate and re- her earthly life and this achieve- tum. duce suffering. But those who say ment made her ready for the mo- To illustrate my intention, I will that this is sufficient are obtuse. ment when the dawn of eternal life start with the testimony of a young Because it is and it remains equal- came for her. sick woman – who was proclaimed ly important to learn suffering and This adventure, in which she Blessed by John Paul II on 7 March to find ourselves in suffering. The was helped by a group of people, 1999 and who was canonised by human condition and suffering, in- beginning with her mother, by her Benedict XVI on 21 October 2012 deed, are inseparable. There is no parish priest, by her female nurse – who endured a life of suffering love without readiness to take a (this was 1925), by her neighbours for over twenty-one years and who step backwards, without the need who visited her and by people that died when she was still young, at to accept the diversity of the oth- she did not know who wanted to the age of forty-three. Her name er in an always new way. Because meet her, had a great impact on was Anna Schaffer. She spent her it is only in this way that we can the physical sufferings of her body life hidden from the eyes of the truly mature. There is no faithful- (‘And even though pain lacerates world in a simple room without ness without pain and patience as my body, in my heart I feel such a being able to leave her room. ‘We regards the changes that we need. blessedness that I cannot even ex- must not be like a snail which also And if only he who has changed press. This happiness, this blessed- carries its home with it but which a great deal can become rich, then ness make me sweet whatever the withdraws its tentacles immedi- only he who has truly accepted suffering’) and on her soul (‘as I ately when it hits a hostile object. suffering and has learnt to accept it often receive holy spiritual com- We should not therefore external- can become rich. He who no long- munion, my soul grows stronger ise but we should conserve to the er manages to suffer, cannot even and the great weakness of my soul extent that this is possible an ap- feel compassion. And he who no disappears’). And her prayer be- proach of holy inner spiritual con- longer manages to feel compas- came: ‘change everything that is centration. What would be the use sion cannot even manage to be- still defective and full of errors’. if we lived only rarely in the ref- long to those who love. A world in I think that I can stop here re- uge of our souls – how could we which one can no longer descend membering this life that was so or- hear the voice of the Holy Spirit? into suffering becomes a cold and dinary and exemplary. As we have If we listened only to the voices of cruel world’. been able to see, the spiritual di- creatures? If ewe ere only rarely at Anna Schäffer did not abandon mension was very important in home and left our celestial guest her life project and her missionary the life of this person, providing a alone – how could we feel his vocation. Let us listen to what she broad framework for the technical nearness and his presence? (this wrote: ‘I see my bed as the silent interventions, the daily treatment quotation is from the notebook of cell of a convent and on this bed and care, following a medical fail- observations that she wanted in a I can faithfully observe the three ure which could not be attributed total way to leave as a testimony holy religious vows. And even to human hands. We have before and which she entitled ‘Thoughts if my body cannot life a convent us a person who built herself up in and Memories of my Life with Ill- life (which would be my greatest her fight against illness to the point ness and my Burning Desire for wish), I want anyway to live a hid- of asking herself how she could the Eternal Homeland’). den monastic life at the level of have attained such an achievement Indeed, as a young girl she ideals. There are a large number of if she had not gone through such wanted to become a missionary flowers that nobody ever sees or a trial. but a terrible accident in her home picks, for example the alpine rose Can we provide a more anthro-

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pological description of a life of goes back to Bacon, well before some time been experiencing an this kind and of the edification of Edith’s birth, which was in 1891), anthropological malaise and that such a person so as to locate the and to the discoveries connect- it must establish order in its under- levels and the nature of the actions ed with the mind of man thanks standing of the relations between of health-care workers? I have to to the works of Fred and others. science, technology, the human say that this question was posed She showed how the human per- person, openness to transcendence, on a number of occasions when son opens himself or herself to the inner life and ultimate destiny. And listening to the representatives unending projection of the Source I would willingly declare myself in of the other great religions of the that is the basis of his or her finite favour of an expansion of the ethi- world and to the representatives of being: the eternal Being and cre- cal perspective and thus ‘of a lim- more traditional medicine. Is there ator ‘who is the support and the ited relevance of the use of princi- a way of going beyond the simple basis of my being which does not ples in the ethical appreciation of use of words, which anyway are possess on its own either a sup- a situation by health-care profes- the right ones but in the final anal- port or a basis’. Her outlook went sionals’, as Professor Michel Du- ysis relatively out of focus, such as from the exterior (everything that puis observed. This is not a matter the word ‘psychosomatic’? I be- is ‘seen’ in experimental science) of minimising the efforts of Beau- lieve that we can answer in the af- towards the interior, by stages, champ and Childress with their firmative referring to the work of a where we can place in its most su- four simple and intertwining prin- woman researcher (I willingly use perficial part the feelings (pleasure ciples but, rather, of understand- this term because for the whole and displeasure), the unconscious ing why there has been such a very of her life she was engaged in a (which Freud and psychoanalysts rapid and universal adherence to search, and this is what can really in a methodical way manage to un- them. be born in Africa: a generation of derstand a little), and if one goes I base myself here on the already researchers) who was given to us even deeper, the place where I cited work of Rafael Gambra: ‘The as one of the patron saints of Eu- feel truly myself, the place where new realism of ideas is a kind of rope in 1999 – . Her re- I take my most important deci- pure and schematic abstractionism search was guided by the wish to sions, the place where, curiously, based upon elementary and uni- understand the ultimate meaning I can be more aware of what takes form notions copied from mathe- of the real; she wanted to honour place, a place that is even visited matics. As man gradually handles ‘the metaphysical tendency which too little, said Anna Schäffer. prefabricated concepts which are corresponds to the human spirit as In this ‘description’ Edith Stein entire and indefinitely diffused, he such’, a tendency towards a ho- mobilised all the resources of a abandons and forgets the relation- mogenous conception of the world method, of a style of approach – ship with things themselves and fully in harmony with the meaning phenomenology – which she had he establishes himself in an envi- of the person. In her approach to learnt from a brilliant philosopher: ronment that is increasingly based human reality, the spiritual need Edmund Husserl. When the First on technology. Thus today’s man understood as the inner life took World War broke out in 1914 he works on numbers, schemata and its place in a perfect work of rea- was already sufficiently advanced abstract levels much more than on son and not in opposition to it. Un- in his work to have many disciples. concrete and differentiated reality. fortunately, I do not have the time He was a mathematician and a lo- In the name of egalitarian theories here to describe her way of under- gician who felt the need to move and legal examples of uniformism, standing the human person. There out of a simple outlook on reality contemporary man has forgotten is a work which is rather accessi- not because it was false but be- or destroyed realities and life en- ble written by Eric de Rus, La per- cause it separates us from human vironments that go back millennia. sonne humaine en question. Pour and social reality. He proposed a He has levelled differences, hier- une anthropologie de 1’interior- new method and in 1936 he hurried archies and customs which con- ite (Cahier d’etudes steiniennes), to end his last great work ‘The Cri- stituted the framework of exist- Paris, Ad Solem – Les Editions du sis of European Sciences and Tran- ence and the authentic freedoms Cerf -- Editions du carmel, 2011, scendental Phenomenology’ which of peoples…Thus through an ab- in which the author states: ‘in her was published only after his death stract ideologism, born precisely the work of reason, theological in 1954. For those who know noth- from the denial of the ‘intellect’ activity, the exercise of the theo- ing about this great researcher and (intellectus) based upon the res logical virtues, mystical experi- great initiator, I would like to refer (the thing itself), the technocracy ence and the blessed vision were to a paper by Jorge Semprun: ‘Ed- of the screen and of printed materi- integrated in a unified way [and mund Husserl, Vienne, mai 1935’ al leads our society, slowly but se- this is what is of the greatest in- which was published in Le métier curely, towards quantitative mas- terest to me] in a process involv- d’homme. Husserl, Bloch, Orwell, sification, that is to say towards a ing the elevation of man towards morales de résistance, Paris, Cli- uniform world governed by condi- the fullness of truth’ (p. 34). Her mats, 2013, which is totally acces- tioned reflexes from which the hu- approach took into account all the sible to health-care workers who man figure and his vital framework contemporary aspects highlighted are not particularly philosophers. tend to disappear totally. The con- by modern science (certainly not If I have explained all of this to sequence of this tendency towards recent developments, but the log- you it is because it is important for ideological abstraction is that ic of everything that we discover Africa to know that Europe has for minds have lost all contact with

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the real and all taste for it. Contem- ble without a purification of natu- of a sick person can be a matter of porary man, solicited by the con- ral activity inasmuch as the facul- very young people. I remember cerns of a life that is increasingly ties of the soul are not immediately the visit that I made in Brazil to a agitated, almost dizzy in character, adapted to God. This fulfilment home where children with AIDS, increasingly ignores the pleasures takes place through the union of who were directly linked to an im- and the pains of a life of devotion wills, just as Christ agreed with provement in the therapy, lived. and commitment’. the will of the Father. To achieve The right to just and honest infor- I have to stop here in my anal- this agreement, the person needs mation was not a matter of emp- ysis of this work – which con- silence because God speaks only ty words! For that matter, it was a tains many stimulating ideas – in a soul that knows how to be si- child less than ten years old who which has the very symptomatic lent. It is to exercise ourselves for explained to us the therapy that he title ‘The Silence of God’, in the this transformation that we have was following, with all the details sense not of a silence that despis- received the invitation to leave on the development of his treat- es or which is a sign of powerless- on a pilgrimage to the Holy Land. ment, being followed by a medical ness but, rather, of that ‘silence Then, we will listen in a different doctor who was attending to him. of Christ who, from the height of way to the patient whom we wish Does this not perhaps place dignity the cross, refused to answer those to serve. at the beginning of every effort? who told him to save himself, who But we have to make a strategic during his life refused all dialogue choice, at this moment, while we with those who spoke to him with A Sharing of Brothers in are together. I cannot conceal from the aim of tempting him, and who, the Church Open to the you that I am struck by the assid- lastly, rejected the devil when he Expectations of the World uousness of this assembly when offered him the easy possession we are already on the fourth day of the whole of the earth. In short, I would like to speak to you now of our deliberations. This reminds the value of silence of God faced about the place that a sick person me of the famous words of Dom with the apostasy of all epochs, has in the Church and in the world. Helder Camara which I heard with faced with those who ‘do not know We needed the failed assassination my own ears when I was still a stu- what they do’’ (p. 124). These ob- attempt on John Paul II, with the dent of theology and philosophy servations lead me to wish for a consequence of having the highest at Louvain-la-Neuve in the early profound dialogue with those who figure of the Catholic Church in a 1980s. He said in the amphithea- open themselves to what can nour- state of permanent frailty, for us to tre which hosted him: ‘We have ish such a level of profundity in the be more aware, inside the Church, a secret weapon, that fact, that is human person. of the fact that a sick member is to say, that we can truly put our- Let us go back to Edith Stein not only the ‘object’ of care but al- selves together’, and I would like whose journey was absolutely fas- so remains a member of the eccle- here to underline two words: ‘to- cinating. I hardly dare to imagine sial Body in the full sense of that gether’ and ‘truly’. This is what in- what the world of thought in Eu- term. And what we read in the life spires me now, taking into account rope would have been if her voice of Anna Schäffer is exactly that: the expectations that have been ex- had not been ‘put out’, both trag- she fulfilled her vocation in illness. pressed in recent days, some just ically and unjustly, on 9 August Let us remember that St. Berna- whispered because reasonably 1942 in Auschwitz-Birkenau. dette Soubirous ran the risk of not held to be impossible to meet. This ‘Today we are living once again being accepted in the communi- is my challenge and if I overcome in an epoch what has an urgent ty of Nevers where she spent half it I will have demonstrated how the need for that renewal that comes of her life in the dispensary of the Pontifical Council for Health Care from the concealed sources of convent and where she developed Workers can place itself at your souls united to God. And many a ministry of encouragement with service. people place anew their last hope the sisters of the whole of the com- I will start from an observation in these concealed sources of sal- munity in the second part of her of the President of our Pontifical vation. This is a great exhortation: life. Let us be certain of the fact: it Council, H.E. Msgr. Zygmunt Zi- a gift without reservations to the is God who guides our individual mowski: ‘Investing human ener- Lord…, this is what is asked of us vocations, in illness as well. gies and resources in the health- so that the face of the earth can be On the same subject we could care institutions of the Church, renewed. With a trust full of faith, listen to the analysis of the place like her presence and her role in we must abandon our souls to the that a sick person has in the organi- the management of non-confes- powerful request of the Holy Spir- sation of the City. Here, as well, he sional health-care institutions, is it…We must live with the certain- or she is not only the beneficiary justified by the need to express the ty of faith that the hidden action of of care, however preventive it may mercy of God towards all men and the Holy Spirit within us will bear be, but in addition his or her ac- in a particular way towards those fruit in the Kingdom of God. We tive presence leads the City to be who are tested by illness and suf- will behold them in eternity’. constructed differently. The world, fering. This is a way of living in a You will have understood that for that matter, has had a President concrete way the commandment of for Edith Stein the Christian life of enormous power who was con- love for God and one’s neighbour is a journey towards the fulfilment fined to a wheelchair, to give only in one of the areopaghuses of the of the person which is not possi- one example. This active presence world’ (‘The Hospital as a Setting

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for Evangelisation: its Human and Africa as regards its challenges, the good of everyone, the kind of Spiritual Mission’, Madagascar, 9 and this was seen as a ‘commit- presence of grace that the Spirit in- December 2012). ment to Africa for the Lord Jesus’, spires in him or her. This is why The Church feels the duty to the very title of the document. Ob- one must start on a pilgrimage, on make her contribution to the ef- serve that the habit of citing this a retreat, in order to truly listen to forts of the whole of society under document, and not only the first the Holy Spirit and obey him in all the responsibility of the state. Al- two words, should be commented freedom. I am convinced that, in though, in some parts of the world, on: this is a commitment for the the drawing up of this approach, her action also takes on the form Lord. We can make the same ob- in the creation of this ‘style’, Pope of substitution, everywhere the servation about that great docu- Francis can help us in a decisive Church (and I see only the Cath- ment of the Second Vatican Coun- way, he being so aware that ‘hope olic Church) wants to be a ‘pro- cil, Lumen Gentium, where the and fears intertwine in the very claiming’ of hope for man, his full light is not the Church but Christ heart of lives as apostles, above all and definitive fulfilment. Only in himself, which the Church has the at moments when we must make placing herself in consonance with mission to reflect, like a crystal choices as regards the modalities the hopes of the world will she be that does not hold light but reflects of our action’, as he confided to able to engage in actions that are it and returns it (see the address the Spanish bishops on the retreat truly useful for suffering man, his given by the Pope when handing which he led in 2006. For him, family and his entourage, for all over this exhortation on 19 No- ‘faith is in itself liberating without health-care workers, in the impel- vember 2011). one having to add anything else’ ling wish to heal, if not to alleviate. On 19 November 2012 (I do not (Amour, service et humilite. Exer- I have heard repeated displeas- think that the date was deliber- cices spirituels domes a ses freres ure expressed at the absence of a ately chosen to coincide with this eveques a la maniere de saint strategic plan, so to speak. Be re- event but it was exactly one year Ignace de Loyola, Paris, 2013, p. assured, I do not have one already after the handing over of the docu- 41). Thanks to him, we rediscov- drawn up, otherwise this would be ment: without doubt heaven closed er the true force of the Gospel, a known about! But I am convinced an eye), the Pontifical Council force that enlightens, that purifies, that in order to meet health-care brought together in its offices in that motivates, and it does this needs in Africa and the urgency Rome (Fr. Simporé and Msgr. Jean without being dangerous for any- of the present moment we should Soubrier were also there) the eight one, not even for those who may not hope so much to see the flow- faculties of medicine in Catho- think that they may become our ering of some further hospitals, al- lic universities on African soil. enemies. This disposition of the beit with high-quality services but, Although the bishops of these re- heart corresponds to a hope of the rather, the creation of a process gions of Africa do meet, thereby exhortation: ‘Live with simplicity, that leads to the establishment of fulfilling the wish expressed by the humility and filial love’ (n. 110). I such infrastructures. This process Second Vatican council as regards close the parenthesis. concerns the whole of a series of episcopal collegiality, this was the This initiative is under the more fields which should undergo a re- first time that the heads of those specific responsibility of the Good al development. This need does eight faculties met in the same Samaritan Foundation which Pope not require that it is active in all place for an exchange of views on John Paul II added to the Pontifi- fields at the same time – to link up the same subject. cal Council for Health Care work- with the splendid paper of Msgr. Being in Benin, where we do not ers as a charitable arm as regards Suaudeau, we can have cells that have a faculty of medicine as such, medical products. It involves are awake but anyway not sleep- I would like immediately to coun- for the time being Burkina Faso, ing too much – but a discernment ter an objection or a possible dis- Chad, Mozambique, Congo-Kin- of those that create a system and appointment. You will see that in shasa (Bukavu and Butembo) as establish an integrating dynamic the process Benin is also expected, well as a faculty to be created in as regards other sectors. The ‘Af- thereby implementing in a practi- Luanda, Angola. The enunciation ricae Munus Project’ network is of cal way the invitation of the exhor- of this last place demonstrates that this character. tation ‘in the name of Jesus, to live the process is naturally extendable What are the origins of this ini- reconciliation between individuals – like the multiplication of stem tiative? It is connected with the and communities and to promote cells! – inasmuch as one is dealing post-synodal apostolic exhorta- peace and justice in truth for all’ not with a cake to be cut between tion Africae Munus which Pope (n. 1). This parenthesis gives me various participants (and thus if Benedict XVI signed precisely an opportunity to lay stress upon possible the least in number) but, here on 19 November 2011 and the importance of the words that rather, of an agreement of inten- which he handed over first of all we pronounce and to ask ourselves tion. to the episcopates of Africa and of if we usually truly believe (one of The subject that brings everyone other continents of the world. On the two words used by Don Herd- together and puts them on the same returning to the Vatican the Su- er). Let us not doubt the fact, in the level is the following: what is the preme Pontiff asked each one of kingdom of the Triune commun- situation as regards a real presence his dicasteries to produce, in ad- ion, not only is there nothing true of specialists in our health-care dition to the existing programmes, that excludes something but each institutions in Africa? The ques- a new specific programme to help person is called to implement, for tion was posed by the paper on tel-

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emedicine. You will see that this I am also sensitive to the ques- opportunity in the presence of the valuable instrument is expected tion of payment. I completely Léon Harmel Institute which had by the initiative we are now talk- agree that we must move out of the same idea as this meeting when ing about. the system of an ‘encouragement in dialogue with our friends of Be- Having reached this point, I payment’. I base myself here on nin: from tomorrow, simple partic- would like to refer to two hopes the Belgian experience to general- ipants at this meeting, like myself, that have been expressed during ise fundamental (first level) teach- on the basis of their professional the course of the papers and the ing in Belgium at the beginning of experience, can imagine a subject discussions: meeting the major the twentieth century which made of research within the framework needs felt by the African popula- possible the recruitment of com- of third cycle master’s degrees or- tion (and thus independently of the petent instructors, assuring them ganised by this institute which will pre-existing plans, generated by a suitable and stable salary (suffi- work to offer you the post of a di- other interests which are complete- cient to maintain a family) and a rector, which I would willingly see ly legitimate) and the real availa- level of real status on the ladder of as ‘dual headed’, in this prospect bility of a generation of African the professions. It is exactly this of ‘intertwined approaches’: one researchers who rightly ask to be that I heard expressed by African European and one African. Scien- useful and acknowledged in their researchers. The initiative must be tists ready to engage in this service efforts and results. able to guarantee those pre-sup- for their brethren can certainly be In the end, it is easy to formu- positions that I believe to be in- found! late the task: to obtain the creation dispensable…and achievable, on I must stop here but I would of complementary master’s de- two conditions. First, that the re- not like to remain silent about the grees (according to the terminol- searcher finds real motivation not question of the enrolment fees for ogy of Bologna). I prefer to follow in the hope of gain but in the joy formation requested of students. this terminology because the conti- of knowing. Second, this initiative Most of the people taking part in nent of Africa is first and foremost should follow the habitual way of our meeting themselves paid for linked to Europe, but without ex- financing ordinary research and the costs (25,000 or 45,000 FC- cluding other alliances with other thus contain the challenge of plac- FA) and here we thank the Raoul continents of the world, such as the ing the projects up for competi- Follereau Institution for its fine Americas or Asia. tion with the ordinary funds of initiative as regards its invited This decision has the advantage, European research. And specifi- people. One must be able to find to be successful, of considering at cally in order to be accepted, pro- a formula that is not based ex- the same time other areas as well jects should be presented which clusively on loans. Some people (they cannot be sleepers): the de- involve a minimum of five insti- here are perhaps aware of this, velopment of university clinics tutions. But this should not worry as regards the States: there is not and the creation of research teams us: the real challenges in the field only the crisis of home mortgag- (which I express in the plural hav- of public health require exactly es, there is also another financial ing heard the hope that there would five if not seven institutions that bomb to which little reference is be (theoretically) paid researchers are concerned with different fields made: the loans for the enrolment engaging in interdisciplinary re- but are intertwined. of students in institutions of high- search). I will open a parenthesis: As regards the creation of these er education, Harvard and others, during our debates various people teams, it will be advisable to in- with the problem that a home can have underlined the importance of volve African researchers who are always be sold, but such is not the the family and of the natural com- already engaged in activities but case with a degree. munity around the sick person as who are far away and those who I could continue but I believe actors of the therapeutic process, have remained in their countries that we have understood what the and here there is an institute for the in very discouraging conditions. process involves. If the Pontifical family. Its application could be ap- For them, the status of contract Council for Health Care Workers preciated in the creation of certain lecturers would be very suitable can be of some help in this field, complementary master’s degrees, inasmuch as what would be ex- we will gain in ‘concrete charity’. I am thinking here for example of pected from them is not the direc- I would like to remember that the psychiatry… tion of research but the advice of first name that the Church used for It is thus the task of each place experts. herself, in Greek, was fraternity to determine the field or fields that We thus have an initiative that (adelphoté). This work will gain could be suitably developed to the is based upon four columns: the from involving the cooperation of point of obtaining the creation of teaching of general medicine; uni- the episcopates of the continent, a complete teaching in the disci- versity clinics; research teams and the SCEAM, in the sphere of its pline. In order to achieve efficacy research subject/subjects; and the new pastoral care for culture so as and sharing, there will not be more creation of the teaching of a com- to transform the ‘absent meetings’ than two fields in each place and plementary master’s degree. of the past with Europe and more given that the dynamic is that of The setting in motion of research in general with the Western world. working together, the other places at the level of choosing what it The exhortation states that Afri- would take part in an intertwining should be cannot but be institution- ca is the continent of hope. Let us way. al. And here I see an immediate show this to be true!

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